Heart to Heart

1. Chucky gets lucky

2. On bypass

3. New heart pumping

4. Recovery

5. The long runRiddle of R & L3. Stroke of genius?4. Attitudes are a' changin'

Chuck Reynolds waited more than three patient months for a heart transplant. A nurse himself, he was notorious for kidding the staff, but the wait was long and worrisome.


*Photojournalism by David Tenenbaum (Unless noted otherwise, all photos, this feature, courtesy David Tenenbaum).





Huge and misshapen, this heart is about to get replaced. That electronic gadget is a pacemaker and the wires connecting to the old heart.










Chuck Reynolds, 54, faced death with a failing heart.

Beating death
POSTED 18 OCT 2001 On Sept. 14, the National Day of Remembrance for victims of the Sept. 11 terrorist attack, Chucky finally got lucky. James (Chuck) Reynolds, 54, had been waiting in the hospital for three and one-half months for a heart.

In a hospital bed, Reynolds looks at the camera with a worried expression.In other words, he was waiting for a generous stranger to die. A stranger with the correct blood type and a heart suited to Reynolds's large chest.

Otherwise, Thomas Starkey, his heart surgeon at University of Wisconsin-Madison Hospital, had told him he would die of heart failure. In fact, Reynolds was already rather far along in the process of retiring from life. A registered nurse from the hills of southwest Wisconsin, his failing heart prevented him from working, even caring for his three young boys.

He was on an express train to the graveyard -- unless his doctors and that generous, anonymous stranger could derail it.

The first human heart transplant was performed in 1967 by the late South African surgeon Christian Barnard. But transplants remain a medical miracle -- last-ditch surgery that helps a small fraction of the people with heart failure, or cardiomyopathy.

The heart bulges to the right; pacemaker makes a tiny, hard-edged image.Near midnight, Sept. 13, Reynolds was told that a young person had died elsewhere in Wisconsin, and the family wanted to leaven the tragedy by donating the organs. One death would allow one life.

Reynolds had already made the decision to get a new heart -- even though that meant having a surgeon saw his breastbone and cut out his heart.

Although a heart was available, Reynolds knew it did not guarantee a restoration of health and life. Was the donor heart in good condition? Would a couple of hours on a heart-lung machine cause clotting or other problems? And most critically, would his immune system reject the new heart?

Scrubbed? Then let's head for the operating room
Chuck, a friend of the author's, suggested that The Why Files cover the procedure. Like many deathly ill people awaiting a transplant, he was obsessed by the shortage of donated organs. He thought publicity about his case would raise the visibility of transplants and organ donations.

5:10 a.m. Clad in scrubs, we enter the operating room, where nine people are preparing Reynolds for surgery, hooking up IVs (intravenous lines), inserting the airway, laying out a toolbox full of stainless-steel instruments on two tables, connecting monitors and draping his body, leaving only his chest visible. Starkey has flown off to remove the donor's heart, which, to prevent deterioration, should be implanted within four hours after removal. In the intense choreography of heart transplant, Chuck's chest will be practically empty when the donated heart reaches the OR.

5:24 a.m.-Glare of light illuminates a hand and scalpel cutting the patient's chest. 5:24 a.m. Starkey's partner, Dr. R.P. Cochran, makes the first cut, gradually working deeper until he reaches the sternum. Through a probe in Reynolds's trachea, the echocardiogram (an ultrasound imagemaker) shows a highly abnormal heart. On the wall, a similar picture emerges from Chuck's X-ray: an enlarged heart with the clear silhouette of the pacemaker that spurred his heartbeat after a heart attack nine years before.

5:45 a.m. The surgeons cut through the sternum with a vibrating, thumb-shaped saw blade. By now, Reynolds is receiving an entire drug store through intravenous plumbing: valium, other muscle relaxers, fluids, antibiotics, heparin to control clotting, Benadryl to reduce allergies, and gobs of anaesthetic. Running the pharmacy is anesthesiologist Diane Head, who explains that while the surgeons have to replace the heart, she's gotta keep the patient alive. We stand with Head near Chuck's head, barely visible beneath drapes, and watch as more and more steel pokes into the growing hole in his chest.

5:50 a.m. A donut-shaped magnet deactivates the pacemaker that has regulated Reynolds's heartbeat. After more than 54 years, his heart has almost beat its last.

5:52 a.m. A heavy-duty clamp spreads his sternum, exposing an enlarged, sickly heart. It's still beating.

6:00am-Three hands visible; a bunch of instruments inside a bloody chest. Opening in sternum is about 5 inches wide.5:57 a.m. The surgeons start cutting the heart loose, cauterizing blood vessels with an electric gadget that emits the odor of burned flesh. The clamp is cranked open, and they cut through the pericardium, the heart's lining. The heart continues to beat.

6:14 a.m. Starkey phones from the Madison airport. He has the donated heart in a picnic cooler and will reach the OR in 25 minutes. The surgeons continue their methodical but hasty task.

It's coming time to remove Chuck's heart.




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Terry Devitt, editor; Pamela Jackson, project assistant; S.V. Medaris, designer/illustrator; David Tenenbaum, feature writer; Amy Toburen, content development executive; Eric G.E. Zuelow, project assistant