Tony Foreman’s heart began to race as he climbed the stairs of a French train station.

It was 2018 and he was traveling with ex-wife Cindy Wolf in the Champagne region, near where they’d gone on their honeymoon. Now they were there as business partners, leading staff members from their Baltimore restaurants on a tour of the region.

As they prepared to board a train to Paris for one last great meal, Foreman’s arrhythmia triggered a shock from the defibrillator surgically installed in his chest. He thought he might make it to a bench before he collapsed. Instead, he landed face down, breaking his nose sideways.

He spent the next week in a French hospital — where, he notes, the food was excellent. “Soup every night, small piece of cheese. Good bread every day.”

He was used to almost dying.

In public, Foreman has remained a healthy bon vivant, known for his love and deep knowledge of wine and appreciation for French and Italian cuisine. Together, he and Wolf co-founded one of Baltimore’s biggest and most respected restaurant empires — their Charleston and its staff have been nominated for James Beard Awards so many times it’s easy to lose count. Petit Louis Bistro and Johnny’s in Roland Park, Cinghiale in Harbor East and Milton Inn in Sparks are meccas for Baltimore foodies. A new spot coming to Hampden has been eagerly awaited for months.

But behind the scenes, Foreman, 58, has been in congestive heart failure for more than two decades. He’s largely kept his health woes away from his work. “The world is not lining up to go to the sick guy’s restaurant,” he said.

Things came to a head last year when Foreman, recently back from yet another work trip to France, was hospitalized for kidney failure, another organ joining his heart in a struggle to survive. The end felt more real this time. He started selling off his prized wine collection — treasured barolos and Bordeaux — believing he wouldn’t live to drink it.

He was saved only by a double organ transplant so risky that world-renowned Johns Hopkins Medicine refused to do it.

Getting to work

Foreman talks about death with a detached matter-of-factness. “Given my particular health history,” he told The New York Times in 2021, back when he had only had three open-heart surgeries, “you spend a lot of time planning for when you die.”

Born with two heart defects, he was told by doctors he would never be athletic. He would be small. But he wore those predictions almost as a badge of honor as he proved them all wrong. Foreman played every sport he could at Gilman School, and grew so tall he had to bring his birth certificate to play baseball to prove he wasn’t older than he claimed, said his brother Clarke, the chief financial officer of the Foreman Wolf restaurant group. “He’s always been the big, strong athlete,” Clarke said.

Behind the closed doors of their family’s comfortable Roland Park home, the brothers shared a chaotic childhood. Their mother, a gifted pianist, started her days with a Tab and rum. His father left when he was young, leaving three sons to fend for themselves. “If I wanted things clean, I had to clean them,” Foreman said. “If we wanted to eat, I had to find ways to make money.”

So, he hustled. Foreman tended bar at Governors Club in Bolton Hill. He fell in love with the front-of-the-house pageantry and the back-of-the-house camaraderie, the old European guys in the kitchen and the smartass busser who nicknamed him “Young Executive.” Wearing his uniform dress shirt and paisley bow tie as he mixed drinks, Foreman was intense and focused, not the guy everyone thought was their best friend.

He was just a kid when he first drank from a case of 1960 Chateau Latour left in the basement by one of his mother’s boyfriends. “It’s always been part of life,” he said. But, he notes, “I don’t drink as sport.” He likens tasting wine to listening to music, and notices how the flavors of a certain vintage awaken and stretch after years in the cellar.

Wine was central to the vision he shared with Wolf, his second wife, upon the 1995 opening of Savannah, their first restaurant in Baltimore, which eventually moved to Harbor East and became Charleston. It was just as important as the exquisite fare Wolf presented to guests. On trips to Europe, Foreman’s discerning palate and knowledge of French and Italian made winemakers “realize this guy knows what he’s talking about,” Wolf said. Out come the rare, old bottles.

Foreman early on became used to putting a positive spin on his health problems, if they even came up at all. In 2004, he underwent an aortic valve replacement at the University of Maryland Heart & Vascular Center. In an article about the procedure on the hospital’s website, he said: “I feel great and I am back at the gym. Just today I was able to leg press 1,300 pounds.” But the reality wasn’t so sunny; he was back in the hospital the following year for another open-heart surgery.

