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Madam Salina, the 32-year-old mother of Cinta Suci Ramadhani, has a Heart Mate II, whose motor and batteries fit into a waist pouch. -- ST PHOTOS: MUGILAN RAJASEGERAN
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Her hopes dashed, she leaves the Heart Centre with her stepfather, Mr Kasmir Ali, after learning that the donor heart is unsuitable. 
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Hopeful of getting a donor heart, Madam Salina Mohamed So'ot (above) waits at the National Heart Centre Singapore with her husband, Mr Ridwan Asmawi, and daughter Cinta Suci Ramadhani. -- ST PHOTOS: MUGILAN RAJASEGERAN
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Madam Salina has lunch, which is bad news as it means the operation will not be happening soon.
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Heart recipient Rahman Abdullah visits her to offer moral support.

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It was just another searing hot Saturday in May. Then the telephone call Madam Salina Mohamed So'ot had been betting her life on came and everything changed.

She had just woken up from a midday nap and was about to have lunch. Her mobile phone lit up: 'Sharon Neo calling...'

She felt a rush of excitement and managed a shaky 'hello'.

Ms Neo, 30, the transplant coordinator from the National Heart Centre Singapore, asks if she has had lunch.

'I was just going to,' she replies nervously.

Ms Neo gets straight to the point: 'Have a light lunch. There may be a potential donor that matches you. You may have to come in later this evening to be prepped for surgery.'

'Thank you, thank you,' gushes Madam Salina before calling her husband, Mr Ridwan Asmawi, to break the news.

'They may have a heart for me. They may want me to come in this evening.'

A weak heart

MADAM Salina, a 32-year-old mother of a two-year-old, was diagnosed with an enlarged heart eight years ago after complaining of breathlessness.

The devastating news came just a week after she tied the knot with Mr Ridwan, her sweetheart since their Institute of Technical Education days. The Heart Centre put her on medicines, hoping to arrest the problem, to no avail.

Last April, her condition worsened and she had to take leave from her job as an HDB administrative assistant to stay in hospital for treatment for a severely irregular heartbeat. She cried when doctors told her that her only chance of staying alive was to get a new heart through a transplant. But first, her condition must be stablilised.

Her doctors decided to implant an artificial heart device that would take over the function of her heart in continuously circulating oxygenated blood through her body.

Within three months, her condition improved and her name was added to the wait list for a heart transplant.

Dr C. Sivathasan, senior consultant and director of the Mechanical Heart Devices programme at the Heart Centre, said Madam Salina was fortunate the technology of the devices had advanced to a point at which they were small enough for an Asian female to be fitted with one.

The Heart Mate II has a smaller pump, about the size of a lemon, which allows it to be planted inside a patient's chest cavity. Another advantage is that the motor and batteries are small enough to fit into a waist pouch, allowing patients to move around and have a semblance of a normal life.

Madam Salina has to deal with some inconveniences, such as having to sponge-bathe herself as she cannot take a proper shower and risk wetting the device.

She has to carry four batteries, 2kg in all, two of which have to be connected at all times to her implanted heart via a cable in her abdomen. They are good for five hours. At home, while sleeping, she plugs into a power console.

She dreams often of the many doors a new heart would open. It would mean being able to take her daughter Cinta Suci Ramadhani cycling in the park, even swimming. The family can also go back to taking short trips to remote Malaysian beaches.

But she stops her reverie in case she gets too carried away.

Last October, she received a phone call telling her to admit herself for a possible heart transplant.

Only after she arrived did she realise she was one of two possible recipients. The other, Mr Rahman Abdullah, 41, was in a worse condition. He was strapped to a much bigger heart device - the motor and battery fit into a small suitcase - and was forced to stay in hospital for the past eight months.

In the end, the donor's heart was found to be a more suitable fit for Mr Rahman.

She felt a twinge of disappointment, but told herself that Mr Rahman was more in need, given his condition.

Hoping for the best

AND so the fraught process has begun again.

Late afternoon, her phone lights up; it is Ms Neo again.

