THE VIRGINIAN-PILOT
Copyright (c) 1994, Landmark Communications, Inc.
DATE: Sunday, November 13, 1994 TAG: 9411100045
SECTION: DAILY BREAK PAGE: E1 EDITION: FINAL
SERIES: TINA'S HEART
A SPECIAL 2-DAY, 8-PAGE STORY
PART 1: SURGERY
SOURCE: BY DIANE TENNANT, STAFF WRITER
LENGTH: Long : 651 lines
``I don't want to die!''
Tina sobbed in her mother's embrace, a hug as warm as three IV pumps and a chest catheter would allow.
You're not going to die, the cardiologist assured her. But an unspoken thought hung in the air - not yet.
We'll add another medication, he said, and we'll double the one you're already on. And then we'll wait some more.
And pray.
Pray that a heart would come for Tina Buck, a donated heart to replace the one that was failing in her 16-year-old chest.
Tina had been waiting for three months, imprisoned by the intravenous lines and heart monitor that kept her alive in Room 510 H at Children's Hospital of The King's Daughters. She couldn't leave the heart unit without a nurse at her side. She couldn't leave the hospital at all.
And now this, the bad news that the medicines weren't working, that her dying heart was destroying her lungs as well. It was only a matter of time.
I want a heart, Tina sobbed. It isn't fair.
But fair didn't play into it. It wasn't fair that someone else had to die for heart recipients to live. But only the Tin Man got a heart the easy way. He sang and danced to a happy ending. The Cowardly Lion found courage. And Dorothy got to go home.
``I want to go home,'' Tina begged the doctor. But the stretcher took her, trembling and afraid, back to Room 510 H. She clung to a picture of her black cat, Jinx, and to memories of normal life, marching in the Indian River High School band.
Debbie Anderson, the hospital's transplant coordinator, left late that night. It had been a long evening, Tina sobbing in her bed, the August storm battering the windows. Debbie paused in the lobby to look out at the gray sky.
A rainbow arced across clouds.
Is it a sign? she wondered.
Debbie went home unsure, and Tina, alone in her room, cried herself to sleep, the Tin Man's lament echoing in the silent halls:
``If I only had a heart.''
April 28 had not really started out so bad.
Swimsuit shopping today! Tina thought, and coughed. First, though, to the doctor.
She had an appointment to check on the cough that had been with her since October 1993. Asthma, the doctors said, then changed their minds - bronchitis. Ready? asked her mother, Beverly Grover, and they headed out.
But when they arrived, a coughing fit kept Tina doubled over in the parking lot for 20 minutes. The doctor sent her to the hospital for an X-ray. And the doctor there asked why on earth the vein in her neck was so large.
Still, Tina didn't feel too alarmed. Just tired, like she did when marching in the band. I just can't keep up anymore, she thought. The doctor came back into the examining room.
I'm calling an ambulance, he said. It will take you to Children's Hospital. You have an enlarged heart. It's serious.
The rest of the day was a blur. Suddenly, Tina found herself in intensive care, intravenous lines in her neck, cardiologists poking and listening and asking questions.
It's not real, she thought, panicked. This isn't happening.
But it was. Idiopathic cardiomyopathy. A failing heart, cause unknown, but probably hereditary. A heart so weak that it grew to twice normal size, trying to compensate, trying to pump blood through Tina's 87-pound body. A heart so tired that it allowed her lungs to fill with fluid. Tina wasn't coughing from bronchitis; she was drowning.
She stared at the white walls and screamed denial in her mind. But it was all too true.
We have medicines that will help your heart, make it last longer, the doctors said, but she barely heard them. All she could hear was the terrifying sound of someone's voice saying ``heart transplant.''
The white walls of Room 510 H were so dreary. It was prime real estate, as hospital rooms went, a corner room, private, with a fifth floor view of the Norfolk skyline. I want to go home, Tina thought, as she perched on the edge of the bed.
Home is Chesapeake, where my room has a different color on every wall - red, blue, green, yellow. Home is where the Marching Braves practice after school in the green grass. Home is where the heart is.
Where is my heart now? she wondered. Who will die, and leave their heart for me? What person is walking around right now with MY heart beating in her chest?
