It's a go

by Jenny Yarborough
Thursday, June 24, 2010

Staff photo by Joshua Curry

Howell Graham was the first cystic fibrosis patient to receive a double lung transplant at the University of North Carolina Hospitals by Dr. Thomas Egan on Oct. 8, 1990.

You can’t tell it from the outside. When he walks by, he seems an ordinary man. But Howell Graham carries a title he’s proud of.

Howell, 48, is the longest surviving double lung transplant recipient in the world.

Born in Tallahassee, Fla. to author Nan Graham and retired U.S. Marine Lt. Col. Ernest Graham, the newborn Howell seemed perfectly normal. But as he aged, Howell’s parents noticed something wasn’t quite right. He wasn’t gaining weight like the other two-year-olds and he was constantly sick.

Howell’s worried mother consulted the books and before the doctor gave his diagnosis, Nan already knew that her son was suffering from cystic fibrosis (CF).

Currently, there are about 30,000 U.S. citizens living with CF—a chronic genetic disease that prompts the body to build an abnormal mucus affecting the lungs and digestive system.

In the 1950s, a CF diagnosis meant a child wouldn’t see past elementary school graduation.

In 1964, Howell’s specialist in Chapel Hill gave him until the age of seven.

But seven came and went. And Howell was just another boy down the street playing rough and a member of the Dixie League baseball team. The only difference he saw between himself and his friends was the extra doctor appointments during which he was monitored and intravenously administered antibiotics.

Despite his disease, Howell attributed his longevity to his parents who lived in positive denial. The young Howell didn’t know he wasn’t supposed to live past his seventh birthday, so he just kept living.

In 1982, he came to Wilmington to attend the University of North Carolina Wilmington. After graduating in ’85, Howell stayed in the city with which he had fallen in love.

The college grad continued to live the normal life of a businessman until 1990 when the build-up in his lungs presented him with progressive breathing difficulties. Even a task as simple as brushing his teeth made him short of breath.

In March, Howell’s physician presented him the option of a lung transplant.

While organ transplants have progressed through the years, in 1990 the concept of a lung transplant was totally new, with only a 55 percent chance of surviving the operation.

Howell said he blew the suggestion off because he wasn’t sick enough. But within a matter of months, a downward spiral caused a change of heart.

"I had absolutely no life," Howell said. "I had no energy. I was miserable at that point and I thought the transplant would do one of two things: a, it was going to work; or b, it was going to put me out of my misery."

The procedure was only about three years old at that time, so the waiting list was short.

When Howell’s turn came up he was told to be ready at any given moment, so he moved to Chapel Hill.

On Oct. 8, 1990, during Howell’s routine hospital visit to receive antibiotics, a man in Pensacola, Fla. simultaneously died in a motorcycle accident.

Dr. Tom Egan, Howell’s surgeon, walked into his patient’s room to tell him he was boarding a private jet to personally inspect the donor’s lungs. Without knowing if they were a match, Howell was prepped for the surgery.

Only hours after the tragic death of the motorcyclist, Egan called the hospital.

"It’s a go," the surgeon said, and Howell was on the table with an armpit-to-armpit incision.

Egan, back from Fla., cracked Howell’s breastbone, removed his biological lungs to replace them with the donor pair.

Thirteen hours later, Howell had a new set of lungs. And a month after intensive rehab, he was released from the hospital.

"My doctor told me I could do anything I wanted except scuba dive and sky dive because they don’t know how the lungs would react to the pressure and those are two things I don’t want to do anyway," Howell laughed.

Today, Howell is nearing the 20th anniversary of the day he received a second chance at life and what he calls his new birthday. Already in the works is a massive anniversary celebration during which he aims to use the party as a benefit for two causes close to his heart—Lung in a Bag, a new procedure Egan discovered using ex vivo (or outside the body) perfusion which enables doctors to restore a donor’s lungs that have been injured or built up fluid postmortem so that the lungs may still be used, and The Sweet Melissa Foundation that supports lung transplant patients and their families.

With Howell’s second set of lungs, he has lived with the positive denial his parents taught him, also surviving a ruptured appendix and colon cancer. Nine Lives II, the name of the 23-foot Scout that he uses to cruise to Masonboro Island, says it all.

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