New breath of life

ON A 2008 winter night, Henry Howell collapsed midway up the staircase in his Darby home. Wild-eyed and gasping for air, Howell fell to his knees, clutching the banister.

In an instant, his lifeline snapped.

The 50-foot plastic tube that snaked from an oxygen machine in the living room to his nostrils got tangled in the railings and yanked loose from the machine.

Howell, then 65, thought he'd die. If not at that moment, soon. Not that he cared. This was no way to live. He couldn't put on a shirt or use the toilet without his wife's help. He couldn't sleep because the constant blast of oxygen through his nostrils was too loud and so cold and dry that it left painful sores in his nose.
Five years ago, doctors diagnosed Howell with pulmonary fibrosis, a severe scarring of the lungs. His lungs were shot, shriveled and mummified.

Not from smoking, Howell believes. He smoked a little as a young man, but hadn't picked up a cigarette in decades.

But Howell said he had years of exposure to asbestos while working for nearly 40 years in maintenance for the Philadelphia Housing Authority.

Howell's doctors said they don't know what caused his lung disease. Asbestos may have played a role, but it's difficult to be sure, they said. Either way, it's indisputable that Howell worked hard his whole life only to be dealt a bad hand.

Philadelphia-area doctors told him that he would die without a double lung transplant. But they also thought he was too old and sickly to undergo the grueling, 7-hour transplant surgery.

They encouraged him to retire and spend time with his family. He spent his days on the couch, too weak to move, tethered to an oxygen machine. He went through 15 tanks of oxygen a week.

Then, when he was just weeks from death, a Pittsburgh transplant team offered Howell a second chance. And this ordinary man mounted a herculean fight to live.

Last summer, Howell underwent a double lung transplant at the University of Pittsburgh Medical Center. Almost overnight, the once-bitter and admittedly self-centered Howell was transformed.

"I came back a better person because I'm so grateful," Howell said. "I don't think about myself no more. I feel for everybody...I know what it is to hurt, to suffer."

With each deep breath, as his new lungs easily balloon with air, Howell thinks of the woman who died too young in a Kentucky hospital and whose family donated her lungs.

"I know that her mother and father had a loss, but I want to let them know that by their daughter leaving, she saved a life," Howell said. "Part of their daughter is in me. She has become my family."

Howell jokes that he's more chatty since getting a woman's lungs. And he has a lot to say.

Danger on the job

Howell decided to tell his story after a Feb. 1 Daily News report that a PHA foreman last year allegedly ordered a work crew to illegally handle and dispose of asbestos debris during plumbing repairs at the Hill Creek Apartments in Crescentville. Howell started at PHA in 1970 — long before people fully knew the hazards of asbestos and nearly 20 years before the city Health Department imposed strict regulations for asbestos removal. But Howell says that even after the dangers became known, PHA did little to protect and educate workers because, in his opinion, the agency didn't want to spend money on asbestos-removal firms.

Maintenance workers like Howell routinely ripped asbestos insulation off leaking pipes and tossed the debris in Dumpsters. Federal and local laws mandate that only trained, licensed contractors may remove asbestos from public buildings, and require asbestos debris to be disposed of in sealed bags, then trucked to a special landfill.

"At least 10 years before I retired, [PHA bosses] knew it was toxic," Howell said. "They knew it, but they didn't do nothing about it....A lot of guys were scared not to do the work."

PHA spokesman Kirk Dorn said the agency has a long-standing policy that when a worker "sees exposed asbestos, he is supposed to leave the room and contact his boss and/or his union representative." PHA then contacts its environmental contractor to handle asbestos removal.

"As a result of your articles, PHA took it upon themselves to give all maintenance workers updated training, which included a reminder about that protocol," Dorn wrote in an e-mail to the Daily News yesterday.

Howell, now 68, said he doesn't plan to sue PHA.

"I was doing a job for the people. Nobody owes me nothing. I don't look for no favors," Howell said, his jaw thrust out, a steely glance at his wife.

Howell's wife, Debora, cries when she thinks about all the years that her husband rose at 5 a.m. and went to work, even when he didn't feel so great.

"He worked hard all of his life — not half of it — but all of it, just to end up like this, on oxygen and unable to breathe?" she said, wiping tears.

Devoted to the job

Howell learned his get-it-done work ethic from his grandmother. As a boy in the early 1950s, Howell worked the family's tobacco farm in Virginia. His grandmother didn't tolerate a "fresh mouth" or excuses. Once, when Howell sneaked a taste of her homemade blackberry wine, she beat him.

