At Tufts Medical Center , many patients linger on a waiting list for a new heart. But on June 15, that list — which regularly tops 100 — got a bit shorter.
On that day, surgeons conducted four heart transplants.
Tufts performs the most heart transplants in New England, according to the United Network for Organ Sharing. But four in one day?
"It's not ideal and it stresses the system to the max," said Dr. Frederick Chen, chief of cardiac surgery at Tufts. But when hearts are available for transplant, and they are a match, the hospital has to make it work, he said.
"It is our duty," Chen said.
Tufts has more patients on the transplant list — by far — than any other New England hospital, with 122 people as of June 24. According to the United Network for Organ Sharing, that's more than triple the number of any other hospital in the region.
Jennifer Glover is one of those four patients whose debilitating heart condition brought her to Tufts on June 15 for a transplant. She said her heart used to keep her up at night: "It skipped and jumped and ticked and bopped."
She used to lie in bed, just listening to its irregularities.
Glover, 56, had cardiac sarcoidosis, a rare disease that shut down the left side of her heart. When it set in three years ago, the disease confined Glover to her bed.
"I couldn't do anything," she said. "I couldn't walk 10 feet across the floor."
The list of potential transplant recipients is organized in order of severity, with those with the greatest need at the top. If a hospital can't accept a donation in time, the organ goes to another patient.
And with a heart, there is no time to wait, said Dr. Gregory Couper, a cardiac surgeon at Tufts. When removed from a body, hearts can sit on ice for four or five hours at most, he said, and doctors need to move quickly.
Heart transplants require two surgeries: one on the donor and one on the recipient. Tufts hospital officials said each transplant had its own dedicated team, and neither surgeons nor supporting staff worked on multiple operations at one time. Logistically, it was a challenge, and all other cardiac surgeries scheduled that day were canceled to make room for the four transplants, Couper said.
"It was a very busy day," he said. Each of Tufts' six heart surgeons participated in one or more of the transplants. Couper performed two of the transplants, he said, and spent 12 to 16 hours in operating rooms that day.
"We didn't want our patients to lose out on transplants that could be a once-in-a-lifetime offer," Couper said. "We needed to do the best thing for our patients."
Couper performed Shayla Titus's heart transplant. Titus said she wasn't sure she would live long enough for a new heart; she had been on the wait list for seven years and had a very rare blood type. Titus, 35, was already living with a ventricular assist device, which helps the heart pump blood, and she needed a kidney transplant, too.
At 19, she found out she had cardiomyopathy, a condition that slows the rate of blood flow from the heart. Since then, she has spent her life in and out of hospitals.
On June 14, Titus took a call from a Tufts doctor, who told her that she was getting both a heart and a kidney the next day.
"I was crying waterfalls," she said.
Titus doesn't want to try to recreate her 20s, a time when her precarious medical situation kept her in hospital beds. Now, she just wants to live.
"I just want to be 35," Titus said. "I want to do 35-year-old things, 40-year-old things, 50-year-old things, and, hopefully, 60, 70, and 80. I just want to live the rest of my life."
Doctors told Titus she had been "on a long road," she said. But, for the Rev. William Clark, the opposite is true: After he was diagnosed with cardiomyopathy in September 2015, everything moved quickly.
Clark, a Jesuit priest, landed in the emergency room one night, struggling to breathe. Doctors gave him medicine, but it stopped working. In the six months after that, Clark had two open heart surgeries to install ventricular assist devices. Then, in May, he had a stroke and, as his health worsened, doctors were able to move him up the transplant list.
Like Titus, Clark found out about his new heart the night before the surgery. He was at Tufts an hour later.
After his transplant, Clark said he feels a connection with the other three heart recipients, who, together, hospital officials call "The Fab Four."
He said he doesn't know them personally, but he understands what they went through.
"On that one floor, everyone's dealing with basically the same thing," he said. "You really know what someone's been facing, what it feels like."
For 48-year-old Tom Gruber, Couper's other transplant patient, it felt like a dream. Gruber, who also lived through a stroke, had battled his faulty heart since the 1990s with an assisted ventricular device and a defibrillator.
After his surgery, as the anesthesia wore off, Gruber said he didn't know if he had made it.
"I kept saying, 'Am I dead, or am I alive?' " he said.
Gruber said he didn't believe the answer a nearby nurse gave him. Finally, his father set him straight.
"My dad said, 'It sure seems like you're alive to me,' " he said.
Each of the four patients said they were recovering well. Glover said a reunion celebration could be in their future — a future many of them said they doubted they would ever see.
After her surgery, Glover remembers once again listening to her heartbeat in bed. But this time, it didn't keep her awake.
"It was like a lullaby," she said. "It was the perfect heartbeat."