Juggling Lives: Heart Transplants for Children
MICHELE NORRIS, host:
From NPR News, this ALL THINGS CONSIDERED. I'm Michele Norris.
MELISSA BLOCK, host:
And I'm Melissa Block.
Commentator Darshak Sanghavi is a pediatric cardiologist. He's seen first hand how a heart transplant can save a child's life. And he'll never forget, when he was a medical student, the first time he watched how this second chance came from another child's tragedy.
Dr. DARSHAK SANGHAVI (Pediatric Cardiologist): Joseph was 17 years old and clearly an athlete. His well-muscled torso, washboard abdomen, and powerful limbs were outlined by the white bed linens in the intensive care unit. A few days earlier, he had been thrown from a motorcycle and sustained serious head trauma. However, his body had suffered no significant injury. Each day on morning rounds, I was always the last to leave Joseph's room, since the team had a habit of leaving the room in rank order and I was a medical student at the time. One day, the attending physician announced outside the room that Joseph's parents wanted him to be an organ donor. A team of cardiac transplant surgeons was summoned from Pittsburgh to take his heart, or in the language of transplant of surgery, harvest the organ.
I find the term comforting. A harvest season is a time of joy, the reaping of the earth's bounty to nourish life. Sometime in the afternoon, Joseph was wheeled to the operating room. The surgeons cut a long incision into Joseph's chest. It was a magnificent and terrible sight. Slightly larger than a softball, Joseph's heart alternately swelled and collapsed in an orderly top to bottom fashion about once every second. It had done this without pause for the past 17 years, hidden until today. Centuries early, blood was thought to have sloshed in a disorderly manner throughout the body, and the heart considered a porous organ of no clear mechanical significance. William Harvey, a 16th century Oxford anatomist examined the blood vessels of almost 80 different animals and discovered an unusual property of veins. When he forced water through the veins towards the heart, the water passed without resistance. However, when he tried to inject water in the opposite direction, it would not go. Harvey realized that blood circulates in a single direction, and that the heart is a mechanical pump. Even the cardiac surgeons, who likely saw hearts beating live everyday, paused to admire Joseph's heart.
For the briefest moment, I imagined the valves within Joseph's heart opening and closing. The surgeons abruptly injected refrigerated clear fluid into a large vein in Joseph's leg and the boy's blood drained into a plastic bag from a tube in his chest. The surgeons were replacing Joseph's entire blood supply with a saltwater preservative. I am watching a boy die, I thought, feeling a chill. Joseph's heart shuttered. The first of the icy preservative entered the chambers. The heart paused for a second to ponder the new fluid within its chambers. Suddenly, it recognized the betrayal. Instead of beating in orderly waves, the heart experienced a mutiny. Sections began contracting and relaxing randomly. Joseph's heart took on the appearance of a bag of snakes wriggling to get free. The situation is called fibulation, a state of electrical disorganization caused by confusion of the heart signaling system.
Shortly, the heart surrendered completely and lay in Joseph's chest, deflated. Joseph's body had finally joined his brain in death. His heart stopped when there was no longer any reason to pump. No longer any oxygen to circulate. A heart can't beat, it seemed, without something nourishing to fill it. I thought again about Harvey, who in some sense, stripped the heart of its metaphors when he found it was only a pump. Yes, I thought with a sense of loss, looking at the limp muscle that beat moments ago. It was just a pump. Would you like to do the closure, the chief surgeon asked me. Students are often asked to suture incisions after a major surgery is completed. I nodded. Hurry up, he called. But I felt a strange sense of obligation to close the wound perfectly, with an under skin stitching that made the incision almost imperceptible. I don't know why I considered this so important, since Joseph was being cremated anyway. Over the next 30 minutes, I made stitch after painstaking stitch, as if Joseph's soul depended on my hiding the empty place where a human heart used to be.
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NORRIS: Darshak Sanghavi is a pediatric cardiologist at the University of Massachusetts Medical School, and author of A Map of the Child: A Pediatrician's Tour of the Body.
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