Peripheral Venous Pressure-Assisted Exercise Stress Echocardiography in the Evaluation of Pulmonary Hypertension During Exercise in Patients With Suspected Heart Failure With Preserved Ejection Fraction
Homeless La Crosse Veteran Diagnosed With Heart Failure Finds Peace In Final Weeks
Brad Schwaegerl stood outside his tent, taking deep breaths of the humid summer air along the La Crosse marshland walking trail. He has been confined to his tent more often lately, but as soon as he steps out, favors from neighbors start falling his way.
A long-time friend brought four couch cushions to pad his bed and another passerby put a cup of ice water in Schwaegerl's hand before continuing down the path.
Schwaegerl looked slightly surprised, but joyful for the help. He has received extra help the past few weeks, cashing in goodwill he's banked over years among the unhoused community.
Recently, Schwaegerl received news he was not ready to hear: he's dying. The 56-year-old veteran was diagnosed with heart failure because his heart is not circulating blood efficiently enough, with some sections of his heart barely functioning at all.
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Brad Schwaegerl uses a stool to prop himself up at the entrance of his tent in La Crosse on Thursday, July 11. Swollen legs which he attributes to a serious heart condition have made it difficult for him to move around.
Saskia Hatvany, River Valley Media GroupWithout reliable access to health care and housing, Schwaegerl found it easier to plan out his death than try and navigate the health care system toward recovery. He's sought appropriate care for years and is ready to find peace in his final weeks in La Crosse.
"That's the easiest thing I've ever done" Schwaegerl said as he left the Stoddard village clerk's office after reserving his grave site. "Isn't that something? All this… stuff. And this is the easiest I've done — dying."
Schwaegerl is a man who wears it all on the surface. Not only does the ink on his skin tell tales from his Desert Storm service to his struggle living with PTSD and homelessness, he's become a respected figure for many in the unhoused community and often is the one to tell people things they need to hear.
In just three minutes, Schwaegerl was able to bring a group of five together to discuss his story just by calling in one favor to a fellow camper, Essence Loken. The group embraced together, smiling wide as they tease one another on how far their friendships extend.
Before he fell ill, and even when he can these days, Schwaegerl is frequently in the center of it all. From the base of the Lacrosse Players Statue to the deep Myrick Marsh, someone in the community will know the answer to, "Where's Brad at these days?"
A good spot on the hill
On July 16, a brown van unloaded Schwaegerl, Nicole Wisniewski, Phil Dickey and a dog named Zenn into the quiet, sunny Stoddard hills. The group walked northeast, eventually finding a gravestone for George and Feryl Kreuzer.
Schwaegerl kneeled at the gravesite of the Kreuzers, his grandparents, bringing Zenn in close to see the headstone for the first time.
"It's a good spot. It's very me," Schwaegerl uttered, looking around the Stoddard graveyard. "It's high on the ridge, so I can look over the others. I can watch and protect others from up here."
Brad Schwaegerl visits the resting place of his grandparents George and Feryl Kreuzer in Stoddard, Wis. On Tuesday, July 16. With the help of some friends, he made the trip to his hometown to visit the grave site. With a serious heart condition and limited access to health care, he made arrangements to be buried there.
Saskia Hatvany, River Valley Media GroupSchwaegerl spent a lot of his youth in Stoddard with his grandparents. He recalled fond memories of trapping for beavers and muskrats on the frozen Mississippi River when he was as young as seven years old.
He even flashed back to him and his mother fleeing Schwaegerl's father in Milwaukee, coming back to the Stoddard cabin to start over again.
Swallowing final tears, Schwaegerl lifted his shirt arm to reveal a faded yellow rose inked on his shoulder.
"It's the first tattoo I ever got. Got it in the Navy. She, oh she hated it at first," Schwaegerl said, looking down at Kreuzer's headstone. "Yellow was her favorite though. She wanted more yellow in her life. Grandpa planted all the trees on the banks here, so it all went green."
