Twenty-nine years ago, just when he was about to enroll at the UW, Patrick Weston’s heart started to fail. After a series of tests and evaluations, the cardiac team at UW Medical Center handed him a beeper and told him to wait for their call. He was in his early 20s, athletic and otherwise generally healthy—an excellent candidate for a transplant.
The doctors weren’t wrong.
Today Weston lives in Missouri, and Daniel Fishbein, the cardiologist who cared for him before and after the transplant operation, lives in Seattle. They recently met for a video chat online. Peering into their screens, each smiled at the familiar, if older, face in front of him. Weston credits Fishbein with saving his life. And in the years since they last saw each other, Fishbein has often thought of the young patient who made a remarkable recovery after his heart transplant. They hadn’t seen each other since Weston moved from Seattle more than two decades ago, but the years dissolved in an instant.
They quickly discovered they are now both empty-nesters, each with two grown children. Then Fishbein shifted into doctor mode and sized up his former patient. “How’ve the last 25 years been?” he asked.
Where to begin? After his transplant in January 1990, Weston was determined to live a full and healthy life to repay the gift that his organ donor, Fishbein and others at UW Medicine gave him.
Two years after his transplant, he graduated from the UW with degrees in biochemistry and biology. He moved back to Missouri, married his girlfriend Jeannie (the couple are photographed at top), started a family and was a successful biochemist for 20 years. Then he attended theological seminary and became a Presbyterian pastor. He now plays golf, reads, takes walks with his wife, spends time with his family and ministers to his congregation.
“All of the life I’m living now is a gift. It’s a gift from God. But it’s also because of the sacrifice of a lot of people.”
Patrick Weston
And then, last year, he had a second heart transplant … an incredible 27 years after the first. All because of a life lived well.
Growing up outside of St. Louis, Weston daydreamed of adventure and life in a new city. He fixated on Seattle. When he learned that the UW received ample federal funding for medical research, the field that most intrigued him, that settled it. In 1987, with two years of college already completed, he moved to the Pacific Northwest.
It was like having the whole world in one place, he says. Within a few hours’ drive, he could swim in the ocean, climb a mountain, explore a rain forest or marvel at a desert. He was an active outdoorsman and he indulged in everything he could.
He had previously been diagnosed with congestive cardiomyopathy, a condition where the heart becomes weakened and is unable to pump effectively. But he had no symptoms before he moved west. In fact, he had been healthy enough to join the football team at Northeast Missouri State University as a walk-on a few years earlier. But after he arrived in Seattle, his heart started to fail.
Doctors put him on the transplant list and sent him home to wait. One night in late January 1990, the beeper sounded its alarm. The hospital told him a man had died in a motorcycle accident, and his heart was a good match for Weston, then 24. Weston rushed to the hospital for a final evaluation and to prepare for the surgery. He was scared and excited. “I sat in the waiting room waiting for them to start. It was the first time in years that I really prayed earnestly,” he says.
After the transplant, as he built up his strength and stamina, Weston pushed to return to his active lifestyle. He hiked, he played pickup basketball, he lifted weights. He enrolled at Bellevue Community College a few months after the operation and then transferred to the UW. He found an apartment adjacent to the Burke-Gilman Trail and rode his bike to class. Jeannie, who was in his circle of friends, was amazed at how quickly he recovered. “He jumped right back into life,” she says.
Not long after the transplant, Weston struck up a conversation in a waiting room with a woman whose child was a heart transplant recipient. “She basically said, ‘You don’t look like you had a heart transplant.’ I remember saying to her, ‘Well, if I was going to look like what you think I would look like, I probably wouldn’t have had it done.’ That was my attitude. I didn’t want the fact I had had a heart transplant to be the defining thing in my life,” he says. “All of the life I’m living now is a gift. It’s a gift from God. But it’s also because of the sacrifice of a lot of people.” First there was his organ donor and his family. But then he credits all the doctors and nurses who helped and cared for him during the transplant and recovery. “They were working so hard,” he says. “I always said, ‘You guys do so much to keep me alive and healthy, [taking care of myself] is the least I can do.’”
During one checkup after his transplant, Weston and Fishbein had a conversation about Weston’s future. Pre-transplant, Weston had planned to study medicine. But now medical school seemed less likely, in part because he had to take immunosuppressant drugs for the rest of his life. That would put him at risk because as a doctor, he would often be around sick people. He decided to pursue biology and biochemistry instead.
Fishbein wanted Weston to think further ahead—beyond graduation, beyond his first job. He wanted him to imagine a future decades later. That’s hard enough for someone in their mid-20s, and harder still for someone in their mid-20s who just had a near-death experience. But then Fishbein said something that startled Weston: “You’re going to be our first second heart transplant.”
