Review: The Story of a Heart: Two Families, One Heart, and the Medical Miracle That Saved a Child's Life by Dr. Rachel Clarke

 Dear Lit Loves,

Wow.  I just completed reading an in-depth story of two children belonging to two loving families when one passes away via a car accident and the other has a failing heart and needs a transplant.  The two children eventually match as donor and transplant recipient.  Additionally, this book relays a thorough history of the field of cardiothoracic surgery and transplantation.  You get a moving memoir and an education regarding the heart and its ability to be repaired, and transplanted!

Initially there is Keira who is about eight years old living in England in a rather large, close family.  When Keira and her mother and brother are in a dire car accident, it is apparent to a doctor at the scene of the crash that Keira quite possibly will not make it through this incident alive.   The doctor appearing on the scene implements Dr. James Styner's Advanced Trauma Life Support technique whereby there is a protocol for addressing trauma patients.  The technique involves knowing what can kill a patient first which is the list you go by when assessing trauma patients:  A is for Airway (is it blocked) B is for Breathing (is the chest rising and falling) C is for Circulation or (is the heart beating and pumping blood) D is for Disability (check for spinal fractures and immobilize body if necessary) and E is for Exposure (has the patient been exposed to prolonged periods of cold or heat).  Keira is given life sustaining measures until she can reach a children's Pediatric Intensive Care Unit.

We all know it is the precarious nature of life that causes a parent to not be able to shield a child from all the bad possibilities in life.  This is particularly true for Max, son of Paul and Emma Johnson, who around the age of eight begins losing weight, sustaining low energy levels, and having shortness of breath.  His parents are informed he has Dilated Cardiomyopathy - his heart is enlarged and is being attacked by a virus.  Eventually Max will require a drug known as Milrinone to increase the force of his heart muscle's pumping ability.  Also, Max will need a Left Ventricle Assist Device to help his heart circulate blood throughout his body.

Some interesting historical details in the book included:

1) 5 Liters of blood are pumped through the body every minute.

2) The Glasgow Coma Scale is the assessment of the level of consciousness of a trauma patient and it is measured from 3 to 15.  In this story Keira scores a three meaning no brain function. 15 meaning optimal brain function.

3) Heartbeats used to define the essence of life and over time physicians learned sustainable life requires brain function thus leading to the argument of whether to keep a patient on a ventilator or to opt for withdrawal of ventilation and potentially select organ donation.

4) Children spend two and a half times longer on a transplant waiting list than adults.

5) A heart transplant is considered palliative care and not a cure.  Average life span of patient receiving a transplanted heart is 14 years.

6) VAD (ventricle assist devices) help improve the force behind the heart muscle and its ability to pump blood.  

7) Heart-Lung machine was invented to take over function of the heart and lungs so a surgeon can make a repair to the heart.

8) The lungs function is gas exchange or removing carbon dioxide from the blood while replenishing red blood cells with fresh oxygen.

9) May 6th, 1953:  Dr. John Gibbons performs first open heart surgery with cardiopulmonary bypass machine.

10)  Brain death of a potential organ donor must be confirmed by two doctors replicating the result of each other's tests.

Eventually, we see Max agonizing in a PICU for months waiting on a potential heart transplant.  Keira's family decides to allow her to live on through donating her organs:  heart, lungs, liver, and kidneys. We see where for children the size of the transplanted organ is critical in terms of matching a donor with a recipient along with blood and tissue typing.   Keira is eventually moved to a theatre (operating room) and there is a moment of honor where all assisting in removal of organs reflect on generosity and cost to family of the donor patient.  Keira's heart is removed, placed in three sealed bags, and the heart is bathed in cardioplegia to not only stop the heart but to preserve it as well.  Keira's heart is then placed on ice in a cooler and a "go" team transports her heart to PICU where Max lies unconscious in an operating room awaiting the new donor heart.

There is a 25% chance Max will not even survive the transplant surgery so his parents know upon seeing him enter the operating room, they may have seen their son for the last time.  The heart is the first organ to form and usually at five weeks gestation.  Once Max's new heart is in place he is given a bombardment of intravenous steroids to keep his cells and body from attacking the newly transplanted  heart.  Some heart transplant patients suffer Hyperacute Rejection whereby a donor recipient's cells attack the newly transplanted heart with a 70% mortality rate.  The author does give a history of immunosuppressants, in particular, Cyclosporine which was found through a soil sample from Norway and considerably inhibits helper T cells from attacking the newly transplanted heart.  

The Organ Donation Act becomes law in the UK on May 20th, 2020 whereby instead of opting "in" for organ donation, trauma patients are assumed to be organ donors automatically unless they expressly want to opt out of organ donation.    In the first year after the new law, 296 patients in England donated organs which is about one-third of all total organ donations.  Each day in England over 200 children need some type of organ transplant and 50 of those are generally in need of a heart transplant.

