[김경희 인천세종병원 심장이식센터장] “A brain death occurred. This is a woman in her 30s, and the cause of brain death is suicide. She currently has good heart function, no diabetes or blood pressure, etc. She says she usually takes medication for her depression.”
year-end and New Year holidays. December of last year was filled with warmth with colorful lights here and there despite the cold wave.
The heart transplant coordinator announced the occurrence of a heart donor (brain death). For some, it will be a cold wave, and for others, it will be a warm spring. For Kim, a patient with severe heart failure who underwent extracorporeal circulation (ECMO), this news must have been a message of hope that she could receive a heart transplant. I had mixed feelings.
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The patient who was about to turn 60 already had diabetes and hyperlipidemia. One day, he suddenly developed chest pain and shortness of breath and was taken to the hospital, where a heart abnormality was discovered and developed into shock, so an extracorporeal circulator was inserted into his body. He was also diagnosed with severe coronary artery disease and underwent coronary artery bypass grafting. He even underwent an intraventricular suture repair (Dor procedure). Epitoplasty is a surgery that checks the boundary between dead and living tissue in the ventricle, seals it with a ssamji, and then applies an appendix to the narrowed area and stitches it up.
A severe infarction had already occurred in the ventricle, and the myocardial wall had become very thin. It was a series of regrets. Perhaps because Mr. Kim was already showing severe myocardial tissue necrosis, he did not recover easily even after surgery. persistent arrhythmias. He was discharged after the defibrillator was inserted. The situation did not improve. Her heart failure continued to worsen, and after repeated hospitalization and discharge, she was eventually diagnosed as needing a heart transplant and visited the hospital. “I have suffered so much in the past. I came here with the feeling of grabbing at least a straw.” I replaced the first greeting of Mr. Kim who came from the province like this.
The patient appeared to be suffering mentally and physically. The same was true of her daughter, son-in-law, and spouse, who had been pouring sincerity for a long time. It would be nice if it went well, but a transplant can only be received when someone dies, and there are people who die while waiting, so I am always cautious, but I told the patient that I would do my best. My meeting with Mr. Kim happened like this at the end of May, when spring was just starting to set.
The patient’s left ventricular ejection fraction was less than 10% on echocardiography. The heart, which should have been conical, had settled into a very round sphere and was unable to pump blood properly. Because of this, pulmonary edema and pulmonary hypertension were getting worse, and due to right ventricular failure, both legs were swollen and indigestion was severe.
First of all, vasopressors and other drugs were used to treat pulmonary edema and leg edema, and arrhythmia drugs were used to wait for a heart transplant. Waiting time is really bad. 6 months already. Unfortunately, in 2022, when I met Mr. Kim, the number of heart donors decreased than in any other year, and all heart transplant patients across the country were having a hard time. Like other patients, they would insert a left ventricular assist device and wait for transplantation while attending outpatient clinics.
Six months to endure with the booster. The patient eventually developed severe ventricular arrhythmias that could not be controlled with medication. Extracorporeal circulation (ECMO) was immediately inserted. The extracorporeal circulator acts as a pump that exchanges oxygen instead of the heart and pumps it throughout the body when the pumping ability is not due to a drop in heart function. have to bear it Delirium may occur due to severe discomfort and fear as the patient is unable to move their legs. When inserted into the leg, it is difficult to endure for more than two weeks, so ECMO is inserted directly into the heart, but even this was difficult for the patient. This is because the adhesions around the sternum are severe because he has already undergone surgery once, and even blood vessels are attached to the breastbone after undergoing coronary artery bypass surgery.
The patient’s will was strong. Mo-nim Kim, who relied on her extracorporeal circulatory system, repeated “I want to walk out” every time she had her rounds, holding her consciousness with tears in her dim consciousness. Every time that happened, I tried to tell a more positive story, but in my heart, I was heartbroken at the thought that I could inevitably die while waiting. It has been 3 weeks beyond 2 weeks since the extracorporeal circulation device was inserted. No matter how strong the patient’s will, the leg veins could not hold out. I managed to insert an extracorporeal circulator directly into my heart, and another three weeks have passed since then.
After inserting an extracorporeal circulator for 6 weeks, a period beyond one’s will, the patient’s stamina was exhausted. Vulnerable to several infections. It was at this time that a precious heart donor appeared. Not only me, but all the medical staff in the hospital began to move urgently.
Fortunately, there was a donor nearby, and since Christmas was over the weekend, the donor’s echocardiogram image was not provided. A donor with young, fair and fair skin. She is a mother of one child. She closes her eyes as if it’s about to happen to her. Tears cover my eyes as I think of the donor and the family of the donor and at the same time see the urgent condition of the patient waiting for a heart transplant.
I woke up and carried out the transplant, praying earnestly that the donor’s heart would return to Mr. Kim and beat again. The operation was successful, and the patient’s transplanted heart started beating again loud and vigorous. There was considerable bleeding, various complications occurred, and even a slow recovery of consciousness, but the patient finally recovered. 3 months hospitalized. I was able to eat by mouth, which I used to do with gastric intubation, and was discharged from the hospital walking on my own two feet.
“I never thought spring would come again in my life. Life is so precious.”
In the cold winter, Kim Mo-nim, who had a hard day like a bare tree branch, would have only looked forward to the days when she could get out of the hospital as soon as possible, breathe comfortably, and spend a warm Christmas end-of-year with her family. After being discharged from the hospital, the patient loved the cherry blossoms, forsythia, and azaleas in full bloom outside the hospital like a child. He expressed his excitement, happiness and gratitude for his new life several times.
The image of a heart donor flickers in Mr. Kim’s expression. How difficult and lonely life was until he took his own life. When it’s hard enough to want to die, can’t we get the will to breathe just for one more day like the patient? Life is so precious. Bright emotions such as courage, hope, and anticipation can only be met after crossing the valley of dark and cold emotions. In the cold winter, just as the flower buds that never seem to come out of the bony branches bloom beautifully at the end of patience. I want to tell you to believe in yourself and wait. “On days when I feel like dying, like a patient with severe heart failure who wants to breathe even for a day.”
