A state of waiting

SEATTLE — Patrick Holland weaved his way through Pike Place Market, taking in the sights and adding to the chatter that filled the air on a bustling afternoon.

Most days since he moved here in January to await a heart transplant, this is his destination on his daily hourslong walks.

“Out on the street, not so many people say hi,” he said. “But they’re talking here.”

Holland relocated to Seattle from North Pole after weather-related travel problems prevented him from getting a heart in December — bad luck that drew national media attention. Now that he’s here, walking and greeting strangers nearly everywhere he goes gives him a chance to spread some positivity or remind people to be grateful, he said. That’s better than being preoccupied by thoughts of his own sickness and loneliness.

His decision to move 1,500 miles from his family was guided by an unavoidable fact: There are no transplant hospitals in Alaska, and the windows of opportunity for someone like him awaiting a heart are brief. “Patients have to reliably be able to get to us when there is a donor available,” said Dr. Claudius Mahr, Holland’s cardiologist with University of Washington Medical Center.

Until that day comes, Holland approaches chatting up strangers like a job. “I just wanted to say hi,” he said to a woman at Pike Place selling pickles.

“Great, baby! How you doin’?” she said.

As he bought a jar of pepper jelly he knew he wouldn’t eat, the vendor asked where he was from.

“I’m from North Pole, Alaska. You’ve probably seen me cruising the ’hood a lot,” Holland said. “I’m up here for a heart transplant.”

“I hope all goes well,” the vendor said, bagging up the jar.

“It will,” Holland said. “Either way.”

Holland said he doesn’t take it personally when people brush past him without so much as eye contact. They may be dealing with their own troubles. He doesn’t always tell his story either, which means he won’t hear pity in their reaction. He doesn’t want pity.

“I just don’t understand it,” he said. “Because it’s like, man, all I need is a heart.”

Relocated

When Holland recounts his heart transplant saga, he’s quick to point out that somewhere — everywhere — there are people who have checked into hospitals who won’t be checking out. He, on the other hand, has hope. He’s still here.

“I rarely even like to talk about it, because it makes me feel like I’m being woe-is-me,” he said.

His heart health had been deteriorating for decades due to coronary artery disease and ischemic cardiomyopathy, diseases in which a buildup of plaque progressively damages the heart and reduces its ability to pump blood.

Nearly 20 years ago, in 2005, a chest X-ray revealed Holland’s heart was enlarged. Since then he’s been kept alive by internal devices, stents, angioplasty surgery, a sextuple bypass surgery and multiple ablation procedures. He’s been hospitalized so many times, he said, that his kids are somewhat accustomed to the sight of their father being hauled away. Sometimes, if his pacemaker doesn’t restore a healthy heartbeat when trouble starts, his body goes weak, then his defibrillator delivers a shock that requires days of recovery.

Bypass surgery in 2007 restored some of his health, said Haley Holland, Patrick’s wife, who remains in North Pole. But in 2018, Patrick’s health started to decline steeply.

Without a transplant, Holland can no longer expect the same quality or quantity of life, said Mahr. “His heart has gotten weak to the point where it’s struggling to keep up,” he said.

That December night, after the call came in, Holland hustled with his brother to the airport in Fairbanks for a flight to Seattle, his thoughts pinballing between fear and excitement. “I’m thinking about, ‘Man, I can get another 30 years,’” he said.

But icy weather swallowed Sea-Tac travelers’ plans by the jetload that day. In the air, Holland assumed it was an amusing slip of the tongue when an announcement welcomed travelers to Anchorage. He had somehow missed the previous announcement that the flight had been diverted.

Alaska Airlines employees scrambled to help, he said. He had a seat reserved on multiple flights to Seattle that were ultimately canceled, he said.

The transplant coordinator reached him by phone in Anchorage. “She said, ‘We’ve been following your flights. And we’re going to go ahead and move forward to give the heart to somebody else,’ ” he said. Holland prayed for the family of the heart’s donor, he said, and for the person he imagined would get a life-changing phone call.

News coverage of his ordeal — from ADN, CNN, People, the New York Post and many more — inspired generosity. Several people in the Seattle area offered him a place to stay to be close to the hospital. In one instance, relatives of a potential organ donor reached out because they wanted Holland to receive the heart, though it ultimately wasn’t a match.

“God, it’s so emotional,” he said as he told the story recently in a Seattle restaurant. “I hate being emotional.”

