In 1985, I became the first South - East Asian to undergo a heart transport. It was performed by the late Dr Victor Chang at Sydney's St. Vincent's Hospital. This is my story.

Among the millions all over world who welcomed the new millennium on Dec 31, 1999, few did so with a greater sense of history or emotions than I. As I watched the champagne flow and fireworks explode, my heart was pounding an indescribable beat.

It was now an unbelievable time I had not thought it remotely possible to be able to greet the year 2000. It was an now an unbelievable reality. By right, I should have left this world in 1985, but for a brilliant surgeon and a 17-year-old Australian boy who died before his time. They allowed me to live through a transplant in Sydney, a reprieve from a diseased heart. It was caused by a viral infection. Doctors in Singapore had given me two years to live - and 1985 was the third year and it was worsening rapidly. But let me start from the beginning.

I was browsing in a bookshop in downtown Singapore. It was in 1982. As I straightened up after replacing a book on a bottom shelf, the floor spun like a merry-go-round gone amok and darkness engulfed me. Sweat appeared all over my forehead. The episode seemingly lasted only a fraction of a second. I must have staggered. I remember catching hold of the shelf for support, closing my eyes and shaking my head. The feeling of nausea gradually left and my vision returned. Must have overworked, I told myself.

Unknown to me, my body was passing me a powerful message that things were going wrong, terribly wrong. I just had a heart attack. It was ironic. For many years I had reported the ills of the world - South Vietnam in the 60s and 70s. the Middle East and Africa, China and Southeast Asia - but this had not trained me to recognise the illness that had hit me. Why should it? After all, I had lived in the fast lane for most of my youth, worked hard, played hard and dreamed hard, seldom feeling sick while doing so, and I was only 42.

When I had a second heart attack several weeks later I again ignored it. Then events moved fast. As Editor of a start-up newspaper, I was under increasing stress. My decaying heart went from bad to worse. I would wake up in the morning, bathe, dress and go to work. But as soon as I approached the lift I would feel an overwhelming sense of fatigue. In the office, lethargy and tiredness would set in. During editorial meetings I would slouch in the chair, taking less and less part in the discussions. "You're looking terrible. why don't you see a doctor?" exclaimed my secretary one day. Without waiting for a reply, she picked up the phone and made an appointment.

The news was bad. I had contracted cardiac myocarditis - a very rare viral infection that had attacked and was destroying the muscle of my heart. In a population of three million, maybe a dozen people on average would get it a year. It was, apparently, just back luck; this time the roulette ball had stopped at me. The gloomy-looking doctor said that, with medication to retard the deterioration of my heart, I had about two years' to live. There was no cure.

For the next two going on three years I spent various periods graduating from one hospital to another. When I could work, it was for no more than five or six hours at most. Then the pain began. Yes, I learnt about pain-killers. I took so many that they soon lost their effect. Yes, I learnt about sleeping pills. They, too, failed to work after some time. At times I considered suicide. It was then that I learned why hospitals keep their windows locked. Soon, my heart was failing to pump enough oxygen to my brain, and my mind began to degenerate.

When moments of madness hit caused by a brain being deprived of oxygen, I would become irrational, making unreasonable demands of my wife and the nursing staff. On one occasion I spent the whole night in a hospital insisting on sitting in the corridor or on the toilet fully-robed until the doctor had me tied to my bed like a lunatic. Most of the time, I coughed incessantly. There was always the pain, excruciating pain from the chest to the lower stomach. Then I got lucky. Very lucky.

Sydney heart surgeon (late) Dr Victor Chang, one of the world.s most brilliant, was visiting Singapore as (then Prime Minister) Mr Lee Kuan Yew's Distinguished Visitor Of The Year; a programme aimed at inviting some of the world's best brains to give lectures to Singapore students and professionals to upgrade their knowledge. He was kind enough to visit me at the hospital and, after looking over my thick file, said: "Come and see me in Sydney. I'll see what I can do." It took a whole fraction of a second for me to say "yes". If I made it, fine. If not, at least I would escape the suffering. But first I had to find the money for the medical bills and at least four months in Australia recuperating.