Overall, this is one of the best, most thorough transplant memoirs I have ever read.  The unimaginable loss of a child from the donor family and the overwhelming anxiety of the transplant recipient's family are never underestimated.  After organs are extracted, Keira's body is returned to her family.  Max excels with his newly transplanted heart.  Max's story is covered widely by the media via The Mirror.  Both donor and donor recipient's family eventually connect and maintain close ties.  Joe and Loanna Ball, (Keira's parents) set up a charity for organ donation and also the same organization supports families who lose children and opt for organ donation.   Though this story did not take place in the United States it most definitely happens each year in the United States as well.  I do believe in the United States a person must opt, upon receiving a driver's license, whether to be an organ donor.  What a richly moving story and a compelling history of organ transplantation.  My hat's off to you Dr. Rachel Clarke!  Bravo!

Till my next review,

Grace (Amy)

Review: Class: A Memoir Of Motherhood, Hunger, And Higher Education by Stephanie Land

 Dear Book Loves,

For this particular post I am reviewing the book, Class:  A Memoir Of Motherhood, Hunger, And Higher Education by Stephanie Land.  If you ever had a doubt how tough single moms are, this book will stifle that doubt.  Ms. Land writes openly and with emotional depth about the challenges of being a single mother and pursuing a degree in writing while parenting her six year old daughter, Emilia.

Not being a mom myself, I still found Ms. Land's writing compelling reading as I prefer memoirs about regular people as opposed to celebrity memoirs.  Ms. Land last wrote the memoir titled Maid:  Hard Work, Low Pay, and a Mother's Will to Survive a couple of years ago.  She related in that book how she became pregnant by an abusive boyfriend and decided to keep the child.  She has her own cleaning business whereby she cleans houses, businesses, gyms, etc. in order to make a living to support herself and her young daughter.  Remember, she tried working under someone else's house cleaning business, but then she decided she could control her schedule and make more money by having her own business located I believe in Seattle, Washington.  In the first book we see the author making the decision to pursue higher education in Montana and she and her daughter move to Missoula, Montana.

With the memoir titled Class:  A Memoir Of Motherhood, Hunger, And Higher Education, Ms. Land continues her story.  She and her daughter rent a portion of an older home, Ms. Land continues her cleaning business, and she is also adding the pursuit of a four  year degree to the mix.  Single motherhood finds her working tirelessly to juggle the pursuits of being a mom, a business owner, and a student.  We see her juggling five classes during her senior year of college.  Additionally, she is attempting to get an increase in child support from her daughter's father.  We see the rigors of dealing with a court system and a judge who value a father's earnings from his full-time job with overtime pay over her job cleaning houses, raising a daughter, and meeting the demands of collegiate reading, essays, reviews, and thesis papers.  Finding affordable child care is a major issue described in this book in that the costs are exorbitant even with having your own business, receiving child support, and utilizing food stamps.  

When Ms. Land's daughter turns six years of age, Ms. Land loses food stamp benefits for herself, but retains them for her daughter Emilia.  Many times the reader sees where food stamps barely cover the cost for grocery staples much less fresh fruit and vegetables.  Going for ice cream and getting a happy meal for your child are extravagances Ms. Land lives for and she will often go without food herself so that her daughter can eat what she likes.  At times this book is so raw and vivid that I found myself shocked and bewildered by all that Ms. Land tackles on a daily basis.   At one point she writes that her life motto is "My life may be relentless".  She is constantly chasing collegiate deadlines, a way to get her daughter to school in a timely fashion, cleaning homes, and hoping that her car starts each morning.  

And then there is health care.  When Ms. Land finds herself with a puncture wound in her leg during this book, she tries to treat it herself knowing that visiting a hospital ER is not a reality she can readily afford.  She does go to the college's student health center where she receives help cleaning the wound, Neosporin is applied to the wound, and she is sent home with a load of bandages.  Her instructions from the student health center are that if it gets worse head directly to the ER.  Though Ms. Land recovers without a trip to the ER, I find myself wondering what does it say about our country when a single mom with a puncture wound in her leg who works hard for a living and is trying to improve her life status via education, can only afford to be seen at a student health center as opposed to an actual ER?  There are a lot of moments like this in the book where I am shocked at the lack of assistance for this hardworking mother of a single child.

