Heart transplantation: the beginning of a new life
Transplantation medicine has now become one of the cutting-edge specialties in biomedical science
Specifically, heart transplantation today represents the therapeutic solution for a number of severe heart diseases in which alternative pharmacological and nonpharmacological therapies are no longer able to ensure adequate survival and/or quality of life.
Receiving an organ such as a heart that restores life is not limited to the replacement of a muscle but involves an experience rich in existential nuances.
Heart transplantation has its own particular dimension in which not only bodily and psychological but also cultural and spiritual implications are interwoven: we are therefore walking on exquisitely anthropological ground.
Heart transplant patients themselves define their experience as “a new birth.” Of new birth Jesus spoke to Nicodemus in John’s Gospel (ch.3) referring to conversion thus to a decisive spiritual change.
Can we speak of an inner change in the recipient of an organ, in this case a heart?
Anthropologist Lesley A. Sharp, in one of her publications, defined organ transplantation as a transformative experience. In her anthropological analysis she emphasized the “restructuring” of the self, of one’s identity in the heart transplant patient.
Certainly heart transplantation brings about a remarkable life change in those who had before them as their only alternative an inauspicious prognosis.
For a long time, organ transplantation has been touted in the United States as a miraculous procedure for improving the quality and longevity of life.
We may also view transplantation as a rite of passage in which the liminal phase is the waiting for donation, a somewhat difficult, painful and conflicting phase. This rite ends with the attainment of a new “status” in which the patient discovers often surprising resources.
The slogan chosen by patients to represent the Heart Transplant Association in Bologna is “…and life is reborn.” A few words to say many things.
Those who receive a heart have so much to tell about their experience.
And we have the honor of listening to
- Angelo. He is on the waiting list for a heart transplant. He says smilingly, “I hope my heart will be preserved because he has loved so much.”
- John. He receives an emergency heart transplant. Three months after the surgery he finally returns to his hometown in Calabria. He is doing well. Before leaving, he expresses a doubt with a thread of humor: “who knows if, besides feeling better with this new heart, I will have new feelings ?”
- Maurizio. Combined heart/liver transplant. Months after the surgery, his wife reports, “My husband forgets that he also had a liver transplant. But he always thinks about the heart that was donated to him.”
- Thomas. Heart transplant with a very troubled postoperative clinical course. Finally discharged, he writes a congratulatory note to the team that cared for him: “On the occasion of the anniversary of the upcoming holidays, I extend to all of you my heartfelt new heartfelt wishes with infinite gratitude.”
- Vittorio. A few years after his heart transplant: “Perhaps the heart transplant does not change us as people but it certainly brings us a new outlook on life by appreciating its values more.”
- Gabriel. He signed to be placed on a heart transplant waiting list demonstrating serenity about this therapeutic decision: “I knew I would have to pass several forks in the road that would then lead me to a one-way street at the end of which a transplant awaited me. They prepared me for this. Now I am ready.” But little did Gabriele know that he would have to wait eight months hospitalized in a cardiology ward because his condition was too critical. During that time he met several patients called to undergo the transplant and greeted them upon their discharge. He went through several phases in which hope alternated with depression so severe that he isolated himself completely from others. When the donation finally came it seemed like a dream to him. The surgery was a success. The day of discharge arrived, and Gabriel was paradoxically reluctant to go home not because he did not feel the benefit of the surgery as much as because he feared leaving that hospital shell that all in all made him feel protected and safe. One of his writings came out in the morning paper: ” In Bologna, in the heart of S. Orsola they have taken my heart problems to heart. They have given me so much hope, a better life, great serenity and a new heart. Thank you with all my heart. Gabriel.” Two months after surgery, Gabriele enthusiastically stated that he had no problems fitting into social and relational life. What helped him was the state of subjective well-being he was increasingly aware of: “realizing that I am able to do certain things stimulates me to perform them…now even the memory of the troubled experience before the surgery is starting to fade. I am now leaving everything behind to start living normally again. I want to resume my work activity soon.” Seven years have passed since then. In addition to continuing his work activities, Gabriele is vice president of the Bologna Heart Transplant Association. He is a point of reference and courage for many other patients who access our center.