Another offer seemed especially promising. A couple living in Seattle’s Capitol Hill district said Holland could use their basement bedroom for as long as he needed. Someone was usually home, too, which meant he wouldn’t often be alone there in the event of a medical emergency. (Holland said the couple prefers anonymity and declined to comment for this story.)

He moved in with them in January, positioning himself just miles from University of Washington Medical Center, among the busiest heart transplant hospitals in the nation.

A record 4,169 heart transplants were performed in the United States in 2022, according to the United Network for Organ Sharing. Mahr, Holland’s cardiologist, said predicting how long Holland, or any heart recipient, would have to wait is impossible. Hearts are allocated by the UNOS through a system that generally prioritizes patients needing ICU-level care. Others with less urgent designations receive transplants frequently, too, because the system also factors the how long the recipient has been on the transplant list and the distance the heart must be transported.

Once a heart has been removed from a donor, Mahr said the goal is to have it beating in a recipient in no more than five hours.

“I’m confident that he will eventually get transplanted with a suitable organ that will serve him well,” Mahr said in mid-March. “But right now he’s ambulatory enough to where he doesn’t have all the stigmata of being critically ill in an intensive care unit, and all of the things that come with that.”

As of March 22, there were 3,381 people on the waiting list for a heart transplant nationwide, according to Organ Procurement and Transplantation Network.

“There are many more patients waiting for transplants than there are donors,” Mahr said.

A rough road goes on

The gut-wrenching ride didn’t end when Holland finally touched down in Seattle in January. Multiple times, Holland has been called because a possible heart had been identified for him, only for the surgery to later be canceled.

The first was in January, less than two days after he arrived. His wife and brother flew down right away to be with him. Holland’s thoughts turned to how his recovery might go and how soon he might be able to return home to his family and his job. “You mentally prepare yourself each time,” he said. “You try not to, but, man, you just start planning.”

He was wrecked again when the transplant coordinator called to inform him there was a problem with the donor heart. “They don’t always give us the details,” Haley Holland wrote on her blog.

In February, when Holland was called in for a third time, Holland asked his wife to hold off on flying down right away on a hunch it wouldn’t happen. The surgery was called off later that same day.

“Got that call, and I heard it in her voice,” he said of the transplant coordinator. “It was hard not to be emotional.”

Mahr said such instances are unfortunate, but sometimes unavoidable. Circumstances that make a donor’s heart suboptimal for transplantation sometimes come to light after a recipient has been notified to get ready for surgery.

“What we tell people is just because you’re being called in doesn’t mean you’re going to go to sleep and wake up with a new organ,” Mahr said.

“This is a finely orchestrated ballet, where things have to happen in parallel,” he said.

For Holland, it’s an emotional challenge layered atop his persistent physical discomfort.

“It’s scary, there’s no doubt about it,” Holland said. “I like to hide it, maybe.”

Holland often pauses to hold his fist to his chest, his eyes cast downward. Sometimes, it can feel like he’s being rammed with a broomstick. “The pressure just feels like someone is squeezing your heart,” he said. “It literally feels like there’s something stuck.”

Some days, his energy level is too low for long walks. Eating is fraught. His lunch is often vegetable soup boiled down to a mush. He eats pistachios a few at a time. A pudding cup can take an hour to finish. He was once 214 pounds, he said. Now he’s closer to 162.

At night, sleep comes slowly. Holland said he often lies awake with nausea and the sensation of his heartbeat pounding in his stomach. Sometimes he turns on a fan and pulls a blanket to his face, hoping the flapping will distract him.

“There’s days where I’m just so sick I don’t want to move,” he said.

As complicated as his condition has gotten, he’s found the best therapy is to think about himself as little as possible.

“If I’m worried about me, then I’m not taking care of somebody,” he said. “There’s always somebody doing worse than me.”

A matter of perspective

Holland hasn’t always had such an outlook.

As a young man, youthful arrogance and naiveté caused him to ignore his heart issues, even though his father was disabled by heart disease and died at age 52, he said. Holland remembers his dad as a man who remained engaged with his family, even as his health waned. His example made a lasting impact, he said, but he saw himself as different because he felt healthy and strong.

Mahr said there’s likely a genetic component to Holland’s condition, though Holland said his lifestyle choices didn’t help. Though he had a successful career as a painter on construction sites and other big projects in Arizona, he fell into a hard-working, hard-partying pattern that included drug use.

