'I opened one eye, took a deep breath, knew there was a new heart beating in my chest and thought: Thank God, we made it!'

October 1 1969

'I opened one eye, took a deep breath, knew there was a new heart beating in my chest and thought: Thank God, we made it!'

October 1 1969

'I opened one eye, took a deep breath, knew there was a new heart beating in my chest and thought: Thank God, we made it!'

ERRIN JOHNSTON'S TRANSPLANTBY PERRIN JOHNSTON AND HIS WIFE PEG ►

It was a Friday, a warm, beautiful June day in 1957. Perrin Johnston, a 43-year-old Toronto businessman, and his wife Peg, a nurse, were doing the weekend shopping. Johnston had come home early from the office, feeling tired. Now, suddenly, he felt an acute pain in his stomach and pains down both arms. On returning home, his color was poor, he went to bed and cardiologist Dr. John K. Wilson was called in. His diagnosis: cardiac infarction — an obstruction in the coronary artery. Twelve weeks later, Perrin Johnston was back at work. Peg Johnston had returned to nursing at St. Michael’s Hospital.

For eight years Perrin Johnston’s life was uninterrupted by illness. Then in February 1965, while dining out, he felt tired and complained of chest pains. In the Emergency Department of St. Michael’s his trouble was diagnosed as angina. Two months later he was back at work on a half-day schedule. Three weeks later he was back in the hospital with his second cardiac infarction.

In four years he suffered six attacks of congestive heart failure, the direct result of the infarctions. He had been robust, six feet, 160 pounds. He wasted to a stooped, gaunt 118 pounds. He was caught in a drama of pain and anxiety that could have only one ending: death.

But it was an ending that a skilled medical team under surgeon Dr. Clare B. Baker rewrote in an operating room in St. Michael’s Hospital on November 17, 1968, when Perrin Johnston underwent that hospital’s first heart-transplant operation.

The events leading to that tenuous moment between life and death began October 18 when an attack, the worst he had yet suffered, again brought Johnston to hospital. This time his death seemed certain.

Perrin and Peg Johnston take up the story:

PERRIN

Peg took my hand and said, “You don’t realize how sick you were, do you?” My vital organs had stopped working, she said. This time if I were to leave the hospital, it would be a very short time before another and probably fatal attack would occur.

Then my wife said what was probably the most difficult thing for her to say to

me in her life: that Dr. Wilson had told her that the only thing left for me was a heart transplant.

The news brought no special fear. Here was something positive that could be done, I thought, to rescue me from the uncertainty with which I had been living. I felt, as anyone about to take a calculated risk must feel, some concern about the unknown. But no deep, chilling fear.

Peg and I talked for a while and I came to a decision: I would have the operation. If Peg was ready and willing to accept this, I certainly could. It was the only logical thing to do. It meant that we were going for broke on one major surgical procedure. I had had enough of living in a state of continual apprehension

— of sudden episodes of congestive heart failure, of erratic pulse rate, of the need for sedation to get to sleep, of exhaustion on awakening in the morning. I had no pain, but constant, debilitating fatigue was inescapable.

I had so much faith in Dr. Wilson that I had not the slightest doubt that if he recommended this big step, it was the only way for me. I knew that Dr. Clare B. Baker, who would be in charge of the operating team, was one of the best cardiovascular surgeons in the world. I knew that Dr. James Yao and Dr. John Hart, who would assist him, were two of the most brilliant and knowledgeable men in the transplantation field. I felt confident.

PEG

By mid-July of 1968 Perrin had grown thin and tired; his strength was fading away. I spent sleepless nights listening to his erratic breathing. He was getting the best possible medical care but nothing, it seemed, could be done for him. I felt helpless and frustrated. Then on October 18 he was re-admitted to St. Michael’s Hospital in severe failure. This time he did not respond to treatment. His condition was grave.

I asked Dr. Wilson if Perrin was going to die. “Peg,” he replied, “you’ve known this was coming.” I couldn’t answer. I had known. I had steeled myself for this

— but I had prayed that something, some

miracle would happen to save Perrin.

Our son and daughter — Bob, who is 30, and Suzan, 24 — had inquired about the possibility of a heart transplant. Both Perrin and I had read the first story about the transplant operation conducted in South Africa by Dr. Christiaan Barnard, and Bob had followed the subsequent stories closely. The next morning I put the question of a transplant to Dr. Wilson.

