Transplant surgeon reflects on a lifetime of patients, career

The hands that wrapped themselves around the hearts of hundreds of patients during transplant operations now find themselves occasionally wrapped around the grip of a 7-iron.

Jack Crumbley, M.D., who enabled his patients to add new chapters to their lives through life-saving surgery, has begun his own new chapter.

Retirement.

Sort of.

He still sees patients when working night shifts at the Ralph H. Johnson VA Medical Center, treating emergency cases and overseeing the work of medical residents.

But now he has more time to indulge himself in hobbies like golf and nature hikes.

And his golfing partners may often be his former patients, whose lives he extended with their new hearts. He has invitations to play from across South Carolina.

“I’ve liked golf forever,” he tells a visitor in his Gazes building office, “and now I’m actually getting to play some.”

The esteem that his former patients have for him transcends rounds of golf, however. There is at least one dog named after him as well as a winning race horse. One wonders if there are children named Jackson — other than one of his sons — running around South Carolina in tribute to him.

Crumbley performed the state’s first heart transplant in 1987: his patient, a 12-year-old boy. Although he had been involved in more than two dozen procedures at the University of Minnesota, where he was recruited by then-MUSC surgery chairman Fred Crawford, M.D., the prospect of starting a heart transplant program from scratch was daunting.

“Absolutely terrified — absolutely terrified,” he says. “It’s a very lonely thing to be several hundred miles away from any other person who knows how to do what you’re expected to do. And, boy, I spent a lot of time on the telephone calling my friends and asking what to do, and calling people I never even knew to ask advice about this, that, and the other thing, and they were always very helpful.”

And stepping into the MUSC operating suite where his first transplant patient awaited? “I was scared to death, but 24 hours later, the kid’s eating a hamburger — what better press can you get than that?”

Crumbley is quick to spread praise for the program’s early success to his colleagues, including Crawford; John Kratz, who became the program’s donor surgeon; Walt Uber, Pharm.D.; the late anesthesiologist Mitch Hollon, who managed anesthesia for each of the first 40 transplants; and his first transplant coordinator, Cassandra McFadden. At crucial times during the program’s startup, Crumbley says, the right people just fell “out of the sky.”

“The Lord seemed to provide experts when I needed them most. You just can’t be any luckier,” he says. “You just can’t be any luckier.”

Cardiac Transplant Medical Director Adrian Van Bakel, M.D., Ph.D., has been with the program since 1991, and recalls the early years when Crumbley not only performed the surgery, but managed the patients after the operations.

“Once they were transplanted, Jack did everything for those first four years,” Van Bakel recalls. “He managed them at the bedside right after the surgery, he managed all their immunosuppression, he saw them in clinic and made rounds on them every day. It became so busy that in order to maintain his surgical schedule, they needed somebody on the cardiology side to do medical management after transplant. So that’s where I came in.”

Crumbley and Van Bakel worked so closely together over the years that their relationship was like that of an old married couple, according to Crumbley. “Sometimes we fight like cats and dogs, but don’t anybody dare to say anything about him that’s not right, and I think he would protect me the same way. You can always depend on him. You can always know that he’ll do the right thing, and he’ll be there.”

Van Bakel concurs.

“If you called Jack for advice at 1 a.m., he would give you advice over the phone, but then an hour later, he would show up at your side to help, even when you didn’t ask him. That, to me, is a friend and a colleague and someone who really is dedicated to excellent patient care.

“If we ever got into disagreements or arguments, it would fester a bit for me, but for him, the next day everything was fine. He never held it in or thought less of you for disagreeing with him. And vice versa, sometimes Jack would call me in the middle of the night while he was doing a transplant and say, ‘Something’s not working right,’ so I’d get ready to come in.

“It’s been an interesting and, I think, very rewarding relationship working with him,” he says.

As a member of an organ transplant team, your time is very often not your own. You go when the call of a donor heart comes in. Once, the team performed a “hat trick,” three heart transplants in a 24-hour span. Family plans, holidays and vacations can be trashed with one phone call. During one Christmas, Crumbley was so concerned about a patient’s prognosis, he stayed by his bedside for several days, never leaving the hospital.

“There were times when he gave up vacations because we would get a donor call just when he was ready to leave town, and he would say, ‘No, I’m going to stay, and I’m going to do this transplant.’ He gave up a lot, at least in the first 10 years,” Van Bakel says.

Crumbley credits his wife, Tricia, a former nurse, for keeping things stable on the homefront during his unpredictable schedule.

“It takes an extraordinarily strong woman to stand in for all the times you’re not there,” he says. “She’d pack the kids up and go camping even when I couldn’t go. She’s an exceptionally independent woman. She filled in and did everything that I couldn’t always do.”

The family aspect extends far beyond that of his household and his professional relationships. At a retirement reception for him in November 2016, more than 110 patients and their families showed up to pay him tribute.

“I still see those patients every day in clinic,” says adult heart transplant coordinator Heather Geffert. “They’re happy for him to move on to the retirement phase, but they miss him sorely. They reference him as a brother figure, a father figure, a friend. I think there’s a tremendous difference between a doctor and a physician. Any doctor can diagnose and treat patients, but a good physician imparts wisdom, gives guidance, and has a tailored knowledge of his patients. He’s one of the greatest physicians, and if you would ask any of his patients, that’s what they would say about him.”

