Twenty-five years after her lung transplant, Pam Smith makes the annual 200-mile trip from her home in Athens, Tenn., to Vanderbilt University Medical Center for her checkup at the Vanderbilt Clinic.(Photo: John Russell / Vanderbilt University)
Pam Smith started the day at her mom’s, eating the holiday’s leftover turkey and dressing. Then she swung by Roses department store to do a bit of shopping. And then back home, where she fixed the VCR to watch her favorite soap, “Days of Our Lives.”
She had just settled in when the phone rang.
Tired, she didn’t want to answer it. It had been a difficult day, moving about with her oxygen tank from one place to another.
But she got up anyway, and when she said hello the doctor on the other end said: “When was the last time you ate?”
“That was an odd question,” Smith says, remembering the day 25 years ago. “He never asked me that before.”
Her answer could’ve actually meant life or death. For her, it turned into a life lived longer than anyone ever expected.
Today, the 51-year-old Athens, Tenn., resident is the longest surviving single lung transplant patient in the United States — a milestone Dr. Mark Steele, medical director of the lung transplant program at Vanderbilt University Medical Center, calls “extraordinary.”
Doctors diagnosed Smith with pulmonary arterial hypertension (PAH), a rare lung disorder caused by an elevated blood pressure within the pulmonary arteries, when she was in her early 20s.
The disease killed her dad at age 27. It later took her sister’s life. Even in middle school, Smith never believed she would live longer than her father had.
She had been married five months when she got sick. It jarred her, but it wasn’t death that bothered her most. It was being told not to get pregnant. She wanted nothing more than to become a mom — but her sick body, with its bulging heart and deteriorating lungs, couldn’t handle it.
“That crushed me,” she says.
For nearly a year, Smith’s name sat on the double lung/heart transplant list. With each passing month, her condition deteriorated. She used a wheelchair. She needed oxygen. Even taking a shower left her out of breath. Her feet would swell and her lips would turn blue.
“It was scary,” she says. Finally, her doctors at Vanderbilt moved her to the single lung transplant list.
At the time, doctors considered the surgery radical. Experimental, even. But her surgeons, Bill Frist and Walter Merrill, were willing to adopt such evolving approaches for patients with life-threatening illnesses.
She had to raise $75,000 before she could be listed to have the surgery. Without it, the 26-year-old would die.
Smith was born on the 24th. She divorced her first husband on the 24th.
When she won $1,000 on a lottery scratch-off, it was on the 24th.
And it was early morning on Nov. 24, 1990, when surgeons completed the organ transplant that would extend her life longer than anyone ever expected.
That day, she became the fourth patient to ever receive a transplant in Vanderbilt’s lung transplant program, which began that very same year. When the doctors called and told her to get to the hospital, she remembers burning up the car alternator to get there.
“It’s an almost three-and-a-half-hour drive,” she says. “We made it in two hours.”
The transplant started 10 o’clock at night on Nov. 23. It was a 12-hour surgery, so Smith believes it was after midnight before doctors put her donor’s lung inside her.
She spent the next five weeks on a respirator. She doesn’t remember the first words she said when they took it out, but she does remember asking the doctor when she could go ice skating.
And there was something more: “I could breathe,” she says. “It was just amazing how I could breathe.”
The average survivorship for a single lung transplant is five to seven years, Steele said. Smith has made it 25.
Steele said Smith’s body managed not to have rejection of the organ, which is one of the primary reasons for losing patients after a lung transplant. The lung, he said, has the highest acute rejection rate of any solid organ.
Smith also has tolerated the resulting chronic immune suppression without complication. Normally patients experience kidney failure, serious infection, serious malignancy. Smith has had some skin cancers, Steele said, but they have been identified early and removed.
And Smith survives.
“This is gold,” she says, “because I’m not supposed to be here.”
Steele doesn’t know what is next for his patient. “We can’t predict the future,” he said, “and we don’t have experience with individuals like her.” But Smith is set on small steps — becoming a 30-year survivor is what’s next for her, she says.
Now she spends her days with her second husband, Paul, the man to whom she has been married 21 years. She goes to the YMCA several times a week to use the step machine and lift weights. She volunteers doing children’s ministry at church. And she serves as a support counselor for other possible transplant patients looking for perspective.
She thinks often of her donor, a young man from Nashville who died in a motorcycle crash. Smith got his left lung; his right lung had pneumonia. She has always wanted to know his family, to thank them, but they have never connected.
Last month, on the 25th anniversary of her transplant, Smith stood outside her home and released a red balloon in his honor.
She watched it until she couldn’t see it any more, up in the clouds, and remembered him, even though she didn’t know him.
Reach Jessica Bliss at 615-259-8253 and on Twitter @jlbliss.
By the numbers
25 years: Time passed since Pam Smith received her single lung transplant at Vanderbilt University Medical Center. Smith, a 51-year-old Athens, Tenn., resident, is the longest surviving single lung transplant patient in the United States and the second-longest known in the world, according to Clinical Transplants 2014, a publication of the Terasaki Research Institute.
95 percent: The one-year survival rate for Vanderbilt’s lung transplant patients, according to Dr. Mark Steele, medical director of the lung transplant program at Vanderbilt. That rate is above the national average, according to the Scientific Registry of Transplant Recipients, a national database that tracks patient outcomes for all transplant centers in the United States.
401 transplants: Number performed since the start of the lung transplant program at Vanderbilt in 1990, according to Vanderbilt Transplant Center data. In the program’s first year, there were five transplants. The transplant center is on track for the largest lung transplant volume this year. A record 26 transplants have been completed, and there are six patients on the waiting list at Vanderbilt.
75 percent: Vanderbilt’s three-year survival rate for lung transplant patients. Survival rates for lung transplants typically begin to taper off after the first year, Steele said. The five- to six-year survival rate falls to around 50 percent.
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