Three years ago, her heart was failing with dilated cardiomyopathy, a degenerative disease that weakens the heart muscle. This week she’s training a starter in the Kentucky Derby. His name is Mucho Macho Man, but he’ll never be as tough as the woman who has brought him here, just 30 months after a heart transplant.
Let’s talk about what it means to “have heart.”
In 2008, Ritvo’s heart was so diseased that it would not function without round-the-clock medication. For months while awaiting a transplant, she was confined to the cardiac critical care unit of Jackson Memorial Hospital in Miami.
But when her regular doctors would take a week off, she’d talk the staff into letting her go home with a big bag over her shoulder, a device that let her administer her own infusions, just so she could be with her family at home, so she could be in the house when the kids came home from school. Just to be there, for a week or so of normalcy.
You can measure heart function. You can hook up electrodes and perform ultrasounds and echocardiograms. You can have all the results there in black and white. But you cannot measure heart. Joseph Bauerlein is a cardiologist at Jackson Memorial. He’ll tell you.
“She would come into the clinic before her transplant, and I would know what her echocardiogram showed — she had just very poor heart function,” Bauerlein said. “But just looking at her, with her attitude, it would be hard for most people to tell she was as sick as she was.”
Ritvo didn’t get sick overnight. She started to feel fatigued all the time in 1999, and learned of the heart condition in 2000. She lived with it, and its frustrating limitations, for nine years. She quit thoroughbred training, her job since age 18, because she didn’t have the energy.
She got by as well as she could, but as the calendar flipped to 2008, her time was dwindling. She became a candidate for a transplant. She became a full-time hospital resident. On Derby Day, 2008, she watched the race from her hospital bed and at some point turned to Bauerlein and said: “When I take a horse to the Derby, you have to come.”
She’s not sure even today why she said it. Standing outside Barn. No. 31 on the Churchill Downs’ backside, remembering the moment last week, she stepped out from under the barn roof to get into the sunshine and acknowledged it’s not the kind of thing she would usually say.
“It just came to me,” she said. “Maybe now we know why.”
You can look through all the heart tests and you won’t find the resolve it took to actually make all this happen. At about 7 p.m. on Nov. 12, 2008, the hospital called. She was in one of those rare periods at home. She remembers very clearly, she was watching the show Clean House on the Style Network when the phone rang, and they told her a donor heart had been located. She and her husband Tim, a former trainer himself who now is vice president for racing at Gulfstream Park in Hallandale Beach, Fla., went upstairs to pray with their two teenage children.
Tim said, “There were a lot of nights when she went to sleep that I wasn’t sure she’d be waking up in the morning.”
But on this night, with the surgery scheduled for morning, Kathy and Tim Ritvo said they felt less fear than relief.
Want to hear some impressive fractions? Her surgery lasted six hours, but she spent only seven days in the hospital before going home. Her surgeon, Dr. Si Pham, director of the Heart/Lung Transplant and Artificial Heart programs at Jackson Memorial, called that recovery, “record time.”
He also acknowledged time had been running out when the transplant was done.
“She didn’t have much longer,” he said. “When the heart becomes so weak, other organs fail — the kidneys, the liver — and the weaker you are, the more difficult the recovery is. So for her, we were very lucky to get a donor.”
Pham talked about some factors that have made her transplant a success – that she is a relatively small person who was in good physical condition, that she is disciplined and lives a healthy lifestyle. But the things that sustained her the most in the years leading up to the transplant aren’t there in her medical records.
“I lost a brother to the same disease when he was 38 years old,” she said. “And I was very determined that my mother would not have to go through losing another child. And I wanted so badly to be there for my kids. I didn’t want to leave Tim with the job of raising them alone. I was preparing myself for the worst, but I was determined to fight.”
Ritvo’s thoughts didn’t turn back to training for a while. She was – and still is – on a heavy medication regimen that includes 30 pills a day, anti-rejection medicine and vitamins. She takes immunosuppressants to prevent her body from rejecting the new heart, but that puts her at increased risk for picking up infection. And horse barns aren’t the most sterile of environments. Horses pick up infections, bacteria. There’s dust. Yet, Bauerlein said, the risk level is “acceptable.”
