photography : reflection : moconnor The Remarkable Story of Two Remarkable Men "But our chances really were a million to one." : Bob Dylan
Jim MacLaren Jim MacLaren has no memory of being struck by a New York City bus. No memory of being thrown like a rag doll 90 feet in the air. No memory of the crushed legs, broken bones and pulverized organs, and, of course, no memory of being pronounced DOA at Bellevue Hospital. But, as the saying goes, the reports of his death were premature, and after 8 days in a coma he woke up in the intensive care ward with his left leg amputated below the knee. 
My wife, Nancy, often speaks of her patients being "struck with a cosmic 2 x 4" and in Jim's case the 2 x 4 came in the shape of a bus. He had already dealt with a number of challenges in his life, progressing from being a fatherless child in a moneyless family to a Yale graduate who excelled in football, theatre and as an academic; not a bad trifecta. One night he was a handsome, intelligent Yalie dancing with debutantes, and the next thing he knew he was a one legged, disfigured unit of pain in a hospital bed. But it's hard to keep a good man lying down and Jim embraced the fierce pain of rehabilitation and got on with his life. His dramatic training led him to jobs on TV and stage and the beautiful girls didn't go away. 
Rehabilitation meant reconditioning his body, and to avoid the pounding on his stump, Jim got back on his bike and rode, and dived into the pale blue waters of the pool and swam as though his life depended on it, and maybe it did. But we are bipeds and Jim felt the imperative not just to walk but to run. He entered a 10k race and his prosthetic rubbed the stump of his leg to a bleeding pulp. To most people this would have been a message to decrease the distance but to Jim it said, "if you can do 10k, you can do a marathon" and he did, first New York then Boston. Jim became not only the fastest amputee endurance runner on earth, but was better than 99% of able-bodied people. I've watched this happen before when someone works so hard to overcome a sickness or injury that they leave the rest of the human race behind. In my own experience, I know Mike Burton who started swimming at age 12 because he had polio, and who, in the thin air of Mexico City, won an Olympic gold in the 1500m event. The record NFL field goal of 63 yards comes from the clubfoot of Rick Dempsey. In our zeal to overcome a problem it's possible to surpass less motivated able-bodied athletes and non-athletes. Jim dealt with his trauma mentally and spiritually as well as physically, and he resonated to the Buddhist philosophy that all pain comes from attachment. Therefore, we need to avoid building an attachment to anything in this universe that is impermanent, including our own fragile bodies. Hitching our identity to some perception of physical performance is a guaranteed path to misery, which is why a number of high level athletes go through a brutal period of decompression when they quit competition. However, as he pursued the elusive concept of higher consciousness Jim pushed his impermanent body to higher levels of physical performance. The Ironman Triathlon was made with people like Jim in mind. He was now able to add a 2+ mile swim and 112-mile bike ride to his marathon running, and it was while competing in an Ironman in Mission Viejo that the inconceivable occurred. 
Jim was leading a pack of cyclists when the policeman directing traffic had a brain lock and waved a van across the road straight at Jim MacLaren. Jim remembers this one: he remembers the grille of the black van that hit him, he remembers the screams of the crowd, he remembers the ambulance ride and going under the anaesthetic and he remembers waking up with a bolt screwed into the back of his skull and being told he was now a quadriplegic.
