Devine Intervention: Stars Align for Pulmonologist’s Lung Transplant
Authors: Dorothy Hagmajer & Talal Elmasry
After night shifts in the ICU, Sean Devine is tired.
This is not atypical. In fact, Sean and his family have grown to expect it. When he is on nights, the critical care pulmonologist arrives home weary in the early dawn. His wife, Liz, and their three daughters adjust their patterns accordingly. Extra hugs. More coffee. A reminder to eat something.
But on this night in particular, Sean returned home with a cough.
This also was not abnormal, Liz recalled. The hospital air conditioning rendered its ICUs chilly. Inevitably, you could catch a cold or even flu. One cough in itself was not enough to arouse serious suspicion.
Until the COVID-19 pandemic.
After that, families like the Devines saw their lives upended in a way only an ICU physician’s family could be. They were all too familiar with the fact that Sean spent his shifts bringing patients back from the clutches of a highly transmittable and devastating respiratory virus. They knew a cough was a potential harbinger of doom.
“There are more allergens in the air where we live,” Liz thought to herself.
Hopefully, it was that.
Danger Becomes Reality
Throughout the pandemic, the Devines had been very, very careful. Sometimes frustratingly so, Liz recalled. There were others who were less cautious — other families who could afford to calculate risks differently, who could avoid the realities of the virus with the click of a TV remote or change of subject. They avoided gatherings, washed their hands and did their best, even when it was hard, and even when the dread of what could happen threatened to overwhelm them.
Sean did his best, too. He changed clothes, showered after shifts and was as hypervigilant about exposure as he could be. He was prepared, conscientious and also — perhaps most importantly — a skilled, pragmatic physician who had seen several patients with the virus depreciate before his eyes.
So, when Sean’s single cough turned into two, then an unrelenting series of full-body hacks and shortness of breath, he knew his caseload had increased by one — himself.
“My biggest concern was surviving it,” Sean said.
After all, he’d seen firsthand exactly what it could do. He’d fought his hardest to prevent it in those under his care and consequently knew all the signs of deteriorating oxygen levels.
In fact, he knew them like the back of his hand, well enough to not ignore and well enough to ask his wife to take him to the ER when he realized he needed the care he’d spent months providing. So, Liz and Sean sped, grimly, to his hospital’s ER. This time, he came as a patient.
“Every night, I would pray,” Molly, Sean’s daughter, recalled. “And that one night, everything just turned upside down. I just kept saying, ‘His story’s not over yet. He has more to add to this world.’”
He was only 53 years old, Molly said. He’d saved the lives of so many patients. It was only fair if his was saved as well.
Sean’s Only Option
Some cases of COVID-19 are mild. You may go to the hospital and be sent home after receiving supplementary care and oxygen, or find yourself able to weather the virus with the help of low-grade, over-the-counter cold and flu medication.
Sean’s was another kind altogether. More specifically, it was the type that pushed his colleagues to do everything in their power to keep one of their fellow champions alive while his condition continued to worsen.
It was the kind where his family prayed every night, fervently, as each update on Sean’s condition (sedated, intubated, weak) left them with a sinking feeling and facing their growing fears.
They were running out of options. Sean’s normal life as a father and doctor seemed to be slipping out of reach. He had complications, doctors said. His lungs were scarred and unable to work on their own.
Unless he got new ones.
Physicians in Pennsylvania suggested something that had only been done a few times before: a lung transplant to ameliorate some of the damage caused by COVID-19.
“My thoughts were racing,” Liz said. “I thought, ‘We have to do this (lung transplant) in order to save his life.’”
1,000 Miles to Hope
Sean was admitted to UF Health on Nov. 13, 2020, but it took him six weeks to regain consciousness. He found himself in a hospital room surrounded by some people he knew, and many he didn’t.
He was in a self-induced coma during the entire medevac flight to UF Health Shands Hospital, one of two places in the United States that had successfully performed a COVID-19 lung transplant. While Liz’s brother-in-law drove the family — including three children and two dogs — straight down from Pennsylvania to Florida, Sean lay inert, connected to an orchestra of machines whose rhythmic pumps and whirs kept his body alive.
