The Tennessean
Sunday, Sept. 26, 1999

Copyright (c) 1999
Marcia's Story     |   home
Part 2 - Transplant Day

Word of a donor's organs compresses months of waiting
into hours of nerve-racking drama.

Photo by Lisa Nipp

Be Still my troubled heart
Story by Sylvia Slaughter
On April 10, a Saturday, Marcia Roenigk gets a call that will bring her perhaps the greatest gift she will ever be given: one healthy heart and two healthy lungs.
She has been in Nashville waiting for her donor organs for two years and one month.
She had moved from Texas to Tennessee to be closer to Vanderbilt University Medical Center, where she prayed she would receive the transplanted organs if it were God's will.
Marcia doesn't fear death, not even on this day, when a surgeon's tools will saw through her sternum and scoop out two vital organs that have been little more than deadwood in her body for years.
"I've made out my will," Marcia had said only days earlier. "I've planned my funeral. If I die before I'm transplanted, I want to be cremated, with my ashes scattered on our farm. I want my brother David (Hardin) to play Amazing Grace on his sax at the memorial service. ... But, God willing, I'd much prefer to live."
The call about Marcia's donor organs comes when she least expects it, only five days after leaving VUMC, where she'd just spent 69 days waiting for a donor match.
Her transplant doctors had sent her home for the duration of the wait because her condition stabilized. The wait is almost over.
At 6:45 in the morning, the phone rings in Marcia's riverfront apartment.
Her mom, Evelyn Hardin, who has been visiting from Texas, sleepily answers it.
She wakes up immediately, the adrenaline flowing: "Moose, the call is for you."
Marcia picks up the phone, then yells to Evelyn, "Mim, that's the call. It's time to go."
Marcia, Evelyn and Marcia's husband, Bob, rush to leave for VUMC, where a transplant coordinator has told Marcia that she believes they have found a match.
In her haste to get to the hospital, Marcia neither washes her face nor brushes her teeth.
But she does remember to feed her two cats.
In a flurry of activity, Bob grabs his laptop computer. Evelyn grabs her sewing. Marcia grabs her husband.
A quiet calm washes over her.
"It's finally happening, Bob," she says. "It's finally happening."
Though she can't predict her future, Marcia believes deep down that her life will begin anew after the transplant.
And if not, she's ready for wherever the ride will take her.

