A rare heart, and then a second one
A cowboy’s donor heart lasted 31 years. The same surgeon put in another one.
Last March, an aging cowboy in a Stetson rolled into Froedtert Hospital in a wheelchair. Chuck Newman had come to see the doctor who’d performed his life-saving heart transplant decades earlier. ❚ They had much in common, the doctor and patient. Two farm boys raised an hour apart in northern Nebraska, they’d played high school basketball against one another and grown up with a passion for horses. Both were on the cusp of middle age when they’d met for Chuck’s transplant in 1988.
Now, the men were in their early 70s, and as they shook hands, the doctor could not help noticing that Chuck’s once firm grip had softened. The cowboy’s face was ashen, his voice weak as a whisper. He looked sleepy.
Lyle Joyce, professor and section chief of adult cardiac surgery at Froedtert and the Medical College of Wisconsin, had known this day was coming.
No human heart lasts forever. Chuck’s donor heart had survived almost 31 years, believed to be the fourthlongest in the history of organ transplantation.
But scans in 2015 and 2016 showed that his coronary artery was narrowing, a dangerous condition. The patient feels no chest pains, yet can be stricken without warning by a massive heart attack.
Even before the fancy machines began taking fresh images, the doctor could picture what was happening inside the cowboy’s chest. The donor heart was now larger than it should be. The coronary artery, no longer soft and pliable, was stiff. A vigorous, healthy heart pumps with a brisk, twisting motion. Chuck’s quivered faintly.
Still, the doctor saw reason for optimism. The second surgeon assisting with Chuck’s care was a man Lyle knew and respected: David Joyce, director of heart and lung transplantation at Froedtert and the Medical College. Lyle’s son.
In the last five years, the pair had performed about 100 heart and lung surgeries together. They made a good team; one the right hand, Lyle said, the other the left. The father admired his son.
“In the operating room,” Lyle said, “he has this precision and efficiency. His stitching is just so smooth.”
At first, the doctors thought they could help Chuck regain his strength in preparation for surgery without using drastic measures. Then, later in the month, the cowboy’s condition crashed, his heart straining to pump enough blood. A machine had to be brought in to do the work of his heart and lungs.
On the evening of March 31, the two doctors returned to their respective homes doubting Chuck would make it to sunrise.
He needed something relatively rare: a second heart transplant.
Unsure he would live long enough to receive a second donor heart, Chuck, a self-described Christian cowboy, did what came naturally to him.
He prayed: God’s will be done.
Only 100 or so second transplants
The surgery he faced was a measure of just how far heart transplantation has come since 1967, when Christiaan Barnard replaced the failing heart of a 54year-old man with one removed from a female accident victim in Cape Town, South Africa. The recipient of history’s first successful heart transplant lived 18 days, then died of pneumonia.
In 2018, there were about 3,400 heart transplants in the U.S. Only 100 or so were second transplants.
The median length of time a donor heart survives these days is 12.5 years, according to Biswajit Kar, a cardiologist at Memorial Hermann Hospital at UT Health in Houston.
A cardiologist for 27 years, Kar has had two patients whose donor hearts lasted longer than 25 years; neither made it to 30.
“There are very few patients alive,” he said, “who have gone past 30 years.”
In the last half-century as heart transplantation has become more common and more successful, some of the marvel and peril of it have waned. The one-year survival rate is now approaching 90%, enough to mask just how difficult it is to live with another person’s heart.
“Literally, you have to dodge many bullets to stay alive,” Kar said. Patients may contend with organ rejection, infections, cancers.
Success depends on a delicate balancing act. Doctors must subdue the patient’s immune system enough to stop it from attacking the new heart. At the same time, they cannot restrain the immune system so much that it is unable to perform its crucial job: protecting the body from viruses, bacteria and other invaders.
In the early days of transplantation, patients mostly died because the body rejected the new heart. Later, when doctors restrained the immune system, they often went too far and patients died from infections.
Over the years, researchers have developed a gentler drug for suppressing the immune system with fewer side effects.
Still, at any given moment 3,500 to 4,000 Americans are on the waiting list for a new heart; about 25% will die waiting. As a result, there is debate among doctors: Should some receive second donor hearts while others still wait for a first.
