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Meet James Holmes: Heart Recipient and NC DMV Examiner

My name is James Holmes and in 2008, I was a police officer for the city of New York, working in the Bronx for the 50th Precinct.  That April I became sick with symptoms that resembled an upper respiratory infection; I had shortness of breath, difficulty breathing, and when I exerted I would wheeze.  That month my wife, a registered nurse, insisted that I go to the doctor. I kept making excuses that I had to work and that I was afraid of missing any time. Thankfully, she did not let up and the nurse-side of her kept insisting until I listened.  I’m convinced that her insisting saved my life. I visited roughly four doctors in the month of April.  Each doctor gave the same diagnosis of “upper respiratory infection” and prescribed antibiotics.  It was not until the fifth doctor, working at an urgent care office, looked at me and decided that, based on my breathing problems and the pallor of my skin, I should have an echocardiogram done.

The echocardiogram showed that my EF, the ejection fraction showing the rate my heart took in blood and sent it to the rest of my heart, was only five to ten percent.  The EF of a normal healthy person my age would have been 55 to 65 percent.  Due to this low EF, the doctor did not want me to leave the office. She called an ambulance and had me transported directly to the hospital.

A thousand questions went through my mind on that ambulance ride: would I die, what will happen to my wife, will my two-year-old daughter still have a father, is my career over?  I hoped that the doctor was wrong, that maybe the echo gave a bad reading and things would be straighten out when I got to the “real” hospital.  The thought of the echo being wrong brought me hope, and I actually began to get angry because I had a midnight shift that night and this ambulance ride was taking away from my time to sleep.  I asked the ambulance tech if the ride was necessary and he said that it was. He burst my bubble telling me that by pulse was weaker than it should be and that the doctor had made the right call.  When I got to the hospital I was brought right to the ER and hooked up to wires and heart monitoring devices. It became more evident that I was going to miss my midnight shift at the police department and, more than likely, every shift after that.

I spent five days in the hospital on that first visit.  I went through what seemed like hundreds of blood draws and tests that I had never heard of before getting sick. The doctors told me that I was in heart failure caused by viral myocarditis.  They told me that a virus had attacked my heart causing it to beat in an irregular way and became misshapen; hearing this I knew my life was changed forever.

Once the shock of knowing that I was in pretty bad shape wore off, I started thinking about all of my responsibilities and how being in heart failure affected them.  My first call was to my precinct.  I was hospitalized so there was no way I could work my shift that night.  I remember how sympathetic my desk sergeant was.  She asked if I was okay and if my family needed anything.  Everyone hears how being a cop is like being in a big, extended family, but it’s hard to visualize until something major happens in your life and those brothers and sisters in blue rally to you.  I must have gotten 30 to 40 phone calls that first night from different people I had worked with throughout the years.  

I spent roughly a week that first time in the hospital.  Heart failure patients get placed on a number of medications to help regulate the heart.  In some cases the medication can help correct the heart failure, allowing the heart to function normally. In my case, this did not happen.  

Dr. Lawrence treated my heart failure for the first year.  He was patient and tried his best to make me comfortable with my situation.  He me down one visit and told me flat out that what I needed to do was visit a specialist from Columbia Presbyterian Hospital in New York City named Dr. Donna Mancini.  He explained that she was the head of both the Heart Failure Clinic and Heart Transplant Clinic for Columbia Presbyterian and forgot more about the human heart than most doctors would know their whole career.   He gave me a contact number and after talking with my wife, I called and made an appointment for the following week.

My first meeting with Dr. Mancini was enough for me to know that she was going to make me better.  Dr. Mancini is one of those people you meet in life that you could never forget.  She stands at about 5 feet tall and has a no-nonsense personality.  On my first visit, she looked at me and said, “You’ve been cheating on the salt. Knock it off.”  I would have been worried about her demeanor, but the smirk she gave put my mind at ease.

One of the early changes to my medication was a Milrinone drip administered by a pump through a PICC line (peripherally inserted central catheter).  Imagine having a plastic tube running into your upper arm night and day giving you an almost constant jittery feeling.  Dr. Mancini explained that the medication was not a long-term solution, and that she wanted me placed on the heart transplant list.  She also explained that, due to my blood type, I would have a longer wait then some.

Her plan for me was to use the Milrinone until I would speak to a surgeon about being placed on an LVAD.  The phrase she used was “using the LVAD to bridge to transplant.”  An LVAD system is a left ventricular assist device that is battery operated and helps the main pumping chamber of the heart deliver blood to the rest of the body.  

The surgeon explained how implanting the LVAD would work and terrified me in the process.  Implantation required a surgery that was very much like the heart transplant I was awaiting, the difference was my heart would remain and a small pump that worked like a jet turbine would pump my blood. The device required two external batteries, each roughly the size of a VHS tape, for the younger people reading this that would be either a big iPhone or a small tablet.  I asked how the batteries gave power to the device inside me and found that I would have a wire, as thick as a cable TV wire, go from the device down to a hole in my abdomen and connect to rechargeable batteries.  At night, I would have to hook up to a base machine that would connect directly to the wire and run my LVAD without the batteries.

The LVAD seemed invasive, and I really wanted nothing to do with it.  My surgeon broke the scenario down as: if Dr. Mancini wanted the LVAD, it was because I needed it to survive.  At the time, I had two little kids at home and decided being there for them and being a father was more important than my fear or discomfort.  My wife and I made the appointment, and I was implanted with an LVAD the next month.