I don't even feel bad, she thought. How can my heart be so bad, when I feel so good?
The answer, of course, was in the three pumps pouring medicine directly into her veins, and a monitor above the bed recording every beat of her own tired heart.
Her friends were the nurses, her surrogate mother Debbie Anderson, the transplant coordinator. Beverly and Tina's stepfather still had to work every day, Beverly as deli manager at a supermarket, Darren at a construction company. They came every afternoon after work, but the mornings were long. Tina solved that by sleeping until noon, and prowling the hospital halls until 2 or 3 a.m.
As the slow days passed, the white walls became covered. Posters and pictures of cats, stuffed animals in every bare space, jigsaw puzzles and medical charts.
Since school was out, her best friends, particularly Natalia Astudillo adapted to Tina's nocturnal ways, and began spending evenings - and early mornings - roaming the hospital's darkened halls and lounges with Tina, her IV pole in tow.
Ivan, she named it. Ivan, the IV pole. He was her constant companion, but he certainly wasn't a replacement for Jinx, her cat.
The doctors wouldn't even guess how long she might have to wait for the transplant. It could be 30 minutes or it could be 18 months, they said.
It was going to be a long summer.
What's going on down there? Natalia asked, as the girls paused at the window overlooking the hospital lobby. It was midnight on June 4, but television lights glared and the lobby seethed with people. She recognized TV reporters Regina Mobley and Terry Zahn. Not the usual Saturday night scene at Children's Hospital.
Telethon, Tina said casually. They're raising money for the hospital.
The girls stood silently and watched. Their silhouettes caught the eye of telethon organizers. Come down, they invited. Come be on TV.
OK, why not? Tina thought. At least it's something different, for a change. She brushed back her waist-length brown hair, and tugged Ivan onto the elevator.
Stand here, they told her. Talk into the microphone.
``Let's go to Regina,'' Zahn said, ``with a special guest.'' And the lights turned on Tina.
``Well, I want everyone to listen very carefully,'' Mobley said. ``We found another patient roaming around in the hallways. Her name is Tina Buck and you were in the marching band at Indian River High School and you found out that you had a problem. Tell me about it.``
Tina took a deep breath. ``I couldn't keep up with everybody else,'' she said, ``and I went to the doctor and he said I had asthma and bronchitis and it just never went away.''
``What's your diagnosis?''
``Um, restrictive cardiomyopathy.''
``And what does this mean for you?''
``It means my heart, I guess, it won't pump right so I have to have a heart transplant.''
``Are your parents watching right now, Tina?''
``Yes.''
``Say something to them. Hi, mom!''
Tina smiled, embarrassed, and then giggled. ``Hi.''
``Tell them how you're doing.''
``I'm doing fine.''
``Why was it important for you to come on this telethon tonight?''
``Donors. For people to know about being donors.''
``Very good. Thanks so much for coming with us. Terry?''
And the lights went out. Tina headed back to her room.
The elderly man's heart matched Tina's blood type, but the surgeon said no thanks to the offer of donation.
July had brought a few offers of hearts, but Tina's doctors refused each one, choosing not to place an elderly man's heart, even a middle-aged man's heart, in the chest of a teenager. No thanks, we'll wait, they said each time the phone call came. We want a perfect heart for Tina.
So Tina waited, too. Life took on a kind of normalcy. A 14-month-old baby joined Tina on the transplant list, and the teenager took pleasure in playing with tiny Elizabeth Henderson.
I'm having a birthday party soon, Tina told the little girl. You'll have to come, too.
On the evening of July 22, the nurses pushed Tina in a wheelchair toward the hospital auditorium. Hand-lettered signs pointed guests and pizza delivery men in the right direction. Beverly decorated two cakes for her only child, and tables groaned under ice cream, soft drinks, sub sandwiches and presents, piles and piles of presents.
People tried to hug her, but Tina responded only gingerly. An IV line had just been inserted into her chest, and it hurt to touch. She managed to smile for a camera. A family portrait: Darren, Beverly, Tina and Ivan.
Elizabeth arrived in a red wagon, her IV pole in tow, a half-pint of milk riding beside her.
