For Bellingham dentist, a harrowing and miraculous journey to his new heart

| PHILIP A. DWYER | THE BELLINGHAM HERALD

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In all likelihood, he wouldn't have returned at all if not for a team of caregivers at the Bellingham hospital who tried to save his heart and then kept him alive with a mechanical one before whisking him to Spokane. There the heart of a stranger was transplanted into his body.

"It's amazing. I owe my life to you guys," Frere said one day earlier this month while sitting at a table at the Cardiovascular Center at St. Joseph Hospital.

Near him were Richard J. Leone, a cardiothoracic surgeon, and Andrew T. Coletti, a cardiologist.

As they tell it, Frere coming so close to death didn't begin with crushing pain in his chest or shooting pain down his left arm - classic signs of a heart attack.

The warnings were more subtle. They began with Frere feeling, "I just wasn't right."

'THIS CAN'T BE'

Frere described himself as a "fairly athletic guy." He ran. He swam. He played with his two boys, ages 7 and 11. His diet was pretty good, as were his blood pressure and cholesterol levels.

So he wasn't alarmed when, beginning in April, he noticed he was short of breath walking up the stairs to his bedroom. He was unconcerned when he started to feel some tightness in his arms, and his chest when he exerted himself.

The symptoms went away, after all.

He was just getting older, he reasoned. Maybe he was coming down with a cold.

It didn't stop him from flying to Palm Desert, Calif., on April 5 for a vacation with Brewer and their families. Halfway through the weeklong vacation, he had a fever and again felt tightness in his arms. He remembered just wanting to sleep.

Then the symptoms cleared again. They flew home on April 12. Frere mowed half his lawn and felt ill again. This time, he was nauseated, exhausted, short of breath and both his shoulders were sore. He went in to lie down.

The next day Brewer drove him to the hospital around 9 a.m.

He checked in and said, "I think I'm having a little chest pain."

And that was just about the last Frere remembered until he regained consciousness in Spokane and looked down at parts of the mechanical heart on the outside of his chest, where he could see his blood being circulated through what looked like a clear garden hose.

"Wow. This can't be. This is a weird dream," he recalled.

DEAD MAN WALKING

It was no dream.

Coletti, the cardiologist with North Cascade Cardiology, remembers hearing that April 13 morning about a "young guy having the big one."

By the time Coletti saw Frere, his blood pressure was "marginal," he was barely conscious, his extremities were cold and blue, and his heart wasn't able to get blood to his brain.

Coletti inserted a balloon pump into Frere's aorta to temporarily help the heart work while doctors tried to save him. But there wasn't much response from the heart.

Coletti next inserted a tiny catheter through the femoral artery at Frere's groin and, using X-ray, guided it up toward his heart. He saw that both the main arteries of Frere's heart were completely blocked.

"From a functional standpoint, there was no blood getting to his heart at all," Coletti explained. "That's usually an autopsy diagnosis."

The blockage was caused by years of cholesterol being deposited in the arteries.

Coletti pushed tiny guidewires - flexible wires the size of a human hair - through the left main coronary artery to open the way for the blood to flow again. But Frere's heart still wasn't responding.

There had been a massive heart attack. The damage was too great. His heart was dead.

Frere didn't know it when he walked into the ER, but he was a fortunate man. Coletti was a cardiologist who had received additional training in cardiac transplantation. Leone was among the few surgeons in the country trained to work with mechanical hearts.

And St. Joseph was one of just three hospitals in Washington state that have mechanical hearts, also known as ventricular-assist devices. The others are in Seattle and Spokane.

"He would not have survived without that," Brewer said. "There would have been no way of keeping him going without the VAD."

As Coletti's team pumped Frere with drugs to keep his blood pressure from dropping any lower, they also were giving him CPR for nearly an hour to keep blood going to his brain in the hopes of staving off brain damage.

Then he was wheeled to Leone's operating room, where his chest was opened, his body cooled into a hypothermic state to protect his brain and organs, and the mechanical heart attached to the weak one in his chest. Frere's was a biventricular assist device, because both sides of his heart had failed.

"It takes over the pumping function of the entire heart," Leone explained as he showed the computer-controlled mechanical heart during an interview earlier this month at the Cardiovascular Center.

Made by Thoratec Corp., the device resembles the face of a big yo-yo with tubes and pipes coming out of it. Part of that "heart," which weighed about 1.8 pounds, rested on the outside of Frere's chest.

After the six-hour surgery, the medical team waited.

"You can't imagine anything more surreal," Coletti said. "He's got tubes coming out everywhere. His chest has been opened and he's just been through hell."

And, they all wondered, how was Frere's brain?

They had their answer that night, when someone put the phone to an unresponsive Frere's ear so his young sons could say goodnight. "Daddy, hi," they said.

"He opened his eyes," Coletti said. "The next thing we know, we see the feet moving, the hands move, and he's there."

"EVERYTHING ... PERFECT"

Four days later, he was flown to Sacred Heart Medical Center in Spokane to wait for a possible heart transplant. The man who never suspected that he had heart problems had been pushed to the top of a transplant list.

On April 30, he went into surgery. His weight, height, blood type and the size of his body's frame all were a match for a donor heart.

"Everything was perfect," Frere said.

"He had an incredibly short wait for a heart," Leone said.

Frere knows little about the person whose heart he now carries inside him. He has the chance to learn more but isn't ready yet. But he is grateful for the donor's gift, and the care he received.

"I feel like I was in the right place at the right time, and I had amazing support," Frere said.

That included Brewer, who was his bedrock. She was there the first terrible night when they didn't know if he would make it. She left behind her life in Bellingham and her business, Serendipity Salon, to be with Frere in Spokane.

"It was like someone had picked us up from our world as we knew it and put us in an alternate universe," said Brewer, 44. "There were so many different times that things could have gone the other way."

But they went the right way. Brewer drove them home from Spokane on July 1. On Aug. 7, Frere returned to his practice, which was kept going by 38 dentists who pitched in while he was away.

His doctors are astonished by his recovery.

"To have that sort of extended CPR, it's extraordinary for somebody not only to survive but to come out as functional as Jeff," said Coletti, who continues to care for Frere and to make sure that his body doesn't reject the foreign heart.

"Never give up," Frere said. "That was my motto through the whole thing. It never came to my mind that I wouldn't be around."