The sum was a seemingly impossible A$80,000 (at the time about S$120,000). I didn't have that kind of money. But on hearing the news, Singaporeans rallied around - a couple of local bankers (who didn't want to be identified), the Lee Foundation, the press community and friends - and the money was very quickly raised. Australia was my only chance at life. An operation in America would be too expensive, and there were no heart transplants in Singapore in the mid 80s. That was to come half-a-dozen years later.

I had taken the journey to Singapore's Changi airport scores of times. As a journalist I had worked in more than two dozen countries, from three days to three years. But this trip was different - it was made in the back of an ambulance. As I stared out of the window I took in the wide, tree-lined expressways and blocks of apartments, telling myself numbly that this could well be the last time I would see Singapore, my home. I felt like a condemned man about to be taken to the electric chair.

There is never a good time to be inflicted with a disease. For me, it could not have come at a worst time. After years of foreign assignments, I had felt that my journalistic angel had smiled on me when I was made Editor of a newspaper, The Singapore Monitor, in a well-educated country of 2.5 million Singaporeans who were served only by one major newspaper. How many journalists in the world would have such an opportunity in their lifetime? During the flight to Sydney my mind was wrapped up in personal thoughts - my life, my wife Pat and my six-year-old son, Pei Kwang (now 21).

The fact that I was going to become the first South-East Asian to undergo the transplant, and was therefore heading for a little rendezvous with history, did not strike me. I was St. Vincent's 32nd patient to undergo heart transplants but all my predecessors were either Australians or New Zealanders. The surgery was so new that some Singaporean doctors were highly pessimistic about my prospects. At least one advised me against going. Since then it has performed hundreds. The average life-span ranges from 10 to 20 years. The waiting at St Vincent's Hospital was the worst period. The pain was overwhelming. For three weeks I prayed either for a donor heart or failing that, a quick death. Hope never flows in endless supply. I was withering fast; then in the midst of all the gloom, I received a card sent by six Primary Six girls from the Convent of the Holy Infant Jesus in Singapore saying that their thoughts were with me and wishing me speedy recovery. I hung on to it and cried every time I looked at it. It gave me an inner strength.

Unknown to me, I was nearing the end of the road. Doctors had given me just one more week to live. But thanks to the generosity of an Australian family whose teenage son had died, death was to be put off. The transplant took place on October 12, 1985.

Starting from Scratch

The difference after the operation was stark. Even though I was semi-conscious and could not even recognise my wife, I realised that a minor miracle had occurred: the pain had gone. The relief was immense. I'd pulled through the operation, I was alive, pain-free; anything else was minor detail. It had taken about five-a-half hours, but all I can remember of that crucial night is the wailing of a police siren as my life-giving heart was being rushed to St Vincent's Hospital.

For the first three weeks I slept with my hands firmly held across my chest every night in an instinctive move to protect my new heart. As my brain struggled to fight off the process of degeneration which followed, I behaved irrationally. On one occasion I climbed out of bed in a frantic search for my heart, saying that someone had stolen it. There were times when I would watch television, apparently enjoying it - when the set was not switched on. This worried my wife, Pat, who thought I had lost my marbles, until it was explained that my behavior was usual for heart transplant patients. I dreamt incredible dreams, lots of them. In one, I found myself in the control room of flying saucer, a round object that emitted a bright light from the bottom. It hovered above a Singapore Airlines plane, broke through a layer of cloud and went straight to the White House in Washington, where it lit up the sprawling complex. There were also painful dreams, like the one in which I was hooked in the throat by a fish-hook. Every time I tried to pull myself free, a spasm of pain would shoot across my brain.

