Tin Man: If I Only Had a Heart
July 22, 2010 1 Comment
As a physician, I have it easy. On most days of the year, as dusk falls beyond the hospital windows, I pack my bags, turn off my beeper, and head home. On my brief trip to the parking garage, with my patients still lingering in my thoughts, I can feel the strain of my tendons and muscles from a long day of work. I can breathe deeply. I can feel my heart pounding inside my chest. I can run.
This is more than I can say for my patients. Day in, day out, they reside in the hospital – most of them too ill to look out the single window in their room. The limited cafeteria menu is further limited by dietary regulations – low salt, low sugar, restricted protein. Cardiac diets, diabetic diets, renal diets – you name it; there are countless excuses for physicians to cross off, line by line, most of the edible items on the menu so that patients are left with what remains: unsalted soup, graham crackers, and jello. They spend most of their time alone in their rooms, waiting for the nurse to come in, hoping a visitor will arrive, praying that the sun will rise so that the bustle of daytime can distract them from the brooding thoughts of nighttime.
One young gentleman on the highest floor of the hospital is doing just this as I write – sitting in his room, waiting. He is waiting for many things, among them the principal reason for his stay: a heart transplant. His heart has failed him for reasons we cannot explain – the cause was not a diet overloaded with high cholesterol, nor was it the “couch potato” syndrome. He was an active, healthy man prior to his illness. Although a genetic component may have played a role – his son needed a heart transplant at the age of 6 – the cardiologists are unable to figure out exactly why. Idiopathic cardiomyopathy is the official diagnosis.
He is one of the few patients who manages to light the room with his smile and his spirit – but no man is entirely invincible in the face of mortality. Today, I took the time to ask him how he was doing. His eyes wandered to the corner of the room and welled with tears, in spite of himself. “It’s hard.” He went on to explain that his life as it is – bound to a bed or chair at best, unable to exercise or even walk, unable even to breathe without diuretic medications dripping through his IV constantly – is not a life worth living. He wants to twirl his grandchildren in his arms, continue to work as a plumber, and ride his bicycle across town.
And so he sits, waiting. Confined to this room and this life, possibly for months. Waiting for a heart that someone else can no longer use. As he warms to me, he asks if any patient has ever requested his old heart in a jar – almost like ashes after cremation. What a peculiar thought – but it fits well with an equally peculiar operation.
To open the chest of a dying patient, remove his heart, place it in a cooler, and fly it by helicopter to the nearest hospital – and to have a patient there, waiting, alive, and heartless. And then to take this lone, wandering heart that has traveled miles upon miles, and suture it to his vena cava, his aorta, his pulmonary arteries…. To place the electrodes on it as it sits quietly in its new, permanent location – his thoracic cavity – and to shock it into life, all over again.
To watch that heart start beating for the second time is a miracle. But I often wonder how it feels to awaken with someone else’s heart pounding inside your body. You have the same blood and brain and face, but that vital life source – the beating heart – is no longer yours. Or maybe it is. But it pumped a stranger’s blood for years and years, grew accustomed to their idiosyncrasies, accelerated when they became nervous, slowed as they rested in bed at night, skipped a beat when they first realized they were falling in love.
And so here you are with this new heart, borrowed from a stranger. Beating anew. Maybe it is not so different after all, this new thoracic cavity. Just another human being – laughing, smiling, crying, trying to be brave in the face of death. Except this time, as it pounds on, each single beat will matter. Each contraction is an extra beat – and breath – of a life you may not have had.