'Salina, the tests show that the heart is suitable for you. Come in by nine, no dinner. More tests are being done but if everything goes okay, the operation may happen tonight.'

Ms Neo meanwhile calls the head of the heart and lung transplant programme, Dr Lim Chong Hee, to update him further on the donor. She has not had much sleep since 1am when she received a call from the transplant coordinator at another hospital informing her that a donor heart may be available.

The donor, a young woman, has been declared brain-dead, and is being sustained by machines so that tests can be done to check if her organs can be given to other critically ill patients.

Dr Lim immediately orders a series of routine tests, such as the echocardiography, a test that uses sound waves to create pictures of the donor's heart. This is to ensure that the donor's heart has no defects or signs of disease. He is pleased with the results of the cross-match tests - it shows that Madam Salina has no antibodies to the donor's heart, which minimises the chances of rejection.

He orders another lot of tests to ensure the donor is free of infections and diseases like hepatitis.

The 45-year-old who has performed more than 100 transplant operations in Singapore and in the United States, where he was trained, knows the odds well. Only one out of every two hearts donated is eventually transplanted. 'Let's say I am cautiously optimistic. The donor is young and the heart seems healthy, so I am hoping it will go ahead.'

The long wait

AT 9PM, Ms Neo calls Madam Salina, who has been admitted to Heart Centre ward 56, and asks how she is feeling.

'I am okay, I am trying not to think too much about it so that I won't get my hopes up,' Madam Salina chirps back.

Late that night, Ms Neo receives more information on the donor's condition. One test showed a possible infection. More tests have to be done, which would take a few more hours.

Ms Neo, a former staff nurse who trained to become a transplant coordinator four years ago, decides to catch a few hours' sleep, knowing the operation would not likely happen that night, and tells Madam Salina to do the same.

The next day, late morning, Ms Neo informs the nurses to serve Madam Salina lunch - a bad sign. She has not eaten for a whole day but looks crestfallen when the tray is wheeled up to her.

It means a delay and she has no idea why. 'It is the weekend...maybe test results are slow coming in,' she tries to allay the anxiety of her mother, who has come for a visit.

She sips the fish noodle soup her technician husband has brought her. Then she plays with her daughter, sketching animals and folding paper aeroplanes for the next few hours.

Mid-afternoon, she is told to resume her fast in case doctors decide to operate at short notice. She skips dinner happily. At 8pm, there is still no news. It is time for her mother, husband and daughter to go home. She goes to bed, hungry but hopeful.

Bad news

NEXT day, mid-morning, Ms Neo calls to explain the delay: 'They found an infection, so they have to check further.'

Madam Salina attempts a few more word puzzles. Just then, she is greeted with a cheery 'Hello' at the door. It is Mr Rahman, who has dropped by to give her moral support.

Told about the delay, he consoles her: 'I am sure by tomorrow you will have a new model, better than Heart Mate II. No need for batteries.'

After a brief chat, she spends the rest of the day watching one TV show after another, doing piles of word puzzles and furtively glancing at the clock.

Finally, a nurse appears with her dinner tray.

Madam Salina's heart sinks.

She is ravenous and it is her favourite food - steamed rice with fish and vegetables - but she swallows it mechanically, not tasting any of it.

Later, as Madam Salina settles back to watch her favourite Malay drama show, Ms Neo, Dr Sivathasan and the centre's chief transplant coordinator, Ms Kerk Ka Lee, appear at her doorway.

She notes their solemn mien and steels herself.

Dr Sivathasan breaks the bad news: 'Sorry Salina, I don't have very good news for you. The donor has an infection...it's a serious one and resistant to many drugs.' He adds: 'Let's hope for another one to be available soon. One without problems.'

Madam Salina looks down, trying hard not to show her disappointment. She thanks the trio. 'It's okay...I am sure one of these days, I will get a heart.'

After they leave, she rings her husband.

'The donor had a problem, the operation is off. I can leave tomorrow ... ' her voice breaks.

Her husband says: 'Sleep well. I will be there tomorrow to get you. We can go somewhere and have something nice to eat.'


Source: The Straits Times © Singapore Press Holdings Limited. Permission required for reproduction.