Heart Health

13 January 2009

The Heart is Beautiful - Part 2

In this episode, the suspense continues. Contrary to all expectations, Melanie thrives, but Trevor wanes.


In this episode, the suspense continues. Contrary to all expectations, Melanie thrives, but Trevor wanes.

CyberShrink comments on the second episode of the series "The Heart is Beautiful", which is screened at 19h35 on M-Net on Thursday evenings. (Read his write-up of episode 1 here.)

The series follows the real-life story of the Gird family, whose daughter needs a heart transplant. Filmed in real time, the series covers the family's wait for a heart donor for their daughter Melanie, not knowing at the beginning whether it's going to happen or not. And then their son, Trevor, gets ill as well.

Even now when the transplant they have longed for for so long, seems about to start, it's hard to believe it's really happening. Yet, they are faced with uncertainty until the last moment, and continue to hope for a good outcome. A major part of the struggle, throughout, has been about being so powerless about something so vital. For now they must watch her wheeled away, down the corridor.

Edge-of-the seat stuff
The recent X-ray and scanned images of her heart are awful, showing so much damage, clot, and non-functioning muscle. The previous heart surgery will make the operation more difficult, too. Dr Vosloo has to start operating before the new donor heart arrives, to reduce the risk that it will be damaged by delay - yet has to keep Melanie's heart as viable as possible for as long as possible, in case the new heart doesn't arrive in time.

Four hundred kilometres away, in George, her colleague, Dr Otto Thaning, works on retrieving the donor heart, which must be chilled, slowed, to protect it in its slim four-hour out-of-the-body lifespan. Melanie will be kept alive during the procedure by a Heart-Lung machine which provides those essential functions until her new heart can take them over again. Such a small package, yet so vital - and with a label "Heart Transplant". But the small plane makes it through the storms, and arrives on time, and the package is rushed through quiet streets and into the hospital.

Surgeons are typically practical, down-to-earth, intent on their craftsmanship with body parts. Their tools often look like those of a carpenter. Melanie's heart is stopped, and removed, and discarded in a kidney-shaped dish, no longer needed. Seeing its state, it's clear Melanie could not have lived for much longer with it. The new heart is carefully trimmed to enable the best fit. The procedures take hours, but can't be rushed.

Dr Vosloo operating on Melanie

Melanie now post-op
The family wait."You just don't know what to feel," says little brother Trevor. Soon the new heart is beating strongly and the ECG looks good, and the machine relinquishes control back to the lungs and their new heart. There are still risks ahead - opposite hazards, of clotting or bleeding; and later, rejection. The failing old heart could have caused some damage to other organs, which now need to readjust to the presence of normal circulation.

Once Melanie is awake and communicating, everyone is relieved, as her clear thinking and remembering shows her brain is functioning well. She's warm and pink again. Dr Vosloo announces that her outlook is excellent, with a good quality of life likely. Soon, she is able to walk out of the hospital.

Melanie in hospital after cardioversion.

The parents were very supportive of each other, though at times they seemed to almost forget their frightened and caring son. When Trevor Jr. told his mom his heart was "running along", or complained of other symptoms, they worried that he might be mainly seeking attention in the family, where so much attention was focused on his ailing sister.

Trevor takes a turn for the worse
Not long ago he was still playing rugby. But then it became obvious that he was also ill. The cardiologist identified the same clinical features in him as in Melanie. Their ECGs, depicting the electrical activity of their hearts, were almost identical. He wanted to try to "live life to the fullest", perhaps expecting that it might not be long. But for some time his symptoms have not been severe, and apart from avoiding sport, he seemed OK and at low risk.

"I can't really run", he admits, and gets dizzy and white in the face if he tries.

Trevor junior's symptoms are now getting worse and he is admitted for assessment. It's soon obvious that he is deteriorating and will also need a transplant. His heart is getting bigger, its functions failing. The family is plunged back into the old fearful waiting and that familiar sense of helplessness. He's such a pleasant kid, and facing doom calmly. "I've made peace with it - you really don't have a choice". He loved sport, and can now only watch it.

The young brother Trevor Jr during a happy day on a wine farm just before his own heart began to deteriorate rapidly.

Suddenly, it seems, he is becoming desperately ill, and nobody knows why his disease is progressing faster now. Could it have been the stress and anxiety of his sister's health crisis that affected him in this way?

Whereas previously Melanie was for him an awful foreshadowing of things to come, now that she is thriving post-op, she's a source of hope. "I hope I can be like that!" Now he re-traces the steps into illness which she had followed, but more rapidly. His cheeks are flushed, the lips blue, and he is exhausted.

What seemed like an ominous future risk has now become a life-and-death struggle. As he has a more rare blood group than his sister, it may be harder to find a good match. Will they need to compromise with a less than perfect match, a less beautiful heart? His chances are getting slimmer, as he wonders: "Am I going to have a life? Or die soon? "

(Professor M.A. Simpson, Health24, December 2008)


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