In December of 1990 my husband, Dorai, and I were joined by our two daughters for a trip to India. We started out from Buffalo with our daughter Nani as soon as her 7th grade class was out for Christmas vacation. Mehala, who was on break in her senior year at Johns Hopkins, met us in NYC with a fresh new passport.
Nani hadn't been to India in 4 years and Mehala for nearly 10. When Mehala and our son, Siva, were young, we went to India often, and stayed for long periods of time. But those were the days when Dorai's parents, and most of his 8 siblings, lived in India
This trip we didn't go south to Dorai's hometown of Madras as we used to do. We flew into New Delhi for a couple of days to meet with friends from the All India Institute of Medical Sciences. To avoid some of the nasty smog in the capitol city, the girls went off on a day trip to the Taj Mahal. When they returned, we reported to the Delhi airport for our flight to Poona, by way of Bombay.
The plane left Delhi 8 hours late. There was a dense fog all around the airport, and air traffic was grounded. When we were finally allowed to board, tired, hungry and cranky, the passengers loaded quickly. It seemed like most of the passengers were working people from the Middle East on their way home through Bombay.
We were all pleased when meals were served promptly after take-off, but as the meals were over, it became obvious that our non-smoking section was not being respected. Almost every person on the plane lit up a cigarette.
Our eyes burned and our lungs were tortured. My husband, who had given up his smoking habit shortly after undergoing a quadrupal by-pass in 1982 began to turn grey. He'd experienced at least one heart failure that I was aware of, and I was afraid he was getting sick.
No amount of glaring at smokers or pleading with the stewards helped the situation. By the time we reached Bombay and had to dicker with the airlines to let us aboard a flight to Poona that was different than our ticketed timing, Dorai was beginning to look very weak.
When we arrived in Poona, Dorai insisted on hailing the cab and fussing over the price with the driver. It was late in the evening when we arrived at the Poona University Guest House. The crisp clean white sheets on the twin beds in our room were a precious sight. Dorai went right to bed, and I brought him some curd rice and fruit from the dining hall. He slept fitfully, and barely seemed to have enough energy to get out of bed in the morning to greet his colleagues in the Department of Chemistry where he would be a visiting professor for 6 weeks.
The first day, our hosts could tell that there was a problem. After the second day, we began to discuss the need to find a cardiologist. A doctor was recommended, and we made an appointment to meet Dr. Durairaj the next day.
The Marian Cardiology Center was a fresh, up-to-date cardiac clinic. Dr. Durairaj was a recently retired Army Medical Officer who had been the personal cardiologist to the President of India. That seemed like a pretty good recommendation.
He also had a very gracious wife and family, who made us feel very much at home in Poona.
The diagnosis was indeed heart failure. Medication and bed rest was proscribed. Dorai spent the six weeks of our stay resting, lecturing, meeting with colleagues in the dining hall of our Guest House and feeling very uneasy.
By the end of the six weeks, Dorai was beginning to get back his strength. He ventured out of the campus for more than just doctor's appointments. We explored the city and did some shopping. Dorai's sister, Shyamala and her family came from Madras to visit with us, and we went out to a fine restaurant in the city.
At last, it was nearly time to leave. We learned that it was Dr. Durairaj's birthday, and invited him and his family to join us for dinner. Dorai sat at one end of the long table, enjoying a scotch and soda and the company of Mrs. Durairaj, while the doctor sat at the other end, and I sat next to him.
The conversation was quite spirited at Dorai's end of the table, so I took the opportunity to speak quietly and frankly with the doctor.
"I will not ask anyone but you," I ventured, "but I trust you to give me an honest answer."
"What do you want to know?" the doctor replied, sensing my seriousness.
"How much longer does my husband have to live with this heart problem?" I asked.
"If he's lucky, he will live a year..., could be as much as two..." he replied looking intently down the table at my husband who was speaking like a professor to his daughter.
"But if I were you, I would get him into the heart transplant program in Buffalo as soon as you get home.
"You know Dr. Bhayana, don't you?" he asked.
"Yes, of course," I replied. Dr Bhyana had done Dorai's by-pass surgery. I was surprised that he now headed up a Transplant Program in Buffalo, and even more surprised that a doctor in Poona would know about it.
