For those who missed it a year ago… FENWAY PARK & CARDIAC KARMA – PART II
Andrew was taken by air-ambulance to Dallas, and admitted to Children’s the next day. He and his mother had 13 years to understand his life, and his heart, and the difficult and unforgiving path which life had laid out for him to get him to this point. Dr. G. had less than a day to take it all in, analyze the salient points, and make decisions which could, in the very real sense of both words, involve life and death. She’s the coordinator of the heart transplant program at Children’s, and she became involved in Andrew’s case because transplant was one of the first, and most likely, options for a kid in his situation. Her decision making process began in the Echo lab. After seeing the extent of the problem on the computer screen, she went to meet Andrew, who was already being treated with intravenous medication to slow both his heart rate and function in an effort to keep him stable. At this point, the choices for Andrew were slim. As the I.V. medication was not giving him a significant lift, the only remaining options were the implantation of a machine to aid his heart function, called a Left Ventricular Assist Device (LVAD), or a heart transplant. The LVAD option is not a pleasant one. It involves combining the left ventricle with a large, complex external device to improve ventricular function. A vigorous teen-ager like Andrew would not have enjoyed life on a pump. The transplant option is a difficult one, as well. A heart transplant is not the panacea many people think it to be. For the rest of the patient’s life daily medication is required, to make certain the body does not reject the new heart as a foreign organ. But there is more to it than just lifelong medication. The process of cutting open the chest, through the muscle wall, through the breastbone, placing the patient on the heart-lung bypass machine to sustain life while the heart is removed and replaced, is a crushing physical challenge for any person to undergo. There are psychological scars involved for transplant patients which are just as real, and often more prominent, than the physical scars. Whether it is the length of time the patient is on anesthesia, or simply the emotional baggage involved in major surgery, not everybody bounces back from it into a completely normal life. Add to that the problems a young teen faces just dealing with all his raging hormones, and the picture becomes quite complex.
“The first thing we consider when we look at a kid for transplantation is that there has to be a need for it. Not everybody who comes in with heart failure gets on the list. If you have a malignancy, an active cancer, if you have a systemic disease that will affect the new heart, if you don’t have a supportive family and, unfortunately, if you don’t have certain financial viability, these are some of the first contraindications. Potential transplant candidates are worked up for cardiology, surgery, financial structure, neurology, and psychological evaluation, as well as other sub-specialties. Then we all come together as a team and make our transplant assessment. I did my surgical transplant assessment and I thought he was a great candidate because he was otherwise a healthy kid,” Dr. G. noted, “very active, came from a very supportive family. So he was worked up, and he was listed for transplantation.”
At that point, Andrew and his family were given a pager and told to always keep it close at hand. The moment a donor heart was located, everything in his life would have to stop, and no matter where he was in the hospital or what he was doing, he would begin the final prep for surgery to replace his heart with that of someone else. Someone who had not died yet.