The room was warm, much too warm. Tina and Elizabeth started perspiring, hair sticking damply to foreheads. Nurses scrambled for portable fans and damp washcloths. It's the medicine, Beverly said. The medicine that keeps their hearts pumping upsets their body temperature. Beverly was used to shivering in Room 510 H, where she accused her daughter of keeping the thermostat set on 50 degrees. But Tina fanned her face with whatever paper was handy.
``Sixteen candles,'' pounded out the karaoke music. ``You're my teenage queen.''
Queen for a day, Tina thought. Queen of hearts. But where is mine?
What would happen, Beverly asked, if we smuggled Jinx into your room and your new heart came at the same time?
She was standing by the sink in Room 510 H, emptying water pistols. Natalia sat on the bed with Ivan's twin beside her, an empty IV line taped to her chest.
``I want to see what Tina has to go through, Natalia explained casually. They gave me this bracelet. This is so cool. I'm gonna keep this.'' She twirled the plastic hospital ID bracelet around her wrist. Beverly laughed and shook her head.
Elizabeth already had received her new heart, just three days after Tina's birthday. She was nearly ready to go home.
That's amazing, Beverly thought. They cut open her chest, take the heart out, sew a new one in, and send her home in 10 days.
That's routine, Dr. Glenn Barnhart had explained. Transplants are one of the easiest heart surgeries. Bypass operations are much more complex, because they are trying to repair a damaged heart. A transplant means a whole new organ, in perfect shape, and just three blood vessels to attach. Simple.
The trick was in finding a heart. Tina had Type O blood, relatively hard to match with a donor. She was only 5 feet tall, and weighed less than 90 pounds. The donor could be a child or a young adult. The most dangerous part, for Tina, was her failing lungs. Her new heart, unaccustomed to pumping hard enough to push blood through those lungs, might fail on the operating table. If that happened, Tina would die. It was risky, but transplant was the only option. But if they had to wait much longer, it might be a heart-lung transplant instead.
Tina was Status One on the national transplant waiting list - the highest priority. The computer at the United Network for Organ Sharing, based in Richmond, tried to match every heart donor to Tina. So far, none had come through.
The doctors were limited to a donor heart no more than 2,000 miles away from Norfolk. A donor heart can be out of a body no more than four hours. The farther away it was, the faster the doctors had to move.
Tina, and her family, knew that 25 percent of transplant patients die before a new heart can be found. They desperately wanted a heart for Tina, but they grappled with the realization that another child would have to die to provide it.
Doctors had only performed heart transplants in infants and young children for about 10 years. No one knew whether a donor heart would last Tina for a normal lifetime, or whether another transplant would be needed in adulthood.
Beverly looked at Tina - honors student, perfectionist, only child, just half her mother's age. I'm ready for this heart, she thought. We can't stop accidental deaths, but we can see that they haven't died in vain. My daughter is worth saving. Please.
``I'm tired,'' Natalia said. ``I don't know how you stand it here.''
``We need to go school shopping,'' Tina said.
``Me and you?'' Beverly asked.
``Me and Natalia.''
``Who's driving?''
``Me, of course,'' Tina replied. ``In my brand new Mustang.''
Beverly laughed. ``I moved your Chevette last night. To cut the grass that was growing underneath it.''
Tina didn't even have her driver's license. She had a learner's permit, but she had landed in the hospital before she was able to use it. The grass had grown under the car for three months.
I want my license, Tina said. I want to get out of here. But Ivan, standing silently by, said otherwise.
The nurses, by now, were used to Tina's friends coming for midnight visits. It wasn't usual hospital policy but Tina needed the boost, so the nurses looked the other way.
Don't get too rowdy, one warned, closing the door to Tina's room. Let's go to the adolescent lounge and play Monopoly, Tina suggested to her three friends.
``Wouldn't it be cool if they had mobile homes in the game?'' Natalia asked.
``Yeah,'' Tina said sarcastically. ``They'd cost, like, $50.''
``Jerk,'' Natalia shot back.
``Geek.''
``Moron.''
``Nerd.''
``Geek.''
``You used that before.'' And all four subsided into giggles.
``I just noticed,'' Nicole said to Tina. ``Your lips are no longer blue.''
``Yeah, it's because I have blood in my face.''
``Remember when your lips were always purple and they, like, thought you were crazy?''