The only word I can use to describe how the LVAD made me feel is “amazing.”  At the point before the LVAD, I had been on every heart failure medication that the pharmacies could whip up.  I was tired all the time and worried that each night I went to sleep, I would not be waking in the morning.  I started getting color back, and walking from my living room to the front door did not feel like I just ran the New York City Marathon.  There were discomforts: blood thinners, constant blood tests to make sure the machine was not chewing up my blood (that’s a thing believe it or not--the turbine can destroy blood cells), making sure that my batteries were charged.  The discomforts were manageable, and I felt good.

I retired from the NYPD in 2012.  Being dependent on the LVAD and not having a definite date for transplantation ended any chances of continuing with the department.  New York City was very good to me and my family. Without their support, I might not have survived as long as I had, and I would definitely not have a roof over my head.  That October, my Patrolmen’s Benevolent Association representative met me at my house and presented me with a very nice picture of my shield and ID card laid out on a velvet pillow.  Thinking back on that picture and the loss it represented still affects me to this day.  I am proud of what I accomplished there and the friends and family that I made.

I was on the LVAD for two years before I finally got the call for transplant.  I was volunteering at my daughter’s school as a classroom parent.  At first, I figured it was Dr. Mancini’s assistant telling me to go up or down on blood thinners. It turned out there was a heart available.  I was told that I would need to get to the hospital to be prepped and ready for when the heart arrived.  I had so many mixed emotions but chief among them was sorrow for the person who lost their life.  I did not learn much about that person, other than it was a woman and that her family elected to donate her organs.  

I rushed home, calling my wife at work, and got my bag together for what I knew would be a month-long stay at Columbia Presbyterian.  I could hear the relief in my wife’s voice when I told her they found a match.  Sabrina is a constant planner, the complete opposite of me, and within 15 minutes she had our kids taken care of and arrangements made for anything else that would need attention.  We made it to the highway and were heading toward the hospital in no time.

When we arrived, I was taken straight to surgical prep and awaited my transplant. It is a hard wait for any surgery, but I can’t imagine any procedure being more nerve wracking than having an organ removed to be replaced by another.  My wife spent that time calming me and being solid as a rock.

My surgeon came to the prep room to let me know that it was not my time.  I’m a big guy and the doctor explained that the woman’s heart was too small for my frame.  Luckily, there was a woman that was slighter of build than I who received the heart.  

On the way home, I talked about the experience with my wife.  Having the false alarm was good in a way. It allowed me to see what getting the call would be like and how my wife and I would be able to deal with it.  It eased my thoughts knowing that my wife had a support system with her family and that my kids were being taken care of.

A couple of months later, I got my second call.  This would be the real deal, and I was better prepared for it.  This time, my wife and I were not the only people to wait in the waiting room, the television show NY MED had started taping my experience and the shows field producer, Yvonne Cuellar, was there to record the entire experience.  My portion of the show was never aired, but Yvonne gained my friendship for life when she stayed with my wife through the 16-hour operation, consoling her and being a friendly ear to listen.  I was never interested in the footage of my operation, secretly I was glad it did not air, but I regret not being able to watch some of the footage of my son and daughter during the recording sessions at the house.  My daughter was six and my son three, both listening as I read them stories.

After the operation, I was in the hospital for four weeks. The original estimate was one and a half months, but due to my age and determination to listen to my doctors’ orders, I was able to leave early.  Most people do not realize that the first year of transplantation is the most crucial.  The risk of rejection is high and the immunosuppressive drugs take a lot out of you.  For that first year, I spent a lot of time just healing and trying to get back into a routine.  My first trip to the grocery store felt like I was preparing for an expedition to a foreign planet: Lysol wipes, surgical mask, hand sanitizer. I made sure I brought it all. Going into the grocery with the surgical mask in place, I felt very insecure.

As the months passed and I got closer to my one-year anniversary, I became stronger and more like myself before I got sick.  I picked up some old hobbies that I thought I would never do again.  I was able to go shooting for the first time in about three years. I was rusty and out of practice, but it felt great to be on the range again.  

After the first year was over, my wife began talking about moving out of New York. I was skeptical at first, the idea of leaving my transplant team was terrifying and I have only ever lived in New York.  I could tell she had been preparing for this discussion because the first thing she did was bring up that we could move to North Carolina to be closer to my side of the family.  She brought up that Duke had an excellent transplant program. She also pointed out that my father had been looking into the transplant program at Wake Baptist.  The cherry on top was when she handed me my iPad with one of those home finder websites bookmarking three very nice houses for sale in Winston-Salem, North Carolina.  

Small story short, we looked at all of those houses and decided on a beautiful home in the perfect neighborhood.  I worried about getting back to work, but my prayers were answered with a job ad placed by the state of North Carolina hiring for driver’s license examiners. I interviewed with some terrific people who looked past my disability and gave me a chance to work for my new home state.  

The best part about working for the NCDMV is that I get to talk to people about organ donation every day.  I get to interact with truly selfless people who are willing to share a part of themselves with total strangers.  My donor is one of the most important persons in my life. I never had the chance to thank him for his gift to me and my family, but my new job with the state gives me the opportunity to thank each and every donor that sits at my desk.

The partnership between the North Carolina DMV and Donate Life is an important one, and I am truly thankful that they have such amazing people working so hard to save lives.