When Elizabeth Gilbert first called Jim and said she wanted to write about him for GQ, Jim's response was "GQ I don't really look the part these days. Armani doesn't make Velcro flies on their pants just yet." Elizabeth discovered that Jim is what is termed an incomplete quadriplegic, which means he has partial use of his arms and twisted hands and can move his legs a few degrees. This tiny range of movement means everything and is the margin between an independent life and round-the-clock caretakers. But with the sensation comes pain, which is the price Jim pays for his minimal allocation of movement. In his own words, "some days I wake up feeling as though I'm encased in wet cement with electrical currents running through it." During therapy the nights were interminable. Jim had a call button for the nurse but couldn't reach it, his body was a labyrinth of pain. "I was all body" he said, "I was too afraid to cry because the tear drops might leak into my lungs and throat and choke me to death." Coughing was not an option, as Jim had lost the use of his diaphragm muscle. Jim changed his Buddhist notion of "who am I?" to the more reductive "what am I?" Jim was awarded 3.7 million dollars compensation, much of which was eroded by medical and legal expenses, but he was still left with a considerable sum of money. He retreated to Kona in Hawaii on the pretext of writing a book, but it was really an escape, a geographical solution to not letting old friends see his struggle. In Kona, he made some new friends, new friends who felt sorry for him and shared their cocaine, friends who would drink with him to help him dull the pain. Never one to deal in half measures, Jim MacLaren became addicted to drugs and booze, until he found himself one night, wasted, unwashed, crippled and alone on the Alii Drive, a famous stretch of the course of the Hawaii Ironman. Alii Drive became Jim's Road to Damascus as he screamed to the emptiness, "Why are you doing this to me?" There was no thunderclap, no flash of light, but somehow the cosmic tumblers shifted and within Jim's body/mind some long forgotten synapses were reconnected. Jim emerged from that Hawaiian night knowing that he has some choices. He discovered what Victor Frankel had found in the Nazi concentration camps, that the knowledge that you can make choices can save your life and ultimately set you free. His first big choice was, "Live or die", and Jim was aware that the path he was on was leading straight towards death. (Here I quote directly from Elizabeth Gilbert's interview with Jim MacLaren)
Slowly Jim chose to see the blessings and to learn the lessons that would have eluded him as an able bodied man. For the first time, he could see something most people go through their entire lives blind to -- namely, that we are not in charge of what happens to us in this lifetime. We are in charge only of how we perceive what happens to us in this lifetime. "I started looking around and seeing people everywhere -- especially successful middle-class American men -- walking around in complete denial, smugly thinking to themselves I sure am doing a good job running my life here. But I could see now that their sense of control was nothing but a mirage. Safety, entitlement, power -- these are all fantasies. We don't drive our destinies. Not that way." Jim realized, to his relief, that once you stop trying to control events you can't control anyway, you can drop all that wasted energy and focus on the one thing you are in charge of. As the teachings of Buddha and Socrates show, you have only one task as a human being: To know yourself. "Look," Jim says. "I have honestly come to believe that I needed these accidents in my life. I completely believe that. Not in terms of paying dues or getting punished by God, but in terms of getting my attention and bringing me deeper inside myself to a place where I could find honesty and peace. Was it destined? Did I literally choose to have these awful things happen to me? No, not in so many words, I don't believe so. But I do believe this -- I believe I was born begging for experiences that would show me who I really am. And that's what I've been given." These days Jim lives in Pasadena and is doing graduate work in the study of mythology and psychology at Pacifica Institute. 
