Meet the Cardiac Cowboys

What captured the fancy of the press corps was casting Alec and Pete as Western Australia farm boys and decided underdogs and battlers, the so-called “Cardiac Cowboys.”

While the science and history behind The Stars That Govern Us is factual with a few admitted liberties taken for dramatic/narrative purposes, as I explained in my Author’s Note, all the major characters in my novel are fictional. Characters form the foundation and the heart (no pun intended) of any story, but The Stars That Govern Us is as much the story of Stirling University’s “Cardiac Cowboys,” Alec Serafeim and Pete O’Neill, as it is a story about the invention of the heart-lung machine.

Alec Serafeim. 

“You’re gifted, Alec.” Pete pushed his shoulders back and fidgeted with his blanket. “You’re a virtuoso with the knife. I’m not just saying that because you’re my mate. You’re the best surgeon I’ve ever seen.”

Alec is the viewpoint character of The Stars That Govern Us. Bold and ambitious, yet deeply insecure and sensitive, Alec is a talented young surgeon and complicated character, utterly dedicated to trying to save the lives of as many children as he can.

Alec’s Backstory.

An only child, Alec was born on 1 December 1925 in Perth. His life was heavily influenced by his mother dying in childbirth shortly before his fifth birthday; he feels a mixture of guilt over not remembering her well and anger toward his father, a general surgeon, for not saving his mother. Alec’s decision to become a surgeon was driven by the loss of his mother; as he admits to his wife, he became a surgeon to do better than his father had, to save “the almost hopeless.”

Alec was ultimately raised mostly by a maternal uncle, Thomas Xenos, and his aunt Susan, on their Arabian horse farm near Kojonup, about 160 miles south of Perth. Alec grew to love horses and is very close to his aunt and uncle while quite distant from his own father. From ages five to seven, Alec suffered from “selective mutism,” a severe childhood anxiety disorder where a child does not speak. While this was undoubtedly triggered by his mother’s death, notably, mental illness runs in the family on Alec’s father’s side; Alec’s grandfather, a ship’s surgeon named Aris, suffered several psychotic breaks and died by suicide when Alec’s father was thirteen.

Alec would have been fourteen or fifteen at the outbreak of World War II. He attended a year of medical school at the University of Melbourne before leaving to join the Royal Australian Navy when he turned eighteen. His combat career was brief; he spent most of his time in the RAN in training. Nevertheless, he was serving as a medic aboard Australia when the ship was involved in a Kamikaze attack in October 1944 at the Battle of Leyte Gulf. He received the Distinguished Service Medal and was invalided out of the RAN due to third-degree burns to his feet. He returned to medical school in March 1945, placing him in the same class year as Pete.

In December of 1945, Alec suffered a severe manic episode that required him to be hospitalized. This incident – and the way he was treated by some of his classmates and some of the upper-level members of the university administration – scarred Alec, leaving him paranoid about relapses and somewhat bitter towards those involved. The incident also served to deepen the then six-month-old friendship between Alec and Pete.

Despite being an excellent student, Alec’s manic episode dashed his hopes of finding a residency position in the United States, and he ended up at Stirling University because his father was a general surgeon there and willing to vouch for his son. The manic episode also caused Alec to become estranged from his future in-laws; his father-in-law flat out told his daughter not to marry Alec. Alec carries a definite chip on his shoulder, and underlying his actions is always the desire to prove others wrong about his mental illness.

In the Novel.

Alec is thirty during the novel and has been recently appointed as Stirling’s head of pediatric congenital heart surgery. He is an incredibly gifted young man, slick with the scalpel but with excellent bedside manners, always with a trinket in his pocket for a sick child. He is married to the daughter of a literature professor at the University of Melbourne, Ravenna (“Venna”), and has a five-year-old son named Ambrose (“Brose”). Alec’s main hobbies outside medicine are running and sailing; he owns a small boat named Sphyrna. (Sphyrna is the name of the genus which includes hammerhead sharks.)