"But he's a diabetic," I replied, speaking of the complication in my husband's health that had arisen soon after his by-pass surgery.
"Buffalo is ready to do it's first diabetic transplant now, " Durairaj said authoritatively. "Your husband will be a perfect candidate.
"You must call Bhayana as soon as you get home."
I did call Bhayana as soon as we settled back into our Buffalo routine. Dorai was back to his science at the University by day, and his duplicate bridge games by night and weekends. I was a substitute teacher, mostly in special education classes. Nani went back to seventh grade, and Mehala to finish off her year at Hopkins.
When our son Siva called, I informed about our stay in Poona, and Dr. Durairaj's recommendation. He was glad we approached Dr. Bhayana and the Transplant Clinic. He'd been worried about his father's failing health for a long time.
When you are accepted into a U.S. transplant program, you are placed on a list with an organization called UNOS (the United Network for Organ Sharing). UNOS oversees all organ transplants in the United States. It registers the vital statistics of the recipient patient, including all necessary tissue and blood typings. Then, when a donor becomes available, the recipient's stats are on file and a match can be made by the local Organ Procurement Organization. (The OPOs are overseen by UNOS.)
UNOS put Dorai on the New York State Transplant List, and for almost a year, Dorai and I went down to Buffalo General Hospital every month for a check-up at the Clinic. Once they'd evaluated him, and agreed that he would be a good candidate, we were pretty much locked into their routine. Dorai agreed to take his medications as proscribed and attend clinic faithfully every month for the evaluation. He would wear a beeper that the clinic would activate if a suitable heart was ready for him, and we would respond immediately to the call.
It was a long year. That summer, we celebrated our 25th wedding anniversary in a lot of places including a big party Buffalo. But Dorai was feeling uncomfortable being tethered by the beeper. We informed The Transplant Clinic that we wanted to travel. We drove out of beeper range, and visited our son and Dorai's other relatives in Texas. Then we flew off to Europe for a scientific conference in Brno, Slovakia. For our anniversary, we drove down to Venice. I loved seeing him in the seat next to me, looking frightened for his life over something besides his heart, as I drove our little rented car across the Alps at 150 km/hour.
Back home again, we settled down. A New Year came. Another heart failure put him in the hospital. He came out a little weaker, but a little more determined that a transplant was a good option.
Spring comes to Buffalo in strange ways. Sometimes it doesn't come at all... but 1992 it was soft and wet. I rejected more of the substitute teaching jobs when they called in the mornings. He spent more days working at home than in his office.
The bridge club called. He was being very short and rude to his partners and oppononents. They kindly asked if I could talk to him. They might have to bar him from the club, if he didn't calm down his rudeness.
I could barely tell him... but I insisted that he had to play with Nani. His history with me at the bridge table was of games that ended in bitterness and tears. But somehow, he was able to be gentle when he was playing with his little daughter. So at 12, Nani began to be a regular at the duplicate bridge club in Buffalo. The club was satisfied.
Was it March? Why can't I remember? He could tell you the exact date.
I remember the time though... because I walked out of the house and down the street and across the wet and rainly hill to the Catholic Church for noon Mass.
As soon as he got on the Transplant List, I assumed the religion of my childhood and went to daily Mass and communion. I figured Jesus had to be correct about one basic thing: come to prayer as a little child. I was an adult when I joined my husband in prayer in our Hindu family. In my deepest private prayers, I wanted my husband to receive a new heart, and have a good life. I could do nothing about that. So I prayed like I did as a little child.
It was March.
I returned home from Mass, and Dorai said they called about 11:40. They wanted him in the hospital by two p.m. I packed his pajamas and extra underwear and a toothbrush, and we left for the hospital immediately.
Dr. Bhayana told us from the beginning of our wait, that he wanted to hold out for a really good heart. He didn't want to give Dorai a 'rag,' as he called it.
"This is a good, strong heart," Bhayana said with a broad smile as he received us in Dorai's hospital room. "It's on it's way from Albany. A perfect match."
By the time our daughters joined us with their cousin Chitra, his body was shaved and he was on a gurney in the corridor outside the operating room. An intravenous line from a bottle was flowing into his arm. Electronic monitors were all around him. They had done a "swan" on his neck, and injected nitropruside to reduce his lung pressures.