On good mornings, he can get out of bed, eat, clean out his bowels, attach his catheter, shower, dress and be ready to leave the apartment in just under three hours. Almost the same amount of time it used to take him to run a marathon, and nearly as physically grueling. It's painful, but he gives his body the time it needs, and then the rest of the day belongs to him. If the weather is nice and he feels strong enough and doesn't have a paper to write, he'll get in his wheelchair and head into the city's Old Town. He'll park at an outdoor café, order up a triple espresso and read in the sun, blissfully alone and blissfully comfortable with his own company. Or sometimes he spends the day with his girlfriend. Her name is Alessandra. Jim calls her Ally, or Ally-mander, or Ally-cat. She's beautiful, blond, smart. They met in an Internet chat room and have been together for two years. "People look at me and call me a saint for being with a guy in a wheelchair," says Ally, "and it's so insulting. First of all -- the idea of me as a saintä This makes both Jim and Ally laugh so hard that the conversation has to stop for several minutes. "Anyway," Ally continues, wiping her eyes. "I'm with him because he's the most intelligent and sexy man I've ever known. Period." As for the sex, yes, they have it. Maybe not the way you have it, but they do have it. Jim does have limited sensation in his penis, but he has to be careful because an orgasm could be a serious health risk. (It could put him into a state of hyperreflexia -- pulse goes down, blood pressure goes up; he could have a stroke or a spasm or even die.) So he expresses his sexuality differently now -- with his hands, mouth, voice, imagination and lots of time. It sounds almost idyllic, the time to study and to think, the place on the California coast, the beautiful blonde girlfriend, a sort of academic beach boy existence. But there are other realities. And it isn't always easy, because Jim still struggles. Jim MacLaren, let's be very clear about this, did not enjoy losing his leg, and he does not enjoy being in a wheelchair. He looks for the blessings where he can find them, and he tries to keep a sense of humor, but there are days when it's not funny and it's not enlightening. Days when he wakes up in so much pain he can't get out of bed at all. Days when he can no longer stand the endless battle over trying to control his bowels ("I'm more obsessed with my feces than the Marquis de Sade," he jokes darkly). Days when yet another infection lodges in his catheter incision and his testicles swell to the size of softballs. Days when he wonders how he's going to possibly survive this abuse for another forty years. "There are moments when I realize all over again what happened to me," Jim says, "and it's still unbelievable. I mean, come on! Jesus Christ, for fuck's sake, how much can one person endure? But I can't stay in that place for long or I'll lose my mind. Instead, I have to ask, What is wholeness, really? What is a full life? What are my actual obstacles? And whenever I find myself frustrated with my handicap or looking with envy at an able-bodied man, I ask myself this: If I could get up out of this wheelchair right now and walk across the room, would that really get me there? I mean, would that really get me to the place I most want to go with my life? Because let's be honest hereãthe other side of this room is not my ultimate destination. My ultimate destination is self-knowledge and enlightenment. Do I have to get there on foot? Or can I find some other path?"
Jim McLaren (No. 2) The Man Who Refused to Die 
How do you top the first part of this article? You don't, and yet there is another remarkable Jim McLaren out there and it's the matching names which was the initial impetus to write this piece. (There is no 'a' in the Mc of this McLaren, which his father said "saved a lot of ink over the years".) People who know me accept the fact that I've had a 40-year Bob Dylan problem. There are others like me and Jim was one. I can remember my first visit to his house in the Vancouver suburb of Burnaby; it was like Aladdin's cave. For many years Jim had a tape of every Dylan concert from his seemingly never-ending tours of the planet. He had a vast network of fellow collectors who could always track down an illicit recording of each Dylan performance. Jim McLaren is intelligent, generous, funny, aggressive and obsessive. He's the sort of person you want on your side in any situation. But it is the latter two characteristics which might have produced the kind of internal stress on which heart disease thrives. Jim recognized his capacity for anger at an early age when, on one occasion, he was furious with his mother because he was not allowed to attend the orphan's picnic. As a young man he channeled his energy and aggression into competitive sports and into a job in commission sales. Jim always felt in control of his destiny, always knew he could out work, out perform and maybe out fight his competition. Mortality was not a big factor in his lifestyle decisions and like many of his Irish friends and relations he drank a bit, smoked and grabbed whatever food was available. Marriage came and went but the stress and adrenaline were never far away. In many aspects of his work and life Jim wanted perfection in an imperfect world, a state that almost guaranteed ongoing internal strife. December 1978 was probably his first heart attack; he was sick and dizzy and felt that he had a major stomach upset, maybe an ulcer. He didn't know that half the patients who have a first heart attack think it's gastric problems. He spent time in bed, got through Christmas and returned to work. In late 1980, he had his first official heart attack, with all its many splendored symptoms. In speaking with him, his cardiologist said, "When did you have your first attack?" Jim replied that he'd never had one, but was informed that indeed he had. Probably the stomach problem of 1978. He was told that his heart and health made him unfit to perform a by-pass, and he would have to take some prescription drugs which would hopefully sustain him till he was fit for surgery. Jim was now introduced to the games and Catch 22's of medicine. He was not fit for bypass surgery, which required him to be stronger and in better health. However, with his compromised heart he couldn't exercise, and found it hard to work. Nitroglycerine became part of his diet and angina was a constant reminder that his coronary arteries were barely functional. Jim's ability as a games player and his aggressive self-advocacy is one of the main reasons he's still alive 25 years after his first 'event' in '78. He figured out that he might not be 'ready' for a scheduled bypass surgery and would probably die waiting, but that an alternative route onto the operating table lay through the doors of the Emergency Ward. The next bad angina attack, Jim called the ambulance and was admitted to hospital. Surgery was scheduled almost immediately and a triple by-pass was performed. The date of the procedure was April 1st but Jim's still unclear who the fool is. 