``No, they thought I was anemic.'' Tina rolled the dice. ``I wish I had more weight. I wish I weighed 90.
``I have a cath Wednesday,'' she continued. Tina didn't like the test where doctors ran a catheter into her heart to check on it, but it had to be done.
``Ooooohh. Does that mean you can't talk? I don't like it when you get those because you can't, like, talk all day and I get bored. Come on, let's go order something. I'm starved.''
``No pineapple on the pizza this time,'' Tina said. ``They were nasty.''
``Oh, I want to try anchovies this time,'' Natalia exclaimed. ``That should be like a dare we all take. Extra sauce and pineapple on it.''
``No pineapple, no extra sauce.'' Tina was firm.
``Let me order,'' Natalia begged.
``I like to order,'' Tina said.
``I want to order.''
``You always say `uh'.''
``Do not.''
Natalia picked up the phone. ``Hi,'' she said to the pizza parlor. ``I just made, like, uh, uh, uh, hang on.''
The friends doubled over giggling, and a nurse appeared at the door. Time to lock up, she said, and the group headed for the small lounge by the elevator to await the pizza.
By now, Aug. 1, Tina was used to waiting. Ninety-five days. Thirty minutes, more or less, wouldn't make a difference at all.
But then disaster struck.
The catherization on Aug. 3 showed that Tina's heart was getting worse.
The medicines you're on are not working as we'd hoped, the cardiologist said. We'll have to double the one you're on, and start a new one. But don't despair.
It was hard not to. Tina sobbed, torn between fear and anger. It's not fair, she cried. I want a heart. It's not fair.
Debbie and Beverly took turns giving hugs and wiping eyes. Behind Tina's tear-streaked face, they exchanged glances. It was a black day.
In the dark sky outside, a rainbow arced.
The beeper woke Debbie Anderson at 4:30 a.m. the next day.
She reached for the telephone and dialed. This is LifeNet, the voice said. We have a heart for Tina Buck. Do you want it?
Let me call the surgeon, Debbie said. I'll call you back. She had done this too often for her hands to shake, but she felt a growing excitement. LifeNet was one of about 70 organ procurement organizations in the United States, established by Congress in 1984 to ensure fair distribution of the few human organs available among the many waiting patients. LifeNet covered central and eastern Virginia. Each donated organ was reported to the national computer bank in Richmond, where information on every transplant patient was kept. If a match could be made between donor and patient, the organ was offered. This time, the computer turned up Tina's name.
Debbie dialed the surgeon on call. But he was concerned about the bad results of Tina's cath test. Maybe we should pass on this offer, he suggested, try to get her stronger.
He called another surgeon, who called Debbie, then the cardiologist.
LifeNet called back. It's been an hour since the offer, do you want the heart or shall we offer it to someone else?
Give us just a few minutes longer, Debbie begged, and she called the surgeon back. Take it, he said.
The race for life began.
Debbie's next call was to the pharmacy, to order the solution that would preserve the heart outside the body. Then she called Tina's floor nurse and, at 6:10 a.m., she got Darren on the line.
``Hello, Darren, this is Debbie. How are you?''
There was a pause. ``OK,'' he finally replied.
``This is the day we've been waiting for. We have an offer for Tina.''
Go to the supermarket and get Beverly, Debbie said. Then come to the hospital as soon as possible. Tina doesn't know yet.
But she did. As soon as the portable chest X-ray unit rolled into her room, Tina knew. She began to cry.
``This is the day we've been hoping for,'' Debbie reminded her. ``Remember, this is what we wished for yesterday. It's OK to be scared. But remember, we're with you every step of the way.'' Tina shivered in her bed.
In the cardiac center of adjoining Sentara Norfolk General Hospital, LifeNet nurse Candy Carpenter was strapping a red Coleman Fliplid 10 cooler onto a dolley. Surgical assistant Mark Dewey arrived. Cardiac surgeon Szabolcs Szentpetery, (pronounced Saint Petery) strolled up, sipping a cup of coffee. A Learjet was waiting at the airport. Upstairs, a frightened teenager cried.
