Patient, physician share a passion for cycling, but both are actually fighters

Will Fleming on bike

After surviving his third liver transplant, a kidney transplant, brain surgery and numerous other complications, holiday celebrations mean more than ever this year to Will Fleming and his partner, Mary Wright. To the Wilmette couple, it doesn’t seem that long ago that transplant hepatologist Josh Levitsky, MD, shared crushing news.

“Will, I’m sorry but we have to take you off the liver-kidney transplant list right now.”

Fleming had become too weak to survive a liver-kidney transplant surgery, and Dr. Levitsky gave him direct but hopeful discharge instructions: Go home. Gain weight. Get stronger.

While it was frustrating to hear he wasn’t eligible for a transplant, Fleming, 68, understood the realities more than most. It was to be his third liver transplant. The first had been in 2005, and within a year that liver failed. His second liver transplant went smoothly, and Fleming lived a full life for 12 years, even returning to cycling 40 to 50 miles at a time. He was an active member of the Evanston Bicycle Club and traveled the country to cycle in scenic locations.

It was after one of his 50-mile rides in 2021 that Fleming rapidly began to feel ill, and he asked Wright to take him to the hospital. Tests showed blood clots in the artery that supplied blood to the liver, and Fleming learned he would need a third liver transplant.

“I was in the best shape of my life when they said I needed another transplant, so it was really hard to believe when they told me,” Fleming, a Wilmette resident, said. “I was cycling, lifting weights and doing calisthenics regularly. I’d been so healthy for so long it took a while to realize I was actually sick again.”

Fleming was placed on the liver transplant list, and his health continued to decline. His kidneys failed, and he began dialysis. Then, he was told he’d also need a kidney transplant at the same time.

“He got down to 99 pounds, and he’s 5-feet-11,” Wright said. “When he became too sick for transplant surgery, a number of his physicians began suggesting different options. They didn’t use the word hospice, but I knew they were talking about just keeping him comfortable.”

Wright asked Fleming if he understood what his physicians were saying. He thought about it for a minute, looked at her and said, “I’m not ready.”

That was the turning point for Fleming, who committed to eating a little more each day. As he gained weight, he gained energy, which he used for light workouts to regain his strength. He put on 15 pounds and went to see Dr. Levitsky for a follow-up appointment.

“It’s a lot to be invested in a patient and then have to make a difficult decision to take them off the transplant list, but we’d discussed it as a transplant team and knew the risks were too high for Will,” Dr. Levitsky said. “Then he came into my office, and it was obvious he’d been working hard to get healthier. I’d set parameters for nutrition, weight, physical function and frailty, and over three or four months he was able to get there. That just showed the will he had to live and that he was a fighter.”

During that appointment, Fleming noticed he wasn’t the only one who had changes to his health.

“Dr. Levitsky was looking good,” Fleming said. “He looked a bit leaner, and he had the light tan of someone who spends a lot of time in the sun. He said he’d started cycling more and promised me he’d go for a ride after I got a transplant and recovered. I told him he had a deal.”

After the appointment, Dr. Levitsky began a campaign to get Fleming back on the transplant list.

“He went to every surgeon on the liver transplant team and talked to them about Will and his recent improvement, and he got them all to agree that they would do Will's transplant,” Wright said. “It was remarkable that he did that.”

Dr. Levitsky said he had to try because Fleming had been tenacious and he’d shown great improvement.

“Our transplant team has very high standards and there was still a lot of nervousness about Will, but we decided to go ahead,” Dr. Levitsky said. “There were people who were in his corner and there were people who were worried about him not surviving the third transplant.”

A week after he was relisted for a liver-kidney transplant, Fleming was called to Northwestern Memorial Hospital for the 14-hour surgery. Then came a recovery that was filled with complications.

Fleming suffered a rare brain bleed and an uncommon disease that forced him to lose the ends of his toes. He needed a feeding tube to provide extra nutrition, and he broke his neck, hip and arm after falls at home.

His recovery took longer than he had expected, but eventually Fleming won the fight and felt strong enough to ride a stationary bike. This fall, he rode his first outdoor miles and shared the good news with Dr. Levitsky, who was delighted to share the news with his colleagues.

“He took a picture with us and showed it to everyone on the transplant team,” Wright said. “He was so proud of Will’s recovery.”