On the morning of his daughter’s wedding, Peter Pawlikowski was in the Heart Failure Treatment and Transplant program of Newark Beth Israel Medical Center. Dr. Mark Zucker, director of the program, looked down at his 60-year-old patient and asked, “How do you feel?” Pawlikowski lied just a little. “Fantastic!” he replied.
Only six days earlier, on July 27, Pawlikowski had received a heart transplant. Most transplant patients are discharged eleven to sixteen days after surgery, though a few are released in as few as four or five days. Pawlikowski had promised his daughter, Kristi, 32, that he would escort her down the aisle. “Though it’s hard to prove scientifically, patients with a positive mental attitude normally do better than those who are depressed,” says Zucker. “Motivation seems to be a factor, and Peter definitely was motivated.”
Yet, as Pawlikowski recalls, “It was touch and go to the last minute. The night before, Dr. Zucker told me, ‘We’ll have to see.’ They were concerned about my pressures and test responses.” In the end, his vital signs were strong enough that Zucker agreed to release him. At noon on Friday, August 3—three hours before his daughter, Kristi, was scheduled to be wed—Pawlikowski’s girlfriend, Barbara Foley, drove him back to their home in Rumson.
“I was hurting, to be honest,” he admits. “But a little pain was not going to stop me. Thank God they have these things called Percocet.”
The pain was centered in his breastbone, which surgeons had split down the middle to remove his failing heart and implant the new one. “The bone doesn’t heal for six to eight weeks,” Pawlikowski says. “Meanwhile, you have stainless-steel wire holding your breastbone together. And guess what? When you move, it hurts. And don’t cough or sneeze or you’ll leave the planet.”
Medical innovators have devised a way to cushion the blow. It’s an actual cushion, a small heart-shaped pillow. “When you feel a sneeze or cough coming on, you grab this pillow and press it against your chest so you don’t feel like your heart is going to fall out,” Pawlikowski explains. “It’s like Linus’ blanket. I always have my little pillow with me.”
When he and Foley got home around 1 pm, he rested in an armchair until he felt strong enough to shower and dress. A determined optimist, he had ordered his tuxedo earlier in the summer, when he was waiting for a heart and officially had only a few months to live.
“A tux is difficult enough to get into when you’re in good shape,” he says. “I didn’t know how long it would take. But my girlfriend helped me, and finally I managed to get myself in order.” He had called Kristi that morning to tell her he was getting out of the hospital and would make it to the church on time. She had a backup plan just in case—her three brothers would do the honors.
Kristi and her bridesmaids had just arrived at Saint Anthony of Padua Church in Red Bank when Pawlikowski and Foley pulled up. “He’s here! He’s here!” the women shouted.
Kristi’s own heart skipped a beat. “When I saw him I just started crying,” she says. “I really didn’t believe he would be there until I saw him at the church. I still can’t believe it. It was a miracle.”
Someone offered Pawlikowski a wheelchair. “No, no, no, you don’t understand,” he replied. “I’m walking my daughter down the aisle.” About twenty minutes later, he did exactly that. There wasn’t a dry eye in the house. “Even I was crying, for crying out loud,” he says.
After Kristi took her place at the altar beside her bridegroom, Matthew Kelly, Pawlikowski and Foley took seats in the back of the church. Dr. Zucker had urged him to keep his distance from other people—the immuno-suppressant drugs he was taking lowered his resistance to germs. “I said to Barbara, ‘Let’s sneak out of here.’” As they got up to leave, the photographer noticed them and asked them to stay for pictures. They obliged, and soon well-wishers were coming up to them, arms outstretched.
“First thing they want to do is hug and kiss you,” Pawlikowski says with a laugh, “and I’m sitting there saying, ‘You can’t! I’m quarantined!’”
At last extricating themselves, they returned home to Rumson, and Pawlikowski gratefully took off his tux. He lay down and got comfortable. It had been quite awhile since he had felt so comfortable.
A trim and energetic man most of his life, Pawlikowski began having heart problems some years ago, and in 1999 he underwent triple bypass surgery. He figured he had been guilty of overeating and underexercising, but genetics also played a role.
“My mother died on the operating table during bypass surgery when she was 76, and I never understood why she wanted the surgery,” he says. “She said she didn’t want to be here if she had no quality of life. Now I really understand what she meant.”
After his bypass surgery, Palikowski felt good for several years. Then fatigue returned, and in 2005 a stent was inserted into the right coronary artery. He felt a little better, but his heart remained weak.
The turning point came almost exactly a year ago. In October, 2006, he had a tooth extracted, and in the process apparently contracted a minor infection. For heart patients, no infection is truly minor. He became increasingly short of breath.
At work he could barely lift a finger—and that’s saying something. Pawlikowski owns Oceanic Marina in Rumson. He usually enjoys tinkering with his 45-foot boat. It’s hard to overstate what the business means to him. Back on the job recently, he said, “I stood on this marina 25 years ago and said, ‘I’ll own this someday,’ and people said, ‘Yeah, yeah.’ Well, 24 years later, guess what? I own it.”
But by late last year, “Just to walk to the end of the dock was a project.” At home, lethargic and bloated, he lacked the energy to read or even watch TV. “Normally, he’s the life of the party,” says Foley. “But he was depressed, and just sat around wondering when he was going to feel better.”
In January, tests showed that Pawlikowski’s heart was enlarged (a condition associated with heart weakness) and was functioning at only 15 percent of capacity. Fluids were backing up in his body. He soldiered on until April.