The troop, minus Zenn, walked back to the van so Schwaegerl could have a private moment at his future resting place. Zenn flipped over and rolled around in nearby taller grasses while Schwaegerl stared down.
Nicole Wisniewski chats with Brad Schwaegerl at a cemetery in Stoddard, Wis. On Tuesday, July 16. Wisniewski and Phil Dickey, two longtime friends of Schwaegerl, helped the veteran travel to his hometown to plan for his burial.
Saskia Hatvany, River Valley Media GroupWisniewski, Dickey and Schwaegerl have been close friends for about six years. They solidified their bond at the former Houska Park encampment while watching each other's backs.
"Zenn was the first dog to protect me from some bad people," Wisniewski said. "Brad's helped with shelter, food, safety and just a good companion. If it needs fixed, he's got a way to fix it."
"A companion for sure," Dickey agreed.
Schwaegerl's grave spot was paid in advance by his grandparents, and his headstone will be free of charge with his military service.
Brad visits the village clerk's office in Stoddard, Wis. On July 16 to make arrangements to be buried with his grandparents.
Saskia Hatvany, River Valley Media Group'Isn't the way I wanted it to end'
As hard fluorescent lights and fuzzed out radio hits from the Valley View Mall descended on Schwaegerl, he shared how he ended up in the hospital in early July. His eyes fluttered and he stretched his arm out. He asked for a moment before continuing.
He closed his eyes and for just a minute, fell asleep. Likely an episode of cardiac syncope, Schwaegerl woke up slightly dazed.
In just four months, Schwaegerl's condition went from well-functioning to entirely dependent on the kindness of others to survive. He went to the hospital July 2 for a skin infection on his leg and woke up being examined for heart failure.
Brad Schwaegerl rests at Valley View Mall in La Crosse on Tuesday, July 9. Since his second heart attack in four months, the veteran said he has been experiencing short bouts of unconsciousness.
Saskia Hatvany, River Valley Media Group"He was gone for a week and his stuff was being ransacked, so we all took it as good news when he got out of the hospital," Dickey said. "That was pretty short lived when we found out the rest."
As Schwaegerl described it, three heart muscles that circulate blood through the organ are dying or dead. He was prescribed a multitude of heart medications including metoprolol tartrate, a pill that treats heart failure symptoms.
Brad sifts through the medication and medical paperwork in his tent on Thursday, July 11 in La Crosse. After a second visit to the emergency room for heart-related issues, he was prescribed a slew of medications.
Saskia Hatvany, River Valley Media GroupWith access to Badgercare, Schwaegerl had the cost of his medications covered. However, without a follow-up appointment, Schwaegerl will not be able to receive refills for his heart prescriptions.
"This isn't the way I wanted it to end," Schwaegerl said, pausing for a while. "Maybe someone just said that's enough, we're ready for you. Time for me to retire now."
July 9 came and went, and so did his scheduled follow-up appointment, as Schwaegerl waited for a ride that never showed up. With poor blood circulation, walking has been painful and Schwaegerl could not reach a bus station in time when he realized his ride was not coming.
Back on the trail of tents, Schwaegerl leaned his chest on a foraged wooden stool to poke his head out of the tent. After discussing his missed appointment, he rifled through paperwork to show how many medications he's been prescribed for the many conditions that afflict him.
He had one more appointment scheduled, but Schwaegerl estimated he has weeks to live. His condition is a stark contrast from how he lived in the winter, when he helped guide campers to new spots after the encampments north of Riverside Park were cleared out by the city.
Getting 'the number' down
Standing on the banks of the La Crosse marshes in late winter, Schwaegerl let Zenn trot around the dry grasses. From the open space, Schwaegerl had eyes on everything from his group of tents, to Zenn to the nearby trail.
Taking his eyes off of Zenn for a second, he pointed to the numbers on his wrist reading 22, 21, 20 with an ellipses at the end.
"The 22, that's how many veterans commit suicide every day. So the 21, the 20… Let's get that number down," Schwaegerl said.