It was beyond dispute that Chuck Newman had been an exceptional steward of the heart he received in 1988. He’d followed the doctor’s orders to the letter, exercising, eating a healthy diet and keeping his weight and blood pressure under control. He could count on one hand the number of days in the last 31 years when he’d forgotten to take one of his pills.
“No matter how you look at it,” Lyle said, “he did everything he could to make that first heart last.”
A remarkable history in medicine
In the late 1950s and early 1960s, when Lyle was growing up on a farm in Plainview, Nebraska, milking cows at 5 a.m., the talk at school was mostly of astronauts and space. Unfortunately, Lyle wore glasses. He’d never be an astronaut.
Another scientific field was rising in the public’s imagination, though, and in this area, the farm boy was well prepared. The field was open-heart surgery, and the early work would have to be done in animals before it could be tried in humans.
On the farm, Lyle and his father worked together caring for the pigs and cows. When an animal died, his father would call the veterinarian to perform a necropsy and the Joyces would watch.
“I suppose it was the anatomy,” Lyle said, explaining his fascination.
There had been no doctors in his family, just farmers.
But the boy was smart, worked hard and had the good fortune to wind up working at Baylor College of Medicine in the lab of Michael DeBakey, pioneering surgeon and developer of artificial hearts. He worked as a lab technician, watching the famous surgeon and another doctor implant total artificial hearts in calves, then cleaning up and trying to keep the animals alive overnight. The calves never survived long.
In 1980, Lyle began a residency in cardiothoracic surgery at the University of Utah.
On his second day in Utah, he and heart surgeon William DeVries implanted a Jarvik artificial heart in a cow, a step toward one day performing the procedure in a human. For the next two years, they would get together every few weeks to implant artificial hearts in cows, 40 to 50 in all.
In 1982, a dentist named Barney Clark came to Salt Lake City to watch them work. The dentist was dying, his heart struggling to pump, his lungs laboring to breathe. He told the University of Utah surgeons that when he reached the point of death they could test the artificial heart on him. A year earlier DeVries had made an application to government regulators seeking permission to implant the Jarvik heart in a human being.
Barney signed an 11-page consent, then signed it a second time 24 hours later, a special condition imposed to ensure that the patient had thought through his decision.
On Dec. 2, less than three months after he had watched the surgeons sew an artificial heart into a cow, Barney became the first human to undergo the procedure. The university and its famous patient became the center of a media circus that lasted 112 days, until the dentist died. The next such patient would make it 620 days.
The Salt Lake City case generated much controversy. Lyle received hate mail from people who believed that in removing the dentist’s heart and replacing it with an artificial organ, “we’d stolen this man’s soul.”
During those 112 days, Lyle focused on his patient, seeing him three to four times a day. As much as possible he avoided the media. He grew close to Barney and his family and for years afterward, received an annual Christmas card from the dentist’s widow.
“I had seen what was possible in animals and had seen this success in Barney Clark,” Lyle said.
In December 1985, Lyle became the first surgeon ever to implant a total artificial heart in a woman: Mary Lund, a nursing home secretary. The artificial heart, implanted at the Minneapolis Heart Institute at Abbott Northwestern Hospital, kept her alive for the 45 days it took to find a suitable donor heart.
The cowboy gets a new heart
In the spring of 1988, the surgeon met the cowboy. Chuck had grown up on a farm in Stuart, Nebraska, and was now a rodeo cowboy in his early 40s.
He was brought to the hospital in a dire condition called cardiogenic shock; his heart wasn’t pumping enough to keep his organs alive. An unknown virus had triggered his heart’s rapid decline.
Lyle hoped Chuck could receive a donor heart, but the prospects were not good. The cowboy was scheduled to receive a total artificial heart at 6 one morning. Just three hours before the procedure, the surgeon entered Chuck’s room.
“You’re going into the operating room,” Lyle said. “But you’re going to get a real heart.”
Against the odds, a donor heart had become available at almost the last minute.
Lyle flew to Omaha, Nebraska, to procure the heart while a colleague prepared the cowboy’s chest to receive the organ. The procedure took around three hours. Lyle and his fellow surgeon sewed Chuck’s new donor heart into his chest.
As Lyle remembers it, soothing classical music likely played as they worked. “Probably wasn’t what Chuck would have wished,” the surgeon said.
