MILWAUKEE – Last March, an aging cowboy in a Stetson rolled into Froedtert Hospital in a wheelchair. Chuck Newman had come to Wauwatosa, Wisconsin, 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.
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 fourth-longest 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. 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.
Kidney transplant: Hospital says donated kidney was transplanted into wrong patient in NJ
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.
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.
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 54-year-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.
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.
A medical rarity: Two patients get back-to-back, triple-organ transplants
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.
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 an necropsy and the Joyces would watch.
Lyle was smart, worked hard and had the good fortune to wind up 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.
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 implant artificial hearts in 40 to 50 cows.
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.
New delivery method: A kidney for transplant was delivered by drone for the first time ever
Organ wait list shortcut: Patients accepting kidneys, hearts infected with hepatitis C
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.
During those 112 days, Lyle grew close to Barney, checking in on him several times a day. For years afterward, Lyle received an annual Christmas card from the dentist’s widow.
In December 1985, Lyle became the first surgeon ever to implant a total artificial heart in a woman.
The cowboy gets a new heart
In the spring of 1988, the surgeon met the cowboy. Chuck, who'd grown up in Stuart, Nebraska, was now a rodeo cowboy in his early 40s.
He was in dire condition. His heart wasn’t pumping enough to keep his organs alive. An unknown virus had triggered the 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 to procure the heart. When he returned, he and a fellow surgeon sewed the donor organ into the cowboy's chest.
The patient made an exceptional recovery. He was ready to go home six days after the surgery.
Something changed, though, on the day Chuck was to return. When the doctor stopped in to say goodbye, his patient looked 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. To help the cowboy pay his bill, they agreed to buy two horses from him, 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.
“Well, they’re just the center point of my life,” he said recently. “I need horses in my life.”
Ten days after the 1988 surgery, Chuck was roping stationary calves, an hour in the morning and an hour at night. Four weeks after surgery, he began riding horses again.
“I ain’t tough,” he said later. “I just ain’t too bright.”
In October of that year, about five months after receiving his new heart, Chuck and his partner captured the world championship in team roping.
“It meant the world to me,” he 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, including David. The boy was now beginning to think maybe he'd become a doctor like his dad.
Lyle sometimes daydreamed about working in the operating room with David. 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 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.
During his years as a surgical resident, David found himself calling his father almost every night. He would mention the procedures he’d participated in and ask his father, “What would you have done?”
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 father was not the drill sergeant type.
Once, a young resident accidentally cut a hole into a patient’s aorta during surgery. With blood spurting from the body’s largest artery, Lyle calmly placed a finger over the hole and told the resident that this would be a good time to learn about repairing the aorta.
The father and son found a rhythm in the operating room.
“When you have a dancing partner like Fred Astaire, it’s one of the most fun things you can do in your life," David said."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 came to Wisconsin, 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 and to everyone's surprise a donor heart became available.
Around noon, David, 43, boarded a Learjet and flew to retrieve the heart.
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. Texts between the father and son showed how the precise coordination was between the two.
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.
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.
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.
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.
Christmas on his horse farm
Chuck’s recovery at Froedtert took about two weeks — remarkably brief, the doctors said.
“It was an act of God,” Chuck said. “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 an instructor for the camp, which draws about 100 students from around 8 to 17 years old. The camp teaches rodeo skills and holds chapel three times a day.
“Our main purpose is to lead them to Christ,” Chuck said.
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.
“He’s well on his way to recovery so he should be home for Christmas,” said Sudhir Kushwaha, his transplant cardiologist at Mayo. “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 he 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://donatelife.net/
Follow Mark Johnson on Twitter: @majohnso
This article originally appeared on Milwaukee Journal Sentinel: Home at Christmas: A Milwaukee surgeon gives a cowboy new life. Again.