A gift from the heart

First-year pediatrics resident KIMBERLY NOBLE befriends an 8-year-old boy who needs a new heart ... and gets it.

As I'm writing this, a little buddy of mine is starting a long recovery process.

He got a new heart last night.

This eight-year-old boy -- privacy laws prevent me from giving his name -- was born with congenital heart disease. His heart wasn't formed properly in the womb, and so it didn't pump nearly as well as his body needed it to.

He'd already had several surgeries in his short life -- chest-cracking, heart-stopping surgeries -- but they hadn't worked as well as his doctors would have liked, and his heart function was steadily getting worse. He had begun to get short of breath just walking across his room. Walking down a hallway could send his blood oxygen levels dangerously low.

Even so, he hardly ever complained about anything (well, except when he was told he needed to share the hospital Game Cube with other children on the floor). I never once heard him say that he was in pain, or that it was hard to breathe.

He was admitted to the hospital for close observation, and to receive intravenous medications that would help his heart function better for a little while. But really, there was only one thing that could fix him -- he needed a new heart.

Last night, he got one.

The call came in the early evening, sometime around 6. The cardiologists were the first to be notified: Somewhere a heart had been donated that matched the boy's body in size, blood type and several other characteristics.

As the first-year resident working overnight on the pediatric cardiology floor, it was my job to write the medical orders in preparation for his surgery. I needed to let the blood bank know that a lot of extra blood might be needed during surgery -- not too surprising, when you consider that surgeons were essentially cutting out a boy's young, diseased heart, and sewing in a healthy one.

I also needed to make sure that he got large doses of medications that would suppress his immune system -- otherwise, his body would promptly attack the new heart as something foreign and begin to kill it.

The floor was buzzing with excitement -- he was getting a new heart! The smiles were infectious. As the nurses and I were discussing the timetable for medications, I could hear his mother tearfully phoning the good news to friends and relatives.

Around midnight, he went down to the OR. I went to the on-call room to lie down while there was a little downtime -- always a good idea when you get a chance, because you never know when another kid on the floor might need a doctor's attention, or when a new child might get admitted to the hospital. Before you know it, it's easy for a sleepless night to pass by.

But as I lay there with my eyes closed, the language of heart transplantation kept running through my mind.

"The donor." As if his heart were a philanthropic endowment made by a wealthy real-estate mogul.

The new heart might be recognized as "something foreign." Like a fruit picked from an exotic plant, or arriving on a ship from the other side of the planet.

Of course, we all use these euphemisms to keep from focusing on the fact that his heart used to beat in another body -- to avoid thinking about the other parents, probably not too far away, who in all likelihood were tearfully relaying a different sort of news.

We try not to think about it, but we all know that the new heart came from a young child who died yesterday. A child who likely left behind a family to cope with an impossible grief.

I don't know the identity of the child who was born with the new heart, or how this little boy or girl died. The doctors taking care of the patient on the receiving side never do. In fact, great pains are taken to make sure doctors treating a potential organ recipient have nothing to do with the treatment of a possible donor -- and to ensure that a patient's decision to donate organs doesn't affect his care.

Nonetheless, even though we have no control over the process, it's an odd realization that hoping for the best for your patient (or child) means wishing ill on someone else.

I hope that the family that donated this child's organs takes some small solace in the fact that one child's death helped save at least one other young life, and probably the lives of several other children -- children who may have needed a kidney or a liver, for instance.

Even more, I hope other families will realize that, however devastated they may be by the loss of a child, a final act of generosity -- to help a very sick child like this one -- just might make their immeasurable anguish the tiniest bit easier to bear.

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asap contributor Kimberly G. Noble, M.D., Ph.D., is a pediatrics resident at Columbia University Medical Center.

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