“I was vacationing in Gainesville with Barbara, and finally I said, ‘Take me to an emergency room—I can’t even stand up anymore.’ The doctors said, ‘Your liver is shutting down, your kidneys are shutting down, the next thing will be your heart.’
“They gave me 24 hours to live. They inserted a pump through my groin that helps your heart work better,” he says. “They said there was only a 10 percent chance it would work.” Pawlikowski’s children were alerted and immediately flew down. “I remember looking up and seeing my four kids standing around my bed, crying,” he says. “Even the nurses were crying. It was like the Grim Reaper was on the other side of the bed.”
But the treatment did work. Slowly, his organs resumed functioning. “But the doctors said, ‘You’re going to need a transplant.’ I said, ‘I don’t believe you.’ That’s how stupid I was. I said I wanted to go talk to my own doctors. They said, ‘You can’t travel for awhile.’ Finally, after a month, I went home. Dr. Zucker had the same prognosis as the Florida doctors. Two other doctors confirmed it. I thought, Hmmm, they might be right.”
A transplant would be no picnic. “Having had a bypass, I knew what I was in for with major heart surgery,” he says. “But once the third doctor said I was going to die, I finally realized I didn’t have much choice.”
First came a battery of tests to determine if he was a suitable candidate. A transplant patient must be at end-stage heart failure with a prognosis of twelve to 24 months to live—but otherwise must be in reasonably good health. “Every orifice in your body is checked,” Pawlikowski says, with typical humor. “I said, ‘I passed everything?’ I was a wild guy when I was younger—I thought maybe my kidneys would be a problem. But they said, ‘No, everything’s fine.’” On June 14, Pawlikowski was placed on the waiting list. In mid-September, 2,651 people across the nation were waiting for heart transplants, including eleven in New Jersey. In New York, the waiting list numbered 256; in Pennsylvania, 169. The perception, Dr. Zucker says, is that crossing the rivers to New York City or Philadelphia to a big city hospital will mean better care for major medical procedures.
“New Jersey is one of the best-kept secrets in medical care,” he says. “Usually, the wait here is one to two months and patients are getting hearts.”
Twice Pawlikowski was called to Beth Israel to prepare for surgery, but both times the donated heart was deemed at the last minute to be an inadequate match and he was sent home. Then, on July 27, the phone rang again. A young man had died—“All I know is he was 22, had an aneurism, and donated all his organs,” Pawlikowski says.
The heart “is the last organ to come out” when a donor’s organs are removed, Pawlikowski says. “They couldn’t find a recipient for the lungs for several hours, so I was at the hospital, waiting. Dr. [Margarita] Camacho [leader of the transplant team], finally harvested the heart, looked at it, and said, ‘This heart is a perfect match. It’s a go. Open him up.’”
Transplant surgery began at 11 pm, less than four hours after the donor’s death. The operation took three hours.
“People told me, ‘You’ll feel the difference as soon as you wake up,’ and I’d say, ‘Get outta here.’But they were right. When I woke up, I felt different immediately. I felt alive.”
At home after the wedding ceremony, Pawlikowski didn’t feel like moving, let alone like getting into the tuxedo again. But the wedding reception was taking place that evening. “I said to Barbara, ‘I made it this far. Let’s do it.’ So I got the tux on again, and managed to get that top button fastened.”
Much fuss was made over the father of the bride when he and Foley arrived at the Molly Pitcher Inn in Red Bank. “They set me up in the corner, like I was the Godfather and guys wanted to kiss my ring. It was a celebrity status I didn’t deserve.” Somehow, the emcee didn’t get the word, because all of a sudden the proud Papa heard him announce over the microphone, “Unfortunately, Mr. Pawlikowski couldn’t be with us…”
“I’m shouting, ‘I’m here! I’m here!’” Pawlikowski says. “Well, we had dinner, which was outstanding, and then Kristi and I danced together. I did too much—I twirled her around. And when I sat down, I said to Barbara, ‘I’m done. I’ve had it. Before I collapse right here, let’s say our good-byes.’ I did not get out of bed for the next two days.”
On Monday, Pawlikowski returned to the hospital and sailed through his first checkup. But recovery is a long process, and it, too, is no picnic. The most unpleasant part is the biopsies—weekly at first, then every other week—which measure the degree to which the immune system is accepting or rejecting the new organ.
“They put a tube in your neck and feed it down into your heart,” Pawlikowski says. “At the end of it is this claw, like in the arcade game where you try to pick up a toy. The biggest thing is when they put that pinch in your neck. Sometimes they have more difficulty getting into your heart. Not that you get used to it, but at least you know what you’re in for.
“You can watch it on a monitor and see it take out a little piece of your heart. Then they send it to the lab. They want the result to be zero. If it’s one, two, or three, there’s more rejection, and you have to have more drugs. The first weeks, the results were fine. The last time [in September] it was a three, because I caught a cold when I was at the hospital. They called and said, ‘We’re checking you in, get up here immediately. We need to get you on steroidal anti-rejection drugs.’ I was there for three days, until the reading came down to a one.
“I take pills four times a day, sixteen in all. One time the compartment thing fell, and the pills went all over the floor. I didn’t know what to take. Barbara straightened it all out. Without her I wouldn’t be here.
“As people get older, they don’t talk about sex anymore, they talk about sickness. At the marina, I hear people complain, and I say, ‘Yeah? I just had a heart transplant.’ They say, ‘Get out!’ One time I pulled up my shirt to show some guy.”
For a transplant patient, such skepticism is the ultimate compliment.