Downing dozens of nitroglycerin pills and fighting chest pain, the woman from Delaware and the man from Kentucky each arrived at Johns Hopkins Hospital last fall. They were patients Nos. 1 and 2 in an experimental heart treatment, sick people eager to grab their last chance at a normal life.
Between them, they could count dozens of hospitalizations, 26 cardiac catheterizations, nine angioplasties and five bypass surgeries. Each had suffered a heart attack, and each had become resigned to a life alone. She was a widow. He, a divorcee, had dated until his girlfriend declared his illness too much to handle.
But a nurse encouraged Eppie Simpson, 42, and Harold Carmical, 50, to support each other through the new and scary treatment. A laser would be carefully threaded through blood vessels, then, once inside the beating heart, the laser would drill holes in it. Somewhere between the strange twinge Carmical experienced when the nurse first told him about Simpson, and the long hug Simpson gave him one day after they dueled on the treadmills, they fell in love.
"I just had a feeling, even before I met her," Carmical said. "Maybe it was fate."
Said Simpson, whose husband died from a brain tumor in 1996: "It's wild ... I had no interest. I never even dated. I just could have cared less. ... But Harold just made everything different. He's kind, he's sweet. If something is wrong, he knows how to make it better."
Last weekend, the couple scouted spots in Johns Hopkins Hospital for their June wedding. They want to celebrate in the place where they each got a reprieve from their terrible illness and from their loneliness. Carmical presented Simpson with an engagement ring yesterday; the diamond was carved into the shape of a heart.
For so long, their hearts had been nothing but trouble.
More than half of all deaths in the United States are attributed to heart disease, many involving first-time heart attacks. But among the 13.7 million Americans who've already had a heart attack, chest pain or both, only a small percentage falls into the same category as Carmical and Simpson.
Rather than having a blockage in one or more defined spots, people such as Simpson and Carmical have the disease throughout their blood vessels. Because the vessels are clogged by calcium, plaque and cholesterol in so many locations, the traditional method, using another vein to bypass the blockage, won't work. Angioplasties, in which physicians insert a balloon and expand it inside the artery to clear the blockage, often fail, too.
"My doctor said, 'Your veins are made of stone,' " said Carmical.
With blocked blood vessels, parts of their hearts are not receiving enough blood -- and its rich supply of oxygen and nutrients. Minimal activity causes pain. Walking down a flight of stairs and even sleeping can bring it on. Carmical's dreams of sailing were deferred; Simpson's attempts to take a vacation landed her in the hospital.
'We understood each other'
"A lot of people who are healthy, they don't understand your situation, and we understood each other," Simpson said.
Yesterday, they underwent tests to evaluate their hearts. Glowing patches on a screen showed muscles previously deprived of blood that are now getting it. Carmical's improvement has been dramatic. He can walk for blocks, he doesn't need to take several kinds of medication, and he no longer feels an ache when he breathes in winter air. Simpson's changes are more subtle.
"It's just like freedom. You can get up and move around a little bit and do different things, and you don't get sick," she said.
Physicians say the procedure shows promise and can help relieve chest pain for up to a year. The risks include accidentally drilling all the way through the heart and causing bleeding, said Dr. Jon Resar, director of Hopkins' adult cardiac catheterization lab, who performed Carmical's and Simpson's procedures. But he said risks are minimal. Doctors also say it's too early to tell how significant of an advance this may be.
Called PMR, for percutaneous myocardial revascularization, the procedure is similar to angioplasty, in which physicians insert tiny tubes into the leg and thread them up to the heart. Once inside, the laser is fired several times to drill holes in areas of the heart deprived of blood. The idea was borrowed from crocodiles, which have crude channels rather than an intricate blood vessel network.
But in humans, the holes close up, some as soon as 24 hours later, others days later. Experts theorize the lasers may work by spurring the development of a network of tiny blood vessels, a process called angiogenesis. PMR's predecessor, TMR, or transmyocardial revascularization -- in which the patient's chest is opened and the laser is fired from the outside of the heart -- is also being studied.
At the University of Maryland Medical Center, Dr. Andrew H. Foster, associate professor of surgery, is testing bypass surgery along with the laser therapy. "It's like a bonus," he said. "I think it will be applicable to a wide variety of patients who have heart disease."
A few weeks ago, the U.S. Food and Drug Administration approved with conditions one manufacturer's laser system for PMR. Dr. Anne B. Curtis, chairwoman of the FDA's cardiovascular devices committee, said the panel ordered the company, PLC Systems Inc., to state in writing that they don't know why the procedure works.
"We're not quite sure why it works, but we couldn't ignore the fact that it did seem to work," Curtis said. "When you have patients who have no other options, you want to let them have it."
Carmical and Simpson had some risk factors for heart disease: She smoked, he had diabetes, and they both had high cholesterol. Genetics were also stacked against them. For Carmical, every family member on his father's side died of heart disease. The same is true for Simpson, whose first heart attack, at 38, happened moments after walking out of the room where her husband lay dying.
Some experts say that emotional and physical lives are intertwined and that Carmical and Simpson might be contributing to their health as much by getting together as by undergoing the procedure.
"There is a lot more evidence that love and intimacy is good for your heart than drilling holes in it is," said Dr. Dean Ornish, clinical professor of medicine at the University of California, San Francisco and author of the best seller "Love and Survival." The book argues that the quality of our relationships can shape our health and that those with a sense of love and connection and community live longer.
In several short months, Simpson and Carmical have become essential to each other. Initially egged on by nurse Kathleen Citro and Simpson's sister-in-law, the relationship blossomed from phone calls to visits. He's sent her daisies and a dozen roses, all red, with a white one standing in the middle.
"She would get down in the dumps," he said. "I'd tell her, 'Always look to the sun.' "
Some nights, while Carmical lay awake in Bowling Green, Ky., he'd have a feeling that Simpson was struggling to sleep in her home in New Castle, Del. It might be 1 a.m., 2 a.m. or 3 a.m. He'd call her, and sure enough, she'd be awake. He'd talk her through the blackness, assure her that the pressure on her chest wasn't going to turn into the big one, the fatal heart attack.
"You get petrified," Simpson said.
On one occasion, after she picked him up from the airport, there was a first kiss. They started joking about marriage, about setting a date.
"One word led to another, and we said yes," Simpson said.
Around Hopkins, they've earned the nickname "Laser Love." Their physician, Resar, says that despite all they've been through, their heart muscles are still strong, so their prognoses are good. Carmical, meanwhile, is planning a honeymoon to shake off their past: traveling to the lowest elevation in the Western Hemisphere, Death Valley, and hiking across a hot, 30-mile stretch of yellow sand. Simpson giggles at the notion.
He imagines them walking, hand-in-hand, bathed in sunlight.
Pub Date: 5/05/98