July 22, 2021 -- Caleb Brooks, a 27-year-old deputy with the Morgan County Sheriff’s Office, lived on a small working farm in Somerville, AL, with his 24-year-old wife, Madeline; their 4-year-old son, Bryar; a menagerie of goats, pigs, and chickens; and a 2-year-old black angus bull named Cash.
While he didn’t grow up on a farm, he’d been around farm animals -- mainly as pets -- for as long as he can remember. But that didn’t prepare him for what happened one rainy day last August.
That day, Brooks was out in the pasture putting down a bale of hay for one of the exotic goats he breeds and Cash. Madeline was there to help him with the gate.
“He came around the side of the hay bale, and he just came right at me, I didn’t have time to react,” he recalls. “He stuck his head right in my stomach -- bull didn’t have horns, it was a black angus bull -- and he started pushing me around the pasture. It’s uneven ground, so I lost my footing and he pretty much just had me on his head, and he threw his head up and I went up in the air. When I was coming back down, I was sideways, and he put his head in my stomach again and slammed me against one of the trees in the pasture. I fell to the ground.”
Due to his first aid training and experience as a law enforcement officer, Brooks knew right away that he was in shock.
At this point, Cash, who weighs nearly 1,000 pounds, had retreated and was about 15 feet away. But the danger was far from over.
“He started pawing up the ground, stirring the dust up like he was about to charge me again. I pulled out my gun and I shot into the ground in front of him twice, and he ran off.”
Horrified, Madeline, who was 8 months pregnant at the time, rushed into the pasture to help her husband.
“I got his phone and called 911. They were most concerned that he had some kind of spinal injury, and I thought that too, I thought he had [broken] his back -- he was ghost white,” she says. “He kept on telling me that he was in shock and all that, and he stayed conscious the whole time. We’re in the pasture, and they’re telling me not to move him, and the bull kind of starts walking over in our direction. And I’m like, ‘What do we do? What do we do?’ Caleb just gets up off the ground and jumps over the fence of the pasture, so I run and close the other gate and run over to him. He kind of stumbles around and kind of falls down on the ground.”
‘There Wasn’t Much Left’
Brooks was quickly taken by ambulance to Huntsville Hospital in Huntsville, AL -- about 22 miles away -- where he was rushed into the first of two surgeries with trauma and acute care surgeon Deepak Katyal, MD. Because of COVID restrictions, Madeline was not allowed inside.
“We took him straight to the operating room. I mean he probably wasn’t in our trauma room for more than 15-20 minutes, just long enough to do the basics and get him straight to the operating room,” says Katyal
“He was in tough shape. He was in shock. To look at him on the outside, he’s a young healthy guy … there were some people that commented that he didn’t look that sick, but I just kind of had that sense. I’d seen this mechanism of injury before, and I knew there was a problem.”
Brooks was bleeding from multiple areas of his intestinal tract. At first, Katyal removed his gall bladder, appendix, and a portion of his small intestine. He was then put into a medically induced coma.
“The worst of his injury is that he had sheared off all the blood flow to the main artery that supplies most of the GI tract overall. It’s called the superior mesenteric artery, and it was completely gone. And I had to completely transect it; there was really no blood vessel left to sew to. There’s two halves of it; one half was bleeding extensively, the other half was just in shreds, and there was no way to reapproximate or reattach those ends of the blood vessel,” Katyal says
“If you picture the GI tract as a long hose, we had to take out about 90% of the hose, and there wasn’t much left. So I tried to put together what I could, and I thought, ‘This isn’t going to really work,’” he recalls.
“He had one area of his GI tract, called the duodenum, that was viable, and he had another area of his GI tract, called the sigmoid colon, that’s part of the large intestine. That was viable, and everything in between was completely gone.”
‘A Jump-Start to Do Well After the Transplant’
Katyal says he knew at that point that an intestinal transplant was Brooks’s only real option. He started calling transplant centers that afternoon. Anil Vaidya, MD, a transplant surgeon at the Cleveland Clinic in Cleveland, OH, responded almost right away. By the end of the day, Brooks had been accepted into the clinic’s program.
