Tools made only a brief public appearance. But in a series of interviews with NEWSWEEK, the patient, his wife and nine members of his medical team offered a vivid account of medical history in the making. Highlights:
EARLY JUNE: After a decade of progressive heart failure, Tools saw his luck run out. He had left his job as a Denver technical librarian five years earlier and moved to Franklin, Ky., to await a donor organ. Now he was too sick to qualify for one. After a rough month in Nashville’s St. Thomas Hospital, he was sent home to spend his last weeks with his family. Until the age of 50, Tools had been an avid bass fisherman who stood 6 feet 3 inches and weighed 200 pounds. He now weighed 140, according to his wife, Carol, and “lived in a recliner.” He rarely ate, and he communicated largely by nodding yes or no.
MID-JUNE: Dr. Joseph Fredi, Tools’s Nashville cardiologist, was seeing him during weekly visits to Franklin and trying to prepare Carol for his death. During one of these visits, Fredi handed the couple a copy of the June 25 NEWSWEEK. The cover story described a new mechanical heart—a device called the AbioCor—that had recently been cleared for initial human trials. Unlike earlier devices, which left patients tethered to large machines, the AbioCor would run off a portable battery. Fredi also produced a letter from Laman Gray Jr. and Robert Dowling, surgeons at the University of Louisville, saying they were ready to try the new heart on a patient. As Tools read the article and the letter, his eyes lit up for the first time in months. Did he want to pursue this? The nod was decisive.
JUNE 26: For once, Tools’s desperate condition worked to his advantage. The AbioCor study was restricted to patients who had exhausted all other medical options and who stood at least an 80 percent chance of dying within a month. By these standards, Tools was a shoo-in. “He didn’t have the strength to lift his head when I came into the room,” Dowling recalls. His heart was pumping only two liters of blood each minute, instead of the usual seven. His blood pressure had dropped to 72/58 (120/80 is normal), and fluid was pooling in his lungs, leaving him starved for air. “He had no personality,” nurse Cindy Reeve recalls. “He just slept all the time.”
JULY 1: While Tools had an abscessed tooth extracted, Gray and Dowling made final preparations to replace his heart. They had implanted AbioCor hearts in 40 calves during pre-clinical testing. And as a dress rehearsal for the first human procedure, their 14-member surgical team had performed the operation on three pigs. Now, as showtime approached, physicians and family members resorted to sports metaphors to voice their confidence. Tools’s son likened the ordeal to a boxing match and told his dad, “You’re going to be the champ.” Dowling put it this way in a conversation with his brother: “Bob [Tools] is at the bottom of the ninth with two outs, but we’re going to hit a home run.”
JULY 2: The surgical nurses started preparations at 4 a.m., and by 8:30 the procedure was underway. It took all morning to split Tools’s rib cage, attach him to a heart-lung machine and remove his dying heart. By 12:30 the surgeons were nestling the shiny new AbioCor into his chest cavity. Once they had stitched it into place and implanted a controller and backup battery, Gray and Dowling ran the device briefly to remove any trapped air. Then they unclamped Tools’s aorta and watched his blood flow through the pumping chambers. Within minutes the device was working at three times the capacity of his old heart. “I looked up [later] and saw all the monitors showing that his blood pressure and vital signs were normal,” Gray recalls. “That’s when I had a really awesome feeling, with shivers up and down my back. It was truly one of the most thrilling times of my life.”
When Tools awoke the next morning, the ventilator tube in his throat kept him from talking. But as he realized he had survived, his titanium heart filled with gratitude. “I hadn’t known what to expect,” he told NEWSWEEK. “Any time you go to surgery, you’re taking a chance. That’s why it felt so great to see people. I just looked around and said, ‘Thank you, God’.”
JULY 9: Despite some lingering fluid retention and a prolonged bout of gastric bleeding, Tools steadily gained strength and was able to breathe on his own for a day and a half. “When the ventilator came out, he said a few words and paused,” Dowling recalls. “Talking was new for him. But then he wouldn’t shut up.” As Reeve says, “It was like he had six months’ worth of talk stored up inside him.” He thanked the surgeons and nurses. He thanked Carol for bearing with him, and he expressed his love for his son. He even asked about his tax rebate.
JULY 27: A day after taking his first steps, Tools amazed the hospital staff by walking 16 feet while two nurses held his arms to support him. When his son came by to visit a few hours later, Reeve asked if he would like to walk down the hall. The son (who has asked that his name not be used) looked skeptical, but Tools was game. Flanked by his son and his nurse, Tools then ambled 30 feet down the corridor before taking a seat in his wheelchair. As Tools sat beaming, his son told him, “You’re the man, Dad. You’re the champ.” The two threw mock punches while a small crowd of nurses choked back tears. “From that day on, he pretty much flew,” says Reeve.
AUG. 21: Having recovered from a lung infection that set him back briefly in early August, Tools was ready to go public. As he strode before a closed- circuit-television camera, dressed in the blue shirt and red tie that Dowling’s 6-year-old son had picked out, the press offered a standing ovation. Tools’s kidney function had returned to normal, his gastric bleeding had stopped, his diabetes was under control and muscle was replacing the fluid that had once engorged his tissues. “If you’d asked me a month ago whether we would be at this point today, I would have said no way,” says Gray. “I’m flabbergasted.” Tools says he is eager to get back to his e-mail and his fishing pole. He is still unable to take in food fast enough to gain the weight he needs, and his future is uncertain. But if his recent past is any clue, he may actually have one.
