Dr. Robert Montgomery beat the odds - and his own genetics - to become a world-renowned transplant surgeon. Until his heart stopped, and he was in desperate need of a new organ.
Season 1 Episode 1 - I Died Seven Times
Feature: Dr. Robert Montgomery, MD, PhD
Narration: Maggi van Dorn
Dr. Robert Montgomery: So for breakfast today, I had scones that my wife made yesterday because I had a heart biopsy yesterday. And that's how our little tradition, every time I get a biopsy, she makes scones.
Maggi van Dorn: A biopsy is usually done in patients who have received a heart transplant to check for rejection. It is not usually done in doctors who perform transplant surgeries.
RM: My name is Robert Montgomery. I'm the Director of the NYU Langone Transplant Institute. We have about 120,000 people waiting for a life saving transplant. About 40 percent of those people on the list will either die or become too ill before they get an organ.
MVD: Not long ago, Dr. Montgomery was almost part of that 40 percent.
RM: I basically died seven times, and either been brought back by the device or I had prolonged CPR. Basically they said, this isn't compatible with you being a surgeon. That’s what I wanted to do with my life and I wasn't ready to give in to that.
MVD: From SiriusXM and NYU Langone Health, this is Vital Signs, where medicine is made personal. I’m your host, Maggi Van Dorn.
MVD: Taking organs from one person and putting them into another is pretty remarkable when you think about it. It all started in the 1950s with a kidney transplant between identical twins. And the next generation of physicians were charged with perfecting transplantation, and making it more widely available. And the reason it's taken decades to achieve this?
RM: I mean they're all foreign, right? They’re all viewed as being invaders! Because we recognize what's self and what's non-self. And when you get a cold or the flu, the virus, your body recognizes that virus as non-self and attacks it. Same thing happens to, uh, an organ from another person. The body knows that's not your organ and it's constantly trying to get rid of it. And so our job really has been to fool the body into thinking that it's okay. It's not gonna hurt you. It's gonna help you.
MVD: In order to fool the body into accepting a new organ as one of its own, you need a match, that is, a donor who shares enough genetic material with the recipient. Today, we don’t need to rely on family matches. And that’s because of a new surgery Dr. Montgomery helped start at Johns Hopkins in the 90s, called laparoscopic donor nephrectomy. It’s a minimally invasive procedure, meaning it uses small cuts in the skin - or none at all - to remove a kidney from a living donor. It changed the way most people think about organ donation, and resonated with one person in particular.
RM: There was a woman who came, um, in the late 90swho had heard about the laparoscopic nephrectomy and she had always wanted to donate a kidney. Now she could do it like she could justify it. But she didn't know anybody who, um, who needed a transplant. So she said, I want to give my kidney to anyone who needs it. That was a really radical thing back then. At the same time we were starting to deal with this problem of incompatibilities between donors and recipients. And we came up with this idea of that altruistic donor and starting these chains of transplants.
MVD: Here’s how the chain works: A person who is alive and well decides to donate a kidney to anyone who’s a good match. This altruistic donation sets off a chain reaction, where other donors give a kidney to someone waiting for a transplant. In return, patients will get a healthy organ from someone they’ve never met but who is a genetic match. So we no longer need to rely on a match between family members. Altruistic giving means everyone in the chain benefits.
RM: And believe it or not, um, it was illegal when we started doing it. When we set up the transplant system in the United States, there was a, you know, a legislative component of it and in there, they said that you couldn't basically receive something for donating an organ.
MVD: The law was designed to prevent exploiting humans for their organs. But it didn’t anticipate the goodness of people. Which is why Dr. Montgomery was so committed to changing public perception...and eventually, the law.
RM: How can you argue with all these people whose lives have been saved by this. So it hit the press and a lot of people then looked into this and realized that this was an issue. And guess what? We changed the law. It's called the Norwood act. And it was signed by George W. Bush.
MVD: Nearly ten years passed, and Dr. Montgomery carried on as Chief Transplant Surgeon at Johns Hopkins.
RM: I'm kind of a loyal guy. I'm sort of a Cal Ripkin kind of person. I thought, okay, I'm going to spend the rest of my career at Hopkins and retire, you know, get a portrait on the wall.
MVD: And then, one day, the phone rang.
