(Dr Jose Chacko Periappuram, who made history by performing the first heart transplant in Kerala, sharing experiences that touched his heart. Read Part 1 of the series.)
Of the many people who have captivated me, Girish, on whom I did a heart surgery, stands ahead of the rest.
I first saw Girish in my clinic about six years ago. Pale and sickly, as soon as he sat on the chair next to me, I realised he was in the last days of his life because of a failed heart. Shortness of breath and swollen legs due to fluid accumulation were also evidence of his condition.
Girish started having symptoms of heart failure while working for a reputed company in Bengaluru. There was only one way doctors could treat his condition — with a heart transplant. For this, he returned to his native place Palakkad.
“Doctor, I know everything (about my condition). I have understood and studied in detail about my illness. I also know that the only solution is a heart transplant. I have come prepared for that and I have complete faith in you, doctor,” he said.
I was surprised to hear this. It usually took us many days to make a patient or his relatives to realise that heart failure is the cause of the illness and that the only way to treat it is through a heart transplantation. But, here was a brave man who had come ready for everything.
I was sure that Girish’s self-confidence and his firm faith in the treatment procedure and the person treating him would definitely protect him.
The only barrier was getting a heart that would be compatible with his body.
I felt like there was divine intervention in our companionship when within a week, we got a heart, with the same blood group as Girish’s, separated from a brain dead person and successfully transplanted it to him. God, thus, protected the firm belief that the organ would be obtained and the confidence that the surgery would be successful.
But the story doesn’t end here. About six months later, when a rheumatic disease (Ankylosing spondylitis) that had affected his hip joint earlier flared up, a hip transplant surgery was performed on him at a leading hospital in Ernakulam by a team led by Dr Jose Pappanacherry.
It made history in India, as it was the first case of a hip transplant surgery on a person with a transplanted heart. That operation was also successful. What can one say except that it was again a success story of confidence.
But, Gireesh's tale does not end there. It was hardly two months after the hip surgery, when problems resurfaced in the form of a fever. He had a burning fever when he was again admitted to hospital. Only after several tests could we understand the problem — the functioning of a valve of his new heart was lost due to pus formation. This required intensive intravenous medication for six weeks. We knew that the response to drugs would be pretty low in transplant recipients.
We also knew that we would be staring at Girish's death if there was no response to the medicine. Girish had fever even during the many days in hospital when he was administered strong medicines. Finally, we had to tell him: "Girish, your condition is serious." His reply surprised us again: “I know that, doctor. I just didn't know when you were going to tell me that,” he said.
Within about a week in the hospital, Girish had a heart attack in the ward. Nurses and other staff members pressed his chest and gave him artificial respiration (cardiopulmonary resuscitation) and kept hold of his life.
The doctors arrived on time and continued giving him treatment for about 45 minutes.
When the fear that his heart would stop beating started slowly entering the mind, it miraculously started beating again. After two days of ventilator care in the ICU, Girish started talking again. That was another instance of god's powerful intervention.
"Gireesh, your journey ahead is a dangerous one, and there is only one way you can hold on to your life."
"How is that, doctor?"
"Another heart transplant."
But I have never seen a heart transplant in a person who has already had a heart transplant before. That had never happened in India before.
He stared at me for a moment in between closing his eyes. Then he laughed. “Doctor, I knew that, too,” he said. “That this would be my end. I looked all over the internet. I know that the modern treatment for valve dysfunction is another heart transplant surgery only.”
I told Girish's sister Sushma: “Girish will get a second heart if you all agree. It’s not too late. That will only happen through god's intervention.”
It was during this conversation that Girish had his second heart attack.
We were totally disappointed. We knew that the body would not have the strength to withstand a second heart attack, even if the mind was very strong. Even then, we continued with his proper treatment and gave him artificial respiration; to hold back the life that was leaving; all the while appreciating Girish's courage. But the hope that he would make a comeback was fading.
After handing over the first aid treatment to colleagues, I left, went to a room near the ICU and sat down disappointed.
I gazed at the monitor and saw Gireesh's heartbeat fading before my eyes.
Suddenly, as if a miracle, I saw the blood pressure getting restored and the return of the ECG. A little while later, I noticed my colleague Dr Jacob opening the door of my room and coming in with happiness written all over his face. “Sir, we have revived Girish's heart,” he said.
I replied that I was watching it on the monitor. But the worry in the mind was when will the next heart attack occur? The knowledge that we will not get a heart before that also bothered us.
But, just a little while later, there was an announcement through the Kerala government’s’ “Mrithasanjeevani" (a network for organ transplant): a donor at a large hospital in Ernakulam with a body type that matched Girish’s, and with family members volunteering to donate organs.
All that one could say was that this was a miracle.
There are many incidents like this happening all around the world every day to show how small the distance between life and death is.
A young man who had suffered two heart attacks and had his heart transplanted was only a short distance away from death, but he was reborn through the heart of another young man who had to leave his own family prematurely… and to make that happen, god had appointed a bunch of doctors who had never had any experience of transplanting a second heart to person.
Today, my mind becomes emotional when I see Girish. It is one of the things I cherish and safeguard in that private casket of memories and realities, the god’s blessing that gave the power to our hands to bring Girish back to his third life.