He looked "freaked." His eyes were wide with fright, and his skin was wet and clammy when I stroked his arm.
The new heart had arrived, but they were keeping him in the hall. Something was wrong.
Finally, Dr. Bhayana called me into a side room.
"His lung pressures won't go down," he said, grasping my hands.
"They always went down all these months when we gave him nitroprusside.
"I need your permission to back off the surgery," he said somberly as he looked down at his shoes.
"Why?" I asked.
"I lost a patient with the same problem two weeks ago," he answered. "I don't want to take the risk with your husband."
I was stunned.
"What will we do?" I asked incredulously. " We've been counting on this. You promised a good heart. How will he survive without a heart?"
"You have to get him a heart-lung transplant," he replied.
At that moment, my daughters came into the room.
"Mom, what's the matter?" they asked, taking seats on each side of me.
"Dr. Bhayana wants to back off the surgery," I replied coldly.
I felt Nani's muscles tighten as she leaned forward.
"Why?" she demanded of him, looking all the world like her father when he was intently pursuing a bridge partner for his abject stupidity.
"You can't do this," she said fiercely. As she stood up, I was afraid she was going to attack the doctor.
I took her arm, and settled her down...
"If he says he doesn't want to do the surgery, Nani," I said, "then I don't want him to do it."
"Thank you, doctor," I murmered. "Have you told my husband yet?"
"No," he replied. "It will be easier if we do it together."
"Wait..." I said taking hold of his arm as we moved towards the gurney. "How will we get him a heart-lung transplant?"
"We don't do them here, but I'm going to a Conference in San Diego in a few days," he replied. "I'll see what I can do about getting him on a list in another center."
"All right then, " I said, hoping I sounding more confident than I felt. "We better tell him."
Dorai felt the change in how the surgical staff was treating him by the time Bhayana and I came to the sides of the gurney. We told him as softly and confidently as we could that they would have to pass on the transplant.
Bhayana said we could spend the night in the hospital. It was too stressful for us to go home, and he'd like to check Dorai out in the morning.
Even before they were able to take out the IVs, another man who'd been beeped while he was walking in the Mall, was shaved and prepped and ready to accept the perfect heart from Albany.
I thought I'd known depression in my life. I won't even go into the many situations where helplessness and hopelessness have overcome me. For days after the surgery, I tried to contact Dr. Bhayana. He didn't return my calls. I went down to his office at the hospital 2 weeks after the surgery. He said he could see me for 5 minutes between other patients.
"What did they say about my husband's heart-lung transplant at the San Diego conference?" I asked.
"Nobody will do it," he anwered shamefacedly.
"What do you mean?" I whispered in desperation.
"Heart-lung transplants are only done for people with congenital heart-lung problems. Your husband's problem is eschemic. Nobody will do it."
I felt myself melting into a puddle on the dull office floor. I couldn't melt. There had to be something we could do. I'd trusted Bhayana, I'd trusted God, I'd trusted my husband's incredible luck. I couldn't pray any harder, my guts were eroding.
"You can try calling around to Transplant Centers yourself," Bhayana began. "Maybe you can convince someone to do the transplant for him."
With that, he handed me a list of transplant centers around the country, and their phone numbers.
I went home, and called every Center. Every call gave me the same indication he said they would. No one wanted to give Dorai a heart-lung transplant.
We have several family members who are medical doctors. I hoped they might have some ideas, but no one had a clue.
I watched him. Sadness came over us both and we rarely spoke. In bed at night we didn't talk, as it got harder for him to breathe. Most nights I simply sat behind him and held him till he had a few hours of rest and I couldn't sit anymore.
He bravely tried to carry on a normal life. The University was out for the summer and he wan't teaching. As soon as Nani was finished with 8th grade, she joined him at the bridge club. Most days, he tried to take a walk in the mall for excercise, usually coming home with some bargain or two.
One afternoon in late May, he came home from the mall and told me he'd met our friend Parthas at the mall. Dr. Parthasarathy was a retired radiologist who'd done some early evaluation on Dorai's heart at Roswell Park Cancer Institute. Parthas retired after his own heart attack.
"Parthas wants you to call him," Dorai declared.
"OK, " I answered, cooking dinner and assuming our friends would be wanting us for a social occassion. "I'll call him tonight."
