Tx. Man with Rare Medical Condition Survives 2 Brushes with Death

Sept. 12--Jim Hewgley III of The Hills near Lakeway is one in a million. Make that several million.

He has a collection of rare conditions -- not the least of which is having all of his organs reversed, including his heart on the right side of his chest. And he recently survived two catastrophes, both of which could have killed him.

"I feel charmed," Jim said. "And grateful ... grateful that I can wake up in the morning."

Heart doctors in Houston who treat patients from around the world said they have never seen anyone quite like him. He even surprised famed heart surgeon Denton Cooley, who stitched up a hole in Jim's heart at age 14.

After that, Jim was more likely to joke with nurses befuddled by his anatomy than to worry about it. Dying was last thing on his mind March 14, a blue-sky day of outdoor fun until he suffered sudden cardiac death.

Since then, Jim, now 67, and his wife, Anne Hewgley, have learned about the importance of CPR, about fate and about the wonders and limits of modern medicine.

"For me, it makes everything more precious," Anne, 65, said. "It's made our relationships with all of our family better and there's an awareness of not taking things for granted."

From Midland to Lakeway

The oldest of three boys, Jim briefly went to the same elementary school as George W. Bush in Midland, where his dad and W.'s father were friends and occasional oil business partners.

In 1954, Jim's family moved to Tulsa, Oklahoma, where his father later became mayor. Jim knew as a boy his organs were flipped -- a little-understood anomaly found in 0.01 percent of the population -- but played football and basketball with abandon. He had yearly physicals and electrocardiograms to monitor the hole in his heart, which caused a murmur but did not interfere with his life.

"I had a lot of fun with the nurses at the clinics, telling them to hook me up backwards," he said.

In 1962, Jim's parents took him to Houston, where Cooley performed the open heart surgery. "Technology caught up to my hole," Jim said.

What Cooley, Jim and his family didn't know until then was that Jim also has Tetralogy of Fallot, a combination of four heart defects that include an enlarged aortic valve, a thickening in the right ventricle and restricted blood flow to the lungs that causes "blue babies." Jim didn't have that telltale bluish skin and believes he was the first patient Cooley had operated on with those conditions, plus flipped organs.

Even so, the operation went smoothly. Jim remembers Cooley, now 95, visiting his room. "He was a real tall guy and did rounds with 20 people following him." Cooley would go on to do the world's first temporary artificial heart implant in 1969.

After his surgery, "I had just a normal life," Jim said.

He graduated from the University of Oklahoma, pursued oil and real estate business ventures, and at age 30, became the youngest person elected to the Tulsa City Commission.

Twenty years ago, Jim married Anne, and the couple left Tulsa for the Lakeway area in 2012 to be near Jim's brothers.

"I like to play golf year-round," Jim said in the kitchen of his home in the gated Hills community. "Anne and I have an aversion to ice."

'Asking God to help'

And that's where he was -- on the golf course -- the day he nearly died.

In all, 13 men were playing together at the nearby Flintrock Falls Golf Course. They were in three groups, and Jim joined the first foursome as the odd man out. They were on the 10th hole.

"I remember getting in the golf cart alone," Jim said, "and my head started spinning."

He felt the cart hit a tree and then blacked out.

Dwight Haley, who was in Jim's group, heard the cart "like it took off real fast" and looked in time to see Jim crash and fly out. Jim was unconscious and convulsing. A few minutes later, he became still and stopped breathing, said Haley, a Lakeway City Council member. That's when Haley started CPR. He was the only one in the group who knew how to do it, he and Jim said.

Two weeks earlier, Haley had taken a refresher course in CPR because his wife asked him to go with her to a class at Lakeway Regional Medical Center. Eighteen years had passed since his last class, and the method had changed. Mouth-to-mouth breaths are no longer done, so Haley put into practice his new training: 100 hard and fast compressions per minute.

"I remember asking God to help me with Jim," Haley said. He had no idea Jim's heart is on the right side, but doctors said that didn't matter; CPR is done in the center of the chest.

In less than a minute, Jim started breathing, Haley said. "He had a surprised look on his face," he said. "I think he was trying to figure out what I was doing sitting on his chest."

Someone called 911, and police and fire units arrived.

"When Jim came to ... it was very emotional," Haley said. "There were some tears and after the medics took over. I had to walk around a little bit and get control of myself."

The doctors say Haley saved Jim's life.

The ambulance, normally at nearby Lakeway Regional, took 14 minutes to arrive, Anne said, because of a horrific accident that killed three people on RM 620.

Jim was in the hospital for seven days while tests were run. Doctors diagnosed an aneurysm at the root of Jim's aorta. He would need surgery, but because of his complex conditions, the hospital recommended he go by ambulance to Houston, where he had had surgery decades earlier.

Remarkably, doctors there retrieved Cooley's records, still kept in an office, from 53 years ago.

Another close call

Dr. C. Huie Lin, director of the adult congenital heart program at Houston Methodist Hospital's DeBakey Heart & Vascular Center, said he had never seen a patient with all of Jim's conditions. As one of only a handful of adult congenital heart specialists in Houston, he found Cooley's records very helpful. He could see exactly what Cooley had done, which also would help the surgeon.

"Our immediate concern was why did he pass out?" Lin said. Sudden cardiac death is often caused by an irregular heart rhythm, so Lin sent Jim to a doctor who implanted a defibrillator to prevent another episode. Jim healed and went back to Houston two months later for the aneurysm repair.

In a complex surgery, Dr. Basel Ramlawi, director of the hospital's aortic network program, replaced the damaged part of the aorta with tissue from a cow and fixed a leaky valve.

"I would commend the team in Austin," Ramlawi said of the doctors at Lakeway Regional. "It's really important to go to a center that has a high volume of these. ... I've done this procedure but never on someone with Tetralogy of Fallot and this type of anatomy."

He estimated that just one to three out of 10 million people have Jim's various conditions.

Jim did well until he woke up at home in late July with a fever. It spiked at 104.4 degrees, and the skin around the defibrillator was red, Anne said. She took him to Lakeway Regional, where doctors determined that the defibrillator "pocket" was infected. The infection could have been fatal.

Doctors removed the device -- the cause of the infection hasn't been determined -- and put Jim on antibiotics. They feared the aortic valve could become infected, so "I got another gurney ride to Houston," Jim said.

The valve was safe, and Lin says Jim is "doing great." Because an irregular heart rhythm might have caused Jim to pass out on the golf course, Lin recommended a new defibrillator. Jim isn't sure he needs it and is undecided.

Lin is handing Jim off to a children's congenital heart specialist he knows in Austin -- someone closer to home.

Not so many decades ago, children with conditions like Jim's didn't live to adulthood, Lin said. Now they do, and Jim's case points to the need for more physicians who specialize in treating adults with congenital defects, he said, adding that Houston Methodist is hosting a symposium Nov. 7 to focus attention on the improved life expectancy of such patients. The Hewgleys plan to go.

Jim's experience also underscores the need for everyone to be trained and up-to-date in CPR, Haley said. Since that day on the golf course, the other men and their wives got trained, Haley said.

"I was just very grateful I had been in that class" two weeks earlier, he said. "The good Lord was looking after Jim."

Jim, who recalls some shortness of breath in the months before his cardiac death, agrees. He is still trying to process all that has happened.

"Several people said, 'You have something better to do.' Maybe I do," he said. "Maybe it's getting the word out about congenital heart problems.

"There's a lot of fate."

"Serendipity," said Anne.

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