If he had it to do all over again, Davey Bauer might have gotten a flu shot. For sure, he would have said no thank you to cigarettes and then vaping.
Instead, Bauer has a story to tell about living for a day with no lungs on his way to a lifesaving double-lung transplant.
His diseased lungs were completely removed from his body, an "artificial lung" did their work and two breast implants – size DD – served as placeholders in his chest cavity, supporting his heart. A day later, a second surgery transplanted donated lungs into his chest.
Dr. Ankit Bharat of Northwestern Medicine in Chicago came up with the idea for the innovative surgeries and tapped his colleagues in the plastic surgery department to help him figure out which implants to use.
"Davey's case is remarkable because it shows that we can keep patients alive after removing their lungs through new technology," says Bharat, who is chief of thoracic surgery and director of the Canning Thoracic Institute at Northwestern.
"I'm lucky to be here," Bauer, 34, said at a recent press conference. "I got a second chance at life."
Bauer's ordeal began in April when he came down with the flu. He is a landscaper and hardscaper who lives in DeSoto, Missouri, near St. Louis. His girlfriend of seven years, Susan Gore, insisted they go to urgent care where he got antibiotics.
"The next day, he couldn't walk," Gore says. She got him to an emergency room and he was admitted to the hospital. But Bauer kept getting worse – the hospital called to tell Gore he was being admitted to the intensive care unit.
"I said, 'What? What do you mean? He just has the flu,'" Gore says.
A secondary bacterial infection had set into Bauer's lungs, and antibiotics weren't touching it. He had to be put on ECMO, the highest level of life support where blood is pumped outside the body for a machine to do the work of the heart and lungs. Still, Bauer continued to decline and his St. Louis doctors started exploring transplant options.
"When we received a call from Davey's medical team in St. Louis, we thought we could help him," says Dr. Rade Tomic, a pulmonologist and medical director of Northwestern's lung transplant program, "but it was also very clear he wouldn't survive the transplant in his current condition."
Bauer was transferred to Northwestern, and soon after he got there his heart stopped and he had to be revived. That's how close to death he was – and that's too sick to be eligible for a transplant.
"He needed to clear the infection before we could list him for transplant, but the only way to do that was to remove both lungs," Tomic says. "This was uncharted territory for us, but our team knew if we couldn't help Davey, no one else could."
Bharat and his colleagues started strategizing. They could engineer part of the ECMO machine to do the work of his lungs. But lungs are large organs, and without them in the chest cavity, the heart could flop around.
"One of our plastic surgeons was very gracious to give us a rapid-fire course on the different types, shapes and sizes of breast implants," says Bharat, "so we picked out a couple options and some of them were easier than others to mold inside Davey's chest, with the DD option being the best fit."
At this point, the Northwestern doctors didn't know how long it would take Bauer to clear the infection or how long before donor lungs would be available.
During the first operation, which Northwestern filmed, Bharat marveled at the weight of Bauer's diseased lungs, heavy with the pus and fluid from infection.
Gore, Bauer's girlfriend, kept the vigil during the surgery: "I would take a breath in and say, 'One breath for me, and one for Davey.'"
Bauer came through the first operation on May 26 well and then surprised his doctors at how quickly his young body cleared the infection. He was eligible for the transplant list within 24 hours. The next surprise was how quickly donor lungs were available: the next day. On May 28, Bharat performed the transplant operation. That too, went well.
"It still blows my mind," Gore says. "I can't believe Davey lived without any lungs. He was breathing, blood pumping, without lungs."
Dr. Amit "Bobby" Mahajan, a spokesperson for the American Lung Association, says the case is "a very cool approach." He sees a lot of potential for it to help cystic fibrosis patients.
"They are young and often have underlying infection," says Mahajan, who is also a pulmonologist at Inova Fairfax hospital. "This could support them to get them eligible for transplantation. The breast implants, in all honesty, are a very good idea for holding the anatomy together."
Bharat, who is the same doctor who performed a double lung transplant on a young woman with a catastrophic COVID-19 infection, is excited about the possibility of making more patients candidates for transplants.
"I never imagined we'd be using DD breast implants to help bridge a patient to lung transplantation," Bharat says, "but our team is known for taking on the most difficult cases and thinking outside the box to save lives."
Bauer had no idea about the breast implants until he was recovering, and he and Gore joke about it now. Gore says, "You get the boob implants, but I don't?"
For his part, Bauer says, "It was very creative and kind of awesome. It makes for a great story."
He says he's changing all his gaming profiles to "DD Davey," and Bharat presented him with a "DD Davey" T-shirt at the press conference.
Six months out, Bauer says he is feeling better each day. He and Gore had to pull up stakes in Missouri and move to Chicago, so he can be near the transplant team for a year. They have a GoFundMe helping to defray costs.
Though Tomic points out that there's no evidence in Bauer's specific case that vaping caused his problems, there is a strong body of evidence that vaping can cause lung injury.
Gore says vaping "certainly didn't help," and Bauer, who initially thought vaping was healthier than smoking cigarettes, wishes he had never started.
"In all honesty, I found it more addicting than cigarettes," says Bauer, who was an avid skateboarder and snowboarder before he got sick.
He's now applying his work ethic that used to help him master cool tricks to his physical therapy and recovery.
He hopes his story inspires others to quit smoking or vaping: "It's not good to inhale anything into your lungs except oxygen."