In 1985, Schwaegerl enlisted in the National Guard at 17 years old. He served in the Guard for two years before joining the U.S. Navy for four years following. While in the Navy, Schwaegerl was deployed in the Gulf War for operations Desert Shield and Desert Storm.
Brad Schwaegerl poses for a portrait with his dog, Zenn, in the La Crosse marshes in April 2024. Zenn has lived with him outside for several years, which at times has made it difficult for the pair to secure housing aid.
Saskia Hatvany, River Valley Media GroupHe served aboard the USS Paul F. Foster when it fired the opening salvo of Operation Desert Storm by launching the first Tomahawk cruise missiles to be used in combat. He developed PTSD from his service and recounted several experiences in combat that contribute to his condition to this day.
To try and heal his mental health, Schwaegerl attempted to take a journey across America to speak with other veterans and mental health professionals while seeking new opportunities across the country.
Schwaegerl became fully homeless after battling a year-long depressive episode. He planned to commit suicide on Jan. 17, 2015; the anniversary of the start of Operation Desert Storm.
"I had someone a few years ago. I was suicidal, and I didn't want her to find me. Didn't want her to find me laying on the ground. So I did my best to get rid of and separate," Schwaegerl said. "It worked. It just took an extra year before I was actually going to do it. And that's when this story starts."
Before following through, Schwaegerl stayed with his sister in the Twin Cities.
Ultimately, Schwaegerl returned to La Crosse and started living outdoors. His veterans benefits had been cut years earlier, his rental history was plummeting and his mental health was worsening.
The Department of Veterans Affairs and the Department of Housing and Urban Development estimate 176 veterans were homeless in greater Wisconsin as of January 2023. The Department of Housing and Urban Development conducts point-in-time studies as an estimate of where homeless people are each January. The study is only completed over one day, and can miss people who are not in one place all day.
Nicole Wisniewski shows off a new tattoo that reads "Brad & Zenn" on her thigh on Tuesday, July 16 in Stoddard, Wis. Wisniewski, who is close friends with Brad Schwaegerl, said he has helped her with "everything" since she has been living outdoors.
Saskia Hatvany, River Valley Media GroupBurned bridges
Time is short, too short for Schwaegerl to find provided housing. With a criminal history, troubled rental history and a dog, his opportunities to find a place have been limited for years.
Schwaegerl admits he's burned bridges after toiling with resource groups for years to secure a spot indoors. From the beginning, having Zenn with him excluded Schwaegerl from most housing options. He also has struggled with drug abuse and sought help from detoxification programs in the past for the issue.
He has been connected with Independent Living Resources, the REACH Center, Couleecap and various county services for about three years straight. He said turnover of outreach staff has caused his case to be restarted several times.
In the past four months, Schwaegerl has been moved three times for different reasons.
In March, he and other campers north of Riverside Park were dispersed by La Crosse police and city staff. In April, he was ordered off a grassy area in the marshlands by a private radio tower company. In May, his place near the Player's Statue on Rose Street flooded.
With new city ordinances passed last month, Schwaegerl could be subject to moving his tent 500 feet every 12 hours if complaints about his encampment add up.
Now, he is staying outside the Veterans Memorial Trail, and the movements have taken a toll. He's lost most of his possessions and his connections to social services.
La Crosse services like the REACH Center and Independent Living Resources send outreach teams to the homeless population to connect them with additional social services. Their goal is to uplift unsheltered people off the streets and into support, jobs and housing.
In January, La Crosse County and city officials estimated there are about 200 homeless people in La Crosse either in temporary shelters or living outdoors.
Schwaegerl catches the first raindrops of a storm near his camp on the banks of the Mississippi River on May 28.
Saskia Hatvany, River Valley Media GroupWhile the outreach teams continue working on the streets, the county and city started a collaborative plan to ensure people don't miss necessary connections like Schwaegerl has. The plan, called Pathways Home, is working on a named inventory of every homeless person in La Crosse to identify specific needs of each individual.
The plan has come under some scrutiny from city officials and residents for not establishing a short-term plan for the homeless population. The Pathways Home plan is a five-year plan that aims for "functional zero" homelessness, meaning people who fall into homelessness will not remain that way for more than a few months with proper structured intervention.
