With a Little Help From Friends -- Little-Known Surgery Saves Officer's Life
By Sgt. 1st Class Kathleen T. Rhem, USA
American Forces Press Service
WASHINGTON, March 13, 2002 In June 2001 Navy Capt. John Pasko was dying. A disabling disease was robbing his lungs of their ability to expand with each breath. He didn't know a little-known surgery and a couple of selfless naval officers were to save his life.
Pulmonary fibrosis causes lungs to lose their elasticity. Most people diagnosed with this disease slowly lose their lung function over four to five years. Pasko was diagnosed with the disease in January 2001 and in desperate need of a transplant by June. Doctors couldn't explain his rapid descent.
At the time, Pasko was a battalion officer at the U.S. Naval Academy in Annapolis, Md. He was a career submariner who commanded the USS Wyoming a year earlier at Naval Submarine Base Kings Bay, Ga.
He was put on the waiting list for a donor lung in the end of May. By June 26, his condition had deteriorated to the point where his doctors at Bethesda (Md.) Naval Medical Center hospitalized him and wanted to put him on a ventilator, a machine that would breathe for him.
Pasko knew once he went on the vent, he wasn't likely to ever get off unless he got a donor lung. He wouldn't allow it. He had something he had to do first. On June 29, he left the hospital and went back to Annapolis to swear in his son, Joey, as a member of the Annapolis Class of 2005.
The captain attended the ceremony in a wheelchair with an oxygen bottle, but stood and administered the oath when the time came to swear in his son. Early the next morning, his wife, Sherry, called 911 because Pasko could hardly breathe, even with supplemental oxygen.
He was placed on a ventilator, and his family began the painful vigil of waiting for a donor lung to be available in time. The call came in early July. A donor had been found, and Pasko was moved to the local transplant center of Inova Fairfax in suburban northern Virginia.
False start. The family soon learned that the lungs weren't acceptable for transplant. It was then that the Inova Fairfax lung-transplant coordinator suggested an experimental procedure available in America only in California.
The University of Southern California runs a hospital that is one of only three in the world that performs living-donor, double-lobe lung transplants.
While Pasko was in a drug-induced coma with a machine breathing for him, his wife set a chain of events in motion that would end on the West Coast with Pasko receiving pieces of two other officers' lungs.
A call went out through the entire close-knit submarine force: John Pasko was dying and needed volunteer donors. Within days, 18 men volunteered, most from Pasko's Navy family.
The two volunteers doctors eventually picked were Capt. Don Boland, Pasko's brother-in-law, and Lt. Cmdr. Scott Fever, who'd been Pasko's navigator aboard the Wyoming. Fever was also stationed in Annapolis and Boland, at the Pentagon.
During the operation, doctors would take one lobe from one lung of each donor and transplant the two into Pasko. Lungs are elastic, so the men's remaining lobe would expand to fill the space left after the surgery.
Pasko explained that doctors removed both his lungs and transplanted one lobe in each side. X-rays today show him with complete lungs, he said.
The Navy had few concerns about allowing the men to be living donors, because their lung capacity was expected to return to normal with no lasting effects from the surgery. The Naval Academy superintendent did call Fever in to make sure he didn't feel pressured because Pasko is a senior officer. Fever told him that was never part of the equation.
Fever said his mother, a nurse, assured him a lobectomy didn't generally entail serious complications. That was good enough for him. "It was like a five-minute call with my mom, and so then I called and said, 'Yes, I'm going to do it,'" he said.
An Air Force medical evacuation crew flew the three men to Los Angeles July 5. Even the flight wasn't lacking in drama. The medical equipment keeping Pasko alive didn't work as efficiently at high altitude. The crew made an emergency landing at Scott Air Force Base, Ill., to make adjustments.
Sherry Pasko said she couldn't describe the relief she felt when the plane landed safely in Los Angeles and her husband was still alive.
"When we landed ... , even the pilot had tears," she said in a Discovery Health Channel documentary about the surgery. "We were just so grateful to have made it."