RM: I got a call from Andy Brotman at NYU Langone saying, you know, we have a transplant program that we think needs some help, and we'd like you to come up and have a look at it and tell us what you think we need to do as a consultant.
MVD: Dr. Montgomery agreed to visit NYU Langone Health, but he didn’t intend to stay. That is, until Dean Brotman - and some might say fate - intervened.
RM: He said, you have some great ideas that, you know, I, I really want this to be a transplant center that is going to be relevant ten years from now, not right now. So, we wrote a report, a white paper, and gave it to the Dean and he basically looked at it and said, let's do it. And that's kinda how it happened. One of the best decisions I ever made.
MVD: Not long after his arrival at NYU, Dr. Montgomery started to explore a new way to make organs available to more people.
RM: We're in the midst of this horrible opioid epidemic. I mean, look, last year 50,000 people died from drug overdose. 25 percent of the individuals who die from a, um, drug overdose have hepatitis C.
MVD: As a result of the opioid crisis, more organs than ever were becoming available for donation - but there was a catch.
RM: And guess what, we were, um, unable to use 50% of those perfectly good organs because traditionally we'd only used hepatitis C positive, organs to hepatitis C positive recipients. So, you know, these beautiful organs were being discarded. Right about the same time then these new drugs were in clinical use that cured hepatitis C and we came up with this idea.
MVD: On its face, the idea was simple: transplant hepatitis C infected organs into people who needed them. If - and when - they got Hep C, treat them with the new drugs, and cure them. But would it work?
RM: In the last 18 months, we've transplanted over a hundred organs from hepatitis C positive donors into hepatitis C negative recipients and cured them. All of them were cured. And then of course, the crazy thing that then ensued is that saved my life.
RM: So my story really goes back a long way. Um, when I was 15 years old, my father died from dilated cardiomyopathy, which is a disease of the heart muscle where the heart muscle just deteriorates and it becomes weak, but it also becomes electrically unstable so that it can go into rhythms that lead to it basically stopping.
RM: Transplant wasn't an option. They didn't have good drugs for this. They didn't have an implantable defibrillator. And so, I watched him slowly die. And then he arrested several times and was resuscitated and last time his brain was badly injured. And he was in like a, a vegetative state for a couple of months, which was the hardest part. And then I had to be, kind of, you know, strong figure for my mom who just collapsed from all that trauma. Um, yeah. It definitely… I grew up fast.
MVD: His father’s death was a defining moment for Dr. Montgomery. It changed everything. And as he would soon find out, it wasn’t an isolated event.
RM: So fast forward, I'm a first year surgical resident at Johns Hopkins. I get a phone call from my sister in law at one in the morning, I'm on duty. And she tells me my 35 year old brother just dropped dead while water skiing. And he had an autopsy and he had dilated cardiomyopathy early stages, but you know it created this electrical instability and he had a sudden death from that. Dots were connected. I got on a treadmill and when I was sort of at peak exercise, I started to develop these arrhythmias. Malignant, like, arrhythmias that could lead to death.
MVD: By chance, as Dr. Montgomery was training to be a surgeon an implantable device had just been invented that would shock the heart if it started beating erratically, or stopped.
RM: So I was the first surgeon in the world who had one of these implanted. It was one of the early prototypes. It was big. It was implanted in my abdomen. They had to open my chest and put these patches, you know, sort of like the paddles that you see in, you know, on um, Grey's anatomy, people shocking people with the paddles. That's all sort of shrunk down and put inside your body. Now it's just a little tiny thing you wear up on your shoulder. Basically they said, this isn't compatible with you being a surgeon. My mentor was somebody who, he really listened to me and he said, okay, well let's see what we can do. And I went into the lab to do research for several years. I went to Oxford Actually and did a PhD.
MVD: Oxford would allow him the chance to dive into research, and the space to think about how he’d reconcile his medical career with his medical condition. But it wasn’t long before he was forced to confront the issue once more.
RM: There was a car accident in front of our house, and I went out and the car was overturned. There was a baby strapped in a child seat in the backseat. And I crawled in to get this baby out of the car, and my device went off three times because of that adrenaline, that surge of adrenaline. When this device goes off, it's like getting hit by a two by four in the chest and you know, not expecting it. That was a moment that potentially could have been very crippling psychologically. So I called him my cardiologist. I said, what am I going to do? You know, is this going to be happening all the time? And he said, I think you've just experienced the worst that you're ever going to have.
