May 2, 2003 - Dad's View:
Eye on the Prize
We wanted a sibling for our son. It sounded simple enough in principle. Yes we were older parents, but with cars and people I’ve always believed that its not the years but the milage that counts. We had tried for another baby since our son Paul was a little more than one, but three pregnancies led to three disappointments. When we found out in the fall of 2002 that we were pregnant with Wyatt, our son Paul was almost three. I was scared. The losses incurred in getting to this point were a huge emotional strain on our small family. Would we catch a break this time? For twenty weeks we did. Ultrasounds showed good growth and a strong heartbeat. Knowing what we’d been through to get to this point, our OBG called on Christmas eve to give us amnio results that showed the right number of chromosomes with an “X” thrown in for fun. Our son would be Wyatt Mattaway. Wyatt because my wife has a soft spot for cowboys.
Biology 101
As often happens in life, our luck had run out more than three months earlier without us even knowing it. Out of the million different things that have to occur in perfect sync for a baby to be born, at around eight weeks something that was supposed to zig decided to zag instead and Wyatt’s path was set forth. Thousands of times every day, cells divide, arteries, veins and valves form and the fetal heart forms four chambers for another healthy baby. Or not. A blocked artery, a valve that fails to open precisely the right width at precisely the right time and the babies left ventricle does not get the tools it needs to develop. The doctor informed us that without surgical intervention, the resulting single ventricle physiology is not compatible with sustainable life. But for us, ignorance was pure bliss. Clean amnio in hand, four happy ultrasounds behind us, my wife went back to her OBG for a 23-week ultrasound to measure the babies body parts and growth. Confident that we were finally on a roll, for the first time in six pregnancies I elected not to go to the ultrasound appointment. It was Friday, January 31, 2003, a nice winter day in the midst of a snowy, freezing New York winter from hell. The tests were all good and only three weeks ago I had seen that little pulsing star that after nearly two-dozen ultrasounds I knew signified that our baby had a nice strong heartbeat. Instead my wife took my Mom, who after two babies four decades earlier was excited to see this new technology in action for such a happy occasion. After a half hour or so of the usual measurements, oohs and ahs and discussions on how much little Wyatt resembled Paul in-utero, we got our first hint of the problems to come with the words, “I’m having trouble getting a clear four chamber view of the heart”. Four hours later a cardiologist at Hackensack Memorial Hospital in New Jersey is telling my distraught wife and mother that our son to be has a relatively rare and extremely severe congenital heart defect known as Hypoplastic Left Heart Syndrome.
Analyze This
Dazed, confused and overwhelmed by “life’s rich pageant”, to the internet we went. Tunnel vision took over. Space shuttles blow up, children lose their parents, and I could care less. Hypoplastic Left Heart Syndrome. It sounds like the name of a bad speed metal band. We research. We surf. We email Dr. Tworetsky at Children’s Hospital of Boston to see if the “science fiction procedure” (in-utero catheterization to unblock the artery to the dying ventricle) is an option. It is not. The ventricle is dead and nothing is going to bring it back. Our options are not ideal, but at least there are two more than there were twenty years ago. Doing nothing and letting our son die is not a choice. That leaves a three-stage “Norwood” surgery or a complete heart transplant. Pluses (not many), minuses (too many to count) for each. Where should we go for second opinion? Where should we go for the procedure? I am now using words like “palliation”, “catheterization” and “procedure” routinely in conversations. I am now the father of a very sick little boy. Colleagues at work listen sympathetically and walk away thankful that mine is not their life.Advantage Mattaway
I analyze municipal bonds for a living. It’s a job that I enjoy and do well but one that when described to people at parties leads their eyes to glaze over as they rush to excuse themselves to freshen their drink. It does however give me a good insight to the best health care providers in our area and whose facilities would best suit our needs and personality. Living about 40 miles northwest of Manhattan, we are fortunate enough to be only about 45-minutes from Columbia Presbyterian Hospital, 2 ½ hours from the Children’s Hospital of Philadelphia and 3 ½ hours from the Children’s Hospital of Boston. In a rare instance of good luck, these facilities happen to be three of the best, most experienced pediatric cardiac centers in the world. We speak to doctors at all three. They all point to recent advances and boast of success rates north of 80% for the first surgery. They all say that our odds improve somewhat because we found out in advance and they can immediately take steps once Wyatt is born to minimize damage to his already broken physiology. They all say that his echo-cardiogram look good and his is a textbook case of HLHS with mitral stenosis and aortic atresia. His tricuspid valve is not leaking and all his other heart related physiology appear to be in good working order. I never want to be, nor did I want my son to be, a textbook case of anything. The internet is a great source for information. I use it daily in my work for research and I don’t know how we would have been able to get through this without it. The support groups and informational sites provide more information than can be processed, especially when emotions are at a fever pitch and the stakes are life and death. There are no filters on the information. Information and opinions come through without subtlety or nuance. If your child makes it through the surgeries, then your doctor or hospital is “ THE BEST!!!. If not, you have a website playing sad music showing pictures of little angels who tried their best but ultimately went up to heaven where everyone has a healthy heart. Our date of induction is scheduled for Wednesday, May 21st. As I sit here writing this I have no idea if we will get to take Wyatt home and if Paul will get to play with his little brother, or if instead we will be the next family whose website features a sappy song and angel rising up to a better place. It is a horrible but necessary part of the process. I cry for the children who never got a chance to be what they were meant to be. I refuse to believe that it benefits anyone for a child to die young. I feel for the parents whose best intentions were not good enough. I am jealous of the parents of healthy children at the playground in the park. Not in that I would wish Wyatt’s condition on anybody else, no child deserves that, but in that it so absolutely sucks that this will be his path.
CHOP
In the end, we exercised the one element of control that we did have. We chose a hospital and a doctor. The hospital is the Children’s Hospital of Philadelphia. The surgeon who will reconfigure the internal plumbing of our sons heart is Dr. Thomas Spray. Both have excellent reputations and a huge amount of experience with this particular defect. They will either save my sons life or not. No pressure. We chose CHOP as much for its status as the “best” children’s hospital in the country as for its dedicated pediatric cardiac intensive care unit and the quality of the care after surgery. It appears at this point that the surgery itself has become so commonplace that the aftercare and risk of in-hospital infection has become the key determinant of patient success. We liked CHOP’s CICU facilities. They are clean and open. Family is allowed to be at your child’s bedside 24/7. The staff is very touchy feely, (at least until I start bitching about missed med deliveries at 3 AM!). Columbia-Presbyterian doesn't even compare. (This may change in 2004 when Columbia moves into a brand new facility but that will be too late for little Wyatt who only has one chance). Boston is also a great facility but too far away. While we hate to think pragmatically at a time like this, we do have a three-year old, and 2 ½ hours away from home is a lot better than 4 hours. We’re hoping that the three-to-four weeks we’ll be living in the Ronald McDonald House will not be unduly disruptive as it is.
Home Stretch
Our current game plan is for me to drive down and drop my wife off at the Ronald McDonald House in Camden, New Jersey on Monday May 12th. That way she’ll be close to CHOP in the event she goes into pre-term labor. I’ll then drive back up, spend a last few days tying up loose ends at work and then drive down to be with her on Thursday as we wait for the 21st. My folks will take care of Paul for a few days and then drive down to Philadelphia on the weekend to be with us and wait for Wyatt. I feel confident that we’ve done our homework and made a solid choice. In the end its up to Wyatt. Son, I hope you find our family worth fighting for. However things turn out, we’ll be right there with you. You have taught us so much over the last five months. I look forward to teaching and learning from each other for the rest of what I hope will be a long and healthy life together