The five-hour surgery took place at the University of Southern California Hospital July 9. The doctors said it was in the nick of time.
Pasko was kept unconscious for a week after the operation to allow his body more time to recover. When he woke up, he knew he felt better but had no idea what had happened to him. Today, he describes his reaction as "a little bit teary" when USC's transplant coordinator and his wife told him what had happened.
"I was just kind of emotional," he said. "I couldn't verbalize how I really felt."
Fever said he was just relieved to see his old commanding officer breathing on his own. "He was up and talking, and that was something we didn't think we were ever going to see again," he said. "It was a great feeling talking to him and seeing that he was OK."
Boland recovered from his surgery without a hitch, but not so Fever. After returning to Maryland, he suffered a collapsed lung and was rehospitalized for a time. Today, he said, he finds himself out of breath a little more easily but suffers no other ill effects.
Recovery has been a long road for Pasko. His body began rejecting his new lungs while he was still in the hospital in California, and drugs did little to stem the effects. The answer came in the form of monthly photophoresis treatments. The experimental procedure bathes his white blood cells in ultraviolet light and helps keep the white cells from attacking and damaging his new lungs.
The long months of inactivity and hospitalization also caused Pasko's muscles to atrophy. He recalled being too weak to even spoon an ice chip into his mouth when he woke up from surgery.
For a man who ran marathons before he got sick, this has been hard to take. But, Pasko said, he's coming back bit-by-bit. "As I get stronger, things get easier," he said. "Now I can take the stairs three at a time."
He's still not running as much as he'd like. "I thought I'd be running by the end of December," he said. "It's been hard to accept that it's taking longer than I thought I would. But still, I see progress week to week."
He said the ordeal has made him "more understanding of other people, less critical." When he first realized he might die, he said he began figuring God had two possible plans for him.
"Plan A is to die with dignity," Pasko said. "Plan B is to play the back nine better than you play the front nine. I kept praying He wanted me to do Plan B."
That's where he sees himself today, trying to play the back nine better. He has become a vocal supporter of organ donation. When Sherry and John Pasko were first married, her younger brother died at 20 of a brain aneurysm. Her family decided to donate his organs and that, Pasko said, helped them deal with the loss.
"You never get over the loss of a loved one," he said. "But as an organ donor, I think on the anniversary every year you can at least know that there was something good that occurred out of that tragedy you endured.
"I don't think people think that way at the critical moment," Pasko said.
When he was in a coma clinging to life before his surgery, the Navy medically retired him. Now he's trying to get a medical board to reverse that ruling and reinstate him to full active duty.
"I think I still have things I can contribute," he said. "I think just for that experience in the last year it's worth sharing with people."
He said he likes working with the midshipmen at the Academy and wants to leave the Navy on his own terms. "I guess I could just take medical retirement and get another job, but I feel like I still have something to offer for the Navy."
The captain said he needs to still do something for the Navy, because he believes being in the Navy saved his life. He received first-rate care at Bethesda and he credits the treatment he received from doctors there with enabling him to survive long enough to get the transplant.
"I've been in the military 22 years, and I've done my share of griping when your child's got a sore throat and can't be seen," he said. "There's probably some truth to that; there are more people that want to be seen that there are doctors. But when you get in trouble, real trouble, military medicine is really phenomenal. I don't think they get the credit they deserve."
Pasko also said he doesn't believe he would have lived to make it to California without heroic efforts by the Air Force flight crew that delivered him there. "The Air Force and Navy kind of worked hand in hand," he said.
The close-knit nature of the military community allowed Sherry Pasko to reach out and touch so many people willing to give up part of a lung to save her husband's life. In all 18 men volunteered. "That's kind of overwhelming," Pasko said, "to think that that many people would be willing to sacrifice for you."
(Editor's note: The Discovery Health Channel program "Super Surgery" will take an in-depth look at Capt. John Pasko's surgery and recovery March 20 at 8 p.m. Eastern time.)