``If the heart is anything other than perfect, Dr. Barnhart wants to talk to you directly,'' Carpenter said to the surgeon. ``Right now, we're thinking of taking Tina at 10:30 for the incision. Do you want me to drive you back here, or have an ambulance meet you at the airport?''
Ambulance, Szentpetery replied. There may be bad traffic.
Szentpetery would fly to the donor hospital to retrieve the heart. Barnhart would work in Norfolk. Carpenter, with the donor team, carried a portable phone. Debbie would wait for her calls, advise the operating room where the heart was at all times. Timing his work by the phone calls, Barnhart would have Tina ready for transplant as soon as the heart, in its cooler, came through the operating room doors.
The transplant team walked to the parking garage, where Carpenter had parked her Taurus sedan. She drove swiftly, but carefully, up Waterside Drive, where a blond girl promoting Oldies 95.7 waved to passersby. Szentpetery threw up his hand in reply.
Carpenter dialed the phone as she cruised down Interstate 264. On our way to the airport, she reported, and hung up.
Two pilots from Martinair Inc. were standing in the airport lobby. Candy dialed the phone again. Boarding the plane, she said, and climbed in.
The Learjet left the runway at exactly 8:30 a.m. Szentpetery glanced out the window at the airport terminal, where, at that exact moment, a press conference was being held to introduce 18 transplant recipients on their way to the 1994 U.S. Transplant Games.
Who wants breakfast? Carpenter called to the back of the plane.
The Learjet leveled out at 36,000 feet. An organ transplant flight has priority over every other aircraft, on the ground and in the air.
Air traffic controllers re-routed flights in two states and cleared runways, giving the Learjet a straight-line course to the city where a heart, beating on life support, waited for Tina. Somewhere in that city, a family grieved. In Norfolk, another family prayed.
Heart recipients are never told where their heart comes from. Too much chance that the donor could be identified. And when a donor gains a face, and a name, guilt sets in for the recipient. Why did that person have to die for me to live? Why was I the lucky one? Szentpetery leaned in the corner and closed his eyes.
At 9:31, the plane touched the runway. An ambulance was waiting. As Carpenter stepped out of the plane, she dialed the phone. ``Hello, this is Candy Carpenter from LifeNet. We're on the ground. . . .'''
She called again when the ambulance reached the donor hospital. She searched medical records while the surgeons scrubbed, looking for donor consent forms, certificate of brain death, blood type. ``Cool,'' she said, closing the folder. ``We're set to go.''
Szentpetery walked into the operating room. A surgical team was already at work, harvesting other organs. ``Hi,'' he said. ``I just want to take a look at the heart and make sure it's OK.''
He stepped to the table and made a quick check. ``The heart looks good.''
``Heart looks good?'' Candy asked, her hand already on the telephone.
``Yeah.''
``Hi, this is Candy Carpenter with LifeNet. Will you page Debbie Anderson please? Debbie, hi. He said it looked good. It took us two hours travel time, from Norfolk General to this hospital. As soon as we have the heart I'll call you and let you know what time we'll be there.''
``We'll have the heart out in about 20 minutes,'' Szentpetery said. ``We've got to go quick. You have the ambulance on hold?''
``Yes.''
Szentpetery clamped shut the aorta. ``OK, we've cross-clamped,'' one surgeon said. ``Lungs down.'' And life support was turned off.
Szentpetery carried the heart in his hands to the bowl where it would be flushed and packed in ice. Gold and purple and pink, the heart was completely still.
``Good morning,'' Candy said into the telephone. ``This is Candy with LifeNet. . . ''
The lid went on the cooler, and Szentpetery strode into the hallway. The clock was ticking now, and the surgeons did not pause to change out of their borrowed operating scrub suits. Within four hours, the heart must be back in Norfolk, stitched into Tina's chest, and beating. Four hours and counting.
Saintpetery flung open the doors that stood between life and death for Tina and walked swiftly to the ambulance. The driver wasn't there.
The surgical team climbed in anyway, just as the driver came running out of the emergency room. As he climbed behind the wheel, a pickup truck pulled crossways behind the ambulance and an elderly woman crept slowly out of the passenger seat.
The ambulance was running, a steady beep signaling its intention to back up. But the truck didn't move, until the woman was on her way into the hospital. The ambulance driver made up the lost minutes at 70 mph through town.