Prayers Ascend, courage abounds
Bob makes it to Vanderbilt in less than seven minutes. He neither speeds nor runs a red light. He has his wife on board.
Once Marcia is in her room, a merry-go-round of lab coats enters and exits.
The banter there is easy, light almost, though everyone moves in staccato steps.
A doctor mentions Marcia's approaching heart-lung transplant.
Marcia jests that he's wrong about the type of surgery: "I'm in to get my tonsils out. ... Oh, and my wisdom teeth, too."
Marcia phones Faith Werner, one of her best friends back home in Texas, and asks Faith to call their other friends.
Bob phones Marcia's brother, Russell, who makes many more phone calls to her father and other family members.
Once the word spreads, family members call Marcia.
Marcia's sister, Susie Aghili, who lives in Dubai in the United Arab Emirates, plans to catch the next plane to the States to be near her sister.
Marcia talks to Susie's young sons on the phone.
"I love you, Paulie," she says to Susie's middle son. "The next time you see me I'll be all pink."
The hospital is abuzz with news of Marcia's pending transplant, Vanderbilt's first heart-lung transplant in more than three years.
Excitement fills the complex from its lobby to the room where Garlon Rich is recovering from his heart transplant.
When he hears that Marcia is scheduled for her transplant, he's almost as happy as he was when he received his heart the Monday after Easter Sunday.
He considers Marcia one of the bravest transplant candidates he's ever met: "She's as sick as any woman I've ever seen," he'd said one afternoon in March as he sat in his hospital room eating bologna and hot sauce. "But she's got the willpower of a dad-burn saint. I've never heard her complain that first time."
Marcia's surgery is scheduled for between 10 and 11 a.m., once the organ procurement team examines the organs to see that they truly are a match and that other variables meet with their approval.
Nurses draw blood, give Marcia medicine and take X-rays.
Marcia worries that she forgot to hug her cats goodbye.
Around 10:30, a member of the organ procurement team phones and says that the organs are from a 30-year-old who died from a brain aneurysm, and they seem to be a perfect match.
Because organ procurement agencies request that donors remain anonymous unless their families want to contact the recipient, Marcia may never know so much as the gender of her benefactor.
"I've prayed for the family, whoever that family will be," Marcia had said earlier.
For now, though, the prayers are for her.
Fellow transplant candidate Jerry Phillips of North Little Rock, Ark., and members of his family gather at Marcia's bedside.
Jerry's preacher son-in-law offers a prayer while Bob and Evelyn and Marcia and Jerry and Jerry's wife all join hands.
Jerry leaves the room, tears streaming down his face. His tears are tears of joy. Marcia's long wait is nearly over. "See you later, buddy," he says to Marcia.
Outside, in the hall, Jerry tries to explain the bond that transplant candidates share.
"It's like we are sitting in the same boat and we become paddlers together, pulling for one another. I love that little gal in there and I love Bob."
Jerry walks slowly back to his room, to the area of the hospital he and Wes Fowler of Brighton, Tenn., have dubbed the Grumpy Old Men's Corner.
Inside her room, Marcia won't relinquish her boxer shorts until the gurney comes to transport her to the operating room. Their cloth some how, some way comforts her.
Marcia momentarily panics, slips out of her boxers and lifts herself onto the gurney.
Nurses believe her anxiety is caused by the medication they've pumped into her.
The nurses leave, giving Marcia and Bob a few minutes alone, then Marcia calls for her mom and hands over her shorts. Bob takes Marcia's hand, looking as if he never wants to let go.
He swallows a lot, his Adam's apple bobbing up and down, up and down. His words are few, and are for Marcia's ears only.
Finally, nurses rush in and sprinkle Marcia with confetti, a good-luck ritual for all transplant patients leaving the unit for transplant surgery. Marcia had been to Jimmy Smith's confetti farewell only a few weeks earlier, just before he received a donor's heart.
Now, her time has come.
A procession of patient and family begins down the long hospital corridor.
As the procession passes, a nurse sings Happy Trails To You. Marcia doesn't notice.
The elevator opens. Operating Room No. 9 is four floors down.
At the OR door, Bob buries his face in Marcia's chest.
Thirty seconds later, hospital staff wheel away the woman he had promised to love -- in sickness and in health -- for as long as they both shall live.
After a semiconscious Marcia Roenigk is wheeled into the operating room, Bob stares at the closed door through which his wife has just passed, then bolts down the hall.
His pants bag.
Bob has lost weight during Marcia's long wait for her heart-lung transplant.
But no one has ever heard him complain about the toll his wife's illness has taken on him.
"I love Marcia," he has said. "I will do whatever I have to do to take care of her."
He meant it then; he means it now.
"Bob and Marcia are about the most in-love couple I know," Jerry Phillips has said.
Bob goes to Jerry's room, where he e-mails family and friends about Marcia's good fortune.
"Pray for those surgeons and the surgical support staff," he writes. "It's going to be a long day for them."
It's going to be a long day for Bob and for Evelyn, too.
