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In
1985, I became the first South - East Asian to
undergo a heart transplant. 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.
Seah
Chiang Nee
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