"Oh, boy, oh, boy, oh, boy! — she took that switch and tore my hand up," Howell said, smiling. "I miss her right now."

At 18, Howell came north to Philadelphia in hopes of a better life. He got a job making metal ladders and later, aluminum picnic tables — a job that cost him the tip of his right index finger when it got caught in a stamping machine.

In 1970, Howell was hired as a "laborer" at PHA, making about $4 an hour to mop floors and shovel black ash from trash incinerators into metal waste cans. He moved up to mechanic and fixed gas stoves and electric refrigerators in PHA homes. He got promoted to "mechanic foreman" in 1978 — a job he held for nearly three decades, topping out at about $48,000 yearly salary.

His job was to get the work orders done. Howell admits he was a bit of a hard-ass. "Get your ass out of here and get your jobs done!" he'd bark at his men.

"If you didn't come into work, we didn't need you," Howell said. "I'd dock people's pay right across the board. I didn't take no for an answer."

His wife hated those middle-of-the-night calls about some PHA family without heat or electricity.

"We'd get a call at 3 a.m. and 'Mighty Man' here would get out of bed and go to work," she said, looking at Howell.

It was 2004 when Howell first noticed that he got winded easily.

Howell had just finished fixing a clogged pipe at the Johnson Homes site in North Philly. As he walked back to the maintenance shop, he couldn't breathe; he had to stop and rest about 10 times.

At first, Howell thought he just needed to exercise more. "It got worse and then it got better," he said.

Eventually, it only got worse.

Too sick to drive
By 2006, Howell couldn't breathe without oxygen. He felt 100 years old. He crawled up the steps to bed. Some nights he couldn't even do that and slept on the couch.

When Howell and his wife went out, they had to take two oxygen tanks, carting them around on a baby stroller. "I couldn't breathe for 10 seconds on my own and that's a feeling I don't wish on a dog," Howell said. "Every minute, you feel like you're going to die. It's a scary feeling."

He dreaded nights. He'd lie awake next to his slumbering wife, and curse the roar of oxygen in his ears. The gas was frigid. He'd tuck the oxygen tube under an electric heating blanket in hopes of warming the air before it reached his raw sinus cavity. When that didn't work, he'd knock himself out with prescription sleeping pills.

The 2008 night that Howell collapsed on the staircase, his wife heard him wheezing and sprang out of bed. She squeezed past him and quickly plugged the oxygen hose back into the machine.

"I felt like I was going crazy," Howell said. "I felt like I wanted to kill somebody."

Howell grew increasingly cranky and bitter, and at times, angry at PHA. He took all his unused sick pay from PHA — about $1,100 — and put it toward a used 2004 Mercedes Benz SUV, which he purchased for roughly $35,000.

He was too ill to drive it.

Eventually, he was confined to the couch. His wife served him meals on a tray; she brought him a portable potty. She filled a pail with water and helped him wash up.

"I'm very stubborn, and I have a long strong will," Howell said. "I don't like nobody to do nothing for me. I like to do for myself. See, when I stopped doing for myself, you knew I was doing bad."

He went to one doctor, then another, and another. All three told him the same thing. He wouldn't live much longer.

"You get somebody good in your life and you don't want to lose them, you know?," said Debora Howell, who at 57 is nearly a decade younger than her husband.

A chance at life

In March 2009, doctors at the University of Pittsburgh Medical Center threw Howell a rope.

They told him that if he moved closer to Pittsburgh, they'd put him on the list for a lung transplant. Doctors needed Howell to be closer because once lungs are harvested from a donor and placed on ice, the organs are good for only eight to 11 hours.

The Howells rented a ranch house in Pittsburgh for $1,300 a month, while still paying the $675 monthly mortgage on their Darby home.

"It's good I saved," Howell said about his PHA retirement nest egg. (Howell would later tap his life savings for prescription pill co-pays for drugs needed after his lung transplant. For two prescriptions alone, he paid $2,300 a month in co-pays).

That spring, Howell began the anxious wait for new lungs.

"You know what I found out? Hope is everything in this world. That word is more powerful than people think it is," Howell said.

The causes of pulmonary fibrosis are many: Long-term exposure to asbestos fibers, silica dust, tobacco smoke, grain dust, sugar cane, bird and animal droppings. Also, pneumonia, acid reflux, and certain medications, like drugs to treat cardiovascular problems.
Dr. Yoshiya Toyoda, who heads UPMC's Cardiothoracic Transplantation section, knew that Howell was in very bad shape. He had "a couple weeks" left to live, Toyoda estimated.

