A 2nd Birthday

I had a patient last week that I was seeing every morning before my attending came in to see him. I'll call him Mike. His heart was failing after having a heart attack. It was so weak, he had to have an intra-aortic balloon pump placed to help blood flow inside his heart better. He was also on two IV drips just to keep his blood pressure on the low side of normal. He was already on the heart transplant list, but his weak condition moved him up to the top of the list. Everyday last week I saw him and he looked weaker each day. Thursday he was pale and depressed-to me, it seemed he was getting worse.

Friday, I came in to see him and the nurse told me that there is a chance he could get the transplant he needed that day. There was a heart available in a city 4 hours away but there were still some tests that needed to be done to see if he was a good match. I went in to see Mike and told him I'd heard the good news that he may have a heart later. His affect was flat and all he said was that he'd "been here before and it didn't work out". With that reply I knew he was losing hope. All I could thing of to say is that we could hope that this time it will happen for him. I patted his arm and left.

All day we waited to see if he would get the heart. The delays were caused by the donor having some health issues that raised some questions as to whether or not the heart should be used. The surgeon came in and told Mike what was going on. Mike called his family and talked to them for a long time, then the surgeon talked to them. Then Mike got back on the phone. When he got off the phone, he yelled, "Doc, my family says go for it!". At around 2pm, there was still one test that needed to be done, but the transplant team decided to go ahead and fly out of town to "harvest" the organ, and if it turned out that they couldn't use it, they would just fly back without it. The brain-dead donor has to be kept alive on a ventilator until the organ is removed. The shelf life of a heart is low: The surgeon has only 4 hours from the time the heart is removed from the donor to the time it goes to the recipient. I found out the hospital has a private plane always on standy-by for instances like these.

All day on Saturday I thought about Mike and hoped he got the heart. I was almost looking forward to being on call Sunday because I wanted to know if he got it. Sunday, I was up in the ICU and asked one of the nurses if he got it. She said he did! He went to surgery around 10pm Friday Night and was in surgery for 6 hours. It was almost midnight put I peeked inside his room to see if he was awake. He was watching TV and when he saw me, he smiled and said, "I got it!". I went in and talked to him for awhile. He was so animated-he had gone from this sad, sick person about to lose hope to a new person who had just been handed another chance. It really made my night better to see him so happy. He looked really good, too. His skin was pink and he seemed to be thinking more clearly.

Mike has a long road ahead of him. He will be on anti-rejection drugs the rest of his life, will probably have several future hospitalizations because just about everyone goes through bouts of acute rejection. He will probably develop diabetes from the long term prednisone use, and the anti-rejection drugs will almost certainly decrease his bone marrow production of red blood cells, white blood cells, and platelets. He is also very weak from being bedridden. That said, I've never talked to a transplant patient who was sorry they did it-it gave them a 2nd birthday.

Last month when I was on cardiology, I found out that transplants are actually decreasing because there aren't as many organ donors as there once were. I found out most donors are young adults who make bad decisions and end up having life-ending accidents. With new safety laws in place like seat belt use, less young people are dying, therefore there are less organs available. I hate it that someone has to die for someone else to live, but what an priceless gift that is!