The cowboy made an exceptional recovery. He was ready to go home six days after the surgery.
“You never let anyone go home that fast,” Lyle said, “but he was a young, vigorous, healthy guy.”
Something changed, though, on the day Chuck was to go home. When the doctor stopped in to say goodbye, his patient looked deeply dejected. What’s the matter, Lyle asked. “Well the finance people came in to talk to me,” the cowboy said. He would need to sell virtually all of his assets to pay his medical bills.
The previous year Chuck had won a third-place award at the world rodeo championships. His life’s goal was to be a world champion. If he sold all his assets, he would lose his championship horse, Abby, a bay mare.
Lyle spoke to his wife that afternoon. Then he returned to Chuck’s bedside.
To help the cowboy pay his bill, the doctor agreed to buy two horses, Abby and a second horse named, Fancy. Lyle kept Fancy, but gave the championship horse back to Chuck.
To say horses were important to Chuck would be an understatement. He was a 10-day-old infant when his family held him on a horse for the first time and took his photo. He started training horses for other people at the age of 8.
“Well, they’re just the center point of my life,” he said recently. “I need horses in my life.”
Ten days after surgery, Chuck was roping stationary calves, or dummies, an hour in the morning and an hour at night. Four weeks after surgery, he saddled up and began riding horses again.
“I ain’t tough,” he said later of his swift recovery. “I just ain’t too bright.”
In October of that year, about five months after receiving his new heart, Chuck went to the world championships in Oklahoma City. With the doctor and his family watching in the stands, Chuck and his partner captured the world championship in team roping.
“It meant the world to me,” Chuck said.
Building a personal bond
As the years went by, the cowboy and the doctor’s family got to know each other well. Chuck came for checkups. He taught all the doctor’s children to ride horses.
“He was just an easy guy to talk to,” Lyle said.
“He‘s very funny, the friendliest guy in the world,” said Lyle’s son, David, who was a boy when he met Chuck and watched him rope calves. “He was so passionate about roping and breaking horses.”
David was 7 when Barney Clark received his artificial heart, and he remembered watching all the attention the achievement garnered in newspapers and on television. His father had been part of something important. It was the first time David remembers thinking maybe he’d become a surgeon.
By high school, the family was living in the Twin Cities and David was feeling the pull of independence. He began to look at heart surgery as maybe something he’d do if he couldn’t come up with something else.
Lyle sometimes daydreamed about working in the operating room with his son. Heck, he’d enjoyed working on the farm with his own father when he was a kid.
Still, he never wanted to push David. He and his wife, Tina, often told their son, “You’ve got to find your own way.”
David did. He went to the U.S. Air Force Academy in Colorado Springs. He studied pre-med.
Then he went to Harvard Medical School, graduating in 2001 and moving on to Johns Hopkins School of Medicine for his residency in general surgery. He also spent two years conducting research at Texas Medical Center.
Despite his high school doubts, David discovered that heart surgery suited his problem-solving personality.
“I’m not interested in sitting in a room discussing different theories,” he said. “If I’ve got a hammer and there’s a nail, I know what to do.”
During his years as a surgical resident, David found himself calling his father almost every night, often talking for an hour or more. He would mention the procedures he’d participated in at Johns Hopkins and ask his father, “What would you have done?”
At the same time, the father often heard his son praised by other doctors at Johns Hopkins. “Another Denton Cooley,” some said, invoking the name of the pioneering surgeon who founded Texas Heart Institute.
A father-son team
In 2014, the father and son became partners in cardiac surgery at Mayo Clinic in Rochester, Minnesota. It could have worked out badly.
“I’ve got friends whose fathers feel like the kid never measures up,” Lyle said. “And to the kid, the father’s old school, he’s outdated.”
But the Joyces had always been close — hobby farming, riding horses. David knew his dad was not the drill sergeant type. He’d watched his father work with residents at the University of Minnesota; one called the older man, “Master Yoda.”
As the father began collaborating with his son in the operating room, the older man thought of all the praise he had heard from the doctors at Johns Hopkins “and I realized what they said was right.”
The son found a rhythm in the operating room with his father.
“When you have a dancing partner like Fred Astaire, it’s one of the most fun things you can do in your life. My father is just a phenomenal dance partner. It seems like he’s reading my mind.”