In 2013, he wed Katie Callahan, who had worked at a wine shop he owns in Annapolis. Around 20 years Foreman’s junior, Callahan hoped their relationship would bring Foreman “to life even more.”

But his health took a nose dive soon after they were married. The fall at the train station in France was just one in a series of incidents in which Foreman collapsed without warning. He fell while talking to Callahan in their bedroom. While standing in their kitchen. There were more surgeries, more complications and slow recoveries.

The sicker Foreman got, the harder he worked. “It was me clinging to whatever power I had to try to affect the lives of people I love,” he said. Callahan craved more time as a family. “I want you here more than I want to be able to send our kids to a particular school in case you die,” she said.

While Foreman continued to keep his health problems under wraps, Callahan said she felt isolated by the pressure to keep quiet about what was going on. “This major event is happening in my life potentially leaving me with two small children and I can’t really tell people,” she said.

Travel, once a source of joy and inspiration, became a reminder of his body’s frailty. During a trip to Sicily with Callahan and their daughters in 2022, Foreman was so swollen he couldn’t put his shoes on. He had a band of fluid around his midsection — a sign, he later realized, of kidney failure — and felt cold even in 90-degree weather as his heart, growing ever weaker, struggled to pump blood to the rest of his body.

Still, from the outside looking in, everything appeared to be fine. In an email sent to guests in early 2023, Foreman expressed excitement about the upcoming asparagus season. He continued to co-host a weekly public radio show on WYPR with Wolf, waxing on wine pairings for their favorite herbs. In February of that year, he posted a photo of Callahan to mark their 10th wedding anniversary, though they’d already decided to end their marriage.

Inside, his heart had reached its breaking point.

The beginning of the end

Foreman could write reviews of hospital food. “It’s always a couple of really exciting things,” he said dryly. “No-sodium turkey with not-good gravy and no-salt rice … terrifyingly plastic-flavored salad with some low-sodium Kraft dressing. … Delightful.”

By spring 2023, Foreman was transferred to the heart failure team at Johns Hopkins. It was clear he needed a new heart. But it increasingly appeared he might also need a new kidney, and possibly a liver, too.

Though Hopkins has done combined heart and liver transplants as well as heart and kidney transplants, they have never done all three at once. “The fear was that if he needed a third organ, it was something we had not done before,” said Dr. Ahmet Kilic, who happened to be the only surgeon doing heart transplants at Hopkins at that time. “Any death that happens within the first year,” he said, “all the scrutiny’s essentially on me.”

A heart and kidney double transplant is already exponentially more challenging than the procedure for a single organ. Heart transplant surgeons must contend with the swollen body of a patient who is in liver failure; with each incision, fluid oozes from tissue. Kidney transplant surgeons must consider that their patient is on any number of medications to stabilize support for their new heart.

Kilic advised a transplant committee that Hopkins should decline Foreman for the operation. The decision devastated other members of the restaurateur’s medical team, including cardiologist Ed Kasper. To him and some of Foreman’s other doctors, the restaurateur was more than a patient. He was an important member of the community — a friend, a representative, even, Kasper said, of “the best that Baltimore can offer.”

And wasn’t Hopkins the best, too?

Kasper and his colleagues were determined to find Plan B. So was Foreman.

Back at his home in Roland Park, people were clearing out the wine cellar. While Callahan navigated school drop-offs and a kindergarten graduation, she tried to reassure their daughters, Odelette and Delphinium, now 7 and 10, that everything would be OK. She wasn’t sure that it would.

The waiting game

Thirty-three years after Dr. Valluvan Jeevanandam performed his first heart transplant, he still gets a thrill out of the procedure, even at two in the morning.

He’s done 1,500 and counting, more than any other active surgeon in the world. He leads the heart and vascular center at the University of Chicago Medicine, a leader in triple transplants. Cases that other institutions deem too risky, or even impossible, they tackle head-on.

When the doctors at Hopkins made the call to UChicago to see if they would accept Foreman as a patient, Jeevanandam didn’t hesitate. The jet-setting restaurateur was flown to Chicago via air ambulance — a private plane with a nurse on board — ICU to ICU.

Foreman said when he met Jeevanandam, he recognized a familiar fearlessness that some people might call arrogance. “Every project I’ve done I’ve been told is the wrong thing and you can’t do it,” Foreman said.

