Registered nurse Tonjula Shelby, a care coordinator in the Division of Cardiovascular Diseases, heart transplant patient R.J. Stewart and Dr. Gabriel Hernandez are celebrating R.J.’s good health as he enters his second year with a new heart. (UMMC Photo)
Story written and submitted by UMMC:
Like a lot of young adults, R.J. Stewart is sometimes glued to his cell phone and enjoys hanging out with family and friends.
R.J. graduated from Provine High in Jackson in May 2019 and began a workforce training program. But that July, he told his mother that he didn’t feel well and that his stomach hurt. “I thought he just didn’t want to go to work,” Angela Stewart said of her son, who is developmentally delayed. “He said he was cold, but he didn’t have fever.”
After his condition considerably worsened in September, he was diagnosed and treated for mild pneumonia. “He stayed off work for a few days and then went back, but he still didn’t feel good,” his mother said.
She took him to a metro-area Emergency Department, and staff performed an X-ray. “They asked if he smokes, or if he drinks,” Angela said. “They said, ‘It’s his heart.’ I would have never connected it to his heart.”
Told that organ was operating at 15 percent of its capacity, R.J. was admitted. Days later, hospital staff “said he needed to go to the University,” Angela said.
That’s when Tonjula Shelby, Angela’s cousin and a veteran nurse and care coordinator in the University of Mississippi Medical Center’s Division of Cardiovascular Diseases, entered the picture. “Once I found out what was happening, I saw that he was in heart failure,” she said. “He needed a higher level of care.”
Shelby worked quickly with Dr. Michael Hall, a cardiologist and associate professor of medicine in the division who happened to be on service at the time, to get R.J. admitted to the cardiovascular intensive care unit on Sept. 23, 2019.
“I kept praying,” R.J. said. “I couldn’t eat a lot, because it hurt.”
R.J.’s initial caregivers included Dr. Gabriel Hernandez, a cardiologist and assistant professor of medicine in the division. “I joined UMMC two weeks before R.J. came to us. He was one of my first patients in the ICU,” Hernandez said.
Hernandez saw that R.J.’s condition was dire. “He had lost weight very quickly, and was heading into the muscle-wasting stage of heart failure,” Hernandez said. “He was sitting in a chair. He wasn’t in the bed, flat on his back, because he was having difficulty breathing.”
When Hernandez asked R.J. to bend forward so that he could listen to his lungs, RJ literally collapsed in his arms. “In my hands, he passed out. He was cold and sweating,” Hernandez said. “We took him to the catheterization lab immediately. The amount of blood flow his heart was producing wasn’t enough to sustain life.”
Hernandez placed an intra-aortic balloon pump, a temporary device to support heart function, in R.J.’s femoral artery. Hernandez and R.J.’s medical team, however, saw that he wasn’t a good candidate for long-term mechanical support.
R.J. has an abundance of family support and prayer warriors. That helped Angela cope as she became more and more worried about her son. “In that moment, I was afraid I would lose my baby,” she said of when R.J. was wheeled to the cath lab.
“R.J. was very scared, but he understood we were trying to help him,” Hernandez said. “He was a great patient.”
Two weeks after his arrival at the Medical Center, R.J. had heart transplant surgery on Oct. 11 after an organ large enough to replace his diseased one became available. “His heart was big and round, like a basketball,” Hernandez said. “It took a lot of support and faith to get the right donor at the right moment.”
A transplant team led by Dr. Brian Kogon, division chief of Pediatric and Congenital Heart Surgery, performed the six-hour procedure. “He was pretty darn sick at the time of transplant,” Kogon said. “Everyone is on a different spectrum. Some decline rapidly, and in some folks, that happens very quickly.”
R.J.’s recovery was remarkable. “Within a week, he was walking around in the ICU,” Hernandez said. And although the COVID-19 pandemic has kept him from returning to work, “R.J. hasn’t changed,” his mom said of her 20-year-old. “He does what he wants to do.”
Of all the surgeries he performs, Kogon said, “transplant is one of my favorite things. You really do take someone who is deathly ill and make them remarkably better in a very short period of time.”
Along with Hernandez, those keeping close tabs on R.J. in his post-transplant management include cardiologists Dr. Craig Long, associate professor, and Dr. Charles Moore, professor; and registered nurse Brennett Brown, R.J.’s heart transplant coordinator.
R.J. is seen annually in the adult heart catheterization lab for a heart function check. That can cause anxiety for R.J., but the team dotes on him and gives him the encouragement he needs.
“Every single week for the first month, we had to do a heart biopsy,” Hernandez said. “That’s what developed a bond between R.J. and the cath lab staff.”
Matt Howard, an RN and one of R.J.’s cath lab caregivers until recently moving to the cardiovascular holding area, bought a stuffed frog for R.J. to help him cope with his anxiety during procedures. “He’s pretty quiet, but if you get to know him, he’ll joke around,” Howard said. “He’s very into what is going on around him.”
R.J. “reminded me of my oldest son,” Howard said. “I wanted to treat and care for him the same way that I would want my son cared for if he were to go through all of this.”
“We let him know we are there for him,” said Taylor Little, a registered nurse in the lab. “He came up here on Halloween, and we were dressed up and looking silly.”
Howard “is R.J.’s number one favorite,” Little said. “I make it my mission to be his number two favorite.”
R.J. and his doctors may never know exactly what caused his heart to fail. “The fact that he hasn’t shown any rejection or infection in his first year is reassuring,” Hernandez said.
Over the Christmas holidays, R.J. and his mom paid tribute to their transplant team by raising money for the University Transplant Guild. “Our friends and family helped,” Angela said.
“It really is a full circle of giving,” said Olivia Milner, an administrative assistant with University Transplant and president of the Guild. “I am personally humbled by the time, dedication and willingness to help others that this family has shown.”
It’s R.J. who, despite his health challenges, is the generous one, his family says.
“I call him gifted,” Angela said.
“R.J. brings joy to us,” Hernandez said. “At his first year post-transplant, he’s has no coronary blockage or signs of rejection, and this makes us feel that he will have this heart for the long run.”