In May 2009, about two months after the Howells moved to Pittsburgh, they got a call: A pair of lungs was en route.

Turned out, the donor was a smoker and the lungs weren't perfect (Doctors will transplant lungs from a donor who smoked up to one pack of cigarettes a day for 20 years). Howell didn't want to chance it, so the wait continued.

A month later, Howell again got a call. But when the lungs arrived at the hospital, one was damaged.

Howell considered the possibility that he might die while waiting, but he pushed the thought away.

"I felt myself getting weaker, but I refused to let go," Howell said. "I kept on telling myself, 'Unh-unh, not this time.'"

Then, in July, a 45-year-old overweight woman had a massive stroke and was rushed to a Kentucky hospital. Although her heart was still beating, the lungs still getting oxygen, she was brain dead.

The Pittsburgh hospital dispatched a medical team to Kentucky. They opened the woman's chest and stopped her heart by clamping the aorta.

"The moment that the heart stops beating, that means the lungs are not getting air supply," explained Dr. Jnanesh Thacker, a UPMC transplant surgeon. "We take out the lungs and pack them in ice."

The woman, who weighed 243 pounds, was six inches shorter than Howell, but her lungs fit because his chest cavity had shrunk, Thacker said.

It took a medical team, led by Toyoda, about seven hours to stitch the woman's lungs into Howell.

Then came the hard part — Howell's fight back from the brink of death.

Running up steps

Howell spent about two months in ICU before he was well enough to be transferred to the transplant recovery unit on the hospital's 9th floor, where he had to relearn how to walk — and breathe.

"When people have lung disease, they learn to breathe a different way; they take short, shallow breaths through pursed lips," said Howell's nurse, Susan Wasson. "After the transplant, they need to learn how to expand their lungs."

People with healthy lungs take breathing for granted, she mused. "It's a natural thing. You breathe in, you breathe out — you don't really think about it," Wasson said. "When you get lung disease, you become focused on breathing because you can't do it."

Like most patients, Howell was initially afraid to get off the oxygen. "The oxygen tube is sort of like their pacifier," Wasson said. "They go into the [transplant surgery] saying, 'I can't wait to get rid of the oxygen,' and when we tell them that they don't need it anymore, they are terrified to take it out of their nose."

Wasson said Howell stood out among other transplant patients. He was motivated. He practiced walking up and down the hallway. He was "bubbly," she said.

"Just the fact that he could do things for himself again made all the difference in the world," Wasson recalled.

Howell recalled the day that his therapist wanted him to try climbing stairs.

"I closed my eyes and I asked God, 'Let me walk up these steps,' and I ran from the first flight all the way to the second flight — it scared that nurse to death," Howell laughed.

From his window, Howell said he could see hospital helicopters take off and land on an adjacent roof. Sometimes, medical staff would emerge from the helicopter carrying a small case, which he assumed held an organ.

"It's a weird feeling — to know that somebody died so somebody else could be reborn," Howell said. He hopes to someday meet the family of the woman whose lungs he has and thank them. Last week, Howell's wife sent her family a letter through the hospital. "I never dreamed I'd pull through," he said.

The will to live
Howell returned home to Darby around Christmastime.

In the middle of the night, his wife hears him walking up and down the steps — with a five-pound weight in each hand.

"He walks up real fast, then runs back down," Debora Howell said. "I say, 'Henry, what are you doing?' He says, 'I'm exercising. Leave me alone!'"

He must travel to Pittsburgh every two months so doctors can make sure his new lungs are working properly.

For the rest of his life, Howell must take medicine.

Inevitably, his body will eventually reject his lungs. How long will Howell live?

Fifty to 55 percent of double-lung transplant patients live for five years after surgery, said Toyoda, who performed Howell's surgery. Some patients live more than 10 years.

Maybe Howell will beat all odds, Thacker, a transplant surgeon, said. "Every individual is greater than any statistic," Thacker said. "Mr. Howell could live for 15 years. He could live for 20. All he needs is a burning desire to live."

Last week, the hospital called to tell Howell that an April 1 biopsy of his lungs showed signs of rejection. But if there is one thing Howell has, it's a burning desire to live.

"I think people leave this Earth because they are not fighters," Howell said. "You got to be a fighter...I refuse to give up."