Once the Devines arrived, Liz went straight to the hospital in Gainesville, where she remained almost every day during Sean’s stay. In the meantime, the family was left in the loving, capable arms of Ann and Tom Collett.
“What are the odds that the place that can do a lung transplant is the place where my other sister resides?” Liz said.
The Colletts, familiar with UF Health due to their son’s recent, successful cancer treatment, were instrumental in providing a much-needed backdrop of support and structure while the Devines settled in for the long road ahead.
Prepping for Major Surgery
In any fight, the opponent is typically top of mind. What you are fighting against, after all, is important, as it dictates tactics, strategy and tools needed to overcome the battle in front of you.
But in the thick of it — when the going gets rough — it is even more important to remember what you are fighting for.
Tiago Machuca, MD, PhD, surgical director of UF Health’s Lung Transplant Program, points these goals out to his patients to remind them of what lies on the other side of recovery.
“Patients that come to us because of COVID lung failure have experienced acute deterioration,” he said. “The acuteness of this transition is very striking.”
Typically, most patients Machuca and his team work with have been experiencing chronic lung failure over a period of several years. Those patients are familiar with their condition, their available treatments, their day-to-day routine and life expectancy. They know what it takes to be ready for a lung transplant and how to recover from one. In short, they’re ready mentally.
For patients who contract COVID-19 and experience severe lung damage, this is all new. It happens in the blink of an eye. They’re only a couple months removed from their “normal lives” when they had functional lungs. Memories are still fresh.
The mental effect can be crushing, and consequently, one of the things Machuca’s team does is make sure the patient understands a new life is in reach.
“Preparing them mentally is one of the most difficult tasks,” Machuca said. “They’ve had several near-death experiences. They were told they were going to die so many times that one of the things we ask is for the family to bring pictures.”
The patient’s room is full of pictures with their families at events, laughing, smiling, healthy, moving and full of life.
“They want those moments back,” Machuca said. “When you see those patients lying in bed after 2 to 3 months of devastating illness and look at the photos on the wall, they are two completely different people.”
If it’s hard for the team to see them as they were, Machuca said, it’s difficult to imagine how much harder it is for the patient themselves.
“Those photos are there to remind them of what is possible,” he said.
And what they’re fighting for.
After all, the amount of physical and occupational therapy required to prepare a patient for transplant is not for the faint of heart. The commitment to the preparedness of each patient before transplant is one of the many reasons why UF Health’s lung transplant program has stellar outcomes (its one-year survival rate of 98.56% exceeds the national average of 89.07%, according to the Scientific Registry of Transplant Recipients).A lung transplant is a significant surgery from which to recover, and part of ensuring the postsurgical recovery goes smoothly means the patient has a baseline of strength and mobility with which to begin.
When Sean first arrived, he was profoundly weak, recalled Kristen Sherwood, MOT, OTR/L. In fact, he could barely move a muscle.
“In the seven years I’ve been doing this, Sean is one of the most physically deconditioned patients and medically complex patients I’ve worked with,” Sherwood said.
She put him on an aggressive therapy plan — two sessions a day, as much as he could safely do while still pushing the limits of what his body was capable of at the time. Despite the discomfort, Sean kept going, and Sherwood returned day after day to help him get stronger.
“Sean definitely had the motivation,” Sherwood said. “And I knew that if we had that, that willingness, that he would do well.”
And what was his motivation?
“His family,” Sherwood said. “His work, too, but really, his family.”
Just the Right Friends in Just the Right Place
While Sean had to let go of being a doctor and accept being in the same vulnerable position as all his past patients, his three daughters — Molly, Claire and Grace — unknowingly had to let go of their father for a lot longer than they expected.
When the Devines first arrived in Florida in November, the girls did not foresee being without their father and mother for as long as they would. Not having the support of Tom and Ann Collett during the holidays and ensuing months would have been unfathomable.
“I think that was the worst time for them, the time from when they got here and the time they could go in and see their father,” Tom said. “I remember just the big smiles on their faces when they had that word that they could go see him, with their mother go see their father, because they hadn’t seen him face to face for about two months. They came back on cloud nine talking about the experience that they could just go see their father.”
For the Devine family, the Colletts were a safe harbor during the ultimate uncertainty, providing emotional stability when their feelings were understandably bouncing all over the place.