John Fox of Seabrook Island has the distinction of being Crumbley’s longest surviving patient, receiving one heart in 1988 and a second 10 years later.

“Dr. Crumbley is amazing,” Fox says. “He’s kept me alive for 28 years.”

Just as impressive as Crumbley’s surgical skills is his personality, according to Fox. “Even when you saw him late in the day, 6:30 or 7, he was always the same person, your friend and your doctor,” he says. “He’s a genuinely nice person, like Marcus Welby (a fictional TV doctor with a kind bedside manner), nice to be around. Some doctors are great doctors, but not nice people. I’m sad to see him go, but I’m glad he’s getting to do what he wants to do.

“He’s a part of my life.”

Holly Patterson of McClellanville, who received her heart in 1999, says Crumbley is “just a really cool guy.”

Through the high times and low times in her life, Crumbley was always there to counsel her. “He was never critical of me because I wasn’t the perfect patient,” she says. “I feel that God gave him a gift and he answered God’s call.”

Although academia and medical centers provided Crumbley’s knowledge and skills, it was his father, a surgeon, who showed him how to relate to his patients.

“I learned medicine in medical school, learned surgery as a resident, learned transplant as a fellow, but I learned how to be a doctor from my daddy. Watching him growing up, you get an idea of what a doctor’s supposed to be,” Crumbley says.

From his father, Crumbley learned how to personally connect with his patients, to talk about their interests, their families, to escape, if only for a moment, their health. “Not everybody does that, and I would say, what do you mean, not everybody does that? Because my dad would come home and say, ‘I got a patient who’s a long-haul truck driver, and he was telling me about doing this or doing that.’ My dad would tell me — not about his patients’ medical stuff — but about the interesting people he met. It just sort of seemed normal to me.”

Crumbley himself has developed many interests beyond medicine. He’s a naturalist and a bird watcher. He’s a scuba diver and, of course, a golfer.

“As time went on,” Van Bakel recalls, “particularly as he shifted out of a surgeon’s role and into more of a medical colleague, an internal medicine colleague, I got to know his personality a little bit better. We would occasionally go to national meetings together, and he was a lot of fun outside the hospital. He had a very broad range of knowledge about things and was interesting to talk to — politics, literature, anything he was interested in. He’s one of those guys who, if he became interested in a subject, he’d become highly knowledgeable in a short period of time, at least more than I would be. He likes history — that’s another subject he was pretty well up on.”

Geffert agrees. “He’s an extremely well-rounded man, truly like a Renaissance man,” she says. “We worked so closely together. He truly became my friend. We share a love of nature and birding and an insatiable curiosity about the world.”   

Eventually, the hands that gently placed hearts into the chests of 227 patients at MUSC began to betray him. Crumbley developed benign essential tremor, a neurological disorder that causes involuntary shaking, most commonly of the hands. It forced him to stop surgery.

“You see me sipping on the decaf, but I’m a two-handed drinker,” he says. “It became obvious to me that it wasn’t safe to operate anymore. Not because I couldn’t do 90 percent of it, but because of the 10 percent I didn’t think I could safely do. I guess the closest thing people think of is being a pilot and being grounded. It was hard to do that, but you know, if you’re not safe, you’re not safe, and your ego shouldn’t get in the way of what’s the right thing to do.”

He shifted his energy more to internal medicine and became board-certified in critical care. He even spent some time in the neurological intensive care unit. Now, he works nights at the VA hospital.

“I keep my foot in the door,” he says. “I’m a vet. I like taking care of the vets. I feel like it’s an important thing, especially nowadays. Our VA, it’s in the top 10 percentile in terms of medical quality anyway. It just sort of seems like the next comfortable place. I guess I’m kinda the fireman. There are things I do to sort of watch over the residents and be a resource for them. For example, I see every emergency admission that comes in the VA. I manage transfers into the medical service, at least. It seemed like a good thing to do at the time. But it’s not the same as taking care of the transplant patients, that’s for sure. And I’ll do that until the VA doesn’t need me or tells me something different to do.”

What hasn’t changed, however, are the bonds he built over the years with his transplant patients and his colleagues. He compares his time as a transplant surgeon to that of your local family doctor. When he learns of the passing of one of his patients, he makes every effort to attend the funeral. It’s what a family doctor would do.

“I got to do something that nobody else gets to do. Surgeons are surgeons, and family practice and internists are family practice and internists. And if you’re a small-town doc, you know everybody in town, and their children, and you know what they do for a living. And it’s been that way, taking care of the transplant patients, having my own little town practice, except they’re all way more interesting, scattered about, and they’re all just so nice. They’re so kind and so easy to take care of. Although medically they’re difficult, very, very, very few of them are personally difficult.

“They gave you the opportunity to be an intimate part of their life, and if you’re an intimate part of someone’s life, then it’s like going to a funeral for family. They get to be like family — a big family,” he says. “I tell you what, those people have been one of the biggest blessings in my life.”

When Geffert sees her transplant patients in clinic, they still talk about how much they miss Crumbley. What one person told her stays with her to this day. “Our long-time patient, Jack Whack, said it best, ‘You know, I miss him like I miss a long, cold drink of water.’ How perfect. There’s no other way to express that kind of yearning for something when you can’t have it. A long cold drink of water — what can replace that? Not much of anything.”