``So what is our ETA?'' Szentpetery asked, as he swayed back and forth with the ambulance's turns.
``We should be at the hospital at quarter to 1,'' Candy replied.
``When we got the heart out, the heart looked good,'' he remarked.
The siren began wailing. Szentpetery glanced over his shoulder to look out the windshield. Bridge construction had backed up two lanes of interstate traffic. Cars began pulling off on the shoulder to let the screaming ambulance pass. The driver cleared the jam, and the speedometer hit 85 mph.
At 11:27 a.m., the Learjet left the ground. Tina had just entered the operating room with Debbie. The anesthesiologist saw how frightened Tina was, and began some small talk. I have a 16-year-old daughter, he remarked. She likes Water Country. Do you?
The other nurses began talking about their pets. Jinx is on my IV pole, Tina told them, and Debbie took the black cat's picture and taped it to her surgical gown, so Tina could see it while she went to sleep. The team worked efficiently, setting IV lines, choosing the drugs that would make their patient sleep. Could I see my mother? Tina begged.
``Is there anything I can tell Mom for you?'' Debbie asked, leaning over her charge.
``Tell her I love her.''
At a quarter to 12, Tina closed her eyes.
In the airplane, Szentpetery still had his surgical mask draped around his neck, and sterile coverings on his shoes. A living heart was in the cooler beneath his legs.
Less than an hour later, the jet's wheels touched the runway in Norfolk. Carpenter dialed the phone again. In the operating room at Children's Hospital, Barnhart made an incision on Tina's chest.
Tidewater Ambulance was waiting at the terminal, engine running. With the cooler safely stowed once again under Szentpetery's legs, the ambulance drove to the gate. It was locked.
The driver tapped the siren once, twice. A maintenance worker came running with the key, and flung the gate wide. Siren wailing, lights flashing, the ambulance hit Military Highway on the way to Children's Hospital.
``So what do you have, just a heart?'' asked the paramedic, nodding toward the cooler. She told about a good friend who died in a car wreck, and how his family had donated his organs. ``A lot of us signed our donor cards that year, I can tell you,'' she said. The ambulance pulled up to the emergency room, and Dewey carried the cooler in.
``Hi,'' chirped a small boy in the waiting room. Dewey flashed him a smile as he strode past. ``Hi, how are you?''
As he rounded the busy corner into surgery, he flashed past the waiting room door. Tina's family stared out at him, saw the cooler, knew what was inside. Dewey never paused.
Barnhart was ready. He stood by the blue-draped table where only a stray wisp of hair showed that Tina was underneath. Her chest was splayed wide open, exposing a beating heart that was twice the size it should be. Dewey scrubbed and joined him.
``OK, you're on the bypass,'' Barnhart said.
``Bypass!'' Dewey called, and a massive machine began taking the blood from Tina's body, cleaning it, warming it, sending it back in, taking over for the heart that would soon be gone. Debbie headed for the waiting room.
Beverly and Darren, surrounded by family and Tina's friends, looked up as she came in. ``The heart is here,'' Debbie said. ``She's doing fine. Everything is going like clockwork.''
``We saw it come in,'' Beverly said.
``You're very observant,'' Debbie replied, sitting beside them.
``A cooler,'' Darren said.
``The whole atmosphere in the operating room is relaxed,'' Debbie said. ``Everything is going just like it should. Once she's on bypass they remove her heart, which is what's going to happen in the next few minutes. Then they put her new heart in.''
Beverly's face was composed, but she tapped her fingers nervously on a red calico teddy bear.
``This is a terrible question,'' Darren said, ``but was her heart as big as it looked in the pictures?''
``Yes,'' Debbie said gently, showing with her hands how large the diseased heart was. Darren took a deep breath and rubbed his face with both hands.
``She had happy thoughts when she went to sleep so we have to believe she's having happy thoughts now. She talked about her cat. She mentioned Natalia's name.''
Beverly sighed deeply.
``She was able to flash me that pretty smile before she went to sleep,'' Debbie continued.
Let me go back to the operating room now, she said. I'll be back to give you updates.
In surgery, Tina's old heart lay still, outside her body, covered in gauze on a stainless steel table. The bypass machine kept her alive. ``Is her new heart ready?'' Barnhart asked.
