Behind The Scenes

The evening of his 39th day as a patient at University of Cincinnati Medical Center, Gary Sawyers was napping in a recliner next to the window in his hospital room when he felt the presence of someone else.

Opening his eyes, he spotted his doctor, Dr. Louis Benson Louis IV, Chief of Cardiac Surgery at UC Health, sitting on the edge of his hospital bed.

“Are you going to sleep, or give me time to put a heart in you tonight?” Dr. Louis asked.

Then, more serious: “We’ve got you a heart, and it’s a good match.”

By the next morning, a new heart would be beating strongly inside the chest of Gary, a 55-year-old father and Cincinnati Bell field operations employee who lives in Bluejay, Ohio, a small town in suburban Cincinnati.

Many heart transplant recipients spend years or even decades managing heart conditions before they reach end stage congestive heart failure and are placed on the transplant list.

But Gary Sawyers didn’t even know he was sick when he visited an emergency room near his home in late August 2017. Feeling ill, he figured he’d overdone it a bit while finishing the basement of his home, or maybe that chili with onions the other day had disagreed with him.

“I’ve never had heart problems,” he said. “I thought it was indigestion, but it wouldn’t go away.”

He and his family were shocked to learn that his heart was operating at just 5 percent capacity and that he was suffering from advanced heart failure.

Instead of spending Labor Day weekend relaxing with his family as planned, Gary was referred to UC Health and the advanced cardiac care team led by Dr. Louis and Dr. David Feldman at the UC Heart, Lung and Vascular Institute.

“They told me that I had had five to seven heart attacks,” Gary said. “I never knew.”

Looking back, he and his family now recognize the signs of heart disease: suddenly feeling ill and out of breath while shopping at the local hardware store, for example. They also understand why heart disease is known as “a silent killer,” especially for diabetics.

“He said he was getting old, getting slow,” said his daughter, Sandy. “Looking back, he was having heart failure.”

A left ventricular assist device (LVAD) – a mechanical pump surgically attached to Gary’s heart to help it pump blood through his body – helped for a few months. But modern medicine has yet to design a more durable artificial pump than the human heart, and Gary began to suffer complications from surviving on an LVAD.

In early January, he was admitted to UC Medical Center and placed on the heart transplant list.

As night falls on this Friday night, Gary Sawyers is about to become the 16th person in Cincinnati to receive a heart transplant since UC Health restarted the region’s first and most experienced adult heart transplant program in late 2015, providing advanced cardiac care close to home.

During the hours before surgery, more than a dozen family members come in and out of his room in the cardiovascular ICU to wish him well. They’ll stay at the hospital throughout the night, receiving updates every few hours from heart transplant coordinator Susan Duncan, RN, and other members of the care team.

Duncan helps heart transplant patients and their families navigate the emotional, and at times, scary journey toward surgery – and the lifelong advanced medical care required afterward. It isn’t just a job: each patient becomes part of Duncan’s own family, and she’ll go above and beyond for them at any hour.

On this night, that means keeping a promise to cartwheel into Gary’s hospital room when he received a new heart. Her execution is flawless, having practiced at home earlier in the evening.

“The best part of this job is a night like tonight,” Duncan said. “There’s no better feeling than being able to tell a patient they’re getting a second chance at life.”

As family members and medical professionals travel in and out of the room to prepare him for surgery, Gary is emotional, nervous and a bit bewildered, as if he can’t believe that this moment has finally come.

“I miss my truck. I miss my dog, Gus. I miss my job. I miss my life,” he said. “I’m getting a second chance. I’m going to eat better – I’m going to take care of myself.”

Moments after midnight, Duncan receives the final green light: the hospital’s laboratory is on the phone with the results of the final round of bloodwork. Confirmed: the antibodies in her patient’s blood did not react with the organ donor’s blood. If they had, the risk of organ rejection would have been too high to perform the surgery.

“All right, it’s a go,” she says.

In the second-floor operating room, the surgical team is calm, cool and professional: it’s time to go to work.

Highly skilled and trained, each member of the team specializes in cardiac surgery. This is what they do.

Each person springs into action to prepare the operating room where they and Dr. Louis will spend the next eight hours performing the delicate procedure to provide their patient with a new beginning.

The nurses, anesthesiologists, perfusionists, fellows, residents and physicians’ assistants move in calm, steady synchronization. Surgical tools are organized and inventoried in a sterile area. The Cardiopulmonary bypass pump – or heart-lung machine – that will keep the patient alive during the surgery is calibrated.

Cardiac anesthesiologist Dr. Benu Makkad sits at the head of the operating table and monitors her patient, who is sedated and unaware of the activity around him. Her purview includes the massive IV pole with a fleet of fluids and medications needed for this delicate surgery.

Medical records are checked, and rechecked. Two circulators – experienced cardiac surgery nurses who run point on the entire procedure – oversee every detail under the watchful eye of Dr. Louis.

“A heart transplant is one of the more rewarding operations I perform,” said Louis, who is also an associate professor of surgery at UC College of Medicine. “It’s important to pause and recognize the incredible gift that the donor’s family made. And then to take that incredibly generous gift, and sew the heart into someone who is dying of heart failure – and then you see that heart start to function and to beat after it’s been quiet for hours – it’s incredibly rewarding.”