Foreman recalled how in one look, Jeevanandam could assess what was wrong with him as easily as the restaurateur can scan an eggplant at a farmers market. “It was as though he looked through my skin and saw what was happening.” Though Foreman no longer needed a liver transplant, he needed a new heart and kidney — and fast. He was given days to live. All there was to do was wait.

Clarke Foreman knew his bigger brother was “losing his mind” cooped up in the hospital. When he flew to Chicago to visit him, unsure whether this was the last time they’d ever speak, he brought with him not flowers but a month’s worth of Foreman Wolf’s financial documents. Anything to take Tony Foreman’s mind off the many tubes running in and out of his body.

Thirteen days later, Callahan was in Baltimore when her soon-to-be ex-husband called her: “I’ve got a heart.” Her parents took the girls while she scrambled to catch a flight to Chicago.

Even for a doctor as confident and experienced as Jeevanandam, cutting into a patient’s chest for the first time is an extra tricky maneuver, particularly if a patient has had an open-heart surgery before; each one “makes the next operation about 10 times more difficult,” he said. Foreman had already had three. When the team cut open his chest, his heart stuck to his sternum with scar tissue.

Within hours of Jeevanandam and his team finishing the heart transplant, another team led by Dr. Rolf Barth began installing a new kidney — both organs from the same, anonymous donor who in death gave Foreman a second shot at life.

A new normal

Days afterward, Foreman shuffled one big-socked foot in front of the other. His thick gray hair resembled “a fantastic omelet draped across my head.” The skin on his legs had split open from so much swelling. Yet he clocked in 2 miles a day in the hallway of UChicago Medicine’s ICU. “There he goes again,” said the nurses, watching him from their station. “Way to go, buddy,” someone else said. It made his blood boil.

Work soothed him, offering a rare chance to feel useful. He responded to messages from guests and workers without mentioning where he was. But some people did know what was going on with him. A few employees and customers in his inner circle even came to visit him in Chicago; they’d go for walks, or grab a meal. “I was sort of shocked that I was important to all these people,” he said.

Foreman did so well that he was released from the hospital ahead of schedule, returning to Baltimore last November. His almost miraculous recovery has astounded his doctors and friends. “You can’t do much better than he did,” Barth said.

It’s been a year since the surgeries, the time period when rejection and other fatal complications are most likely to occur. Now on the other side of that milestone, Foreman is sharing his story with The Baltimore Banner in hopes it will inspire others. “If it makes even one person become more engaged in their health care, that’s a big deal,” he said.

Jeevanandam hopes that the restaurateur’s story also encourages patients seeking transplants to keep searching. “Don’t just give up because one program says no.”

Though Hopkins wasn’t able to do the procedure, Foreman’s doctors there are thrilled to see him thrive. They now have two additional surgeons for the department, enough to handle a dual — or even triple — transplant. If Foreman had gone before the committee today, Kasper insists, “We would have done it.”

Now separated from Callahan, Foreman gets his daughters three or four nights a week, which forces him to take time off from his restaurants. The girls get a kick out of the scars that go down his chest and crisscross his abdomen. For Halloween, they had him paint his face green and dress up as Frankenstein’s monster.

Despite going through such a life-altering experience, Foreman rejects the idea that this change in heart has fundamentally transformed his makeup. Of course he feels a sense of urgency to live every moment to the fullest, to prove to himself that he’s not wasting what he’s been given, but he’s always felt that way.

True, his organs work. Blood pumps throughout his body and he has color in his cheeks for the first time in years. He can stroll up and down the hilly paths of the Roland Park neighborhood where he lives and grew up without losing his breath.

But he’s still Tony Foreman. Even his sense of taste has remained remarkably intact. Doctors wondered whether the many heart medications he’s on would alter his taste buds.

And even though a manual given to UChicago’s heart transplant patients says to abstain from alcohol, the restaurateur, never one to take no for an answer, checked the protocols at transplant programs elsewhere in the U.S. He contacted the cardiologist who treated him in France back in 2018. The consensus: with meals, in moderation, wine is totally fine.

So the connoisseur has limited himself to around three ounces a day, the equivalent of about half a glass. There has been only one occasion when he broke that rule. A few months back, he took out a vintage from his collection — that now mostly empty cellar — and luxuriated in a 1989 Château La Mission Haut Brion he wasn’t sure he’d ever be able to enjoy. “It was worth it,” he said.

He’s even bought a few new bottles.