Heart Health

13 January 2009

The Heart is Beautiful - Part 1

Will Melanie find a heart donor before it's too late? CyberShrink writes on the first episode of M-Net series: The Heart is Beautiful.

Too much attention is paid to dramatising heart surgeons, and too little to the bravery of the patients and families involved. This highly skilful and gentle South African series puts that right.

In the remarkable The Heart is Beautiful television series, we meet the extraordinary, ordinary Gird family, who handle threat and uncertainty with dignity and courage. In a very rare event, two of their children are suffering from an uncommon hereditary heart disease, fatal unless a successful heart transplant can be carried out.

Melanie is 19, has been ill for years, and is steadily deteriorating. Periodically her heart develops a serious irregularity of rhythm, and she has to be rushed to hospital for cardioversion - a careful electric shock to set the rhythm right again. But the procedure has risks, as it could be fatal in itself, and can weaken the heart further.

Most unusually, her younger brother Trevor (15) has the identical heart disorder, though he seems to be fairly well when we meet him. There is obviously great love between the pair, but he must know that as she is now, he will be, one day.

They have been referred to one of South Africa's leading heart surgeons, Dr Susan Vosloo of Cape Town. She works in the Chris Barnard Memorial Hospital. She was mentored by Barnard, she's talented and calm, a down-to-earth surgeon who achieves astonishing things, and she's not at all attention-seeking.

Being permanently temporary
Melanie's life is greatly constricted by her illness, even if the symptoms don't seem dramatic - dizziness and tiredness predominate. But she's had to hasten into hospital 40 times in the last year for cardioversion. It's been getting worse since she was 13, and at 15 she had major surgery to try to reshape the right side of her heart, to improve its function. By now, there is little useful activity of the right side of her heart, as there is little functional muscle left and what there is, is weak and irritable.

The family visits relatives on a farm near Paarl for Christmas, and to see Dr Vosloo in Cape Town. She has done 75 transplants, most frequently on children, with excellent success rates. In a bitter example of every cloud having a silver lining, there's a better chance of a donor heart becoming available during the holiday season. After the years of uncertainty and dread, the family tries different ways of coping. Their comments are revealing: "You never get used to it. You just learn to handle it."; and: "I hope. Without hope you have nothing left".

Their mother urges them to concentrate on what they can do, and not on "bad things you can't change". She gets awkwardly joky at times, and Melanie seems not to appreciate this, though it's a common defence tactic. The father tries to be strong, and little Trevor seems overwhelmed at times, but is always loving and supportive.

Creepy prayers
They know Melanie is marked as the highest priority on the transplant list. "I pray to get a heart every day". They seem to recognise that this is somewhat creepy - effectively, they are praying that someone else will die, so that she can live. Then on December 22, they get the call they've been longing for - a heart has been found, in George. They must rush back to Cape Town, in hope of a transplant.

It seems odd, given her condition, that we see her getting on and off the plane with no sign of a wheelchair or lift to the cabin door. She seems eager, and shows no fear of surgery, but her only alternative is early death. It's a delicate dance that's required.

Once a potential heart has been identified, permission must be got from the family, the donor chest opened - and then if the condition of the heart is satisfactory, it must be chilled, removed and rapidly transplanted to the recipient, within a narrow time window of four hours. Beyond that and it won't be viable. Surgery will have to start on the recipient, her heart must be removed and replaced with the donor organ once it arrives. Timing is extremely critical.

The potential donor is a young woman, brain dead after a motorbike accident, but there's been chest and lung damage, too, which is a concern. Dr Otto Thanning of the transplant team decides, after inspecting this heart, not to proceed - it is not in a satisfactory condition.

Euphemisms and eggshells
This is enormously disappointing news for Melanie and the Girds; but as is gently pointed out, it's better than the disappointment of proceeding with an unsatisfactory organ, and losing the patient. "The right thing will happen at the right time," the family decides, comforting themselves. Just as we avoid looking directly into the sun, so everyone talks frankly but cautiously of "bad outcome", rather than death.

They just have to wait, and try to be patient. But they're in luck. Amazingly, within days, a second heart has been found, also in George. The surgical teams go to work, in both hospitals, with energetic scrubbing of hands to get everything surgically sterile.

As they open up in George, the new heart looks beautiful. A healthy purple muscle, a little yellow fat, and beating strongly. There's the paradox of the donor - brain dead, but with a living heart. It is harvested, deeply chilled to slow its metabolism, and packed for transport to Cape Town. There's worry about bad weather - a heart delayed is a heart wasted, and if the recipient's heart has deteriorated, the patient may not survive the wait for another.

But they're in luck again, and as it arrives, the transplant proceeds.

The series has been made with care by talented producers/directors Jan Groenewald and Pieter de Vos. Their clear sensitivity and affection for the subjects of the series mean they were obviously trusted and allowed special access.

The scriptwriter is Christopher Wood, who wrote scripts for two James Bond movies (Moonraker and The Spy Who Loved Me) as well as other major films. A highly promising young South African composer, DuPreez Strauss, has written and produced the highly effective yet expertly unobtrusive music for the series. Having worked here and in the US on major musicals and other theatre productions, he's a rising talent well worth watching.

(Professor M.A. Simpson, aka CyberShrink, December 2008)


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