“It’s up to Perrin,” he said. “But we’ll have to wait for a few days.” In other words, wait to see if he survives.

Perrin’s case would have to be presented to the hospital’s medical committee, Dr. Wilson explained. He would also have to speak to Perrin about the operation. But I preferred to break the news to my husband. This was something personal, a pact between Perrin and me, the final thing I could offer him.

On Thursday, I phoned Dr. Wilson and said, “This is it.” I had my hair done, put on my best suit and off I went.

Perrin and I sat and talked of many things. Finally, after several cigarettes, I said, “Well, darling, this is our time of decision.” I told him what Dr. Wilson had said. Perrin replied, rather inappropriately, “Well, I’ll be damned,” and asked for a cigarette.

We talked about it quite unemotionally. He remarked that obviously I approved or I wouldn’t be discussing it with him. I told him, yes, I wanted him to have everything science could offer. There was no sentimentality regarding his heart; it was simply a worn-out muscle. Morally, I had no qualms. Perrin needed a new heart and somewhere there was someone who had no further need of his. This was the hope we had to cling to.

PERRIN

The following day Dr. Wilson came to see me. The necessary blood and tissue typing had already been done, he said. St. Michael’s was completely set up for heart transplants; my case was going to be presented to the hospital’s medical and surgical board the following Tuesday. Meanwhile, Dr. Bernadette Garvey, a hematologist and immunologist, would make further tests on me.

I felt as if a great weight had been lifted from me.

On Tuesday, Dr. Wilson told me that the board had accepted me as a possible

Feg:‘Darling.

transplant recipient if a donor of correct tissue type could be found.

PEG

Dr. Wilson explained that in presenting Perrin’s case to the hospital’s medical and surgical board no names were used; no one knew he was my husband. The decision: Perrin was given priority.

Perrin’s room in the hospital was on the floor above the one on which I worked, and after work I would pop up and we would chat or read. We did not discuss the impending operation. We didn’t avoid the subject because we feared what was about to happen; there was nothing, really, to discuss — we had made our decision and we were confident that Perrin would come through the operation all right.

PERRIN

Bob and his wife Luce kept in touch constantly. They were now moving from New York to Montreal. Luce was eight and a half months pregnant (on November 11, 1968, Paul Wilson Johnston was born, the second name a tribute to Dr. Wilson).

Peg and Suzan visited daily. We were more and more accepting in total the impending operation. I guess no one enjoys the thought of surgery, and I was scared. Bpi we all'were united in a very positive and optimistic outlook and we were able to buoy each other’s spirits.

The waiting period now was a time for reflection. I came to the conclusion that, win or lose, I was about to make a contribution to society that few men had made. I felt a real meaning and purpose had been added to my life.

Curiously, I felt better now, and to condition myself I would take short walks in the hospital corridors, carefully select my meals and enjoy them. I felt more and more assured that all would be well.

On Saturday, November 16, Dr. Wilson told me that he was going to a meeting in Montreal and that Dr. Luigi Casella, a cardiologist, would be taking over for him.

Sundays were quiet days, usually spent reading the weekend newspapers and watching a football game on TV. Peg and Suzan would arrive at supper time, bringing with them a picnic lunch and we would eat together. This evening I was very hungry and enjoyed an especially

good turkey dinner. Then the nurse came in and asked Peg if she would go to her desk with her and she would show Peg where she had a cache of tea bags. They seemed to be gone an awfully long time.

On her return. Peg took my hands in hers and said, “Well, darling, this is it.”

PEG

On November 17 on our arrival at the hospital we were met by the nurse on duty, who asked me to call Dr. Casella at his home immediately. I went to the desk to phone. Sitting at the desk was Dr. Yao, the cardiovascular surgeon. He glanced up from reading Perrin’s chart. I said, “I’m Peg Johnston.” He grinned and said he knew. I said, “That is my husband you are holding in your hands.” He said very softly, “Oh my God.”

I phoned Dr. Casella. He told me there was a possibility Perrin might have his surgery that night. They were waiting for donor’s consent, the tissue match was the best one possible, but Perrin was not to be told because they could not proceed until consent was obtained.

The moment had come. My feelings were mixed. I was jubilant that now, at last, something was to be done to save Perrin’s life. But I was scared stiff, too; I knew the dangers involved in the surgery.