'Open to perspective'
At the Stoddard grave, Schwaegerl recounted scenes from his past, present and future.
The Stoddard cabin, the kindness of friends and the strong canine friend all make appearances in his recollections. Pausing for a bit, he thanked his grandparents for teaching him unconditional love.
"I feel like I could get with a do-over," he said softly, looking at the stone below. "I'd be more like them, less like me."
While the future is not clear, Schwaegerl has not given up. He's held out for a long time, and said he will go until he can't. His final hope is that a family member opens a door for him or he can be placed somewhere of his own for a short amount of time to rest.
"O, T, P. That's open to perspective," Schwaegerl said, motioning to a blue tattoo on his forearm. "In other words, be open to more than what you know. You can't know all."
Homeless La Crosse veteran diagnosed with heart failure finds peace in final weeksSchwaegerl gets out of his tent in La Crosse on July 11. Since the recent decline of his health, swelling in his legs have made it difficult to sleep and move around in his living quarters.
Saskia Hatvany, River Valley Media GroupBrad Schwaegerl's campsite sits on the banks of the La Crosse river in early April 2024, where he moved after being evicted from Riverside Park along with dozens of other unsheltered people. Shortly after moving to the site in the marshes, campers were asked to leave the land, which is owned by private radio company Civic Media.
Saskia Hatvany, River Valley Media GroupBrad Schwaegerl leaves Valley View Mall to catch the bus back to his tent on Tuesday, July 9 in La Crosse. Since his most recent visit to the hospital in July, Schwaegerl has been using a walker to get around.
Saskia Hatvany, River Valley Media GroupBrad Schwaegerl takes a pause at Valley View Mall on July 9, 2024. Recent health developments have faced him with new challenges as he navigates life on the streets.
Saskia Hatvany, River Valley Media GroupThe Mississippi River waters creep towards the edges of Brad Schwaegerl's tent on May 28, 2024. Schwaegerl and several other campers were forced to relocate for the third time in two months after the river flooded in late Spring.
Saskia Hatvany, River Valley Media GroupBrad Schwaegerl stands on the edge of the Mississippi River in La Crosse on May 28, 2024.
Saskia Hatvany, River Valley Media GroupBrad Schwaegerl and Martina Haskins share a moment near their camp as a storm sweeps into the La Crosse area on May 27, 2024. Schwaegerl considers himself a leader and a watchdog for the unsheltered community, which he has been a part of for approximately seven years.
Saskia Hatvany, River Valley Media GroupBrad Schwaegerl watches his dog Zenn play in the marshes on April 12, 2024.
Saskia Hatvany, River Valley Media GroupBrad Schwaegerl poses for a group photo with friends and neighbors near his tent on Thursday, July 25 in La Crosse.
Saskia Hatvany River Valley Media Group Be the first to knowGet local news delivered to your inbox!
Global Burden Of Heart Failure: Prevalence, Incidence, And Risk Factors Unveiled
In a review article published in the journal Nature Reviews Cardiology, the authors provide a detailed overview of the global burden of heart failure, including the incidence and prevalence of heart failure, disease etiology, risk factors, and disease outcomes across geographical regions and populations.
Review Article: Global epidemiology of heart failure. Image Credit: Vector_Leart / Shutterstock
Heart failure is a multifactorial clinical syndrome caused by structural and functional cardiac abnormalities. The key symptoms include shortness of breath, ankle swelling, fatigue, and clinical symptoms, such as increased jugular venous pressure, pulmonary crackles, and peripheral edema.
Heart failure can be of three types depending on the left ventricular ejection fraction, i.E., heart failure with preserved ejection fraction, heart failure with mildly reduced ejection fraction, and heart failure with reduced ejection fraction.
Non-modifiable risk factors of heart failure include age, gender, and genetic variants. Medically modifiable risk factors include hypertension, diabetes, obesity, hyperlipidemia, atrial fibrillation, sleep apnea, poor renal function, pregnancy-related hypertension, chronic kidney disease, and chronic obstructive pulmonary disease.