“For quite some time, I did (think I was going to lose my dad). Not going to lie,” Molly, 17, said. “I just kept hearing things were going downhill back at home. But then once we got down here (to Florida), and he was going to get a transplant, a part of me was relieved because he’d get a second chance at life again.”
For a learned medical patient like Sean, that belief didn’t materialize so easily. Sean had a deep understanding of the danger he was in. He knew he was a COVID patient needing a transplant, and he knew not many lung transplants had been performed to save a COVID patient’s life.
Fortunately, he was in the care of a lung transplant team that had been spearheading a transformation for seven years. During this time, the program experienced increased volume and had established a dedicated lung unit of experts seeing advanced lung cases. This put Sean in a place that found itself uniquely positioned to treat his condition.
“The fact that we are a leading center in the world for lung transplantation in COVID patients, I don’t think that this happens by chance,” said Machuca, Sean’s surgeon. “I think that somehow we were gradually preparing ourselves to deal with the most complex patients with advanced lung disease.
“We were increasing our (extracorporeal membrane oxygenation, or ECMO) volume. We were increasing our consideration of ECMO as a bridge to transplant, so patients that are somehow similar to COVID patients, they were already in our unit on a regular basis almost, so then when COVID came, we knew what to do. We just weren’t sure if it was possible. It was novel.”
What initially felt like pushing the boundaries became routine work for UF Health’s team of specialists as UF Health Shands Hospital became one of the first two hospitals in the country capable of performing lung transplants that were COVID-related. Only about two dozen such procedures have been performed at UF Health, and Sean became one of those rare beneficiaries on Feb. 9, 2021.
After 10 hours, his double lung transplant surgery was a success. However, his challenging recovery, both physically and mentally, was just beginning.
Recovering From Major Surgery
Postoperative physical therapy began the same day as Sean’s operation, which included walking up and down the halls and doing mild weightlifting. There was no time for Sean to rest before hitting the home stretch of this marathon, but at least he was circling back to a normal life.
And considering all the hurdles in front of Sean and the people who helped him clear those, it’s hard to believe divine intervention didn’t play a part along the way. Liz has no doubt that a higher power was involved in helping Sean, who she calls “literally a miracle.”
“I don’t say that lightly, because the odds were stacked against him,” Liz said. “His condition was dire, and the only option was a lung transplant, and lo and behold, it’s in a place where we have family and he was accepted, so there’s nothing other than the Lord carrying us for this. In my heart, I know that that’s how this happened.”
For Sean, his journey back to a normal life, the one he was reminded of by all those pictures surrounding him in his room, wouldn’t have been completed without a belief in the loved ones around him.
“Faith and family played an important role in the whole process, because there are a lot of unknowns,” Sean said. “You have to have faith in your family that they’re going to be with you the entire way, and that certainly got me through it, because there are certainly some down moments that you have to pull through.”
That started from the moment Sean arrived sedated at UF Health Shands Hospital, needing roughly two months to wake up and for his mind to clear enough to realize where he was and what was going on. At that time, Sean was unable to hold his head up on his own power.
Sherwood, who saw his entire preparation for the transplant and recovery from it firsthand, was in awe by the end of Sean’s stay.
“One moment that really struck me was when I got to work with him one time when he went to the medical surgery floor,” Sherwood said. “It was just him and me, and he got fully dressed, you know, shirt, shoes, pants, ready for the pulmonary gym with very little assistance. He was standing by himself, and in that moment, just to see the progress that he made, it was pretty heartwarming.”
Physical therapy was the biggest challenge for Sean, whose atrophied muscles got sore easily when working out, but pushing through that paid off as he “feels great” now. And Sean is thankful to have made it to the other side of an experience that he knows has and will change his life in many ways, but he won’t let it change his life to the point where he stops helping others.
“Most people don’t get a second chance at life, and I plan on using it to the best of my ability for as long as I can,” Sean said. “Overall, I feel great. It has obviously changed my life. At the same time, it reinforced my outlook on life, and my perception of life that you can be serious, but you also have to be upbeat and happy in life. Whether I change the focus at work remains to be seen, but I fully intend on returning to work.”