Suzan and I proceeded to Perrin’s room.

His tray, containing a turkey dinner, arrived and I thought, “Oh my God, I can’t let him eat it; he should be fasting if he is to have surgery.” But Dr. Casella had told me to say nothing — so I said nothing, but prayed the dinner would be awful. Perrin ate everything, remarking on the excellence of the meal.

Time passed. We talked. Then I was called outside by Nurse Pam Daniels. Dr. Casella was waiting to speak to me — donor’s consent had been obtained. Perrin was to receive the heart of an 18year-old boy killed in a fall. The loss of the boy’s life grieved me; I love young people. But now, I knew, I had to think only of Perrin.

I returned to the room and took Perrin’s hands in mine. I told him the time had come. “Well, I’ll be damned,” he said, and reached for a cigarette.

PERRIN

Then things began to happen quickly. I

wasn’t worried; I had no second thoughts about my decision to go ahead. Dr. Casella and Dr. Yao came in and Dr. Casella explained that the operation would take place shortly. Dr. Yao stabbed me in the seat with a needle containing A.L.G., an anti-rejection compound. Father Tipping came to give me his blessing, although I am not a Roman Catholic. I appreciated this very much.

Time was getting short. I was shaved and transferred to a stretcher. Peg and Suzan came with me as far as possible on the operating-room floor. We kissed one another. We hid all emotion but the love we had for each other.

PEG

Dr. Yao brought a consent form for the operation. 1 read it and Perrin signed it — he trusted me.

Perrin was in fine humor. He was given his pre-op sedation, and on to the stretcher he went. Suzan and Mrs. Kathleen O’Brien, the afternoon supervisor, pulled the stretcher and I walked at the head of it, with Perrin’s face in my hands. I thought: “I must contain myself. Perrin and Suzan must not see my fear. I must not cry, for Suzan’s sake because she is being so brave and, of course, for Perrin’s sake because he would worry about me.” I knew we needed each other’s strength at that moment. I felt God’s presence; I knew He was with us that night.

Perrin was complaining about his sore posterior, where Dr. Yao had injected the anti-rejection serum. “Never mind, honey,” I said, “in a few minutes you’ll get a lovely anesthetic and you won’t even know you have a bottom.”

We accompanied him as far as we

this is it’ Perrin (Well. Il 1 be damned’

‘We prayed for a miracle, the doctors provided it’

could on the operating-room floor. Suzan kissed her father very lovingly, and said, “Daddy, we’ll be seeing you. We have a dinner date at Sutton Place. God bless you.”

It was my turn. I kissed him and told him I’d be with him all the while and see him later. “God bless, darling.” He winked, and away he went.

I turned away and, somewhat confused, I took the wrong turn and found myself in my own section of the hospital. There I met Sister St. Jude, who kissed me and said, “Dear, I’m going to the chapel to light a candle, and it will stay lit until he is well again.”

We had not seen Dr. Clare Baker, who would conduct the operation. I felt no need to talk to him about Perrin’s surgery: he was the man in whom we had complete confidence. I knew he was rather retiring in his relationships with the families of his patients. If he wanted to talk to me, he would. He didn’t and I was satisfied.

PERRIN

I was wheeled into the operating room where I was greeted cheerily by a nurse and then transferred to the operating table. I was surprised at the general tranquility and simplicity of this room. My only recollection is that of the huge light directly above me. Then a doctor appeared and told me that I would feel a needle prick in my arm. Then some other voices in the distance. And that was it.

It was some time after this that I opened one eye, took a deep breath, knew there was a new heart beating in my chest, and thought, “Thank God, we made it!”

PEG

Suzan and I returned to Perrin’s room. Sister Patricia Anne and Sister Regina Marie arrived bearing a huge tray of coffee and cake. Sister Patricia Anne sat with us and we talked of everything but what was uppermost in our minds. Sister Mary phoned: the operation was going well; they would be finished soon.

With that, the door opened and there stood Dr. Casella in his green operatingroom gown. I dropped the phone.

He was grinning from ear to ear. I had a crazy idea he was about to burst into an Italian aria.

“He’s fine,” he said. “Perrin is fine. His vital signs are normal. He is going to be great. He was on the heart-lung machine for 64 minutes, shortest time ever.”