Lifestyle-related risk factors of heart failure include smoking and alcohol drinking habits, unhealthy diet, lack of physical activity, stress, and socioeconomic deprivation.
Prevalence of heart failure in North America and EuropeThe prevalence of heart failure is gradually increasing worldwide, which can be attributed to aging populations, an increase in risk factors, better treatment outcomes, and improved survival. A 29% increase in the global prevalence of heart failure occurred between 2010 and 2019.
An estimated global prevalence of heart failure was 56.2 million individuals in 2019, with the highest prevalence observed in East Asia, North America, and Western Europe.
In the USA, the prevalence of heart failure was estimated to be 2.5% among adults, whereas in Canada, it was 3.5% in 2022. In Europe, the estimated prevalence was 1.7% across 13 countries in 2019. The highest prevalence was observed in Germany and Lithuania, and the lowest was observed in Greece, the Netherlands, Spain, and the UK. However, in Spain, estimates of heart failure prevalence have ranged from 2.6% to 6.8%, depending on the population studied and the care setting.
In the USA, heart failure with preserved ejection fraction has been noticed in approximately 50% of all heart failure patients in the past decade. In contrast, a comparatively lower prevalence of heart failure with preserved ejection fraction has been observed in European countries, where heart failure with reduced ejection fraction remains the predominant subtype.
In the USA, a reduction and an induction in heart failure prevalence have been observed among older adults and young adults, respectively, in the past decade. Regarding gender-related variations, a higher global prevalence of heart failure has been observed in women (35 million) than in men (29 million).
Regarding race- and ethnicity-related variations, the highest prevalence of heart failure between 2013 and 2016 has been observed among non-Hispanic Black adults, followed by non-Hispanic White adults and Mexican American adults.
Prevalence of heart failure in Asia and AustraliaThe estimated prevalence of heart failure in Asia and Oceania is 722 per 100,000 population, with East Asia having the highest prevalence and South Asia having the lowest prevalence in 2019. Notably, Japan, South Korea, and Thailand have the lowest prevalence in Asia (<1%).
Considering left ventricular ejection fraction, heart failure with reduced ejection fraction has been observed in 81% of all heart failure patients in Asia.
Prevalence of heart failure in Africa and South AmericaThe estimated prevalence of heart failure in South America was 1% between 1994 and 2014. Although no population-level estimates are currently available for African countries, data obtained from five African countries shows that 53.7% of patients have heart failure with reduced ejection fraction, 30.1% have heart failure with mildly reduced ejection fraction, and 16.2% have heart failure with preserved ejection fraction.
Global incidence of heart failureOver the past decade, the global incidence of heart failure has decreased. However, this reduction varies significantly by region and demographic. In the USA, heart failure patients aged 65 years and above have experienced a reduction from 36 cases per 1,000 individuals in 2011 to 26 cases per 1,000 individuals in 2016. A similar reduction has been noticed in Cabada.
In Europe, the incidence of heart failure ranges from 1.99 in Italy to 6.55 in Germany per 1000 person-years. In the UK, a 7% reduction in the incidence of heart failure was observed between 2002 and 2014.
A higher incidence of heart failure has been noticed in women compared to men in the USA and Europe. However, the incidence of heart failure with preserved ejection fraction is significantly higher in women than men in Europe.
In the USA, the highest incidence has been observed in non-Hispanic Black adults, followed by Hispanic adults, White adults, and Chinese American adults. In the UK, a 61% higher risk of incident heart failure has been observed among individuals with the lowest socioeconomic status.
In Australia, the annual incidence of heart failure was 0.348% between 2013 and 2018. In China, the age-standardized incidence was 275 per 100,000 person-years in 2017.
In South America, an incidence of 1.99 cases per 1000 person-years and 5.57 cases per 1000 person-years have been reported in Brazil and Argentina, respectively.
Mortality rateA variation in heart failure-related mortality has been observed across geographical regions and populations, which could be due to the differences in healthcare access, economic resources, population health profiles, and clinical management practices.