While Bob writes on the hospital's seventh floor, Evelyn waits on the hospital's second floor, in the Surgical Intensive Care Waiting Room, to field the calls from family and friends.
One call is from the police chief in Beasley, Texas, where Evelyn serves on the city council. ("If you can call us a city. We're only 600 people," she says.)
While she waits, Evelyn talks about Marcia -- her third-born child out of four -- Marcia's childhood and college days.
"Moose weighed only 5 pounds, 12 ounces when she was born. ... Marcia got her nickname from Moose, the Caboose, on TV. ... I can remember stepping over 25 or 30 sleeping bodies in my living room when Moose was at Lamar University. ... Moose is special. ... I'm like any mother. I would give Moose my heart and my lungs if only I could."
Back in Operating Room No. 9, Dr. Richard N. Pierson III heads up the team that will remove Marcia's deteriorating heart and lungs and replace them with the heart and lungs from the anonymous donor.
Dr. Walter Merrill heads up the organ procurement team, now on a chartered plane to a hospital in Iowa, where the donor lies brain-dead, attached to life-support to keep the heart beating and the blood oxygenated.
Ideally, the heart and lungs should be transplanted and functioning within four to six hours after harvest.
The two physicians synchronize their every move by periodic phone calls -- Dr. Merrill aboard a Lear jet and Dr. Pierson in OR No. 9 -- to meet the deadline.
They do. Because they are dedicated to medicine. And to Marcia. And to her counterparts at Vanderbilt.
Dr. Merrill dreads flying, but does so.
"Medicine is my calling," he says later. "When we landed, I was three shades of green, but I kept remembering (Marcia's) lust for life."
Dr. Pierson has been up long before daylight performing an emergency heart bypass, but he doesn't allow himself to get tired when he is offered probable organs for Marcia.
Paul Chang, a research assistant professor of surgery, carries the organs into the operating room in an Igloo cooler around 2:40 in the afternoon.
Because the lungs are inflated, the block of organs looks like a huge country ham.
Dr. Pierson commands a quiet operating room.
He's calm, and ends every request with a "please."
"Sternal saw, please." "Forceps, please." "Clamps, please."
He accepts every instrument with a "thank you."
Pierson stands in one place almost the entire length of the seven-hour operation. Sweat rivulets run down his brow, his gloves and his scrubs are bloody, but nothing about the operation is grotesque.
Not even the empty chest cavity that once housed Marcia's old heart and lungs.
Because he focuses so on Marcia, Pierson makes only one attempt at humor during the procedure.
When he positions the donor heart and lungs in Marcia's chest cavity, he playfully asks, "Anybody got a shoehorn up there?"
The scrub team has its own laugh, too.
Just before the heart and lungs are positioned, a Rolling Stones CD plays Start Me Up.
It's only coincidence. Or possibly a precursor for later concern.
For 45 minutes or so in the OR, Marcia's new heart and lungs work perfectly.
But when the operating team starts to take her off the heart-lung bypass machine, her blood pressure drops.
Her heart starts fibrillating, quivering.
The heart-lung bypass machine is reactivated while Pierson defibrillates the organ with a paddle and massages it with his hands for 30 minutes.
The heart resumes a steady thump, thump, thump.
Then, when he starts to take her off the heart-lung bypass machine a second time Marcia's heart begins to quiver again.
Pierson grows concerned. Very concerned. So far, so good, and now alarm.
He tries three different drugs to stimulate heart function. None works. But a fourth, a drug Pierson had just recently read about, does.
Marcia would say her angels were watching over her.
Just before Marcia is sent to the Surgical Intensive Care Unit, where two nurses will be at her side 24 hours a day, Pierson talks with Bob and Evelyn in a conference room.
He quite honestly tells them that he doesn't know what caused the two bad episodes.
"Sometimes," he says, "there are just gremlins you can't explain."
To be ultra-cautious, he tells them that he has decided not to "close" Marcia for a day or so.
He will leave her breast bone open as a safety margin. The open chest will prevent the breast bone from pressing down on the transplanted organs and will also allow him easy access to her heart should he need it.
"Every one of these operations is a roller coaster," Pierson tells Bob. "Your wife's is not an exception. However, I think she's going to be just fine in time."
Bob feels relieved because Pierson believes Marcia is stable enough for the doctor to go home.
Otherwise, the doctor says, he would spend the night at the hospital.
Around 9:30 p.m., Bob passes on the opportunity to go see Marcia, who is in a medically induced deep sleep.
Instead, he offers Evelyn the brief visitation.
Evelyn stands at Marcia's bedside for a few minutes.
She comes out: "There are so many tubes," Evelyn says. "So many tubes."
And there are. Garden-hose-size tubes weave throughout Marcia's body. A ventilator breathes for her. A monitor's bleeps report every heartbeat.
Bob asks Evelyn to come home with him and rest. Evelyn won't leave her hospital vigil, though.
Bob will keep his vigil in the Roenigks' apartment, only a 15-minute drive away in traffic. He had promised his wife before the surgery he would go home and hug the cats for her.
Both Bob and Evelyn have had a long day.
They expect to have a long night, too.