Also, child care is a major hurdle for Ms. Land.  Many times a friend or roommate will watch Emilia after she gets home from school each day.  In order for Emilia to attend day camp during the summer, Ms. Land barters with the day camp's owners by cleaning their facility in exchange for a discount on the cost of sending Emilia to camp daily.  And sometimes Ms. Land has to depend on the generous mindset of her professors who allow her to bring Emilia to class with her.  Why could the college not have offered a child care center for students who are also parents.  And why could it not be staffed by students pursuing a degree in early, middle, or high school education? Even better, what about a sliding pay scale for students like Ms. Land who are doing their best to raise a child, obtain a degree, and additionally run her own business? It leaves  you seeing where the gaps are in education, the family court system, and food stamp benefits.  Honestly, we have hospitals that offer child care for their staff so obviously, where there is a will there should be a way.  Are these benefits only for the wealthy members of our society?  

There is a big revelation and/or event in this book that I will not give away here.  In the final chapters of the book we see Ms. Land finishing her four year degree along with having $50,000 in student loans that she will have to start repaying six months after graduation unless she continues in a collegiate MFA program at another university.  Her first jobs are as a data entry clerk and she also obtains a paid YWCA internship. She does not explicitly say it, but I am sure she is still running her home cleaning business just to make ends meet.  Here's what I hope:  Ms. Land secures a spot in a phenomenal graduate school, she maintains a tenacious yet loving spirit, and she continues to show readers and the world the stamina it takes to be a single mother making a life for herself though the systems that rule her life are lacking in so many fundamental ways.

Till my next read,

Grace (Amy)  

Review: The Mango Tree: A Memoir of Fruit, Florida, and Felony by Annabelle Tometich

Dear Lit Loves,

This month I read the memoir, The Mango Tree:  A Memoir of Fruit, Florida, and Felony by Annabelle Tometich.  The interesting part of the opening of the book is that the reader thinks this is going to be a book about a daughter and her siblings who have to bail their mother out of jail because she shot at the car of a man who dared try and steal mangoes from the trees in her yard!  No.  This is a book about a quite complicated family.

This narrative revolves around the author learning to find herself through a childhood that was quite heartbreaking and precarious.  At one point, her father's mom lived with the family and the grandmother absolutely detested the girl's mother simply because she was someone from a foreign country.  Never mind that Annabelle Tometich's mother allowed her mother-in-law to move in with their family in order to help in her caretaking.  This is a mother with a generous and devoted heart who believes when it comes to family, helping is essential even if a relative is demeaning to you.

Next, we witness a young Annabelle coping with the fallout of her mother and father's explosive fights.  Her dad often leaves home and much of the parenting and household duties fall to Annabelle's mother, Josefina.  And then Annabelle learns that her father has died by suicide though she will tell others that her father died in a car accident just to avoid all the stigma that comes along with sharing that a family member has died via suicide.

The author has a contentious relationship with her mom who likes to save everything including broken crayons as she can place them in a balikbayan box to take with her on the next trip made to her home country because the relatives there have so little compared to the abundance the family enjoys in Fort Myers, Florida.  Also, the author's mom has a distinct problem hoarding just about everything especially VHS tapes and DVDs of various American television shows and movies.  Though Annabelle struggles to keep the house clean, her mom appears to prefer it in a catastrophic state. The truce:  live and let live.

Annabelle sees her mother in a whole different light when they take a trip to Manila.  While in Manila, Annabelle gets to see how her mother's extended family lives quite poorly.  The family in Manila is thankful just to have a roof over the heads and food on the table.  Annabelle sees what it is like living in a desolate, poor area of the world where her mom essentially raised her siblings.  Her mother brings all the balikbayan boxes with her for her relatives and is generous with her time, money, and profound love. 

At one point, life becomes wo overwhelming for Annabelle's mom that she insists they are going to leave Fort Myers, Florida and move to Manila.  In order to prevent this, Annabelle must start helping her mom with getting her brother and sister to school, cooking, cleaning, and mowing the yard.  

Finally, the reader sees Annabelle go off to college in Florida and befriend people while attending a university.  She loves college life so much that she actually stays year-round at the university.  This part of the book speaks to the point of how we are unable to choose are biological family, but once we are adults, we can choose who we would like to have in our lives that we treat as family.  

Young Annabelle works in the food industry, as a journalist, and by the end of the book, we find Annabelle with her own family at a neighborhood party.  When she overhears someone telling the story of how a local woman shot what I believe was a BB gun at a man who was on her property stealing mangoes, Annabelle claims and defends her mom for the strong, independent woman she is and for how much of those same qualities her mother, Josefina, has helped her to also acquire.

What a heartbreaking and dynamic memoir.  I found myself at times having to put this book down due to some of the big issues tackled in the book.  In the end, I found myself relating to the author in that we all come from dysfunctional families and we are defined by them in ways both positive and negative.

A solid, eloquent, and emotionally moving memoir.

Till my next review,

Grace (Amy)