HOUSTON CHRONICLE ARCHIVES 

Paper: HOUSTON CHRONICLE
Date: SUN 10/02/94
Section: LIFESTYLE
Page: 1
Edition: 2 STAR

THE WAITING GAME/GAME OF HEARTS/Portable pump keeps transplant candidate going

By CLAUDIA FELDMAN
Staff

IN the pre-dawn hours of Dec. 7, 1993,Alfred Flannigan lay in bed next to his sleeping wife and tried to wish away the gigantic pressure he felt in his chest.

He knew the pain was a warning sign of heart trouble, but he tried not to panic. He'd had some ice cream mixed with late-night TV before he turned in. Maybe that was it - indigestion.

He paced back and forth, then woke Bobbye, his helpmate of 32 years. In all the years she'd known and loved him, he'd never had a headache. He'd never had the flu. A cold was as sick as he ever got.

For a few moments they considered together. Maybe Maalox would help. Alfred gulped it down. But the fiery pain didn't go away.

They needed to dress and get to the hospital, Bobbye told Alfred as she started to churn out of bed. He stalled. Couldn't he go to the doctor in the morning?

No, Bobbye said. She was a secretary at Parkway Hospital. She worked with cardiologists. She knew about heart attacks.

OK, Alfred would go. But first he changed from pajamas to jeans and started to shave.

"No, no, no," Bobbye insisted, fear in her voice. "We have to go now."

Cardiovascular disease accounts for about 50 percent of all deaths in the United States, and it almost killed Flannigan. That December night he had a heart attack that virtually wiped out the left ventricle of his heart. For five weeks, doctors at the Texas Heart Institute, a part of St. Luke's Episcopal Hospital, tried every conventional strategy to help him. But the balloon pumps, the pacemakers and the medicine didn't work.

He needed a new heart, and none was available.

As Flannigan sank toward death, Dr. O. Howard Frazier offered the family one last hope. It was an experimental left ventricular assist device, a pump called a HeartMate.

Two types of HeartMates are being tested today, and the people who make the pump at Thermo Cardio Systems Inc. in Woburn, Mass., decide randomly who gets what. One is a pneumatic pump that involves a console on wheels, something like a tea cart, to which patients are tethered.

The second, newer version is battery-operated, and the patients wear the batteries in a harness strapped to their shoulders. They aren't tethered to anything.

By the luck of the draw, Frazier could offer Flannigan the battery-operated pump. But there were two conditions. He had to agree to a heart transplant as soon as a donor became available.

No problem.

And the family needed to understand the maze of government regulations surrounding the pump. The U.S. Food and Drug Administration finally had rescinded the most restrictive rule - a stipulation that patients with the battery-powered HeartMate wait at a hospital for their transplant. But nobody had made the transition from hospital to home yet.

For Alfred and Bobbye, both sticklers for rules, lovers of routine and desperate for help, the raft of FDA regulations held little fear.

On Jan. 15, Flannigan became the sixth patient at the Texas Heart Institute to get the battery-powered pump. On April 18, he became the first HeartMate patient in the world to be discharged from the hospital and allowed to move back home.

He ate his beloved barbecue and apple pie. He and his family watched movies on the VCR in their family room. Flannigan visited, walked, read and went to church.

"I give the glory to God," he said.

Flannigan is sitting in an easy chair in his living room. "Sometimes I cry when I tell my story," he begins seriously, then his eyes start to twinkle and he cracks a smile. "I won't today."

He was born in Nacogdoches. His dad was a truck driver; his mom took care of the five kids. The family moved to Houston when Alfred was 4. He rarely got sick, and he stayed out of trouble.

"I wasn't perfect," Flannigan says, "but no wild stories."

About the worst he ever did as a teen-ager was smoke. As a young adult, he quit.

In high school back in Nacogdoches, Flannigan excelled in physics and chemistry. He dreamed of becoming a biochemist and entered Texas Southern University here to begin work on that dream.

He had the grades, the desire, but not the money to pay tuition bills. After a few years he quit school and went to work for what was then Cameron Iron Works, now Cooper Industries.

Alfred knew Bobbye from Nacogdoches, then TSU. She had hoped to be a history teacher, but she, too, had to drop out because she couldn't raise the tuition money.

One of Alfred's brothers had introduced them.

"We've always been sweethearts,"she says.

The Flannigans have four grown children, three girls and a boy, and the two eldest are married.

It is great, Alfred says, when the kids achieve independence and start families of their own. He flashes a smile and raises his hands above his head, as if celebrating a victory.

Bobbye gives him a look that says, "Tell the truth, wise guy."

"He felt no man was deserving of his daughters," Bobbye says, remembering. "I was a bit leery, too, but we gave our children our blessings, and everything has turned out very well."

Bobbye is 47; Alfred is 51. A few years ago they moved to a two-story home in Shepherd Park Terrace. They started to travel. They were at that point in life when they had the time and money to enjoy themselves.