Jim was now 'in the system' and although he didn't know it, hospitals and doctors would be part of the scenery for the rest of his life. During the surgery, they not only found blocked arteries, but an aneurysm, which would have been lethal had it ruptured. This was an early lesson in pushing hard for the treatment you feel you need. One of the things which often goes unmentioned about bypass surgery is that you sometimes have more trouble with the part of the body from from which veins are harvested that with the heart itself. True to form, Jim had a major staph infection in his leg. (I always liked the name of a local hospital softball team who called themselves The Staff Infections, Jim also told me of a group of heart transplants who formed a bowling team called the 'Straight Liners'.) It was time for rehab and Jim faithfully attended his 'Healthy Heart' classes. He began working out and did a very male thing, he did too much. This is a lesson I've never learned, and my need to run like I used to run and lift what I used to lift, has probably cost me thousands of dollars for physiotherapy and too often left me injured and frustrated. In Jim's case his strength training led to an umbilical hernia. The waiting list for surgery was about a year; a year in which Jim's recently acquired fitness slipped away. Old lifestyle habits returned and Jim went back to his work as the top commission salesman in his company. But there was always dissonance and stress in his life, and his organs and immune system were struggling.
In 1984, Jim was back in hospital with pneumonia, possibly associated with earlier staph infections. When he was admitted he was delirious and hallucinating and the admitting physician suspected withdrawal from hard drugs. He woke to find himself with restraints on his arms and legs. He convinced the medical staff that he was not a junkie, but endured a debilitating sickness. His kidneys shut down and Jim lapsed into a coma, but dialysis and antibiotics brought him back to consciousness and he was released to rehabilitate again and go back to work. The work-get sick-recovery routine was growing old fast and in 1986 he took a golfing sabbatical and became a golf bum. By the time he was ready to resume a working life, Jim's company had folded and he found himself on some sort of a black list as a bit of an agitator. But by 1988 the work issues were moot and a stroke sent Jim back to hospital and left him with balance problems, weakness of his right side and a sufficient loss of vision to make him ineligible to drive. The world was now closing in and the rhythm of Jim's life was arrhythmic, as his heart had a mind of its own and alternately raced or slowed down. His flawed heart was a dominant factor in his life, though he still found pleasure in the music and poetry of Bob Dylan whom he wrote about under the pseudonym D. Babylon (an anagram of Bob Dylan). He was a regular on ambulance runs to Emergency when the pain was too excruciating or the cardiac storms too wild. The doctors responded with more drugs, stronger drugs, drugs to handle the side effects of the other drugs and new, experimental drugs which might just tame the erratic little pump in the center of Jim's chest. In 1990, the inevitable occurred in the form of another heart attack. The news was all bad, and, as one doctor tactfully put it, he might not need to buy Christmas presents this year. (A variation of the 'don't buy too many green bananas' theme.) This, of course, inspired Jim to buy generous Christmas gifts for everybody and he was determined to be around to give them out personally. He got through Christmas but felt like Townes Van Zandt when he wrote his song "Waiting around to die" or Bob Dylan who had his own brush with death after a coronary event and subsequently wrote: Or
From many medical conversations two phrases lodged in the McLaren mind. One was that he would never again run 100 meters and the other referred to the possibility of a heart transplant, which the physician said, "Would be like giving you AIDS" referring to the rather crude immune-suppressing drugs they were currently using. Jim McLaren was waiting to die so he spent his remaining funds on friends and family and thought of Bob Dylan's song "Restless Farewell".