After my recovery a friend invited me to go fishing. With this memory still fresh in my mind, I declined. In my isolated room, strung by a series of tubes attached to my body, I had just enough left in my brain to realise that I was, in fact, a new person. The first evidence that I had escaped the twilight zone came one morning when a nurse was helping me with my bath, something that had been a daily routine for weeks. But that morning something happened. To my embarrassment, I became sexually aroused as she washed me. Until then I was not even aware that I was being helped. The Australian nurse was not fazed as I would have expected - in fact she was delighted. "Good on you Mr Seah. You are now back to normal." she said. As time passed, my mind began to clear and the hallucinations gradually decreased. To find out the state of my mind, the doctors would ask me what day or date of the year it was, questions which took me much effort to answer. To help me regain a clear mind, I had to play Scrabble and memory games.

Most of the time I was asked to pair off pictures on cards that were placed face-down after I had committed their locations to memory. On other occasions, a passage of about 100 words was read to me slowly a number of times and I was asked to recite as much as I could remember. Eventually, I became reasonably good at these games. Physical exercise was also part of my resurrection. When my legs were strong enough to walk, I was made to ride an exercise bike. I called it "my torture chamber" but it worked miracles on my frail body. When I left Sydney nearly four months after the operation, I was able to cycle for almost 45 minutes starting from 10 km/h, rising to 30 km/h. If you think it is easy, try it.

During the last three months of my stay in Sydney - even though Pat was there with me (with Pei Kwang attending a Darlinghurst kindergarten) - I was made to do everything by myself; so much so that I began to think that the word "self-reliance" was invented by St Vincent's. But they knew my pronounced mood of lethargy had to be destroyed. I had to relearn how to brush any teeth, shave, change my clothes and later, learn what each medicine was for and when and how to take them. I began reading newspapers and listening to the radio as the journalistic part of me returned. The doctors now would ask me what were the day's headlines, which was easy enough in Australia at the time: rising interest rates, 20 per cent.

After about a month, I began to realise that I was unnecessarily short-tempered, often for no valid reason. I also found myself easily moved to tears: a moving TV soap opera or a few touching words to me, were enough to set them rolling. Then all of this was replaced by a mood of escapism. I shunned people, as if I was building a mental wall around myself. For eight or nine months, I was reluctant to meet people, even friends back in Singapore. The extrovert part in me disappeared; I just wanted to be alone. A knock on the door would send me rushing into the bedroom and hiding. Mercifully, these symptoms are long gone. I am still a freelance journalist.

Beginning this year, I have begun this web-site, a 24-hour job cherishing every moment of it. I travel occasionally with my family and enjoy moments with my wife and son, who aspires to study life sciences, hopefully in the US. In short, I earn my keep. But for many who are self-employed, their biggest obstacle is paying the bills. Singapore is a society which frowns on welfarism where health costs are largely paid by employers or families. Its form of corporatised public health does not make it the best place on earth for those who need constant, expensive care.

Life is as good as we make it, and I don't intend to sit idly as the new digitalised world goes by. For me to undergo a transplant operation in order to be half put out to pasture is not my idea of living. I want to continue working maybe eight to 10 hours a day, six days a week, although at 60, I am not as active as I want to be. During my earlier days of treatment I learned something a normal person has no chance of learning. Once my heart was hooked up to an echo-gram, which allows a colour, three-dimensional look at how the heart is doing. I saw the aorta opening and closing in seemingly endless motion: it is an action that happens millions of times, day and night.

For those who sacrifice love and family to pursue materialism, think about this: Our whole life depends on this little aorta beating away opening, closing .. opening, closing. Non-stop at work or play or sleep every day of every year. When it stops, and it will, all that we have so painfully achieved, our degree, bank accounts, stocks, cars, houses, will come to nought. We came into this world with nothing and we will leave with nothing. In this, there is no difference between Mr Bill Gates and the corner bag-lady.

During the darker days when I was preparing for death, the things that occupied my mind were nothing materialistic, but my family and the beautiful things in life that I had not enjoyed enough of because of my career. No objects of value are worth risking the priceless experience of waking up in the morning . In the hustle of earning a living, most people do not regard life in this poetic way. Since the operation, I do. My biggest regret is that I am unable to personally thank the Australian family, which granted me this new lease of life. Under Australian law, the doctors were not allowed to reveal the identity of the donor family, or to tell them who benefited. There is, however, forever a place in my heart for them.