RM: Uh, it was a real formative moment of building resilience, which was the only thing that's really gotten me through all this is just learning how to be resilient, how to go on, when your legs are knocked out from under you get up again.
MVD: Being a surgeon takes a lot of training: how to make incisions, connect vital organs, remove invasive tumors, and suture a patient back up again. Much of it is technical. For Doctor Montgomery, it was also mental.
RM: So adrenaline, as we all know, makes it beat harder and faster. And if you have the possibility of a short circuit in the system, that's when it's gonna come out. I just had to train my mind that when I was under great stress, when everything was falling apart around me, like it does in the operating room, I had to be the one that was not part of that chaos. I had to be the one that was in perfect control of my body and my mind. The most important thought was: Okay, I could die doing this. Right? What could be worse than that? So anything less than dying is ok. So that was like the initial thought that I had, like what there to be afraid of?
MVD: Dr. Montgomery finished his training and, by his own description, lived a pretty stable life for about 30 years. Except for those times he nearly died.
RM: I basically died seven times and either been brought back by the device or, in a couple of instances the device didn't do what it was supposed to do and I had prolonged CPR. Broken ribs, broken spine from that.
MVD: Each time, he was able to bounce back, though slightly weaker than before. But you can’t outrun genetics forever.
RM: One time I collapsed in, uh, Argentina and I was on a ventilator for three weeks in a coma. Kinda shook that off somehow. I had to relearn how to walk and talk and eat and everything.
RM: And then it all sort of led up to a little over a year ago, I was at a medical meeting in this little town in Italy. Matera, it's called. And I developed what's called ventricular storm, so I just, my heart just kept arresting, you know, and then I'd get shocked. And then I'd have another arrest. And they took me to this little tiny little hospital in the middle of nowhere and they kind of pseudo stabilized me. And there was a priest standing there when I came in and gave me the last rites. And the next morning, um, I looked at all these very earnest people around my bed and I said, you know, I'm really sorry but I have to go, you know, I gotta get back to the United States and I, I think I really probably need a transplant now. And they were like, oh, that's impossible, that's impossible. So I signed out against medical advice. You know, the Italian people are so wonderful. Rather than just like sort of saying, um, okay, well, goodbye, good luck, they left and they left my IVs in and they gave my friend who was a transplant surgeon, all these resuscitation medications and we got on an airplane and flew back.
MVD: When he returned to the U.S., Dr. Montgomery was critically ill. He spent two and a half weeks in the intensive care unit, not knowing if - or when - a new heart would become available.
RM: After about two and a half weeks of being in the ICU, I got a phone call at four in the morning, from my surgeon, and he said, it's as if you incarnated your donor. Because this is exactly the kind of donor you were talking about. He died of a heroin overdose and he has hepatitis C. And his voice sort of cracked a bit. It was a really emotional call. And I just thought to myself, okay, well, you know, I'm about to start another adventure and we'll see how it turns out. And I just surrendered myself to it. It felt comforting actually to put myself into someone else's hands, you know, not have to rely on myself trying to keep myself alive.
MVD: Dr. Montgomery put his life in the hands of NYU’s heart transplant team, The donor was a young heroin user who had lived a hard life, and died young. It was a life quite different from Dr. Montgomery’s own, where a steady, measured approach was essential to survive. So what did that new heart feel like, beating inside his chest for the first time?
RM: It felt like my heart, it felt like a wild horse. Like, like it was just partying, you know, in a way, like it was just so used to the chemicals, the drugs that my donor had been taking. That it was now in, you know, in this new place, but it wasn't quite ready to give up that identity. It felt like it needed to be settled down, needed to be kind of tamed. And, um, I don't know, maybe that's a crazy thought, but that's how it felt. (Was it tamed?) Yeah. Yeah. It's settled down. It, you know, it took a couple months, but it, it did. And now it's, it just feels like a beautiful heart.
MVD: But this beautiful, brand new heart was not...entirely perfect.