We all hugged and kissed each other and shook hands and almost danced.

I thought of Perrin. I could picture his face, and I wanted to smile at him. We have a silly favorite song, Dear World, and I thought: “Dear world!" I thought of Bob and Luce — I had to phone the good news to them. I thought of the doctors, of their exhaustion and elation. I thought of Dr. John Wilson in Montreal, missing this miracle. And I gave thanks to God.

I phoned Bob. I kept thinking: “Dear God, dear God ...” I said, “Bobby, he’s okay!” My big son said, “Oh, mummy, mummy.” Neither of us cried. Bob phoned Luce, then she phoned me. She was so happy and excited and was crying and laughing.

When the celebration following the good news was over, I paused for a moment to take stock. I did not cry. I could not think. I was numb.

PERRIN

I opened both eyes. I felt no pain, no sense of strangeness that a new heart was beating in my chest. It was noon and I was in the Intensive Care Unit. I was connected by wires to a monitor and had an assortment of tubes plugged into me here and there. Dr. Casella, gowned and masked, was beside me. I asked about the cold he thought he was coming down with the night before. It hadn’t developed, he said.

The only real discomfort I felt was from the anti-rejection shots I had been given before the operation. I felt surprisingly well. Like all who have suffered heart attacks, I had. before surgery, been constantly conscious of my heart, conscious of its beat, aware of any irregularity. Now, for the first time in four years, I was unaware of my heart. I knew only that I had a new, healthy one, which obviously was functioning as a healthy heart should. There was no sense of something “foreign” inside my chest. I did not listen apprehensively to the beat of the new heart, worrying about how it performed. I found that, thank God, for the first time in years I could forget my heart, and I could sleep soundly.

The nurses spoke to me. I answered them — and promptly went back to sleep, feeling very content.

PEG

There was great excitement throughout the hospital following “our first transplant” and everyone was vitally interested in Perrin’s progress. While we were having coffee, Dr. Yao visited us. He said Perrin was fine and had been conscious one and a half hours after his operation, which is remarkable after such surgery. Dr. Donald Finlayson, the anesthetist, and Dr. Casella would spend the night with Perrin.

Sleep for me was impossible. At about 5.30 a.m. I arose and went to mass in the beautiful little chapel. What peace and confidence I felt.

When I returned to the room, Suzan was awake. We decided we should try to eat breakfast. I had been told that Perrin had been transferred to the Intensive Care Unit at 5 a.m. and was doing well. We were jubilant.

That day is confused in my memory. I know we were constantly congratulated and wished well, with many hugs and kisses from old friends. Around 2 p.m. Dr. Finlayson and Dr. Casella came to our room and said, “Come, see Perrin.” I wanted to run all the way, but sedately walked the corridor with Suzan at my side. I was capped, gowned, masked and booted and taken into his isolation room.

He was lying on his side, tubes and machines all around, but he looked wonderful. I took his hand and kissed it. He said, “Hi there.” I asked him how he felt. He said, “I have a sore bottom. I had one last night and I still have it!” I stayed for about two minutes and then I just had to get out of there. That was the last time I held hands with him for three weeks.

PERRIN

My isolation room was partitioned off from the rest of the Intensive Care Unit with large windows on two sides — one directly in front of me and one to my

Ä new heart-and then ayen for TV’

left. The door led to a small room containing the sterile caps and gowns that the doctors and nurses put on before coming in to see me. I was able to see my family through one window and soon an intercom system was installed so that we could talk. The lights were on in varying degrees at all times, and for a few days it was hard to distinguish night from day.

On Tuesday I sat on the side of the hed and dangled my legs. Later, Peg, Bob and Suzan and I had a pleasant conversation via the intercom. Wednesday, Dr. Finlayson came in and asked the nurses if they were going to just let me lie around in bed; get him up, he said, let him walk around the bed. Each day there was a marked improvement in my condition and doctors from other hospitals were brought in to see and talk to me through the glass.

I am afraid that the rest of the Intensive Care Unit was vividly aware of my presence. If I was uncomfortable or felt pain when turning, I would emit a sound similar to that of a bull being hit over the head with a log. I complained about being stuck in a child’s cot (beds in the Intensive Care and Coronary Units are smaller than regulation hospital beds and have raised sides).