After his first marriage ended, he came to Alaska in 2000 looking to make changes. “Didn’t like who I was and didn’t like where I was,” he said.

The way he tells it, Holland prayed 22 years ago to become a person who cared for others, someone less self-interested and money-hungry.

“I went on this charge of helping everybody,” he said.

He started by sponsoring addicted people through prison ministry work. Lasting sobriety of his own coincided with meeting Haley, he said. She was making sandwiches at a gas station food counter. He invited her to go bowling.

“I had gotten clean the day I met my wife, and that was 18 years ago,” he said.

“He was nothing like I had ever met before,” she said. The couple has four children, ages 17, 15, 12 and 4. Patrick also has three adult children from his first marriage.

Haley said Patrick’s desire to help people intensified as the years went on. In 2016, Holland began work as a direct service provider for Fairbanks Resource Agency, a nonprofit that serves people with disabilities. In recent years, he has worked privately with older people who need care at home.

“I want to give everybody a chance to have their best life,” he said.

In Seattle, Holland took a job at an assisted living center. Two days a week, he leads group activities, like cooking or crafts. He loves the work of keeping the residents engaged and included, he said. He collects their pearls of wisdom, like “Don’t play the stock market,” or his recent favorite from a joking resident, “Don’t trust the bald guy.”

The road ahead

That March afternoon at Pike Place Market, Holland stood at an overlook above the waterfront and Puget Sound and talked with a stranger about their shared Arizona roots. He needled the folks waiting in a long line outside a Starbucks popular with tourists.

“This must be the best coffee in the world!” he deadpanned.

At a leathersmith’s table, he talked with a fellow shopper.

“You had a heart transplant?” a woman asked.

“I’m waiting on a heart transplant,” Holland said, later calling the situation “not a bad deal.”

The shopper mentioned her recent car trouble. Broken parts had been replaced, but those parts were broken, too.

“Everybody’s got something going on, right?” Holland said.

In his strongest moments, Holland exudes the confidence of a preacher, firm in his spiritual convictions and hopeful that his attitude can make a difference for others. He’s heard that he’s already inspired someone to register for organ donation.

“If I can make a dent like that? And maybe they can make a dent? I’d like to think I’m a part of a good chain,” he said.

But his whole story includes darker scenes, too, he said outside the market. Evenings are the toughest, when he’s alone in his borrowed bedroom. Above him, he can hear the footfalls of his hosts. As grateful as he is for them, they aren’t his wife and kids.

“I know what’s going to happen. I’m going to go home and I’m going to turn on the TV and I’m going to nonstop think about my family,” he said.

He makes video calls home several times a day. Still, he thinks of the milestones he’s missing with his kids.

“I want to say I focus on other stuff, but I don’t,” he said.

Guilt, too, weighs him down. His wife hasn’t wavered, he said, but he feels like he robbed her of the life she could’ve had if she chose to be with a man in better health.

“I feel terrible that she has to go through this,” he said.

Late one recent night, Holland said, he called her upset. “I told her I can’t do it anymore, waiting here,” he said. She was quick to remind him why they chose this, “so we can get another 30 years, or even another 10,” he said.

Haley Holland said her mindset back home is to do what needs done, and stay committed to the idea that the illness won’t erode their relationship.

“I read a line a long time ago that said ‘Soulmates are made in the trenches of marriage,’ ” she said. “And this is a trench, and we are in a battle.”

Mahr, Holland’s cardiologist, said individual circumstances are hard to predict, but many transplant recipients live near-normal lives six months after surgery. “If you look at the larger statistics, the system works in the sense that it’s the right organ for the right patient at the right time,” he said.

From Pike Place, Holland walked uphill through downtown toward his temporary home, pausing occasionally to rest and placing his hand to his chest. Sometimes, he catches a bus, but he walks as far as he can, feeling like he must push through to keep himself as healthy as possible until surgery.

“So many things have been taken away,” he said, facing the incline. “But my plan is to get it all back, and I’m very hopeful.”

On March 20, Holland was matched with a heart for the fourth time. But while he waited at the hospital, the organ was found to be unsuitable. “It’s unfortunate that it happened to Patrick, because he’s had enough roller-coaster emotions,” said Mahr, his cardiologist. “But it is not uncommon, and it may not be the last time.”

Haley Holland and the couple’s kids had already traveled to Seattle to be with Patrick before they got the news that surgery was called off. They spent the following day walking together through the city and in Pike Place Market.