The stronger she got, the more she wanted to get back to the track. She grew up around racing. Her father, Peter Petro, owned horses. Two brothers were jockeys, including one who died of cardiomyopathy while awaiting a transplant at age 38. Another brother still is a trainer on the east coast, and she had trained with her husband since they’d been together. The Petros thought their little girl might be the one child who followed another route. But they couldn’t keep her away from the horses.
Tim was hesitant when his wife wanted to go back to work, but she started helping around the barn, and then saddled a horse for him one day, and she was back. And he saw that it made her happy.
As the sun poked through the clouds at Churchill Downs last week she said, “I’m not a sick person here. I’m not a heart transplant patient here. I’m a trainer here.”
Mucho Macho Man’s owners would tell you she’s a good one. Dean Reeves, who bought majority interest in the colt last year, originally hired Tim Ritvo to train him, but did not hesitate to leave Kathy in charge when Tim took a job at a racetrack.
“She’s very hands-on, very old-school,” he said. “She seems to have a great feel for what the horse needs.”
Jim Culver of Dream Team Racing, the original buyer of the horse and still a minority owner, called her training style “maternal.”
Both men, by the way, have undergone heart procedures of their own.
Ritvo won 149 races from 1990 to ’98 and had a horse finish eighth in the Breeders’ Cup Juvenile Fillies, but has never had anything like this colt.
She said she doesn’t spend much time thinking about what it would be like to win the Kentucky Derby.
“I don’t do that because I feel like I’ve already won,” she said.
Lots of times in sports, we talk about “heart” when a player can pound out a few more yards while going off-tackle or dig in when the game gets into overtime. But there’s a measure of heart that gets beyond toughness and into the area of what a person gives.
For Ritvo in this Derby, there’s a goal beyond the finish line. Ritvo doesn’t know who donated the heart that saved her life. She has written a letter and given it to the hospital to be sent to the donor’s family members. They haven’t come forward. She hopes they will.
But this week, she’s hoping to use the attention she gets from her accomplishment to encourage people to become organ donors, and to encourage people who are waiting for donations, to show them that there is life and success to be found after the wait. At 42, her long-term prospects are good. A heart that isn’t rejected in an otherwise healthy person can last a little more than 20 years, when another transplant is a possibility.
“Lots of people go on to live good lives after heart transplant,” Bauerlein said. “But to train a Kentucky Derby horse, well, that’s extraordinary.”
Ritvo has taped a public service ad for organ donation in Kentucky and told her story to Sports Illustrated and USA Today.
“I just feel like I’ve been put in this position to tell my story as much as I can tell it, and hope that it can do whatever good it will do,” she said. “When you have been given this gift, you feel the need to do something with it.
“If just one person sees my story and takes some hope from it, or decides to take the time to become an organ donor, then that will make whatever happens worthwhile.”
Even Ritvo’s colt has a heart-touching story. When Mucho Macho Man was foaled – more than three weeks after his due date – in Ocala, Fla., on June 15, 2008, his heart was not beating. He lay on the ground lifeless, according to Carole Rio of Rose Grove Farm, while she and her husband Jeff and others prayed. She put her hands on the foal and rubbed him, then stopped and prayed some more.
“Then all of a sudden this sucker just jumped up and started running,” she said. “He didn’t just stand up, he jumped up and took off.”
On the farm, they called the strapping yearling “Lazarus.” On the track, he is a running example of what can come of a second chance at life.
If all of this seems to have a fairy tale quality about it, Ritvo would tell you that the fairy tale has already happened.
“The horse brought us here and everything has fallen into place for us to be here,” Ritvo said. “No matter what happens Saturday, it’s going to be meant to be. I am not worried. We’re going to get the right post and right track and right trip. Every bit of this is a gift.”