“Timing of referral is key for their survival after transplant. In Caleb’s case, he was referred immediately, and that gave him a jump-start to do well after the transplant before any co-morbid problems like liver failure, clotting of the venous access for TPN, etc., happen.”
TPN, or total parenteral nutrition, is a way of feeding a patient by bypassing the gastrointestinal tract and putting fluid directly into a vein to provide nutrients. Unable to process food, Brooks was put on TPN right away and stayed on it for 5 months.
Intestinal transplants are still quite rare; a few transplant centers in the world do them, according to Vaidya
The United Network for Organ Sharing, a nonprofit group that works with transplant hospitals, organizations that acquire organs, surgeons, and patients, says the United States has the most sophisticated donation and transplant system in the world.
“Intestine transplants are comparatively rare,” says Eric Steigleder, a UNOS spokesperson. Currently, 21 transplant hospitals have intestine transplant programs. By comparison, there are more than 200 kidney transplant programs across the country. Since 1990, there have been 3,233 intestine transplants in the U.S., and 91 of them were done in 2020, he says.
The Cleveland Clinic did six of those.
In 1984, Congress passed the National Organ Transplant Act (NOTA). As a result, the Organ Procurement and Transplantation Network (OPTN) was created to manage a national registry to match patients with organs. They focus on increasing the number of transplants, providing equal access, and improving outcomes.
About 39,000 transplants were performed in 2020, according to OPTN. More than 107,000 men, women, and children are on the national transplant waiting list, and every 9 minutes, someone new is added to that list.
For patients on the intestine transplant waiting list, there’s a 6%-7% chance they will die before getting transplanted, says Vaidya
“If referred in time, and one doesn’t wait too long on the list, the survival at 1 year is 94%, and then it comes down to 89% [at] 5 years. And at 10 years, we’re looking at a 70% chance that you’d still be with your first intestine that was transplanted,” continues Vaidya. He says he believes Katyal is the main reason Brooks is still alive today.
"The primary surgical team in Alabama were the one that actually saved Caleb’s life,” says Vaidya “I mean, we had done everything in the aftermath, but they were the ones … at the forefront, and were able to control the bleeding and take out all the damaged intestine and tidy up inside Caleb’s abdomen, so I think they were perhaps the most important team in this whole scenario.”
Brooks spent nearly 2 weeks healing at Huntsville Hospital before flying to Cleveland to meet with Vaidya.
“I had no doubt I could help him. I knew that this person had hardly any intestine inside, he had to be transplanted, that was very, very clear in my head. There was no way that Caleb would have survived without an intestinal transplant,” says Vaidya.
‘He Was Just a Miracle’
“Dr. Vaidya pulled me aside and said, ‘I can fix him, you don’t worry about him, worry about yourself, you need to take care of yourself and your baby, I’ve got this,’” Madeline recalls.
In early December, the clinic called to say it had a perfect match. In a surgery that took around 10 hours, Brooks got his new intestine. By then, his wife had given birth to their second son, Luke.
“I had my transplant on December 4 and got out of the hospital December 15 or 16. I was back home in Alabama on January 5, and I started back to work January 11.”
It was a speedy recovery by most measures. In fact, the day after he came home, he went to his older son Bryar’s baseball practice, where he’s the coach. Right now, he has no restrictions, and Vaidya says his prognosis is “very good.”
“Caleb is special,” Vaidya says. “He just didn’t want to be in the hospital, so he was there for, I think, 11 days in the hospital, which was a record. Typically, patients spend 5-6 weeks in the hospital after transplant. In the first few days he was out of his bed, he was walking around, he was just a miracle because he was just driven to get better.”
Now, Brooks says he tries to live every day to the fullest.
“An incident like that changes your view on a lot of things. When you’re pretty much looking death in the eyes, it gets you to thinking what’s more important in life … how you manage your time, so to speak. and doing more things with your family and trying to live life with no regret.”
Madeline says their faith kept them strong, and she has this advice to anyone going through a major medical event: “Never stop fighting.”
“But literally, this was a God thing, this was a blessing. Caleb is living proof of a miracle. And we just kept on going the whole way through. We just stayed positive, even if we had bad days.”