20 years later, heart transplant beats on
CHARLESTON, S.C. (AP) — As John Bryant left the Medical University of South Carolina in the summer of 1997 — a year and a half after the heart attack that set it all off, after he passed out in his sister-in-law’s house with his niece yelling, “Uncle John, don’t you do this to me” — one of his doctors imparted one more reminder of mortality.
“You can go home, start feeling good, go back to your old habits,” Bryant remembered the doctor telling him. “You won’t be here long. We’ll bury you in five years.”
Bryant, then 61, was the first person in South Carolina history kept alive by a heart pump while awaiting a transplant and the second to receive a heart-kidney transplant. The heart pump, a left ventricular assist device, or LVAD, had been developed in the 1980s. By the time Bryant’s heart failed, the technology was still new enough that transplant surgeon Jack Crumbley had just learned how to use it on cows in Texas.
Bryant had been in and out of hospitals after his heart attack. A spell of amnesia followed, then heart stents and blood thinners that didn’t work in the long term, then debilitating exhaustion. He stayed on the pump for three months before the transplant.
When he got home, he took the doctor’s advice. The longtime truck driver never smoked and rarely drank. Working hard was his old habit. A month later, he stood atop his Goose Creek house to cut down a tree.
His wife, Margie, mortified, took a picture and drove away.
He still does things like that, Margie said. Bryant has outlived doctors’ expectations fourfold, and perhaps beyond that. His extra 20 years have been active ones: road trips with his son-in-law, births of grandchildren and great-grandchildren, supervision of home improvement projects.
Just last year, there he was, back on the roof, overseeing a re-shingling project — all 80-plus years of him, and at the center, a much younger heart, still beating.
John Bryant requested to not be the hero of his own story.
Take, then, the EMT who zapped him with a defibrillator 19 times on the way to Trident Medical Center after his heart attack. Later, the family learned the EMT’s own father had died of a heart attack: He hadn’t been able to save him. He wouldn’t let another man slip away.
Take Margie, who went to bat for a debilitated John when his heart finally needed replacing. John didn’t seem all that interested in a transplant, Margie remembered one of the doctors saying.
“Isn’t he all doped up?” Margie retorted. They agreed to move forward.
There were the doctors who performed the transplant, and before that, put him on the pump that pulled him from the edge of death. There were the nurses, who made Bryant feel comfortable in the months beforehand. Even when they turned off the pump for eight seconds for routine maintenance, and Bryant horrified them with a faked, dramatic death-gasp.
Take, too, the young man whose heart Bryant received. He was in his 20s, from Orangeburg, had been in some kind of accident, Bryant’s family remembered.
Later, the donor’s family invited Bryant’s to a family reunion, and the man’s mother pressed her ear to Bryant’s chest, listening to the steady, unceasing thump of her dead son’s heart.
First and 143rd
“New Heart/Kidney #143 June 27, 1997,” reads John Bryant’s hat, navy blue with a mesh back, a gift from a hospital friend who got heart transplant number 142.
One-hundred and forty-third, but also first. Jack Crumbley, the transplant surgeon, had returned from Texas a few months before Bryant arrived. There, O.H. “Bud” Frazier, a doctor who helped develop the world’s most widely used LVAD, had sold him on the technology.
With Bryant, Crumbley saw an opportunity to use it. He hoped the LVAD would allow Bryant’s kidneys to recover when they failed, simply making him the state’s first person to be bridged to transplant with an LVAD.
The kidneys didn’t recover. Crumbley has never found evidence of the LVAD being used as a bridge to a multi-organ transplant before Bryant, and so Bryant is the first for that, too.
LVADs have evolved in the past two decades. Where the large model doctors used on Bryant kept him confined to a hospital, newer technology lets patients continue normal lives while awaiting transplant.
MUSC’s heart transplant program has pounded on in the meantime. Three-hundred and eighteen adults have gotten heart transplants since 1997. Sixteen have gotten heart-kidney transplants.
That Bryant’s own vitality remains after two decades is “remarkable, but not surprising,” said Crumbley, who performed MUSC’s first heart transplant in 1987 and retired last year.
“Some people are couch potatoes whether they’d gotten a transplant or not,” he said. “And some people, you’d have to tie them up and cuff them to a rail to make sure they aren’t active.”
“Word on the street” suggested a three-to-five year life expectancy in 1997, he said, but doctors now know about half of heart transplant recipients live at least 12 to 15 years. Crumbley has had patients who have now lived 30 years after a transplant.
A number of forces could wind a new heart’s tick for days or decades. The skill and care of doctors involved play a role, Crumbley said, but not as much as a recipient’s effort to follow doctors’ orders afterward. Luck, he said, lords over them all. Still, the old truck driver with persistent energy deserves some credit.
“He’s always tried to do the right thing and tried to take care of himself,” Crumbley said.
“Before the transplant, I was like a bull,” John Bryant said. “I could run through the woods, do whatever I wanted to do. Up ’til about five years ago, I was still a bull.”
He doesn’t move as well as he used to. He likes to sit on the front porch, because he sometimes gets cold in his house’s air conditioning, even with a long-sleeved shirt. His hearing has started to go, maybe as a side effect of one of his medications.
“I’m getting more deafer and my wife is getting more louder,” he said with a laugh.
But his silver hair shines, and his wide, blue eyes glint with caught light. He mows his lawn and repairs discarded wood pallets for resale. He encourages people considering life-saving transplants to go through with the procedure.
“If you don’t do it, you’re going to die,” he said. “What have you got to lose?”
Near the end of July, Bryant will return to MUSC, where tiny pieces of his heart will be taken for biopsies. This will tell doctors if Bryant’s body shows any sign of rejecting the heart. It never has before.
But when time does finally reach up and grab hold of him for good, well, he’ll have at least put up a fight. Perhaps he could chalk up his survival to any combination of things, to his omnipresent family or his drive to stay busy or his doctors’ reliable handiwork. But no, he leveled his weathered voice and told his secret.
“To myself, I promised the family of my donor I’d try to keep him alive as long as possible.”
Information from: The Post and Courier, http://www.postandcourier.com