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Tim Ritvo has known his wife, Kathy, since they were teenagers growing up in Boston. He was an aspiring jockey, and she came from a horse racing family. It was a match made on the backstretch.
Now, as Ritvo looks back on those early years of their relationship, he sees the warning signs that no one could have suspected then.
"I used to go out and jog and ask Kathy to go, too," he said. "She was a little thing, only 85 pounds, but after running just a short way, she would stop and say she had a burning in her chest.
"She would say that she just wasn't a runner."
But as their relationship grew and Tim and Kathy married and had two children, her issues with stamina and fatigue persisted. She was chronically tired, but doctors thought it was just the normal demands of raising children.
At times, she was told she might have only a cold or the flu.
"But it got to the point where we would dress up to go out at night," Tim said, "and she would start crying because she couldn't even put on her heels."
By late 2000, with the family living in South Florida, Kathy reached the breaking point. She was pregnant with their third child but barely functioning. She had a bad cough, was running a fever and couldn't sleep.
Three days before Christmas, Tim took Kathy to the hospital. That decision probably saved her life.
There are many inspirational stories in sports, but perhaps none as compelling as the one Kathy and Tim Ritvo are sharing with the media during Kentucky Derby week. Three years after watching the Derby from a hospital bed with no assurance that she would live long enough to watch or attend another, Kathy is saddling her first Derby horse, a strapping bay colt named Mucho Macho Man.
She is the ultimate survivor, having undergone successful heart transplant surgery in November 2008 after being diagnosed with cardiomyopathy during that fateful hospital visit in 2000. The disease is an inflammation and enlargement of the heart muscle that makes it increasingly difficult for the heart to pump blood.
There are different types of cardiomyopathy, and causes can range from a viral infection to genetic predisposition. Kathy's father, Peter Petro, died of a heart ailment when he was 73. One of her three older brothers, Louis Petro, died suddenly in 1996 when he was only 38. The cause was cardiomyopathy.
Her brothers Nick, a jockey, and Mike, a trainer, do not have heart issues.
Kathy had been living with the undetected condition for most of her life and might have met the same fate as Louis if not for her third pregnancy, which exacerbated her symptoms. On her doctor's advice, the pregnancy was terminated.
"Our third [pregnancy] may have saved her life," Tim Ritvo said.
Now, Kathy prepares for the biggest race of her career with a horse that oddsmakers and experts give a good chance of winning and that has the Village People among its fan club members. As the anticipation builds, she remains calm and composed.
"After you have had a heart transplant, you're honored just to wake up in the morning," Kathy said. "And I am blessed to have a Derby horse."
Mucho Macho Man is a rambunctious colt. During a phone conversation 11 days before the Derby, Ritvo apologized for the interruptions while her 3-year-old was horsing around outside the barn at Churchill Downs.
"I'm gonna kill him," she said. "He sees some horses and thinks it's time for fun and games. He's nosy."
Now 42, Kathy is feeling better than she ever has. It is remarkable that she was able to train and saddle more than 150 winners while her disease was progressing. After leaving the hospital in 2001, she was put on medication, which helped her function day to day.
But by 2008, when she was 39, the medications were no longer effective. "She couldn't go the whole day without getting exhausted," Tim said. "At night, she couldn't make it up the stairs so she slept downstairs."
She was hospitalized at Jackson Memorial in Miami during Kentucky Derby week, and that was when her doctor said only a transplant could save her.
She was placed on a transplant list and spent the next six months waiting, being fed medication intravenously "just to keep my heart pumping," she said.
She was in and out of the hospital, sometimes for a week or so, sometimes for three weeks as doctors tried to keep her heart functioning until a donor was found.
Those six months were a mix of hope and despair, but also of impending finality. "I wish I could say I was positive the whole time," Kathy said. "But the hard thing to do is to wait. I didn't want to get sicker.
"I had to hold on. My husband and two children [teenagers Michael and Dominique] didn't know if I'd be there in the morning. The kids knew I was very ill, that I needed a donor. But I didn't want to scare them."
Tim said it was a difficult time, knowing he couldn't do much more than lift Kathy's spirits. "I tried to keep her very confident, told her, 'You're going to get a heart,' but it's easy to say that when you're not the person who is sick."
Kathy was home with her family watching TV when the phone call came on Nov. 13, 2008. "They said they had a heart and wanted to know if I'd accept it," she said.
It's not a rhetorical question. Kathy said that faced with the delicate transplant surgery and complications that could arise, some people have second thoughts.
But she told the doctors yes, that she wanted a new heart. They would conduct more tests on the donor heart and call back. When they did, Kathy would have to come to Jackson Memorial immediately.
She and Tim talked about the surgery to help pass the time. They counseled their children and waited for the next phone call.
"They called back sooner than we expected," she said. "But I was all ready to go in. I just wanted this to be over one way or another. I didn't want to live my life like that."
She couldn't help but feel sadness, too. She was getting a second chance but knew "someone else's life was over."
The surgery confirmed what her cardiologist, Dr. Joseph Bauerlein, had suspected: Kathy would not have survived much longer without a transplant.
She was released from the hospital a week later -- "my shortest hospital stay ever," she said -- and began the recovery process. In a perfect world, her doctor would not have wanted her to return to training horses because the medication she takes to suppress her immune system and prevent her new heart from being rejected also makes her susceptible to infection and illness.
"I'm not supposed to be around dirt," Kathy said. "But this [horse training] is not a new thing for me. I've had my trainer's license since I was 18."
She takes precautions, such as avoiding people who have colds or other illnesses. She washes her hands often. "I have a good team of people who work for me," she said. "The guys get me a towel if my hands get dirty. They remind me to wash my hands. And I take care of myself."
Now, three years after the surgery, Tim said doctors have told Kathy the odds are getting increasingly better that she won't need another transplant.
And she is back pursuing what he calls her passion: being around horses.
A Derby contender, he said, is just a bonus. Kathy took over training Mucho Macho Man from Tim when he became director of racing for a corporation that has holdings in several racetracks.
"If you compare him to an athlete, he looks like a basketball player," Kathy said about Mucho Macho Man. "He's long and still growing. He actually won't be 3 years old until after the Belmont Stakes [in June]."
Mucho Macho Man is listed as a 15-1 shot after being upset in the Louisiana Derby, where he finished third to Pants On Fire and Nehro. But he lost a shoe during the race, so there were mitigating circumstances.
Tim said that no matter how Mucho Macho Man performs, his wife already is a winner.
"It's an unbelievable final chapter," he said. "We're humbled by having a horse that can compete in the Derby, and it's just a huge bonus.
"Kathy will never have a losing day."