In addition to his brilliant mind and his skill in the operating room, Dr. Louis is a funny and easygoing guy who’s always ready with a joke and a smile. He even keeps the board game “Operation” on a shelf in his office, a gift from the patient on whom he performed the hospital’s first heart transplant just two years ago.

Tonight, however, Dr. Louis is all business.

He oversees the surgical preparations with a laser eye and attention to even the tiniest detail, such as where in the operating room the new heart should be placed when it arrives. He won’t crack a joke for several hours, and his easy smile won’t appear until even later, when he has judged the surgery to be a success.

The surgery is long, but Dr. Louis doesn’t leave his patient’s side for a moment, except to examine the new heart to ensure it meets his high standards.

“Our heart looks good. Let’s get going,” he says.

Dr. Louis dons his surgical glasses, or loupes, which will magnify every detail of the surgical area by a factor of 3 ½ times, and takes his place at the center of the operating table.

Over the course of the eight-hour surgery, 15 people will perform critical tasks in the operating room: from preparing the surgical equipment, to monitoring the machine that controls the patient’s body temperature, to operating the heart-lung machine, to the delicate task of removing one heart and connecting another.

“It’s all about timing – everything is very coordinated,” said Stephanie Talero, RN, a 16-year cardiac nurse. “The people, the patients, the team. I still get goosebumps when the heart comes in the room.”

In the early hours of Saturday morning, two surgeons wheel a cooler into the operating room. They walk rather than run, but otherwise it feels a bit like you might see on TV. The room falls silent, and the moment feels sacred.

The only sound is the beeping of the surgical machines and the calm voice of Dr. Louis, directing the surgeons how to unpack and handle the delicate organ.

First, a clear plastic container is lifted out of the cooler and placed on the table. Then, the heart, on ice in a clear, sterile bag, is slowly lifted from the plastic container. Gently, gingerly, the heart is removed from the ice and placed on the operating table. Dr. Louis, wearing his surgical glasses, inspects it intently, checking every angle, valve and artery.

After a few moments, he’s satisfied.

The transplant begins.

The heart is an amazing organ.

In clinical terms, it’s a muscle that pumps blood throughout the body via the circulatory system, supplying oxygen and nutrients to the body’s organs and tissues.

That’s a medical way of saying that the heart supports and sustains all life in a person. When the heart fails, life ceases. Sometimes that happens suddenly, as in the case of trauma or cardiac arrest. And sometimes it happens slowly, as in the case of cardiac failure over time.

It is no exaggeration to say that a heart transplant provides new life.

When a new heart is transplanted into a person, the surgeon removes the diseased heart from the recipient’s body. But a gleaming, beeping machine known as a heart lung bypass keeps the patient’s blood circulating through his or her body from the time the heart is removed, until the moment the new heart – connected to the patient’s own arteries and blood vessels – begins beating on its own.

During that moment, time seems to stop.

The surgeon and surgical team have executed their jobs flawlessly, mindful of not only the fate of their patient, but also of the precious gift of life, which a grieving family has entrusted to them on this night.

For a brief moment, however, the future seems out of their hands. It’s up to the heart to begin beating and send new life coursing through their patient’s body.

Not long after dawn on this winter morning, it does.

And Dr. Louis’ shoulders, which haven’t left the operating table since the surgery began, relax just a fraction.

He cracks his first smile of the night.

The surgery itself is an incredible feat: working in perfect precision and synchronization for many hours, a team of highly-skilled medical professionals have restored life and hope to a man and his family.

But the transplant itself is one step in a much longer, just as important process.

In the hours, days and weeks following the surgery, Drs. Louis and Feldman and the care team monitor Gary and his new heart closely. He receives anti-rejection medication, along with a host of blood and cardiac tests to ensure that his body is working as it should.

The medication makes him a bit loopy and gives him strange dreams. His partner, Delonda, stays by his side throughout the recovery process, consulting with his care team every step of the way.

By Sunday morning, Gary is awake. Within a day or two, he’s up walking. And exactly 14 days after his surgery, and one day before his 56th birthday, he is discharged from the hospital to recover at home.

“He’s defied the odds from the beginning,” Delonda said. “He was determined to be home by his birthday.”

His recliner awaits, and his dog, Gus, excitedly greets him before he enters the house. Over the next few weeks and months, Gary will need to visit UC Medical Center several days each week for monitoring, tests, and adjustments to his medications.

“A heart transplant is a lifelong journey – it requires a lifetime of medical care,” Duncan said.

Thanks to Dr. Louis and the team who restarted UC Health’s heart transplant program, Gary Sawyers and patients like him are now able to receive that lifelong care close to home instead of having to drive an hour or two for their many medical visits.

Three weeks post-transplant, Gary is already making plans to return to his job of more than 20 years. He has been overwhelmed by the support of his coworkers, who had shirts made to support his medical journey and have been flooding his home with cards and well wishes as he recovers.

“I feel lucky to have this care so close to home,” Gary said. “I can’t imagine being far away from my family and my home. And the care here has been amazing. “It is by the grace of God, Dr. Louis and his team, the UC Health cardiac care team, and the many prayers from family and friends that I have been given this second chance at life,” he said.