The early 90's saw Jim still alive and fighting with various levels of government for a livable disability pension. He managed to beat down a fair bit of bureaucratic resistance but it seemed like a phyrric victory because in 1994 the heart attack hammer struck again. One thing was becoming obvious about Jim McLaren, he was one stubborn son-of-a-gun who just might be worth saving with the help of modern technology. His heart had gone from atrial fibrillation of around 250 beats per minute to 18, but it didn't stop. Maybe a pacemaker would be the solution to all his problems, something to keep his errant heart from beating to a different drummer. In short form:
Initial trials were promising and on a Saturday, Jim got a pass to leave the hospital to have lunch with a friend. Within a few hundred yards of the hospital, he felt he'd been punched in the chest, the defibrillator had misfired. Jim grabbed some railings and was hit again, sending his friend Rene running for the ambulance. Then things became Pythonesque; nobody knew how to control the pacemaker except the surgeon who installed it. He was reached on his cell phone while Jim lay absorbing a series of Tyson like jolts to his heart. When the surgeon arrived, the equipment was locked in some sort of classified cupboard to which no one could produce a key. They ripped the door off and finally had a device to turn-off the defibrillator. Jim had been defibrillated 12 times which should have been more than enough to kill him. But, as Sonny and Cher noted, sometimes "the beat goes on." (Although no longer in Sonny's case.) Jim now entered a space where his life was in the balance. He was dying and the doctors had pretty much exhausted their bag of tricks. The problems with his heart could not be bypassed, drugged or controlled with a pacemaker. There was only one possibility left, and that was a new heart. This sounded like the 'faint hope' clause to which lifers cling in jail. But the concept of a transplant had to be explored, which meant that Jim had to be evaluated. Jim was examined by cardiologists, physiologists, psychiatrists and even social workers. He knew he was under the microscope and felt like an old dog in a dog show, somehow trying to impress the judges; or more accurately, like an old dog in the pound, who, if he's not selected by someone looking for a pet, faces a death sentence. He was told the odds were against him; he had a history of stroke, compromised lungs, previous kidney failure, a susceptibility to staph infections, he was over 50 and his body had been ravaged by the sicknesses associated with a failing heart. However, Jim McLaren doesn't quit and he proceeded to give a performance worthy of an academy award. He was Mr. Sunshine, thinking about the future and what he'd give back to society, he joked his way through the endless testing and put a positive spin on every set-back or situation. One thinks of the old song, "Smile" sung by Nat King Cole
I'm sure his attitude was a factor and it's likely that the evaluation team recognized a life force that defied probability and that didn't necessarily show up in standardized tests. The decision was to accept Jim as a candidate for a transplant and he was given a beeper which, when it sounded, would tell him a new heart was on its way. The single biggest challenge in Jim's 25-year battle with heart disease had been overcome. Jim was now waiting around to live instead of to die. He was beeped while on a routine visit to his doctor and, as he was being transferred to hospital, his new heart was being flown to Vancouver, packed in ice. As he was being wheeled into the operating room, he heard some family members saying, "Goodbye, Jim." Jim stopped the gurney, had it wheeled back and made a second pass. He said he would accept, "see you later", "take care" or "au revoir" but not "goodbye". The operation was textbook, just over 2 hours, much faster that his original bypass. The day after the operation all the reasons which made Jim a bad risk manifested themselves. He lapsed into a coma, was trachiotomized and given paralytic drugs to spare his new heart as much as possible. Last rights were given, then given again and again. The odds against him surviving were long, but never bet against Jim McLaren. He made a slow but almost complete recovery; he had some neuropathy on the right side of his body, which gave him a drop foot, which was gradually correctable with a splint. But for the first time in nearly 20 years Jim had a strong, functioning heart. The McLaren machine had a new engine.