Alec’s dream was to work in a large hospital in the United States; he chafes working at a public hospital with limited funding in the most isolated city in the world, and it is ultimately the lack of alternatives that leads him to decide to build a heart-lung machine in the hospital basement.

Alec isn’t intended to always be likable throughout The Stars That Govern Us. He is a complicated character, one who can often be contradictory. He is sometimes overly sensitive, arrogant, jealous, and obsessive, and he pushes ahead when he shouldn’t. Nevertheless, Alec is a good doctor with far more good qualities than bad, and he learns over the course of the novel how to be a better friend and doctor.

Alec has a good sense of humor. He likes to tease Pete over his propensity for having so many girls and over his cat, a white Persian named Fluffy. Although the Serafeim family has no pets, Alec loves animals, especially horses and birds, and he is notably upset over the idea of testing on animals. He is not a vegetarian, but he prefers to only eat fish. He is absolutely loyal to his wife, and they have a happy marriage, although Alec sometimes worries he is not good enough for her. He loves Pete like a brother. (He also fights with Pete like a brother!)

Alec loves literature and is well-read in the classics, having grown up with a schoolteacher as his “adopted” mother and in an era without television. He can easily quote Shakespeare and many famous poets like Tennyson or Keats. He runs to keep his mental health symptoms in check, and he enjoys anything to do with water, including swimming and sailing.

Physically, Alec is small and athletically built, with dark brown hair, dark olive skin, and thick curly black hair. He is a sharp dresser, and he often worries about how he appears to others.

Five Fun Facts About Alec.

  1. Alec’s most prized possession is unquestionably Jarrah – a black Arabian mare he received as a seventh birthday gift from his aunt and uncle. Jarrah appears briefly in the novel and is definitely a bit of a diva.
  2. Throughout the novel, Alec suffers from a combination of symptoms that are intended to be most consistent with obsessive-compulsive disorder and bipolar depression. An overlap between the disorders is common; about twenty percent of people with bipolar disorder also suffer from OCD.
  3. Alec is a “car guy.” Heart surgeons have to be mechanically oriented, and Alec loves working on his muscle car as a hobby.
  4. Alec’s full-name is Alexandros Vasilos Serafeim. Alec was named after Alexander the Great. He is not fond of being called Alexandros (although he detests being called Alexander even more), and professionally, he uses the name A.V. Serafeim.
  5. Alec isn’t based on anyone that I know or any specific historical figure – but the idea of a surgeon who loses his confidence and/or his desire to continue performing surgeries is loosely based on John Gibbon’s decision to give up doing surgeries with his bypass machine because of the human cost.

Who would I cast as Alec?

I would probably have cast Gregory Peck as Alec. There’s a bit of Atticus Finch about Alec, and I think Peck had the depth to play someone like Alec. (The only problem: He was too tall!).


Pete O’Neill.

If Alec was Stirling’s recognized wunderkind and visionary, then Pete was the hospital’s meticulous and steady workhorse; even if they hadn’t been best friends who had cemented their medical school bond through years of toiling in Stirling’s surgical apprenticeship program, everyone agreed they complemented each other perfectly as surgical partners.

Co-protagonist of the story, Pete is Alec’s best friend and surgical partner. A good doctor and a bona fide war hero who suffers from chronic illness related to wounds suffered during the battle of El Alamein, he serves as both a foil and a friend throughout the novel.

Pete’s Backstory.

Born on 14 October 1923, in Belfast, Ireland, Pete was the last of eight children and immigrated with his family to Western Australia in 1929, shortly before the Great Depression. He grew up somewhat poor on a cattle and wheat farm in Varley, a dusty crossroads at the edge of the Wheatbelt, and attended correspondence school. His experience with the Royal Flying Doctor Service during his mother’s battle with leukemia when he was a teenager led him to become interested in being a doctor, and he was attending school in Victoria with the goal of admittance to the University of Melbourne’s medical school when World War II began.