A systematic review involving 1.5 million heart failure patients has shown that the 1-year, 2-year, 5-year, and 10-year survival rates of heart failure are 87%, 73%, 57%, and 35%, respectively. A systematic review involving 1.5 million heart failure patients has shown that the 1-year, 2-year, 5-year, and 10-year survival rates of heart failure are 87%, 73%, 57%, and 35%, respectively.
Comparatively higher mortality has been observed in Black adults compared to that in other races and ethnicities. In the USA, age-adjusted mortality in young adults has increased from 2.36 in 1999 to 3.16 in 2019, which is a more significant rise than that in older adults.
A New Artificial Heart In Houston Might Save Millions
Sometimes, when I was watching various artificial heart experiments in the basement of the Texas Heart Institute, I wondered if I was experiencing something akin to Thomas Edison's housekeeper. That is, someone with only a tenuous reason to be in a place where history was being made—or was made today, when it was announced by the Texas Heart Institute that a new total artificial heart, the BiVacor TAH, had kept a Houston man alive for several days. It is, as one of its developers likes to say, the cardiac equivalent of a successful moon landing, a medical breakthrough that could change the way the millions currently suffering from heart failure are treated. If the device is proven to go the distance, it could spell freedom for people all over the world who now cannot get out of bed because their damaged hearts won't even let them walk across a room.
The news came to me in the form of a text last week from famed Houston heart surgeon Dr. Bud Frazier, who let me know that he couldn't go to lunch "because I'm with the patient now and no one knows the physiology of pulseless blood flow" as well as he did.
"You should see the patient if I can save him from his doctors," he joked. A few seconds later, I froze. Frazier can be very elliptical, and I suddenly realized what he was telling me. I texted him a question in return, my hands shaking. "Is this the BiVacor?" I asked. It was.
I had been waiting for this day while my hair turned gray. Back in 2013, I started working on a book about the fifty-year quest to build the world's first artificial heart. As one well-meaning friend pointed out, it was, at the time, a book about failure. In 1963, the then most famous surgeon in the world, Dr. Michael DeBakey—who made Houston's illustrious Baylor College of Medicine into a medical powerhouse through sheer force of will—had promised that more than 100,000 people would be walking around with artificial hearts in their chests within a decade. His timetable was equal to that of then President John F. Kennedy, who promised in 1962—at Rice Stadium, no less!—that we would have a man on the moon within eight years. We all know what happened next: The U.S. Alighted on the moon in 1969. But decades rolled by and the artificial heart remained, along with a cure for cancer, one of medicine's holy grails.
Failure after grisly failure followed, some of which, like the human experiment that was poor Barney Clark in 1982, became a national TV sensation. The problem with any and all artificial hearts had long been that the real organ beats sixty to eighty times per minute, about 115,000 times a day—more than 2.5 billion beats in an average lifetime. It is almost a perpetual motion machine—until it isn't. Up until very recently, no one had been able to come up with a device that could possibly persevere. The contraptions broke down. They required the patient—or victim—to be tethered to a giant machine that pumped while making so much noise that it could induce near insanity.
Now, though, Frazier told me that his team in Houston was working on an artificial heart with genuine promise, a quest to which he had devoted much of his life. At that point, Frazier's most successful attempt consisted of implanting two left ventricular assist devices put together—a single LVAD being a pretty successful machine that helped weak hearts pump more blood. The dual LVAD, a sorta kinda heart replacement, had even made it to the cover of Popular Science in 2012 and kept a man with fatal organ failure alive for a bit. But it had the jerry-rigged feel of something Rube Goldberg might've come up with if he'd been a heart surgeon.
Before Frazier came along, previous iterations of artificial hearts had invariably tried to mimic the organ's pumping action, including one created in the 1960s in DeBakey's lab (and that his nemesis, Dr. Denton Cooley, subsequently put in one of his patients without the former's permission). Frazier often told me that he didn't think a total heart replacement would be possible as long as inventors continued to imitate the heart's pumping action, because pumps wear out. A patient in that situation would either need replacement surgery or a transplant, which come with their own set of problems. Frazier suspected that something like the spinning action of a turbine was the answer. The Wright brothers, he liked to say, didn't get in the air by trying to imitate a bird in flight.