In May 2017, Froedtert hired the father and son as transplant surgeons.
Nearly two years after they joined Froedtert, the Joyces had a familiar visitor: the cowboy.
Racing against the clock
On the night of March 31, Chuck lay deathly ill. David had “that sick feeling that we’re going to be going to a funeral.”
The next morning, though, the tough old cowboy was still alive. Then, to the surprise of the Joyces, a donor heart became available.
Around noon David, 43, boarded a Learjet and flew to retrieve the heart. Doctors cannot disclose where the heart came from, but the Joyces said it was recovered within a 250-mile radius of Milwaukee.
Transplants are carefully choreographed to ensure the donor heart is outside the human body for as short a time as possible. Four hours is the
target. Time is critical because all human tissue must receive oxygen-bearing blood to survive.
The race to retrieve Chuck’s new heart and return to Froedtert played out in texts between David, his father and other medical staff.
1:42 p.m.: David texted an emoji of a plane landing.
1:46 p.m.: Lyle texted, “We’re going to bring Chuck in about 10 minutes.”
Chuck said the last thing he remembers Lyle telling him before the surgery was that they would do the best they could. “I knew they would,” Chuck said.
4:08 p.m.: David texted an ambulance emoji, indicating he was carrying the donor heart on his way to the airport for the return trip.
4:32 p.m.: David texted a plane taking off.
5:18 p.m.: David texted an emoji of a plane landing. He said the estimated time of arrival at Froedtert would be 5:45 p.m.
Sometime before 6 p.m., David walked into the operating room where his father waited with Chuck, who was sedated.
“Is it a good heart?” Lyle asked. “Great,” David answered. “Perfect.” Minutes later, Lyle cut out the donor heart that had sustained Chuck for more than one-third of his life.
“Oh man,” the doctor said.
He worked on Chuck’s right side, his son on the left. They spoke quietly as they sewed.
The family dynamics of father and son disappeared, as they always do. “You shut out the world,” Lyle said. “You are so focused on what needs to be done.”
Once the surgeons finished sewing in the new heart, they gradually weaned it off of the heart-lung machine that had been supporting it.
The heart had been outside a human body for less than three hours.
By 9 p.m., the doctors had finished sewing in the wires used to bring the sternum back together.
The father and son walked together to the hospital’s patio cafe to debrief. The two ate sandwiches and drank Mountain Dew.
They marveled at how improbable the transplant had been. Just keeping Chuck alive for the weeks leading up to his transplant had required a sustained effort by more than 100 doctors, nurses and other medical staff.
“This was about as close as we’ve come to watching a patient slip out of our grasp,” David said of the wait for Chuck’s heart.
Chuck’s recovery at Froedtert took about two weeks — remarkably brief, the doctors said.
“It was an act of God,” Chuck said. “That’s all that can be said about it. The Great Healer himself made it possible.”
On June 15, the cowboy was back at the annual Rodeo Bible Camp in Bloomington, Iowa. He works as one of the instructors for the camp, which draws about 100 students from around 8 to 17 years old. Instructors teach the campers how to swing a rope, track a cow and rope a steer from a horse. The camp holds chapel three times a day.
“Our main purpose is to lead them to Christ,” Chuck said. “It’s all from the heart. It’s my main thing for the year to do.”
In mid-December, the cowboy had to check into Mayo Clinic in Rochester. He’d come down with cytomegalovirus, a common virus to which transplant patients are especially prone. The medications they take to prevent the immune system from attacking the new donor organ leave them more vulnerable to the virus.
His doctor at Mayo, transplant cardiologist Sudhir Kushwaha, said Chuck needed to eat more and get his strength back.
“He’s well on his way to recovery so he should be home for Christmas,” Kushwaha said. “It attests to his overall toughness and strength of character. To get through one transplant you have to have a lot of fortitude.”
Chuck’s voice broke as talked about coming home to his horse farm in Glidden, Iowa, to spend Christmas with his four children and the woman he calls, “the love of my life,” Shelly Strahl.
After the holidays, he hopes to return to the rodeo. Even at 73, even on his third heart, it’s his passion.
“I’ve got me a partner lined up, if I get to feeling good this winter,” he said. “Probably be ready for spring.”
People wishing to become organ donors can find more information, and register to be a donor at https://donate life.net/