I’d been following preparations for the first implant for several months. Then, just days after the surgery, Dr. Laman Gray Jr. at Louisville’s Jewish Hospital and the University of Louisville told me that the patient had learned about the heart through an article in NEWSWEEK–an article that I had helped to write. As a health reporter, I’m used to disseminating information about new medical devices and procedures. But to make such a direct and significant an impact on anyone’s life is unusual–and it’s even rarer to hear about it. People frequently call in to ask for more information, but seldom to say thank you. In a real sense, I had helped to save this man’s life.
That’s no doubt why I felt a lump rising in my throat last week as I was escorted to the nurses’ station where Robert Tools and his wife, Carol, were waiting for me. I had caught my first glimpse of Tools the preceding day at a nationally televised press conference, where he faced reporters by a remote video connection. But to see him in person and shake his hand took my breath away. Here was a man who, just two months earlier, had been literally days from death. His cardiac index–a measure of the heart’s pumping capacity–had stood at a paltry 1.4 before the surgery. “In medical school, we were taught that you need a cardiac index of 2 to be alive,” says Dr. Robert Dowling, who with Dr. Gray performed the heart implant. Tools had been so weak at that point that he could barely hold his head up. Now he was sitting bolt upright, his eyes wide and alert, his humor intact. “Every day he’s peeling back years,” said Carol. “It’s like science fiction in the making.”
In talking to Tools and his wife, it quickly became apparent that they were both blessed with a strength of character that had served them well. Tools had somehow clung to life long after doctors thought he should be dead. And Carol, for her part, was never willing to give up on her husband, despite the long years of illness and the dire prognoses. Tools’s Nashville cardiologist, Dr. Joseph Fredi, had told her weeks before the surgery that her husband was dying.
“You mean right this minute?” she asked.
“No, but it could happen any time,” replied Fredi.
“Then he’s not dying,” she shot back.
That spirit was apparent when the couple came to Louisville to see if Tools qualified for the artificial heart. In order to proceed, he and Carol had to sign the first of two consent forms. The initial consent required the couple to acknowledge that the artificial heart was experimental, that there were no guarantees it would work for him, and that completing the screening process did not mean that he would necessarily receive the heart. Nurse Kim Chappell recalls that it was hard to get Tools and his wife to concentrate on the fine print of this initial consent form. “He raised his head, looked me in the eyes and said, ‘I have no other choice. I’m going to die. I’ve already decided.’” When Chappell told the couple that she had to leave them alone to discuss it, Tools once more protested, “I’ve already decided.”
Going into an experimental operation, both the patient and his surgeons might reasonably have been apprehensive. The odd thing was that they weren’t–at least not in the retelling. On the part of the surgeons, perhaps that was understandable. The doctors had been working toward this goal for years, implanting artificial hearts in 40 calves and three pigs. But what about the family? “We were not leery,” says Carol. “We had complete faith after reading that great article and hearing about all the testing that [the manufacturer] Abiomed had done. We said, ‘This will work.’”
During and after the surgery, too, nurses say that Carol was rock steady. On more than one occasion, Kim Chappell went to reassure Carol, but instead found Carol reassuring her. In the hours immediately after the operation, Carol told Chappell, “He’s going to be OK.”
“Sure, he is,” replied Chappell, assuming that Carol needed to hear a positive message from a member of the medical staff.
“No, I mean it,” said Carol. “He’s going to be OK. He wiggled his fingers and turned his hands over.” He was responding neurologically.
The next morning, Carol was stunned to see that her husband already looked better than he had in years. With his circulation restored to normal, his skin and vital organs were receiving nourishment that they had not received for a long time. As Dr. Dowling puts it, “I don’t know where the soul is. But the heart fuels the body.”
In the weeks after the surgery, the hospital staff began learning who Bob Tools really was. Before the surgery, he had shown virtually no personality. Now that he was feeling better, he proved to be highly intelligent and a great tease. “It was as if his personality was being reborn,” says nurse Cindy Reeve. “He was talking and bright-eyed and thankful to be alive.” He showed courage, even feistiness. Night nurse Rebecca Dentinger told him, “There’s a reason why you were the first patient to receive this heart. You have the personality for it.”
As Tools and his wife both told me, one of the highlights of the recovery period was Tools’s 59th birthday, on July 31. The couple have never really observed birthdays. As Carol explains, “If you do it right, plain living is enough.” But this one was different. Before the surgery, doctors had given Tools only a 9 percent chance of living to see this day. He had defied the odds. The hospital staff threw a party for him, complete with balloons, cheesecake and presents. “It was the best birthday I ever had,” says Tools-and the best gift was the simple fact that “I was alive; I was here to celebrate.” The significance of the event hit Kim Chappell the next day as she was writing the patient’s age on the charts that nurses fill out daily. “One day he was 58. The next day, he was 59,” she says. She stared at the chart as the realization sank in: “He’d lived another year.”
But living is not enough without a good quality of life. I wondered if there had been a day when Tools had woken up and said to himself, “I feel good.” He admitted that that day had not yet arrived. But he said, “There are days when I feel good to be alive.” It was a subtle, but important distinction. Although Tools is recovering much faster than doctors had dared to hope, he still has a long way to go before he can lead a normal life. In particular, he needs to regain weight and strength. “We haven’t really gotten to the good part yet,” says Carol. But with characteristic optimism, she believes they will. And doctors agree that the chances look increasingly good.
On the glass wall of Tools’s room is a sign from one of the nurses featuring a quote from the ancient Roman epic “The Aeneid.” “Fortune favors the brave,” it says in big, bold letters. Tools had the courage to proceed with a daring medical experiment-and so far, at least, fortune has smiled.
