Transfusion-Free Cardiothoracic Surgery
James Hemenway's Story: Denial and a Second Chance
Denial almost cost James L. Hemenway his life. He had been leading a fulfilling, albeit routine, healthy existence. He had lived in Idaho his entire life, settling in a town called Payetta. There, he insulated houses, drove a school bus and with his wife, MaryEtta, raised three boys. Life was good.
In 1993, Hemenway began experiencing severe difficulty breathing. "It was a very frightening sensation," Hemenway says. "It felt like I was suffocating."
Hemenway's doctors originally attributed his breathing difficulties to asthma. But his lungs began filling with liquid and he couldn't breathe, so he went to a specialist in Boise. His diagnosis: cardiomyopathy, probably due to a past flu virus.
Hemenway was told that he would eventually need a heart transplant. For years, he did not want to face reality. "I was in denial, and I was scared," Hemenway says. "In addition, my religious beliefs do not allow the use of blood products, so I needed to find a place with the commitment and expertise to perform transfusion-free heart transplant surgery."
Hemenway investigated programs across the country, and even made appointments for evaluation. Yet he could not bring himself to undergo the procedure. When his condition became truly unbearable, he began another search. Finally, he heard about the USC Transfusion-Free Medicine and Surgery Program, and contacted Program Manager Randy Henderson. He liked what he heard.
On June 25, 1999, Hemenway flew to Keck Hospital of USC for an evaluation. He was admitted on July 1, and began the wait for a heart. During that time, he received Epoetin Alfa (erythropoietin).
"The staff at Keck Hospital of USC was simply wonderful during this waiting period," Hemenway reaclls. "The nurses never let me get down in the dumps."
Finally, on August 16, a heart became available. "Felicia [Schenkel, R.N., transplant coordinator] and one of the doctors came to my room and told me they had a heart," Hemenway says. "I admit that I was still scared, and the only thing that got me through was that I really needed this operation. Denial wasn't an option any more."
The operation was a success. "All of the residents and fellows who were training at Keck Hospital of USC wanted to watch Dr. Starnes to see how transfusion-free surgery was done," Hemenway said. "Afterwards, they all proclaimed that the operation was the 'fastest and slickest job' they had ever seen. All without the need for any blood products."
Dr. Starnes points out that the challenge in transfusion-free procedures is not so much during the operation but following it. "The anti-rejection drugs that suppress the immune system tend to interfere with the body's ability to produce red blood cells," Dr. Starnes notes. "Knowing that, we are extremely precise during the operation to minimize blood loss, and then use special medications to keep the red blood cell count up postoperatively."
Hemenway had a tough recovery. After nine days, his heart went into rejection and he was readmitted to the hospital for five days so that his physicians could get the situation under control. At the end of September, Hemenway received the okay to return to Idaho. Interviewed in late November, he says that he "feels good, just weak at times."
Hemenway adds, "It will take some time to build myself back up, but other than that, I get more active every day. My family is thrilled with my new heart and the tremendous care I received at Keck Hospital of USC. And I'm thrilled that I lived to see the birth of my grandson in late fall."