"No, you have to call him now." Dorai insisted. "We talked for more than an hour at the mall. He thinks I'm depressed, and if I don't get some help, I won't live."
"I'll call him. Just let me clean my hands," I answered.
"Gini," Parthas said to me quite somberly on the phone, "I don't believe your husband will survive his next heart failure if you don't do something immediatley."
"What in the world do you expect me to do, Parthas?" I nearly shreiked. I was totally confused by the man's demands.
"I just called his cardiologist, Dr. Balu. I told Balu that the two of you have to get together tonight and work out a plan. You have to save Vaidhyanathan's life... Now call Balu, and get him over to your house," he said emphatically and hung up the phone.
So I called Balu.
Dr. Balu came over to our house that evening at 9 o'clock. We spent about three hours, with my husband drinking scotch and listening to us, batting back and forth ideas of what to do.
"Perhaps we can find a surgeon who will do a 'wrap'," Balu mused, considering a proceedure whereby a muscle from the back is wrapped around the heart, given an electric shock and used as a pump.
Finally, we came to the conclusion that it wasn't our job to define a proceedure, rather Balu would make some calls to eminent heart clinics and see if one would would take Dorai for an evaluation.
As good as his word, Balu got ahold of Cleveland Clinic the very next day and explained the situation.
"They don't seem to think his lung pressures are too high for them!" Balu enthused, after sending them Dorai's records. "They want you to go down and get an evaluation in their heart clinic."
We took the very next appointment, and drove down to the Cleveland Clinic for an evaluation.
"We think you are still a good candidate for a heart transplant," a letter to Dorai declared. The Cleveland Clinic was ready to take him as a potential heart recipient, if Dorai wanted to join the program.
Dorai agreed to go on the Cleveland Clinic heart transplant list, but remained on the New York State list, where UNOS had him very near the top of the list to receive a new heart.
Once again, he got a beeper.
And again, we waited.
Only this time, it wasn't nearly so long.
In late July, Dorai was hospitalized for another heart failure.
I admitted him in the Buffalo General Hospital for treatment with diuretics about 9 o'clock in the morning. Buffalo General notified Cleveland that he was a patient.
I returned home by 11 a.m.
Around 11:30, I received a call from the Cleveland Clinic.
Due to his hospitalization, Cleveland Clinic bumped Dorai up to the top of their recipient list. Cleveland Clinic requested that Vaidhyanathan transfer from the New York State list, to the Ohio list immediately. They had indication a good match would soon be available.
I gave Cleveland his phone number at Buffalo General.
They called him and took his permission, which was immediatly faxed from Buffalo General.
The ball was rolling...
Cleveland called me.
They had requested Vaidhyanathan be discharged immediately from Buffalo General.
Could I bring him to the private airport for Prior Aviation by 4 p.m.? A jet would be waiting, to fly us to Cleveland.
I tried to call my daughters. Nani came home in time to join me. I left a note for Mehala on the refrigerator. This was in the days before cell phones.
We drove downtown to Buffalo General.
He got in the car, and we drove back up to the airport without stopping at home for anything.
Waiting in the airport was the hardest part. It was nearly an hour before the little Lear jet arrived. Nani and I were hungry. We'd forgotten to eat in all the confusion. We munched on candy bars, while Dorai looked at us contemptuously.
The little jet was strangely unlike any plane we'd ever flown in. Compact and full of paraphanalia from the company that loaned it out for emergency flights like this, it wasn't luxurious. But the view as we sailed over Lake Erie was like being on the wings of an angel. The lake was serene. The sky was full of beautiful pink and white cumulous clouds as the sun was barely beginning to set. It seemed like only minutes, before we landed at a private airport in Cleveland, An ambulance met us and whisked us away to the Emergency entrance of the Cleveland Clinic.
The transplant coordinator met Nani and me, and took us to the surgical waiting room, while attendants took Dorai to prepare for surgery.
She told us he was getting a very good heart from Akron... another good heart from an "A" city. I was too numb to even pray that this one would become his.
Four hours later, Dr. Stewart came into the surgical waiting room, and informed me that he had completed the surgery. It would be another hour before they would have him down in recovery, and maybe two hours before I could see him... but in his eyes, I could see the kind of triumph that comes from winning a great game.
This time, he got his great heart.
to be continued.