``I'll get it,'' Dewey said. The heart had already been lifted from the cooler, and floated in a small bowl of ice and cardioplegia, a drug that would keep it paralyzed until the surgeons were ready to let it warm up and start beating again.
``We're all set,'' Barnhart said. He laid the heart on an orange-striped linen towel draped over Tina's chest. Debbie left the room to tell Beverly.
``This is so exciting!'' Carpenter whispered. Three banks of lights shone down on the table. Gold-handled clamps lay in a row, each holding a black-threaded needle. Barnhart peered through a magnifying eyepiece fastened around his forehead. The room was absolutely silent. Tina's blood pulsed steadily through the three transparent lines of the bypass machine. Nurses kept a careful eye on her body temperature, which was lowered to ease the strain of the operation.
``Hey, Debbie,'' Barnhart said. ``What time did the heart come out?''
``10:40.''
``And what time is it now?''
``1:42.''
``OK.''
Less than an hour left.
He began tying knots with his gloved fingers, over and over and over. He addressed Jeannie Jackson, the nurse at the bypass machine. ``How long has it been since cardioplegia?''
``Fourteen minutes.''
``Did she cool fast?''
``Yeah. She didn't cool real fast to start with, but she cooled.''
One nurse picked up bloody sponges with forceps, and stuffed them into plastic bags so they could all be accounted for.
Barnhart glanced at the anesthesiologist, Dr. Oscar Salter. ``We're going to be about two minutes here from taking off the clamp.''
``All right, ventilating now.''
``The clamp's coming off.''
``OK,'' called the bypass nurse. ``Clamp's off.'' It was 2:08 p.m.
Tina's new heart started beating by itself.
Everyone turned to face the heart monitor screen. The lines wriggled unsteadily, high, then low, erratically tracing a green line.
``Let's see what it looks like here, the first couple of minutes,'' Barnhart said, gazing at the line.
``Pacemaker,'' Salter said.
``We'll have to defibrillate,'' Barnhart answered. He picked up the electrical paddles that would deliver a shock to Tina's new heart, hoping to establish a strong, steady beat.
``I think this pacemaker's broken,'' Salter said, fiddling with the thin electrical leads. ``Is there another pacemaking device? It won't go on. This thing's broken.''
The second pacemaker came quickly, handed through the door to a waiting nurse.
``OK, let's have the paddles again,'' Barnhart said.
``OK, you're at 10 (joules). Charged,'' the nurse said.
The lines on the monitor jumped. Debbie went to the waiting room again, where social worker Peggy Fanney was sitting with Tina's family. Debbie took the parents into a smaller room, alone.
``The new heart is in,'' she told Beverly. ``What they're doing now is just trying to get the electrical system adjusted. Remember that the heart has its own electrical system and it's in a new place. But she's doing fine.''
Beverly took several deep breaths without speaking.
``How much longer, do you think?'' she asked finally.
``I really don't know.''
``The heart did start on its own?'' Darren asked.
``Mmmh huh, mmmh huh.''
Beverly hugged herself, tight.
``Trying to get the electrical part squared away. Is that normal?'' Darren asked. ``Have you seen that before?''
``Oh, yes. We don't see that as a bad sign. When we come back next time, hopefully we'll tell you that Dr. Barnhart will be talking to you soon. Then you can see her in the intensive care unit, maybe while they're still working on her. I'll try to hurry that along so you can get in. Just to see her. Maybe not to hold her hand but to see her.''
``That's enough for right now,'' Beverly replied.
Debbie began explaining that Tina would be in a glass-walled isolation room, with ventilation tubes down her throat, blood transfusion lines and a bandage down the center of her chest.
``The operating part is such an important part,'' Debbie said. ``But then you look behind the drape and see that ponytail. It makes it that much more important.''
The donor, she said, was a girl.
``I guess the heart that went in was much smaller than the one that came out?'' Beverly asked. Debbie nodded.
``How much younger?'' Darren asked. ``Can you tell us?''
``About 11.''
Beverly's eyebrows went up. Darren looked away. ``Such a great thing for us but to think that another family. . . ,'' his voice trailed off.
