Warren Mauston was St. Paul's pacemaker pioneer

Fifty years ago, retired car salesman Warren Mauston drove 60 miles from his home on St. Paul's East Side to watch the 1966 World Series with his son in Lake City, Minn. The Baltimore Orioles beat the Los Angeles Dodgers in Game 1 en route to a series sweep.

Mauston died the next day of heart failure at 79. For all intents and purposes, he should have died more than six years earlier.

In the spring of 1959, Mauston became the first U.S. patient to be fitted with an external pacemaker during a four-hour surgery at St. Paul's Bethesda Hospital.

Two years earlier, Medtronic founder Earl Bakken and University of Minnesota heart surgeon Walt Lillehei devised a battery-operated external pacemaker they hoped could control a human heart's rhythm. And Bethesda surgeon Samuel Hunter and early Medtronic engineer Norman Roth had noodled with connecting pacemaker wires to dogs' hearts.

But Mauston, at 72, was now the man on the operating table. He suffered from a serious cardiac problem called heart block that had stopped his heart more than 25 times in 24 hours at Bethesda, rendering Mauston unconscious and all but dead.

Doctors used drug injections and heart massage to keep him alive. Figuring they had nothing to lose, Hunter and Roth packed their apparatus in a truck and headed to the hospital.

"We pushed Mr. Mauston, who was unconscious, into the operating room and opened him up," Hunter recalled in 1979. "The heart looked sick — large and blue with grayish fat — and it didn't look like it would go."

One problem: Nothing happened. So Hunter jacked up the current. Presto.

"The heart started with a gallop, and it just kept going like a washing machine — vroom, vroom, vroom," the surgeon said. "Immediately, his heart and all his tissues in the chest changed from a slate gray-blue color — a sure sign of death — to a bright red, because blood was circulating."

Before doctors and engineers could pat themselves on the back, Mauston literally arose from near death.

"The patient — with a great roar — came right off the table and woke up," Hunter said. "We hadn't given him an anesthesia, because he had been essentially dead and we didn't think about it. We were working as fast as we could."

Hunter hollered for the anesthesiologist, who put Mauston back to sleep within a hectic 15 seconds. Then they all exhaled and thought about the medical history they'd just forged.

Mauston's new pacemaker was the size of a paperback book, hooked to his heart with wires protruding from his chest — a setup that caused ongoing infections for the rest of his days. His wife, Teresia, came up with a holster to alleviate the rash that arose from his pacemaker being taped to his chest.

But while pacemaker innovators would have preferred implanting the device, Mauston declined. Born in New Haven, Conn., in 1887, he compared his decision to his grandmother's opinion of outhouses back on her farm. She declined indoor plumbing, and Mauston quoted her to his doctors: "Some things just don't belong inside."

Despite his constant infections, Mauston lived well for six-plus years. He fretted about not being able to get around the golf course with his wooden-shaft clubs like he once had. So he putted on his living room rug, climbed stairs and walked around his Payne Avenue neighborhood.

In 1961, Mauston's externally controlled heart withstood cancer treatment, a bout with pneumonia and a car crash. And he fared far better than Hunter's next patient, who died on the table six weeks after Mauston's pacemaker hookup when his heart collapsed as the surgeon connected the same sort of device.

Mauston's pacemaker was a far cry from today's devices, implanted in countless patients. The machines made Fridley-based Medtronic a multibillion-dollar business with 9,500 current employees in Minnesota, despite a 2014 sale that shifted headquarters to Ireland.

Mauston, who never graduated from high school, was the father of six children — three of whom died in childhood and two of whom are still alive. His wife lived until she was 103. Mauston coached the baseball team at Gustavus Adolphus Lutheran Church in St. Paul and, according to census records, sold envelopes in 1930 and autos by 1940.

"He was not a doctor or inventor," his grandson said. "But he was the first patient to be fitted with an external pacemaker, an important role in helping to develop the pacemakers used by so many people today around the world."

According to the 2001 book, "Machines in Our Hearts," Mauston was the perfect human guinea pig for that first pacemaker.

"Mauston had an ideal personality for the role of pioneer patient," author Kirk Jeffrey wrote. "He thrived in the limelight and did not appear unduly anxious" about either his external pulse generator or the wires sticking out of his chest.

"He liked to see the light blink," assuring him the machine worked, said Roth, the engineer who shared the name of the breakthrough device — the Hunter-Roth electrode — with Mauston's surgeon.

Mauston allowed his surgeon to turn off his pacemaker to show visiting experts. Within four seconds, he'd slip into unconsciousness before Hunter turned his device back on.

"I'd snap it on again, and he'd come right out of it," Hunter said, adding that Mauston would describe his "sliding toward eternity" in upbeat terms.

"He always said it was like falling back, down a well or down a big barrel," his doctor said. "And he said it wasn't unpleasant."