I developed unusual sleep habits. I slept whenever I felt like it — but not usually during the night; this was the time 1 wanted to talk and be sociable. Polite attempts were made to try to silence me but to no avail. A sleeping pill would put me away for a couple of hours. One night I went to sleep around midnight, without sedation, and around 2 a.m. I was awakened by a nurse holding a pill and a glass of water. I asked what it was. A sleeping pill, she said. “Oh no!” I yelled. “That’s the oldest hospital joke in the world!” But it turned out that this was actually their strategy in trying to get me to sleep more.

The doctors were pleased with my progress. I began to bug them about seeing the Argos-Ottawa football game on Saturday, the seventh day after my operation. A TV set was installed at the foot of my bed. I put on my housecoat and watched that disastrous game; the Argos lost 36-14.

PEG

On Tuesday, Bob, Suzan and I went to see Perrin. He sat on the side of his bed and spoke briefly but cheerfully to us. After we left him we put our arms around each other and wept — the first

time any of us had wept, and they were tears of joy.

In a few days Perrin was walking about his room and grumbling about missing the football game on Saturday. A TV set was installed. But Perrin was grumbling about all sorts of things, which was most unusual for him. Not once in the four years of his illness had he bemoaned his fate. But he made up for it now!

Suzan and I stayed with Perrin five days at the hospital. Now we decided we must return home and pick up our lives again.

PERRIN

The mental attitudes of the heart-transplant recipient and his family provide an important contribution to the knowledge of the medical and surgical team. I was not a tranquil or passive patient; I had to feel that I was participating in the overall effort. Because of this, the doctors and nurses kept me constantly informed as to my condition, and I told them exactly how I felt about the medication and discomforts.

I knew that 1 had had one of the most successful operations of this kind ever performed, and that it must have been in the cards for me to be around for some time. From now on I would be able to give as much to humanity (through knowledge gained from my convalescence, tests and treatment) as I had received.

PEG

Suzan and I were attempting to keep up with the letters and telegrams that our friends and relatives were sending, and we wrote our notes on the desk on our side of the glass partition. Perrin would dictate the occasional answer from his side. By now, he was healthy, happy and very talkative.

Three weeks and three days after the operation Perrin was transferred across the hall to what he called “the bungalow,” a semi-isolation area, containing a room where we scrubbed, gowned and masked before entering Perrin’s own room. One evening Dr. Yao came by and told me 1 looked dreadful in that gownand-mask get-up — for heaven's sake, he said, take it off. I was happy; it meant Perrin was getting better.

He was now allowed to walk in the corridors accompanied by a nurse, and would visit me on my floor of the hospital for a few moments every day. He was happy to be among people again.

PERRIN

In the new quarters I still used an intercom to talk with visitors other than my family, but Peg and the children were now allowed to come into my room. It was a treat to occupy a full-sized bed once again and to have a telephone. Soon I was able to go for walks in the hospital, capped, masked, gowned, booted, and accompanied by a nurse similarly dressed. We looked like invading Martians. Then I advanced to wearing my own clothes and walking about on my own.

It wasn’t until just the day before that Dr. Wilson asked me what I thought about going home for Christmas day. I replied that I had better go as I had heard on the radio that I was going.

December 25 arrived and I was dressed and waiting when my family came to pick me up. I was on my way home for the first time since October. It was wonderful.

PEG

We opened presents for a few minutes, and then the press arrived. They took up most of the morning. We had a memorable day and Perrin returned to the hospital at midnight more fit than any of us.

PERRIN

I had no ill effects from my short excursion to the outside world and plans were made for my discharge from the hospital.

I was told that when I left the hospital I was to lead a normal life within the limits of my tolerance for exercise. Moderation should be the keynote. Today, I jog, walk miles, shop, attend movies and the theatre, dine out on occasion and go to parties. I prepare our dinner every night and do minor repairs around our apartment. I am taking a year off and hope to return to the world of business in a few months. I take one day at a time, and these have been good days.

But all this was still ahead for me when Dr. Wilson came to my room in St. Michael’s Hospital and told me that there was no point in my lingering about the hospital any longer. I could leave on Friday, January 3, he said.

At last that very special, long-awaited day arrived. Peg and I were ready and waiting when my father came by to pick us up. We left the hospital through a crowd of reporters, photographers, TV cameras, flash bulbs and bright lights.

I was going home. □