``How wonderful that there are generous people in this world who are able to make that decision,'' Debbie responded. ``Probably nobody understands what that family is feeling better than you.''
``Today was either gonna be the greatest or the worst day of our lives,'' Darren said. ``Go back in and find out more for us.''
The clock in the operating room showed 2:43 p.m. The team was weaning Tina off the bypass machine, putting blood back into her body a little at a time, trying to see whether her new heart could handle the job.
``OK, let's go,'' Barnhart said. ``Give me another 50 (cubic centimeters).
``OK now, looking good. Let's have another 50 up here. Another 50.''
``Transfusing. Now,'' Jackson said.
``Another 50.''
``Transfusing. Now. Fifty is in.''
``One hundred. Keep going.''
``One fifty.''
``Keep going.''
``Two hundred.''
``Clamp.''
``Clamped.''
Barnhart kept his eyes on the monitor. ``That looks very good for the first few minutes after transplant,'' he said.
Salter hung a bag of Type O blood on Ivan. ``Lookin' good,'' he said.
Tina's new heart had been out of a body for 3 1/2 hours, well within the four-hour limit.
``This morning she said, `I just want my heart. I want to go home','' Debbie said, looking down on the table. ``So she was ready.''
Barnhart took his surgical gown off at 3:59 p.m. ``OK, thanks, thanks a lot,'' he said to the team. ``Good job.''
At the table, the closing surgeon was twisting thick metal sutures to pull Tina's breastbone back together. Debbie went back to the waiting room.
``They're just on the final stages of stitching the last part,'' she told Beverly and Darren. ``She's on a pacemaker but the heart rate is really good and strong.''
``If the heart's beating on its own, what's the pacemaker for?'' Darren asked.
``Everybody - the last four patients - have required pacing. It's not a big deal,'' Debbie soothed him. ``There he is, there's the man of the hour.''
Barnhart strolled in the room. ``She's doing real good,'' he said. ``Overall, there's nothing I'd like to see better at all. She looks real good, OK?''
``Thank you,'' Darren said, his eyes locked on Barnhart's. ``Thank you.''
While they talked, Tina was wheeled into the isolation room, where 10 nurses, techs and a cardiologist, scrubbed and sterile, crowded around her. Tubes ran in and around her body, monitors blinked on each side. A ventilation tube ran down her throat and she lay still, very still. Beverly and Darren slipped up to the window quietly. Darren gently rubbed Beverly's shoulders, while she hugged her stomach.
``You can see the incision's covered with white gauze,'' Debbie explained.
``Where is the blood coming from?'' Beverly asked, staring at a drainage tube.
``Just the chest cavity.''
``Why does her stomach jolt?''
``That's the ventilator. She could breathe on her own if we'd let her but she's sedated so we want to let her heart rest.''
``I've seen enough,'' Beverly whispered, and left the room.
But she was back within an hour, at the bedside. The ventilation tube came out. And by 11:30 p.m., Beverly was rewarded. Tina whispered to her mother:
``I did it. I deserve a medal.'' MEMO: Tomorrow: THE RECOVERY
Tina grapples with the mental difficulties of a transplant, and
struggles to return to normal teenage activities.
ILLUSTRATION: MOTOYA NAKAMURA/Staff color photos
The torture for Tina Buck and her mother, Beverly, above, increased
when an Aug. 3 biopsy showed that Tina's heart was worsening. But
the next day a donor was found. Doctors, left, had four hours to fly
to another state and bring back a heart, ice-packed in a picnic
cooler.
A donor heart can survive only four hours outside a body. Tina's
surgeons finished the transplant in 3 1/2 hours, beating the clock
by 30 minutes. All eyes were on the monitor, left, as Tina's new
heart began beating. Intensive care nurses swarmed around her,
below, once she left the operating room.
``The new heart is in,'' transplant coordinator Debbie Anderson,
top, told Tina's mother, Beverly, and stepfather, Darren. When
surgery was finally over, elation set in, then a quiet joy.
MOTOYA NAKAMURA/Staff photos
Tubes, monitors, masks, gloves. The isolation room in intensive care
bustled with activity when Tina first came in after the operation.
The greatest fear for those on both sides of the glass wall was
infection.
KEYWORDS: HEART TRANSPLANTS by CNB