Initially, Weston was annoyed. He was just coping with his first heart transplant. He didn’t even want to think about a second one. But then he realized Fishbein meant it as a compliment: He was doing so well, he would live long enough to need another new heart.
“You couldn’t ask for a lovelier, more compliant, engaged patient. That makes life for a transplant physician that much easier.”
Paul Hauptman, cardiologist
Now, 25 years later as they chatted online, Fishbein didn’t immediately recall the conversation. He’s not surprised that he had the thought, though. As they talked, that decades-old conversation and the reasoning behind it came back. “You were a young guy,” Fishbein said. “It’s great to get you to your 40s. We wanted to get you to your 60s and 70s. I think that was kind of my intent.”
In the early 1990s, the practice of heart transplants was still relatively new. According to the International Society for Heart and Lung Transplantation, there were 2,291 heart transplants in North America in 1990—nearly 20 times the number from 1982. That meant there was only a small sample of recipients, and they had not lived long enough to allow researchers to draw any conclusions about life expectancy. Nobody had yet lived two decades with a transplanted heart, and a patient getting a second transplant based on longevity (rather than rejection) was unheard of.
Over the years, both Fishbein and Weston have seen the heart transplant industry evolve as doctors and patients learned what works and what doesn’t. “It’s not like you guys were just cowboys flying by the seat of your pants,” Weston starts … and Fishbein finishes the thought: “Now it’s like, this is what we do, this is how we do it, we’ve got good results with it. We know now what to anticipate.”
The oldest surviving heart transplant patient from the University of Washington had the surgery in 1987, three years before Weston. In North America, the median survival length (the point at which half of recipients have died) for heart transplant recipients is 12.5 years. Patients who received their transplants at the UW live longer than that.
“Fifty percent of patients at UW Medicine are alive 16.25 years after receiving heart transplants—testimony to the amazing medical care provided by our heart failure group,” says Jason Smith, a UW Medicine cardiothoracic surgeon. “This longevity is far above the national average and even further above the international average (11 years). And some patients derive extraordinary benefit with long survivals like Mr. Weston’s.”
The fact that Weston’s first heart transplant lasted 27 years puts him in the top 10 percent of life span for heart transplant recipients. And he didn’t just live long with that heart, he was healthy with it until just recently.
For years, Weston made an annual trip to St. Louis to see Paul Hauptman, a cardiologist and professor of medicine at Saint Louis University. “Dr. Hauptman and I had the exact same conversation once a year for 20 years,” Weston says. “So, how are you feeling? I’m feeling great. Well, then let’s not change anything. It’s working, I’ll see you next year.”
He had lived with his first transplant for 27 years, one month and one day. That’s longer than the heart he was born with.
Recovering from and living with a heart transplant is complicated. Patients have to take specific medicines in specific amounts at specific times, and being unable or unwilling to follow the protocols puts them at risk. A surprising number of heart transplant recipients either can’t or won’t care for themselves properly. Medical professionals throughout Weston’s care speak glowingly about dealing with him. “You couldn’t ask for a lovelier, more compliant, engaged patient,” says Hauptman. “That makes life for a transplant physician that much easier.”
Weston’s second heart started to show signs of problems about six years ago. Though he felt fine, tests suggested a thickening of his coronary arteries. “The symptoms tend to be nothing, nothing, nothing, and them bam, you know something is wrong, and that’s exactly what happened to me,” Weston says.
He found himself worn out after minimal exertion such as walking up his driveway. His heart rate soared for no apparent reason. On Nov. 8, 2016—he remembers precisely because it was Election Day—he called Hauptman to describe the symptoms. Hauptman told him to come in immediately. Weston was admitted to the hospital, and his condition spiraled.
He was much sicker than he was before his first heart transplant in 1990. This time he spent nearly seven months in and out of hospitals in St. Louis and Kansas City. He was put on the transplant list. He withered away in his hospital bed until May 25, 2017, the date of his second transplant.
He had lived with his first transplant for 27 years, one month and one day. That’s longer than the heart he was born with.
The first year after surgery is the most important for a heart transplant recipient, and Weston has made it through his fine. He now faces the same familiar challenges he did after the first transplant, though they are magnified a little because he is older and now has a second foreign organ in his chest. But the recovery has been relatively issue-free. In fact, he was healthy enough seven months post-transplant to have a long-needed ankle replacement surgery … so now he’s on his third heart and his third ankle.
As the video conversation winds down between the patient and the doctor who first helped save him, they marvel at the path that has brought them back together. Two heart transplants, 27 years and 1,800 miles apart. “This is a conversation that, a couple of years ago, I never imagined we’d be having,” Weston says.
“It’s exciting to see you doing so well,” Fishbein replies. “This is the kind of thing that’s very exciting for me personally. It makes my day to talk to you.”
Could there be another conversation 25 years from now?
Weston, who by then will be in his late 70s, is counting on it.