MUSC News Center
Double lung transplant gives patient new bounce in step
Dawn Brazell | MUSC News Center | Sept. 11, 2014
|Photos by Sarah Pack|
David Flurett walks on the treadmill as part of his physical therapy at MUSC 19 days after receiving a double lung transplant May 18. Photo Gallery
Just hours before midnight May 17, light blazes along a dark hallway from one lone operating room. Inside, nurses bustle about, prepping for what’s to come.
David Flurett, 57, hopes it will be him.
Cuddled up against his wife who has crawled up into his hospital bed, Flurett seems oddly chipper amidst a chorusing beep of monitors. His wife, Debra, compares the wait for her husband’s double-lung transplant to having a baby. They didn’t know exactly when it would come or if tonight might be a false run.
All they know is that surgeon Chadrick E. Denlinger, M.D., is en route to pick up the donor lungs. All they can do at this point is wait.
In the corner of the room is Flurett’s 42-pound backpack, custom made for the three tanks of oxygen he has to carry. He specially designed it so he could remain mobile at home and at work, where he handles fire systems' testing and maintenance at the Savannah River Nuclear Solutions site.
Rarely sick a day in his life, Flurett’s luck ran out a couple of years ago when an annual physical and X-ray revealed a spot on his lungs.
“They couldn’t figure out what it was. I had never had anything wrong with me ever, so I just passed it off. As the year went by, I noticed when I was doing stuff in the yard, I’d start coughing and just couldn’t quit.”
When he had his next physical, it showed up again and was worse. He was referred to a pulmonologist in Aiken, and had a CT scan and breathing test.
“We went back to get the results. My wife had ordered pizza. Pizza is our big celebration thing so she went to order pizza because she thought we were going to get really good news,” he said. “They sat us down and said, ‘I hate to tell anybody this, but what you have is terminal, and there’s nothing we can do for you. We’ll have to put you on the lung transplant list.’ My wife was devastated.”
Flurett was, too, but he wasn’t as surprised by the diagnosis based on how hard it had gotten for him to breathe.
On the continuum of diagnoses, Flurett got one of the worst – idiopathic pulmonary fibrosis or IPF, which is a chronic and incurable disease that causes tissues deep in the lungs to stiffen and scar. According to the Coalition for Pulmonary Fibrosis, more than 128,000 Americans suffer from IPF, with 40,000 dying from the disease each year.
Flurett pulls his wife in closer to his side as they talk of that day they got the news. A tight-knit crew, he and his wife love being home together with their two dogs and two cats, piddling around in the garden and house. With surgery looming, they reminisce about how they met.
Flurett grins. “I had to pursue her relentlessly,” he said. She was a control room supervisor in one of the reactors, and he was one of the subordinates, but that didn’t stop him. “I just happened to notice her in the control room and thought she was the prettiest thing there ever was.”
He kept calling her, staying on the radar. Debra said he finally wore her down and she agreed to go out once, just to show him how it wouldn’t work. “That was 29 years ago,” she said, adding that they married in 1985. His wife said he has applied that same drive in getting prepared for his transplant as he has in life. “He’s ‘Mr. Happy Go Lucky – Failure is not an option’ kind of guy. He’s the perfect person for a lung transplant. He will surprise everyone I think.”
Flurett’s calm demeanor cracks only once as he tears up talking of family. His son Orion is a Clemson engineer graduate bound for the Navy and his daughter Ariel, 22, loves horses and has an associate’s degree in business.
“I was thinking 20 years out, 30 years out with my life and planning. Now it’s just condensed to two years or five years. All my focus went to my family to make sure everything was squared away before I took this journey.”
His surgery a go, Flurett’s surgical team huddles around him. The clock reads 1:50 a.m., but it might as well be 8 in the morning. The air hums with energy. Flurett’s chest rests open. There’s a flash of pink as his lungs slip into view and then back out, like cycling surf that is in sync with his breath. They are lungs that in a few hours, will no longer be his.
Surgeon John Kratz, M.D., and chief resident Jeffrey Griffin, M.D., prepare to remove Flurett’s lungs as they wait for news of Denlinger, who is expected to arrive shortly. The call finally comes at 2:15 a.m. that the donor lungs have arrived at the local airport, and Denlinger is en route. At 2:35 a.m., they go onto cardiopulmonary bypass, just as Denlinger and Danny Eads, M.D., roll the donor lungs down the hallway.
Lifted from their sterile nest inside an ice chest, the two lungs still are attached to the donor’s trachea and part of the left atrium, the back of the donor’s heart. Denlinger quickly separates the lungs, a marbled color like speckled birds’ eggs, into respective left and right sides, and they are gently placed into sterile basins.