RM: So I got hepatitis C. It showed up in my blood several days after the transplant. And one of the great success stories of certainly my lifetime in medicine has been a cure for hepatitis C. So, soon as it appeared in my blood, I took the medications that kind of appeared in about 2011 in clinical trials. And were a total game changer. And within a couple weeks, the virus was completely eradicated from my body. And I took the pills for two months. There is that kind of ick factor when you tell a patient, I really think that the only way you're gonna get a transplant is if you accept an organ from someone who has been taking IV drugs and is infected with the hepatitis C virus, right? People will recoil. But now I say, I did it, and you should too, because it's probably gonna save your life.
MVD: Dr. Montgomery will speak about his new heart every chance he gets, because no matter the astonishing things he’s achieved as a doctor, his life is now grounded in the gratitude he feels as a patient.
RM: So I've been given this tremendous gift. The gift of, you know, the actual organ. The gift of life The time. And so, you know, I think the impact that that has on me, and it's, it's, you know, this experience is individual. It's different for everybody, but for me, I, you know, it's like, I need to earn it. Every day, you know, in a deliberate way. Um, and that's why I'm here today, you know, telling this story. And this is just one part, one phase, as I sort of plan, like what's next? You know, what are the other ways that I'm going to earn this?
MVD: It has been more than a year since Dr. Montgomery’s surgery. He is back at work at NYU Langone’s Transplant Institute, saving more lives. But with a new heart, comes a new perspective.
RM: I am looking at this differently. I can tell a patient, look, after your kidney transplant, you have a 97 percent chance of having that kidney working one year from now. Okay. But what exactly does that mean? What's their quality of their life going to be like, are they going to be working a year from now? Are they going to be depressed? Are they gonna, you know, have financial problems? And the truth is that people who've had a transplant, they just feel so lucky that they're still alive. But that's a low bar really when you think about it. I mean, we should really be thinking about not just, preserving life, but improving life, enhancing it.
MVD: Before his new heart, Dr. Montgomery’s future was uncertain. Now, he’s thinking not only about his own life, he’s plotting the next revolution in organ transplantation.
RM: All these things that we've done, I've been great and they've saved lives. They've saved my life. But the future is going to be a moonshot. We've gotten really good at what we're doing, but 40 percent of our patients don't make it across the finish line. And that's pretty unacceptable, I think. I think the future, it’s an unlimited renewable source of organs. Bioartificial organs and xenotransplantation using pig organs that have been genetically engineered to make them easier for the human immune system to accept. That’s what the future is.
MVD: While the future may bring bioengineered and artificial organs, we must rely on organ donation for now. And for that, it’s the thoughtfulness of ordinary people that still saves lives.
RM: None of us like to think about dying. But we do a lot of things, you know, we, we get life insurance policies, we plan our estates and things like that. And one of those things should be a discussion with your family about what your desires are in terms of what it should be done with your body and your organs when you die. And I think to not have that discussion transfers a burden onto your loved ones at the worst moment for them to have to shoulder that burden. You know I would never presume and say, well everybody should donate their organs. It's a personal decision. But whatever your decision is, first of all, make a decision. And secondly, let other people know what it is. This is really a way you can be a hero at the end of your life, you know, and really transform and save other people's lives.
MVD: Dr. Montgomery’s life was prolonged numerous times, until it was finally saved - by the most selfless gift one person can give another. It’s something all of us can do, and only takes a minute. For more information about organ donation, or to sign up to donate, visit OrganDonor.gov. And be sure to let family and friends know, so that they can support your wishes.
CREDITS
Vital Signs is a co-production of NYU Langone Health and SiriusXM.
The podcast is produced by Jim Bilodeau, Julie Kanfer, Rob Schulte and Keith King, with sound design by Jim Bilodeau and writing from Julie Kanfer.
SiriusXM’s executive producers are Beth Ameen and me, Maggi van Dorn, in partnership with Allison Clair and Jim Mandler of NYU Langone Health.
Don’t miss a single episode of Vital Signs and subscribe for free wherever you listen to podcasts. To hear more from the world-renowned doctors at NYU Langone, tune into Doctor Radio on SiriusXM channel 110. Or listen anytime on the SiriusXM app.
For the Vital Signs podcast, I’m Maggi Van Dorn. Join us next time as we bring you the stories of medicine made persona.