Alfred was in motion, working or taking care of chores around the house, from morning till night. That was how he enjoyed himself. The only time that man was still, Bobbye says, was when he slept.

She had an easier time relaxing. She enjoyed her secretarial job at Parkway Hospital. Then she would come home and putter. She'd visit with friends. She'd haunt garden stores until the plants she wanted went on sale. "They'd start out at $10," Bobbye says. "When they got to $2, I'd put them in the ground, and they would grow."

For her.

"I love to have my hands in the dirt and get sweaty," she says. "You know?"

Everything changed drastically after Alfred's heart attack. The Flannigan family stuck together -that didn't change - but suddenly Bobbye was the sole breadwinner, responsible for the entire house and running to the hospital at least once a day, too.

Alfred watched her struggle and chafed to go home. Every day, it seemed, he felt a little better, a little stronger. Finally he was so well that he was counseling other heart patients.

"I'll never forget those guys,"Flannigan said. "We formed a small fraternity."

Some of his cohorts are waiting for their transplants in the hospital because they have pneumatic HeartMates instead of battery-operated HeartMates, and the FDA won't allow them to leave the hospital with their consoles.

Flannigan hopes that rule will change. He also pays tribute to Mike Templeton, one of Frazier's first patients to get a battery-operated HeartMate and the one who argued that patients with the battery packs should be allowed to wait for their donor hearts at home.

Templeton felt like a prisoner in the hospital. He missed his wife and two little girls, and he hated the burden that was put on his wife. He lived 505 days with his pump before he had a fatal stroke.

"He was the real pioneer," Flannigan says today. "I'm trying to fill his shoes."

When Flannigan was in better shape than the medical staff taking care of him, he was allowed to go home. But not before Bobbye and the children were thoroughly trained in his nursing care, and the whole family got a trunk full of instructions.

The HeartMate is in Flannigan's abdomen, connected with stitches to his natural heart. Blood falls from his own heart into the pump, then is propelled into his arteries. A small cable passes through the skin of Flannigan's abdomen, connecting the pump's motor to two rechargeable batteries. A small tube that serves as an air vent for the pump also comes through the abdomen.

Because of the machinery, Flannigan can't swim. He can't drive. And perhaps trickiest of all, he can't be alone. Someone well-acquainted with the operation of the HeartMate and thoroughly trained in emergency procedures has to be with him at all times.

That means Bobbye at night and on weekends. When she goes to work, however, Alfred is visited by Alvine Duggan , a licensed vocational nurse.

Says Duggan , "He was discharged from the hospital the 18th of April, and I started work the 19th. I've been with him since Day 1."

Duggan changes Flannigan's dressings and drives him where he wants to go. Mondays, Wednesdays and Thursdays, he exercises in St. Luke's cardiac rehabilitation lab. On Tuesdays, he studies the Bible with church friends. Fridays, they go get the medical supplies he'll need for the next week.

"We ride around," Duggan says. "We do whatever he wants to do. I've taken him to my house for lunch. We'll go shopping or to the hardware store or Target or Walgreen's."

Once in a while, Duggan says, they bicker. "It's just silly stuff, like the way we cook. He likes fried. I boil."

On their rambles, they stick to places that are close to the hospital. Flannigan wears a beeper, just in case Frazier finds a suitable heart donor. Alfred is 5 feet 9 inches tall, about 200 pounds, with B-positive blood.

"I only wish he could get his heart," Duggan says. "This is the only time I can say I'd be glad to be out of a job."

Day in and day out, Flannigan waits for news of a donor heart. With a new heart, he could go back to work and start paying his enormous medical bills. He could go visit his mom and mother-in-law in Nacogdoches. He and Bobbye used to go often. Now they're afraid to cross the city limits for fear Frazier will find a good heart and Flannigan will be too far away to accept it.

Already Flannigan has waited eight months for a transplant, and it could be a lot longer. Every year 35,000 to 50,000 Americans need donor hearts. Only 2,000 are available.

Please, Flannigan says for himself and thousands of other patients, please think about organ donation when a loved one dies. It's the gift of life.

Frazier, one of the premier heart transplant doctors in the world, has made the same plea day after day for years. Almost always he is calm and upbeat. But once in a while he is frustrated. His patients can't hold out forever.

"We still don't have the donors we need," he says.

Frazier hopes that one day pumps more sophisticated than the HeartMate will render organ donation unnecessary. Meanwhile, the heart surgeon marvels at Flannigan's patience, stamina and grace under pressure.

Flannigan, the man who used to be in motion morning till night, has learned to take it easy. His heart attack has helped him appreciate the good things in life, he says, and ignore the rest.

"I do a lot of piddling," he says. "I like to observe what Bobbye's doing."

She cracks up.

"He's telling the truth there."

And no, he says, he doesn't mind that his pump makes a constant shhh-ing sound. "I love it. It's a beautiful sound. I hear that and feel the pump's vibration, and I know everything is OK."

 

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