Meanwhile, Penny Mitchum, R.N., anticipates what the surgeons need often before they ask for it as Kratz and Griffin remove the diseased lungs. Perfusionist Heidi Doffing uses her quick wit to keep the mood light, the team sharp. It’s far from her first case of the day, but she monitors all vitals diligently. Flurett’s blood flows through a maze of tubes, an artificial circulation system, an invention that’s the genius of other researchers from days past. Flurett’s heart still beats, but it’s mostly an empty beating heart now that he’s on bypass.
The team talks about how much they like Flurett, what “a good guy” he is. A mood of camaraderie settles in.
Denlinger switches out with Kratz, working quietly and methodically to sew in the donor lungs one at a time. Trained by the pioneers who developed the techniques for doing lung transplant, Denlinger is doing his favorite type of operation. He’s drawn to its complexity and technical challenges and the magic of that final moment that he hopes will happen soon.
The bypass pump circulates approximately five liters of blood each minute, essentially replacing the normal function of both the heart and the lungs. After both lungs are completely sewn in, it is time for the moment of truth.
The lungs turn from a pale ashen white, from being on ice, to a flushed pink. Dr. George Guldan, M.D., the anesthesiologist, gently reinflates the lungs with the ventilator and the flow through the bypass pump is cut in half. After ensuring that there are no bleeding issues the bypass pump is turned off completely.
At 6:17 a.m. May 18, Flurett pulls in his first breaths with his new lungs. The room quiets as the entire surgical team stands captivated by the monitors. They watch the oxygen level hold steady at 100 percent and celebrate that his vital signs remain stable.
“The lungs turn pink and look alive and that’s awesome,” Denlinger comments. “The true test of the operation is once we wean off the cardiopulmonary bypass. The best part of the operation is when we turn down the (bypass) pump and prove that the lungs are capable of doing what they are supposed to be doing – they are oxygenating the body. That’s success. That’s really what I look forward to in the entire case. It’s like touchdown for the space shuttle.
Debra watches her husband pace the length of MUSC’s rehabilitation room June 6 doing his prescribed laps. “He wants to go back to work,” she said, smiling. She’s not surprised. “He’s an Energizer bunny. Failure is not an option. He just floors them. Most people just want to walk across the floor without oxygen, but he wants to go on and beyond that.”
That’s not to say he’s not grateful for being off oxygen, constantly tethered to a cord.
“You could see his frustration. It’s great having my husband back – having the person I married and the person I remember instead of this frustrated person who was attached to this umbilical cord of oxygen – It’s nice having life return much more to normal. I can’t keep up with him now. What’s it going to be like with new lungs?”
It’s a problem she’s grateful to have.
There are challenges that come with transplants, such as the immune suppressant medications necessary to give the new lungs a chance to work. Life expectancy rates also are lower than for other transplants. The median survival for double-lung recipients is 5.5 years.
Debra said she’s grateful for their second chance at a better quality of life.
“It’s amazing. I’m still trying to wrap my mind around how they can take your lungs out and put someone else’s in.”
Flurett said he feels “tremendously better” and is grateful he no longer is attached to oxygen by long hoses that his wife accidently kept stepping on, trying to choke him. Debra rolls her eyes at the running joke.
Rehabilitation is challenging, but Flurett praised MUSC’s team approach. “Everyone seems to enjoy their job on that floor which makes it a lot better for the patient. I’m impressed with team that Dr. (Tim) Whelan has gathered together. Dr. Luca Paoletti, Dr. Whelan, Dr. Denlinger, a great surgeon, Clancy (Flounders), Jason (Ferro) – everyone works well together.”
His wife agrees. “You get the sense that they know each other very well, and they know us well. And they told us that. They said ‘we will know a lot about you and your family. You will become a part of us when you get this transplant,’ and she was absolutely right,” she said of Flounders, who is the lung transplant coordinator.
Flurett said it’s difficult to describe what it’s like being able to breathe again and focus on something normal, such as getting back into shape. He’s thankful for the gift of his donor. It’s a philosophy he shares. “I’m a donor. We’ve had time to think about it. If I die on the table, this is what I want done.”
Debra said it feels like a miracle to be three weeks out from the transplant and see her husband return to as normal as he was the day she met him. “When you first get diagnosed, you become very aware that you have a very limited time together left on this Earth and what are you going to do with that. Now this is a new lease on life, and you can look out five, 10, 15, 20 years and there is that to look for instead of ‘I have to get my ducks in a row in the next three to five years.’”
Flurett said it is a game changer. “Three weeks ago, I had maybe a year to live. Now everything is turning out great. Now I should be able to live another 20 or 30 years,” he said, pausing to smile at his wife, “as long as she keeps me healthy.”