My thanks to a stranger

Heart transplants are a lifesaving procedure, but often we do not know much about the donor of the heart that can save people’s lives. In this article from the September 1993 edition of Reader’s Digest, Douglas Whynott looks back on his mother’s heart transplant and considers who the generous donor could be.

“She needs a new heart," my father told me when I called on that December afternoon. An unrelenting optimist, he spoke as if she merely needed to have a part replaced. But, although my two sisters and I knew that our mother had heart problems, this was shocking news. We went together the next day to the hospital in Boston for a conference with her doctors.

Dr Marc Semigran of the transplant team reviewed my mother's medical history. She'd had an irregular and rapid heartbeat for most of her life. Her present treatment—the use of a series of cardioversions, or electric jolts, to restore a normal heartbeat—would not work in the long-term. She had an enlarged and weakened heart, as well as a faulty valve.

"With medication," Dr Semigran said, "you have a 60 per cent chance of living six months. You could have a longer life with a transplant, but there are risks. You're at the top end of the age group."

"I'll be 60 in January," said my mother.

Sixty years old, we were told, was generally the cut-off point for heart-transplant patients. Hearts are hard to come by, and recipients must be good risks. The lungs and other organs must be healthy and strong. While the transplant surgery was actually a straightforward procedure, the doctor said, acceptance by the body was the difficult thing. By nature, the body wants to reject the heart, the intruder.

Tests would show whether my mother would be placed on the viable recipients' list. One test, we were told, was a treadmill, to check the strength of the lungs. We winced at this. Although Mother had stopped smoking several years before, she had smoked 40 cigarettes a day for 40 years.

If accepted into the programme, she would probably have to wait nine to 12 months for a donor. She was told to go home and try to live a normal life.

While we waited, I thought a great deal about my mother. She grew up in Yarmouthport, Massachusetts, a tenth-generation descendant of its founder. She told me stories about life in the early part of this century and gave me glimpses of our forebears: a general-store owner, a sea captain, a clergyman.

My mother also gave me the experience of watching her play the electric organ. She decided, in her early thirties, to play jazz, and practised three, four, sometimes eight hours a day. With a foot beating at the pedal, chords popping in her left hand, melody in her right, her head bobbing, she played the latest song she had set out to master. My father endured the practice. Lying on the sofa, waiting, he'd wonder aloud when she was going to shut the damn machine off and get dinner.

My family was coming together, trying to provide strength, trying to work out what to do. We'd already gone from shock, over our mother's condition, to worry, that she wouldn't be a viable recipient.

Word came later in December that she had been accepted into the programme. Her cardiologist, Dr Jeremy Ruskin, told us one of the reasons she had been accepted, at her age, was that she had such strong family support.

We all began to adjust to the idea of our mother's having a new heart. A granddaughter asked, "Will Grandma love the same people?"

But Mother had to decide whether to consent to the operation or to let life run its course. My father, from the beginning, told me that they were going to do it, together. Their marriage, which had at times seemed to be between two free agents, now looked different to my sisters and me. My father, a responsible husband but very much a lone wolf, earned gratitude from Mother and a new regard from us.

One Monday in May, at about 8pm, my mother received a phone call from the hospital. A heart was available, and she was to come immediately. My father phoned to say they were on their way.

About to be taken to surgery, Mother, always attentive to her appearance, wanted to look her best. She kept her contact lenses in and resisted parting with her girdle because she didn't like the way she looked without it.

As she was about to be wheeled off, my father took her face in his hands and looked into her eyes. His look said everything about their 42-year relationship.

Heart transplants are generally done at night, to take advantage of reduced traffic in operating theatres. The visitors' room where my sister Judy, Dad and I were waiting was empty. The word was that if we didn't hear anything by 2.30am, the operation would be under way. The procedure would take three hours. As 2.30 approached and passed, we sweated out the next three hours. Then at 5.30am, Dr Semigran came in and said, "They're just getting started up there. Things got held up."

Meanwhile, Judy had gone for a walk and was standing by the lifts when the chief transplant surgeon came rushing down the corridor. He was carrying a picnic cool box containing the heart. Judy returned ashen; her eyes wide.

We settled down for another three hour wait, dozing intermittently. We imagined my mother up there. "Come on, Marilyn," my father would say now and then.

Just after 8am, Judy and I went to the coffee shop. Soon we saw my father walking towards us. Never had we seen him look so soft, so happy. "The doctor said the conditions could not have been better," Dad told us. "They got a strong heart from a 21-year-old man. But I won't tell her that. She won't want to know."

An hour later we went to the intensive-care unit. Mother looked as if she had been washed ashore. She seemed frail and yet, somehow, even in her sleep, determined. There was a breathing tube in her mouth.

Afterwards I picked up a newspaper and began reading about a recent shooting. On Friday night, some students had walked into an alley in a large city to meet a man and woman. One of the students had some marijuana to sell. The two buyers, however, decided to steal the stuff and began to run. The man fired a gun to frighten the students, but he hit one of them in the head.

The student was taken to a hospital, where he remained on a life-support system for the weekend. His family gathered, and they conferred. At 1pm, on Monday, he was pronounced dead, and preparations were made to switch off the life- support machine. I suspect his heart is now beating in my mother's chest, although I will never know for certain.

The irony of the transplant process is that one family's loss is another's gain; that tragedy begets fortune. And what an act of altruism was involved, the giving of a heart to another. It is a kind of life after death, our hearts beating beyond us.

My mother was awake the next day. Her first words were, "I want my make-up." On Thursday she got out of bed. On Friday she was sitting in a chair. On Saturday they had her pedalling a bicycle unit clamped to the bed.

But she was having trouble with the emotional part. She did not want to know anything about the donor; when the nurse brought up the subject, Mother cut her off. The nurse told me to listen to my mother's signals. And so I did.

I wrote a letter to my mother and tried to say things that would reassure her. This was a miracle, I told her, an action of grace. She should develop a feeling of love for this new part, of gratitude for the doctors, for the process, and for those people who made a decision not for her, but for humanity. I suspected those thoughts would come to her on their own, though.

And they did. She returned to the church she'd grown up in. Ultimately, she would believe that her new heart came from God and that, once in place, it was her own. That was essential. No eerie déjà vu for her, no imaginings of transplanted personality. A heart is a heart; a pump is a pump. And a gift is to be accepted as one.

The antibiotics and steroids that make heart transplants possible were fine tuned to her system. She had three incidents of rejection and had to return to the hospital for adjustments, but she made good progress.

For the first time in her life, my mother began to exercise. She walked several miles a day. A year after her operation she took up aerobics. My father started calling her "an old showgirl", and she laughed self-consciously.

In her hometown my mother has become a heroine. But Mother is quick to grant to others a share of the spotlight—her husband, foremost. Then she points to her family and friends and to the doctors, especially Jeremy Ruskin. And, inevitably, in a quiet tone of voice, shaded with the inherent mystery of the process, she speaks of the anonymous helpers in this network of life-giving.

Whoever you are, thank you for my mother's new heart.