Day in the life of an MSII

All names used in this story have been changed.

During the first two years of medical school, you learn just enough about medicine to feel helpless when confronted with an actual sick person. Relatives will call you, mention a bunch of symptoms, and expect you to know the diagnosis. Instead of telling them the truth- “Honestly, Aunt Lisa, I’m probably the last person you should be asking”—you say some important-sounding words, make a differential of possible diseases, and recommend they go see a real doctor. I imagine they find this answer disappointing, but it doesn’t stop them from calling you again in a month, with a whole new spectrum of symptoms, and renewed expectations.

Yet this guessing game I play with my relatives is much preferred to another common occurrence- being told about an illness in someone I know. In the past (pre-med school), these moments were bad enough. Now, my mind flashes to pictures of symptoms, to lists of drugs, and to charts with 1 and 5-year mortality rates. You don’t say these things out loud, of course—no one wants to be told about the worst-case scenarios playing out in your brain. So you keep these images to yourself, and hope for the best.

In December, my mother told me about a family friend who was in the hospital with Congestive Heart Failure (CHF). This man, Joe, was someone I saw on Christmas Eve, and occasionally at summer barbeques. I had no previous knowledge of his health problems, but was surprised at his diagnosis, because he was still relatively young- around 55 years old. His wife, Carly, would send out daily emails updating friends and family about Joe’s status. When my mom showed me the latest email, though, I was shocked. Joe’s ejection fraction (the amount of blood pumped out his heart with each beat) was 5%. The average ejection fraction for a healthy person is 50-65%. In heart failure, EF typically falls below 40%. When she said 5%, I thought I had misheard. 5% was unheard of. 5% was basically a death sentence.

Joe was in the hospital to have a Left Ventricular Assist Device (LVAD) placed into his body. The LVAD would help his failing heart, increasing the amount of blood that it was able to pump. It would not solve his problems, but if successful, the operation would without a doubt increase his quality of life. It took weeks for the surgical team to reach this decision, though—Joe’s heart problems had progressed to the point that there was a good chance he would not survive the procedure. Finally, the team agreed there was no other option. Fittingly, the operation would take place on Christmas- what better time for a miracle?

My mom and I anxiously awaited Carly’s inevitable email. Thankfully it came early in the morning- the operation was tentatively a success. The LVAD had been put into place, along with a defibrillator, and Joe’s ejection fraction was rising. Clearly, he was not out of the woods, but this was a good first step.

A few days later, after my way-too-short holiday break, I returned to school.  That night, I played basketball with a few friends. Right before we started, I received another email—this one entitled “Please Pray”:

Joe’s kidneys have shut down completely.  He is in continuous V-TACH.  His defibrillator went off more than 84 times and is now out of battery.  He has been paddled over a dozen times. He is only getting enough oxygen to keep his brain functioning. He was put on the heart transplant list this morning.  If he does not get a heart within 24 hours of this morning he is going to die….Carly

It all just felt so unfair to me. Joe’s family had to endure weeks in the hospital, hours on the operating table, and then a week of recovery. And just when things seemed to be going well, Joe’s body let him down. I didn’t get it. And I thought about it for another hour while I played basketball, and at the end of that hour, it still made no sense. This wasn’t the way the story should end.

When I got back to the sideline, my phone was blinking at me, indicating another message. I opened it:

We have a heart!!!! They are getting Joe, the OR and the surgical team ready. Surgery will begin around 8 or 9pm. Doctor says this will be THE most risky heart transplant surgery they have ever done and they have done over 600 but I don’t care. My Joe will do what he has to do.

I think there can be no doubt in anyone’s mind that the thoughts and prayers of all his friends and relatives have had a major hand in all the good that has happened. Please, don’t stop now….time for a full court press.

Carly

There I was, phone in one hand, water bottle in the other, grinning like an idiot. Someone asked me what happened. I didn’t respond, because the truth was that any words I uttered would have been woefully incapable of capturing my feelings. Even now, I’m at a loss for words. Despite the odds, somehow this miraculous journey continued. And even with an incredibly difficult heart transplant awaiting Joe, the only thought in my head was, “well, at this point, he HAS to survive.”

It’s been over a month and a half since the surgery. Joe is able to speak, and stand, and will soon be taken off of oxygen. The new heart is working well, and there have been no rejection issues associated with the transplant. He has been at the hospital for over 2 months. Hopefully, he will be home soon.

The post is entitled “Day in the Life of an MSII,” and it’s clearly a misnomer. In fact, most of my days are spent at class, and at the library, and watching funny YouTube videos to distract myself from the aforementioned class/library. And in those days, I learn the material that will help me become a doctor. But from Joe, I learned what medicine feels like from the other side of the bed. I’ll remember the feeling of helplessness that goes along with sending a loved one into the operating room. And I’ll know that despite the statistics I (hopefully) memorize, each case is its own unique struggle—a struggle that reaches far beyond the doctor and the patient.

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