The stakes of his work could not have been higher. Heart failure currently kills 6.2 million adults in the U.S. And 26 million people around the world. Those numbers suggested sizable interest in a book about heart disease, I thought. And eventually Mattress Mack entered the picture as a funder—he had lost a brother to heart disease, despite Frazier's efforts to save him—resulting in a character lineup from central casting: Bud Frazier as a West Texas philosopher-savant and Vietnam vet; his partner, heart surgeon Dr. Billy Cohn, a zany inventor who could sell ice to those proverbial Eskimos; and, finally, the super rich furniture salesman who kept a couple tiger cubs as pets.
And there was one more thing: It so happened that in 2011, a young Australian named Daniel Timms had shown up in Houston with an alternative he had been carrying around in a backpack. His device had one moving part and was the size of, say, a sweet orange from the Rio Grande Valley. Timms had talked his way into seeing Cohn, who at first wasn't particularly interested in talking with a kid who needed a shave and clean clothes, and kept his invention wrapped in a rag in a flimsy backpack. But then Cohn got a look at what Timms was carrying, the precursor to what is currently described in a Texas Heart Institute press release as "a titanium-constructed biventricular rotary blood pump with a single moving part that utilizes a magnetically levitated rotor that pumps the blood and replaces both ventricles of a failing heart." At that moment, the dual LVAD that Cohn had been working on with Frazier was consigned to, if not the dustbin of history, then one of those museum shelves that show the development of an idea in midstage. In Timm's invention, Billy Cohn and Bud Frazier, it could be said, had the Holy Grail within their grasp.
Probably to their deep regret, Cohn, Frazier, and Timms let me hang around as they improved upon the original BiVacor. One day in 2014 I was in the animal lab in the Texas Heart basement, where there was a healthy-looking calf on a treadmill. Timms stood at a control panel while everyone else stood around staring at the calf. No one in the room seemed to be breathing, except the calf, who began moving along the treadmill while Cohn offered it a carrot. The calf kept walking, trying to reach the snack, with an expression that suggested it was trying to figure out what the big deal was. Then it was over. Frazier told me to put my head to the animal's chest, which I dutifully and quickly did, because I kind of intuited that no one was all that happy to have a journalist in the room.
I pressed my ear into the calf's soft hide and heard . . . Nothing. Nothing that sounded like the lub-dub we are all accustomed to, nor did I feel any pulsing rhythm against my ear. There was just a very soft whirring sound I heard after someone handed me a stethoscope. That was when I knew what Thomas Edison's housekeeper might have felt if she'd come into a previously dark room set aglow by a single bulb.
My deadline for the book was in 2018, and I met it with the best ending I could summon at the time. It was not a story of failure but of persistence—Frazier had devoted his life to a singular pursuit. So, for that matter, had Timms, and I never doubted the team would succeed. Still, Frazier had reached his eighties, was white-haired with worn-out knees, and he often told me he worried he wouldn't be able to stay above ground long enough to see the end. Still, he kept the faith. Every time I saw Frazier over the ensuing years, he told me they were six months away from implanting "the pump" in a person. (Why they called the BiVacor a pump when it doesn't pump is, I guess, force of habit.)
Well, Frazier did live to see it. There were a lot of FDA hoops to jump through and a ton of money to raise. And a lot of calves gave their lives so that humans might live. But for the first time ever, the BiVacor heart now sat in the chest of a local man who otherwise would have died from heart failure. Then he got the heart transplant that is keeping him alive today.
The device is still experimental and is being used first as a "bridge to transplant." There will be more human trials, but, very likely, one day BiVacors will sit on hospital shelves, waiting to be put into service in hospitals all over the world. In the meantime, Frazier will be found at the bedside of every BiVacor patient, watching and waiting.
Pumps wear out, but some people just don't.
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