(Dr Jose Chacko Periappuram, who made history by performing the first heart transplant in Kerala, shares experiences that touched his heart. Read Part 1, Part 2, Part 3, Part 4 and Part 5 of the series.)
I will never forget him coming up to my OP with his beautiful six-year-old daughter.
He began by saying that his daughter Chinchu, who was born with a hole in the wall separating the chambers of the heart, needed surgery and that he had visited many hospitals for two years looking for treatment for her condition.
“Doctor, we are members of a family that is in a lot of financial distress. No matter how hard I try, I am not able to finance my child’s heart surgery,” he said.
He had knocked on many doors for help. At hospitals that perform surgeries for free, the wait for his daughter’s turn would have lasted years. Many patients in a similar situation had died because the surgery on them could not be performed in time.
I looked at the father's eyes and into the child’s face that exuded vitality, not knowing what to do. I then glanced through his daughter’s medical records.
That was a time when there was no surgical facility in private hospitals in Kerala for congenital heart diseases. The surgery for such diseases was done only at a central government-owned institution in Thiruvananthapuram. I had been in situations that had given me a good understanding of the stories of patients who had been waiting there for years for a surgery, just as the child’s father had said.
The walls that separate the right ventricle from the left ventricle of the heart help prevent impure blood from mixing with pure blood. The right ventricle receives oxygen-deficient blood coming to the heart from different parts of the body and pumps it to the lungs. The lungs fill the blood with oxygen and return it to the left ventricle of the heart. This is how the blood circulates in the body.
The blood pumped from the left ventricle goes to various parts of the body and that is what supplies oxygen to all the organs. However, Chinchu had a serious condition in which impure blood was getting mixed with pure blood through the large hole in the wall of the heart. That hole should have been closed before she joined nursery.
Many tests were done on the child and it was decided to do a surgery to close that hole in the heart. But then I had to tell that loving father that I did not have the expertise to treat congenital heart disease through surgery.
Then and even now, congenital heart defects are surgically treated only by specially trained doctors. It was with some difficulty that I could explain to him the fact that I did not have the experience to do such a surgery. After the meeting, he left with his child disappointed.
But, two weeks later, he came back to my OP, holding Chinchu close. He stood silent for a moment and then sat in the chair opposite me. His eyes became moist as he began to speak to me. “Doctor, you have to operate on my child at this hospital somehow. We like this hospital and you, doctor, very much. In the two weeks since we went back home from here, there has not been a single day when Chinchu has not talked about you, doctor.”
When I looked at her face, she gave a smile. Some individuals, or some patients, stir doctors’ minds in a way that cannot be expressed. Their expressions and speech never fade from the minds of doctors; it is like an innate relationship.
I patted that father on the shoulder and said, “We will try. I do not do such surgeries but a close friend of mine is an expert in it. We will seek his help.”
“Doctor, you will have to somehow get my daughter’s heart treated,” the father said in between sobs. When carrying his pain in my heart, I reached home and told my beloved Jaimie about Chinchu, my grief doubled. We had three sons and we saw Chinchu as the daughter we never had.
I sent Chinchu's scanning and other test results to my friend. He said she was in a condition where surgery will be possible, but that it should be done without delay.
So, on a day that was convenient for him, I fixed a surgery in the operation theatre of the hospital where I worked, just as Chinchu’s father wanted. She was soon admitted to the hospital and shifted to the operation theatre two days later.
Such a surgery is done with the help of a device called the heart-lung machine, which immobilises the heart and lungs. It is a complex surgery in which the device carries out the functions of the heart from outside the body while the heart and lungs remain immobilised.
The surgery itself involves opening the heart thus immobilised and cooled and sewing a man-made sheet to cover the hole in the wall separating the chambers.
The heart of a small child weighs only a maximum of 40 or 50 grammes. Such surgeries need to be performed very precisely. But often children with only minor congenital disease can have other heart problems that we do not know about. The could, perhaps, be muscle dysfunction, or there could be a lack or deficiency of blood vessels reaching the lungs. It may not be possible to detect all the complications through the tests conducted before the surgery.
The doctor was able to close the hole in Chinchu's heart in about two hours. Those were anxious moments. During the surgery, I would step out of the operation theatre from time to time to inform Chinchu's father about the progress and also to comfort him. That affection was probably a reflection of our months of closeness, or the trust he had placed in me.
After the surgery it was time to remove the heart-lung machine and restore the normal functioning of the heart and lungs. When I entered the operating theatre again, the surgeon told me: “Jose, Chinchu's heart has not resumed functioning as expected. The functioning of the right chamber is unusually poor. We have not been able to restore Chinchu's blood pressure to normal. Let's give this machine’s support for half-an-hour more. After that, we can again try to restore the functioning of the heart.”
As the time passed, I felt the courage to face the father, with whom I had interacted constantly during the surgery, fading. But I had the faith that the baby's heart would beat again and return to normal because of all the love and prayer she got.
When I returned to the operating theatre 30 minutes later, the doctor gave me the same news again: “We are not able to restore proper functioning of the heart. What can be done?”
We then tried to revive the heart’s activity with the help of various machines that can help maintain its functioning for up to two-and-a-half hours after surgery. During that time, I kept talking to Chinchu's father explaining to him in detail about the small difficulties being faced and tried to give him courage.
Chinchu's condition kept deteriorating. My heart stopped for a moment when I realised that her heart will not beat anymore. It was as if someone was trying to shatter all the dreams of the father and separate the child from him.
I had to bring Chinchu's father to a small room next to the operating theatre and give him the sad news. His grief became my grief, too. The pain that he held in the chest came out in the form of tears and filled his eyes.
We embraced each other for minutes, and cried and shared our grief.
Hours later, when that unconscious body was being handed over to the father, my mind whispered — we are all human, not gods. We have limits, we have limitations. It is those limitations that weaken human beings and bring them closer to god.
Her heartfelt smile and bright eyes filled with hope still linger in my mind, even after 20 years. That baby angel is a part of my heart surgery life that I want to forget but will always remember.