Free Alpha Docs by DANIEL MUÑOZ

those too sick to get a heart, plus several who change overnight from one category to another. This means constantly weighing two possible conclusions: Is the patient progressing enough to eventually go home, or, if not, could he or she be a candidate for more advanced therapies, such as a transplant? The reality is that it’s rare for a patient to check in to the CICU, immediately get placed on a transplant list, and then get whisked away to the OR (operating room). This happens only when the patient’s decline is so precipitous that he or she cannot go home but still meets the criteria for a transplant, if a compatible heart can be found fast. More often, patients are put on the transplant list and then go home to wait…and hope they live long enough for the call: “Come in. Your new heart is here.” A patient could spend months, even years, on the list, with deteriorating odds; a good candidate at the beginning can sometimes become a weak candidate later.
    A transplant is not just another operation. It means mobilizing vast resources, people, talents, rooms, equipment, commitments, and finances. The hospital wants all operations to be equally successful, but some operations—transplants—are more equal than others. Though there are approximately three thousand patients on the national heart transplant wait list each year, only about two thousand hearts become available annually, most often from victims of injuries that have left the heart unscathed. As a result, the wait time on the list varies greatly, from fifty days to well over five hundred. It’s brutal but simple math. Hundreds of candidates each year never receive a heart.
    But sizing up patients for transplants is about more than just the obvious factors, such as blood type. Having someone else’s heart placed inside of you is a major undertaking for both your body and your mind. The heart, unlike almost any other organ, carries symbolic overtones that are impossible to ignore: Your heart is your essence, your emotional center. Even the smallest details, both objective and subjective—patient history, illnesses, genetics, habits, foibles, fears—may affect the fate of a transplant. How will you react to having someone else’s essence in you? Will you think or act differently? Are you not only physically but psychologically prepared for a second chance, a new life? On a very practical level, will you take the immunosuppressant medications that will fend off organ rejection and thus keep you alive? The surgery is physically brutal and exhausting; the recovery, long and draining. If the mind cannot help the body, the ordeal will be all but impossible. It’s up to the mind not only to make the emotional adjustment but to then be the conscience that ensures the body takes its anti-rejection medicines and shows up at appointments and doesn’t play Russian roulette with its new organ. Even after a patient receives a transplant, it is still our responsibility to do the post-transplant biopsies to make sure that the heart tissue remains healthy. This means spending time in the cath lab, looking for evidence of rejection on a cellular level. The resounding lesson of heart failure and heart transplantation is that every single detail, from the patients’ mood to their cell tissue, matters.
    Still, the extraordinary becomes the ordinary fast. What scares the hell out of you on Monday is a day’s work by Wednesday. It’s not that we take things for granted; we just become less intimidated and more conditioned about what to expect. Patient after patient comes in with congestive heart failure, and we do temporary fixes—diet adjustments such as salt reduction, diuretics to get rid of fluid buildup, blood pressure medications, ACE inhibitors (which lower arteriolar, or small artery, resistance), beta-blockers to relax the heart and fend off arrhythmias.
    We see a youngish grandfather who has come in for his routine “oil change”: His fluid retention needs to be