The transplant has made me look at life differently. I try not to let minor irritations bother me. I no longer get bothered by rude drivers and long queues. I think a lot more about life and its meaning; I accept that I came into this world with nothing and will leave with nothing. Everything I have, I will leave behind. This vision of a heart transplant patient being a fragile, even helpless, creature who needs help at every turn, not to be trusted with important errands, I was told, still prevails in society today.

In Singapore, it is less pronounced now since the republic has gone through more than a dozen heart transplants since 1990. The biggest long-term problem for these people is, of course, finance. Unless he is dirt poor (which means he earns $1,500 or less) or has a considerate employer or a rich family, this can be unsurmountable. In recent months, I have been asked by several people this question: "How much does a patient need to spend?" For years now, I did obtain official help - in the form of lower price for the very expensive anti-rejection drug, cyclosporin. This has reduced my cost of staying alive to $450-500 a month. Apart from this - precious little else.

Unlike in Australia, there is no long-term subsidy in Singapore to help transplant patients. In a society like ours, where employers look after a worker's medical costs, my advice to anyone wanting a transplant is to plan carefully, make sure his sums add up before taking the plunge. If he is, for example, a middle-class, self-employed person without his own resources, the long-term costs may be too much of a strain. Nothing dramatic here, just the hard reality of life. In a highly competitive world, few employers are prepared to keep paying huge medical bills for a worker when they can easily get a normal one cheaper. Transplant patients incur large medical bills and employers, naturally, do not like to be burdened by them.

Another shock of a transplant is that the recipient needs great will power to live a disciplined life. You can't eat and drink as you please or forget about exercise or pretty soon your health will deteriorate. Thus, on average, only 52 per cent of the earlier heart transplant patients lived for five years. Now you talk in terms of one or two decade. I'd read of a person who survived for a record 23 years. No surgical miracle can prolong life if the patient lacks the will to live under a different lifestyle and big constraints. Medical science cannot do more than give man the chance; whether he can summon enough determination can only be decided by himself.

Six months after my return, I found out that three of my fellow transplant patients in Australia had died. Two transpired because they lost the will to live. The constraints were too strong to bear, the obstacles, too large. Survival also depends on sacrifices on many of the things you liked, including: EATING - a patient has to observe a strict diet; largely bland food with low cholesterol, little salt or animal fats, a minimal amount of sweets, chocolates, ice-cream or other things that make for tasty meals. He has to watch his weight constantly. Eating outside becomes a burden. SPORT - No competitive, over-active sports, just regular exercise every day; brisk walking, jogging, swimming, aerobics but nothing terribly strenuous. TRAVELLING - For someone like me who likes to travel to exotic places or live an outdoor life, the curbs can be over-whelming. Patients are discouraged from long-distance travel especially to places where health standards are low and drinking water suspect. They should be close to adequate health facilities.

Catching a bug like a cold, a normal event among normal people, can be disastrous for a transplant patient because the drugs suppress immunity. He must get quick, specialised medical treatment when things go wrong. Since he takes blood-thinning medicine, the patient has to make sure he avoids cutting himself. I did once while adjusting the lawnmower and my house resembled a scene from an Alfred Hitchcock murder, blood was everywhere. Of course, trying to live a normal life with abnormal constraints is not easy. In fact, sometimes I feel like a sheep dog straining to keep its flock together; as fast as one errant lamb is maneuvered into line, another one darts away. But there's little time for regrets - or for the past. According to the law of averages, my chances of remaining alive another 10 years are pretty slim.

The biggest threat is, of course, rejection. When a foreign organ is introduced into your body, it tends to reject it. And as life continues the transplanted heart will also, realistically speaking, become weaker. The odds will drop, slowly at first and then rapidly. Mentally, I guess I'm prepared for anything. Besides I have lived past the last millennium and that already counts for a lot. So I'll just tip my hat to the past - and roll up my sleeves for the future.



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About the Editor
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My own high-tech journey started from the ballpoint pen through the typewriter before arriving now in cyberspace - in the name of - spanning over 40, sometimes tumultaneous, years.


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