- Gianluca. Taken from his book “racing for life,” I recall 31 on pg 77: “On high our hearts, they are turned to the Lord!” chimes a uniform chorus. This phrase has a certain effect on me, even as a child I used to raise my hands running around the house shouting it over and over again…perhaps because of the inherent sense of hope it holds…I imagine myself lifting up my little old heart with calcium coral inside it, now dwelling in the histology department, and feeling at the same time the strength of the immense gift I have been given. I can walk for hours, just a month after surgery, without going into breathlessness. I feel my lungs filling more and more, my whole physique responding to this new engine that is powering me. And in lifting that little heart that has accompanied me for forty-three years I thank, silently, today and for time to come, the person, I am told a young boy, who in his misfortune saved my life. In the myriad of reasons, with many pros and few cons, that can be invented when talking about donations, only one helps me render the real value of this gesture. Saving a life, sometimes multiple lives. The immensity of your gesture on behalf of humanity, without reservation. Thank you boy. On high your heart given for my life.” From memory 32 pg 78: “It’s just been 4 months since the surgery. I like to see myself in the mirror and every week notice improvements. Walking, exercise bike, as soon as possible I will resume the running bike and light weight training..I think anyone who meets me can read in the look I have towards the world the state of grace of this period of my life. So much so that I have been asked to be part, together with a group of organ transplant boys and girls, of a project in which our faces will be the testimonials for the year 2012 for the awareness campaign on donations and transplants.”
- Armando. Excerpted from his book “The Tractor and the Wheelbarrow.” From pg 137 : “by now it is night but, caught up in the excitement of having learned who it was that gave me the heart, I am not sleepy at all…I reflect on the matter. I take the newspaper back in my hand, I flip through it looking at the picture of that wreck of a car with the roof raised…underneath I find the picture of Federico with that serious look. No, he looks more stern than serious to me. He stares straight into my eyes, and the more I stare, the more his gaze penetrates my head, becoming accusatory. “ah that’s it! did you want to bring me here, in front of this picture, to make me feel guilty again? Well, you’re succeeding, you know?” I think distressed. From pg 145: “in the darkness of the room, my mind replays Federico’s stern gaze staring at me intimidatingly. It is an ever-present image that leads me to ask myself, “but who am I now? am I still me? am I Federico? am I another person?” this doubtful thought also arises for me thinking about that state of mind I felt during the preparation for the surgery, in which I had lost my dignity as a person, in which I considered myself only a piece of flesh, of matter: then who have I become now? I am certainly not Federico: I have only his heart and in any case, I could not have turned into him. But I feel that I am not even Armando anymore: centrifuged in an experience that I never imagined and piece by piece, I begin to be similar to a machine to which parts have been replaced and therefore is no longer intact. But who am I? I keep asking myself, tormenting myself.” From pg 245: “Federico’s gaze has not accused me for some time: I find him always serene, sometimes smiling. I think back to the torment he gave me in the early days, to the almost desperate crying in feeling guilty about his death, to the sense of emptiness he had left even in me who did not know him. Not that things are all hunky-dory now, but the time spent trying to metabolize this thing that had overwhelmed me without even giving me time to process it and the group meetings, but especially the chats with the psychologist, had meant that now, even if inaccurately and still a little bit wobbly, the needle of the compass was starting to point me north again. I am happy about that.”
These narratives of experiences lead us to reflect on the strong emotional, psychological and symbolic impact that heart transplantation has on the person. And it is the person who is the real focus of the anthropological study in which illness, death, the body and the value of the gift become fundamental issues.
“Je ne veux pas savoir de quelle patrie tu viens, je ne veux pas savoir de quelle religion tu es, tu souffres et cela me suffit.” (Pasteur)
Gianna Canu
Nurse in the heart transplant center at Policlinico S. Orsola/Malpighi. Bologna
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