PART 2 (Please read first): No place for old pessimists

I am going to avoid making any comments about the facts in this post – a previous version came across as too arrogant, triumphalist even.

Our family has taken to using H1, Heart 1, for my original, birth heart, to distinguish it from H2 or Heart 2, my new, transplanted heart.

The San Andrean Fault size changes resulting from my heart failure and restoration as a result of a new heart transplant, have forced me – I think until the end of time – to ditch my former non-motivational, pessimistic approaches to achievements.

Firstly, the physical deterioration in my condition was so rapid. Of course, every day one is exposed to the risks of living in a world where anything can happen very quickly. Kids fall down in a playground, people die in high speed vehicle accidents, industrial machines come careering down, mines collapse, war mongerers target one’s village not because the age-old politics has changed but because tonight they needed a half-decent toilet for their troops.

But, secondly, the treatment responses have been so quick. In recent days, two things have emerged.

It turns out that I was effectively on the formal – what the heart unit here calls the active – waiting list for a new heart for only 3 days – and that time straddled a weekend. We had been advised I would not go onto the active list – which is nationally co-ordinated and theoretically includes public and private sectors – until every cliched “i” had been dotted and “t” crossed.

This is an absolutely essential protocol. One doesn’t want a situation where a donor heart is ready for transplant in one part of the country or section of the process but there has not been administrative sign-off in another. In my case, we were awaiting medical aid approval for the transplant procedure. But, even with all administrative conditions met, we anticipated a very long wait for a matching donor heart. Some people have been on the active list for years.

The “work up” tests (another “in” term used in the unit) conducted by Dr Basil Levetan and others at Christiaan Barnard Memorial Hospital had dealt fully with my medical status – I needed this treatment, this was their recommendation and provisionally I was accepted on the programme, but it was not official and I still needed to go on the active list. We now needed other agreements.

Mid-afternoon Friday, the co-ordinator of CBMH’s heart unit, Helena Williams, received confirmation of medical aid approval, meaning I was now an official awaiting transplant patient.

On Monday, the unit received information of the availability of a possible heart donor (not for me, but for anyone on the programme). Given my rapidly deteriorating status, the prospect I would not leave hospital again in that status and the medical matches between donor and recipient, a final decision was taken for the heart to be transplanted to me. The urgency of pushing hard to achieve everything in time for the transplant window the next morning, continued unabated.

The cardiac catheterisation laboratory is a regular stopover for biopsy specimens to be sent for pathology tests.
The cardiac catheterisation laboratory is a regular stopover for biopsy specimens to be sent for pathology tests.

Yesterday Friday), I went for my first post-transplant angiogram and biopsy. In the latter procedure, the surgeon inserts a small “grabber” into your groin to literally slice off a few small pieces of H2 to send to the laboratory for tests. These regular biopsies are critical to monitoring whether there is any rejection of H2 by your body. Outright rejection appears to be a rare occurrence. Instead, management of rejection through increasing dosages of immunosuppressant medication (more about this another time) is important throughout the life of a heart transplant recipient.

Pathologists have developed a scale for determining the level of rejection of a new heart in someone’s body. It runs from 0R, 1R, 2R, 3R. The first two grades require no intervention, but the latter two will lead to changes in medication.

In my biopsy yesterday, a result of 0R was returned, which is the most favorable grade, suggesting a complete absence of rejection of my new heart and virtually no difference between my H1 and H2 from a tissue composition point of view.

PART 2 (Please read first): No place for old pessimists
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