(Dr Jose Chacko Periappuram, who made history by performing the first heart transplant in Kerala, shares experiences that touched his heart.)
A withered face, lips that had turned blue, feet that were swollen due to fluid accumulation, and gasping for breath even when just seated in front of me – that was the condition of six-year-old Naomi. Seated next to Naomi was her mother who had difficulty walking due to a congenital defect in her leg. And along with them was a good Samaritan named Francis who had offered to help them.
The small child’s heart valve had stopped working for years. The functioning of her lungs was also significantly affected due to the effects caused by the heart valve’s failure. Naomi needed a very complicated open-heart surgery.
The child and her family were members of the ‘Jehovah's Witnesses’ sect. It is a part of their belief that they do not accept blood from strangers even when there is a threat to their lives.
They don’t accept blood components such as plasma, platelets, and human albumin. Therefore, many hospitals in Kerala were not ready to perform a surgery on Naomi.
On examining Naomi's test reports, I realised that the functioning of her lungs and heart was so badly affected that expert cardiac surgeons would hesitate to perform a surgery even if she was willing to accept blood from others.
The plight of the mother who had lost her husband, the glowing eyes of a six-year-old girl who had not had her fill of life, the requests from colleague Francis who wanted to help them financially… all this greatly perturbed my mind.
The experience of treating Jehovah's Witnesses at Cardiff University, a leading hospital in the UK, gave me the confidence to accept Naomi for surgery.
The problem in Naomi's heart was with the most important mitral valve. The surgery was needed to replace that valve. Naomi's haemoglobin was just 9 grams even before the surgery. Iron tablets given to raise the haemoglobin level did not prove effective as her intestines had lost their absorption capacity.
The only way for such people is to have surgery without losing a single drop of blood.
The most difficult problem in such cases is that although there are many different solutions that can replace blood, none of them can raise the haemoglobin levels. If haemoglobin falls below six grams, then patients rarely survive a surgery.
Everyone got ready for the surgery – Naomi's mother, relatives, and friends with prayers and hope; and doctors and nurses with minds filled with anxiousness and stress.
Naomi's heart suddenly stopped while she was being anaesthetised for surgery. The heartbeat should have been restored with normal medication and primary care but it could not be. As the anxiety peaked, we had to urgently open Naomi’s chest and support her with a cardiopulmonary resuscitator.
I attached Naomi to an artificial heart by pressing her heart with my hands and stopping the blood flow to her brain. Naomi lost about half-a-litre of blood in the process — or about half of her total blood.
One can imagine the problems that could arise when half-a-litre of blood is lost in a surgery that should be done without losing even a single drop of blood.
We began the operation with little hope. After hours of surgery, the failed valve was removed and an artificial heart valve was fitted. We then began to remove her from the device that was aiding the functions of her heart and lungs.
We were disappointed when we checked Naomi's haemoglobin level at the time. It was just 4.1 grammes.
As medical science stood frozen since external blood could not be provided to a person with so little blood, with sinking hopes, we freed her heart and lungs from the devices that were supporting her.
But, to our surprise, Naomi's heart began to function with the new valve. That gave us great confidence. As soon as the surgery was completed, Naomi was transferred to the ICU.
After 48 hours of collective efforts of my colleagues, Naomi was removed from the ventilator. Subsequently, the progress of her health was rapid. On the 12th day after the surgery, when she left the hospital, her haemoglobin level had risen to 8 grammes.
When she came to the hospital for a follow-up examination two weeks later, she had become quite a normal girl. Her haemoglobin level had by then gone up further to 10 grammes.
When we saw her without any breathing problems and lively with glowing eyes, we all wondered who could have given Naomi the blood when her haemoglobin level had fallen so low, and we had only one answer: it must have been Jehovah.
Since then, I and my colleagues have done heart surgeries on hundreds of Jehovah's Witnesses inside and outside Kerala without giving them external blood, all thanks to the immense confidence that Naomi gave us.