Pete’s father converted to Catholicism after being wounded during World War I and has a strong hatred for the British Crown; he refused to let his son enlist in the AIF at the outbreak of World War II. As such, although just seventeen, Pete enlisted in July 1940, claiming he was nineteen and forging his father’s signature. He served with the 2/24th Battalion as a stretcher-bearer and saw service first at Tobruk, then at El Alamein, where he was severely wounded in the left side, lower back, and pelvis by machine-gun fire during the fighting at and around Tel el Eisa Hill in July 1942. For risking his life to rescue three wounded comrades and one wounded enemy combatant, Pete received the Victoria Cross.

Pete was invalided out of the army due to the severity of his injuries and began medical school in Melbourne in 1944. Unlike Alec, Pete always wanted to return home to Western Australia, and he willingly chose to become a surgical houseman at Stirling over other more prestigious hospitals that offered him a position.

In the Novel.

Pete is thirty-two and the father of six children, all girls; his wife is pregnant at the beginning of the novel with what ends up being their seventh daughter. He is estranged from his family, his father apparently never having forgiven Pete for deciding to serve in World War II.

Pete is far more cautious than Alec and serves to keep him honest. Partly, Pete’s conservatism is simply a difference in medical philosophy. Like most surgeons, Alec believes doing “something” is always better than “nothing;” Pete, who suffers from chronic pain, believes just as fervently in “do no harm.” But Pete’s conservatism and playing of the devil’s advocate is also driven by the fact that he genuinely cares for Alec, and doesn’t want to see his partner hurt in any way.

Pete is intended to be a mostly likable character. He has a temper, but his main flaw is he is a workaholic and stubborn, unwilling to rest when he should. Nevertheless, his loyalty is unquestionable, and he serves as the catalyst for convincing Alec to continue as a surgeon.

Like Alec, Pete is an animal lover. He owns a deaf white Persian cat named Fluffy – ostensibly bought for his daughters, but as Alec puts it, Fluffy is “100% Pete’s cat.” Pete has a good sense of humor and enjoys teasing Alec. Pete is an excellent surgeon and a good doctor, and although he exhibits a temper, he never loses his poise with children. He has a good relationship with his wife, Kate. Unlike Alec, who loves sleek and fast cars, Pete drives an ancient ute (a utility vehicle) that is constantly breaking down. Pete loves history and is proud of his Irish heritage, displaying a green Irish battle flag from the American Civil War in his office.

Physically, Pete is very tall and very thin. He has pale skin, freckles, red hair, and blue eyes and is somewhat lackadaisical about his appearance, often wearing mismatched socks. He walks with a cane and has a very noticeable limp. He carries a green tom bowler marble in his pocket for good luck.

Five Fun Facts About Pete.

  1. Pete’s full name is Peter John O’Neill. Pete’s name is the only one in the novel intended to be symbolic – Peter means “rock,” and for Alec, Pete fulfills that role. Pete claims his name derives from the fact that his father knew Pete would be a doctor and thus named him after Saints Peter and John, who healed the lame man.
  2. Pete is a Roman Catholic, just like Alec’s wife.
  3. Pete had a pet ewe as a boy named Daisy – she was abandoned by her mother (a “bummer”), and he raised her on the bottle, ultimately deciding to keep her as a pet versus selling her at the market as required for his Junior Farmers project. Not surprisingly, he becomes incredibly fond of the Border Leicester lambs Alec purchases for the heart-lung machine project.
  4. I based some of Pete’s mannerisms in his speech on Mr. Kane, an elderly man from Belfast who lived in my neighborhood when I was a child.
  5. As with Alec, Pete is not based on anyone specific, though Richard Varco is known to have often volunteered to be first assistant on Walt Lillehei’s open-heart surgeries despite being a great surgeon in his own right.

Who would I cast as Pete?

I would have cast Gary Cooper as Pete. Cooper had a quiet, understated screen presence and could play a wide variety of characters very well. He had a genuineness to him that I think fits Pete’s personality.