 Jim McLaren quickly became Gym McLaren as he finally had a heart that would deliver sufficient oxygen so that his muscles Back in Canada, Jim became active in his church and used his guitar and voice to give thanks for a second chance. As it says in psalm 150, "Let everything that hath breath, praise the Lord" and Jim now had plenty of breath. You can hear Jim's "A Recipient's Prayer" and some of his transplant friends singing the song "Living Proof" from a CD titled "The Gift of Life".
If all this sounds a bit too much like a Hallmark card I should add that Jim McLaren is still the same feisty, fractious and funny man he always was. He has diabetes. He battles with the bureaucracy associated with organ donation; he's frustrated with the politics of health care and sometimes feels exploited as a hard working volunteer. He feels the voices of the organ recipients are often not heard by those who make decisions, which will affect those who have received transplants in the past and those who will need transplants in the future.
Unlike the stories I've heard from people such as Deepak Chopra, Jim didn't suddenly acquire different tastes, possibly reflecting those of his heart donor. (Who is unknown to Jim). But I suspect that the donor was not a big Bob Dylan fan because, of late, Jim is far too involved in other things to spend much time obsessing about Bob.
Heart Transplants From the Beginning As a graduate student in physiology from Stanford, I had a part-time job in the pulmonary function lab in the medical school. A lot of our testing seemed to involve emphysema patients who all seemed to be past or present smokers. There was excitement among the technicians when they were told that some of the work they were doing was on potential heart transplant recipients who were patients of Dr. Norman Shumway. Dr. Shumway had many animals living with second hearts and was preparing to do the world's first human transplant. In fact, Christian Bernard beat him to it, but the methodical Shumway, who pioneered the technique, quickly followed with the first US transplant. What I realized was that, in many ways, the initial recipients were not good test cases, in that they were very sick and had developed complications that could not be quickly fixed with a new heart. Much better recipients were two of my physical education students at the University of Victoria. Both young men were in good shape but both had a viral infection which was destroying their cardiac tissue. Simon Keith was a top soccer player who, after his transplant in England, went on to play soccer for Canada. Tony Beeftink was a good all-round athlete who is a schoolteacher and has run many marathons since receiving his new Canadian heart. 
After writing this article I met with Jim (or James as he now prefers to be called) to do some proof reading. It was a typical cheerful lunch and we quickly got off on a tangent of heart disease songs, which included:
We swapped lawyer jokes and I'm sure it never occurred to the waitress who served us that one of those cheerful old men was a medical miracle. Jim suggested that I include a few sentences on the importance, not only of organ donation, but also of blood donation, without which his surgery could not have taken place. He also said it was important to remind people that while some heart disease is unavoidable, the majority of people can avoid the trauma of sickness and surgery by the simple practice of exercising regularly and eating sensibly. I say 'Amen' to that. Dylanologists that we are, we decided to give Bob the final words and Jim provided the perfect quotation that he still uses on his email.
Contact the British Columbia Transplant Society at 1-800-663-6189 for information on how to register on the BC Organ Donor registry or visit their website www.transplant.bc.ca transplants are not possible without blood donors. please visit the canadian blood services site aor call 1-888-2-donate. in the US, contact the american red cross at www.redcross.org/.
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could work hard. He rebuilt wasted tissue and then,even with his foot problems, took himself to the track to run the 100 meters that had been declared out of reach many years before. It took him 33 seconds and he could almost hear the Chariots of Fire theme as he shuffled/jogged the track. A year later by the summer of 1997, Jim's time was down to 21 seconds and, given a 50-meter start, he'd have been a close 2nd to Donovan Bailey. He set his sights on the World Transplant Games in Sydney, Australia that fall. It would have been great if he'd been able to do a personal best time, however, he was a last minute substitute for the volleyball team and pulled a hamstring which kept him out of the 100 meters. But that sort of thing happens to athletes and Jim McLaren was now an athlete.
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