Dr. Najjar

Jul 26 8:53pm – As I was sitting this evening reading some email and thinking about a long day, the phone rang.  It was a number that has called several times in the past few days but I haven’t been able to get hold of the call for one reason or another.  I was able to take the call tonight – and the flood of emotions and memories came sweeping over me again.  But it is mostly good – I appreciate the people up at Washington Hospital Center so much.

Dr. Najjar from WHC was calling.  During Regina’s stay at WHC, we called him Dr. Ninja for no reason other than we liked to think that he moved with the grace of a ninja – he and his young ‘fellows’ doctors who followed him around each evening making the rounds to visit with patients on 4D.  But I will call him by his real name – Dr. Najjar.  Check his credentials here.  As you can see, he is the Director of Heart Failure at WHC.  And I think more of him and his staff tonight than I ever have.

He called around 8:30pm.  We talked for probably 15 minutes.  He wanted to check up on how I was doing.  He offered condolences and sadness from him and his staff in “my loss”.  He used words like “heart-breaking” and “shock” in describing, he said, still what he and his staff is feeling right now.  He said he remembered Regina’s smile and positive attitude.  He thanked me for being with her the whole time – he said not many family members can or are willing to do this.  He said that staff is working top to bottom to better understand what happened to Regina and, hopefully, prevent it from happening again.

I told him what the “cause of death” was on Regina’s death certificate.  He chuckled a bit and said that the words hardly begin to describe what actually happened.  He asked if I would like to know what happened.  Of course, I said.

He explained…

Regina went in to OR on Tues morning with the staff fully ready for an extremely difficult surgery.  They anticipated her heart being “glued” to her sternum due to past surgeries – doctors had seen this in scans previously done on her.  To prevent any problem with getting her old heart out, a bypass was set up through her groin (we had been told they would do this) in case her old heart wouldn’t come out easily.  In fact, this is exactly what happened.  Within moments of seeing the “mess” (he called it) in her chest, she was immediately put on bypass.  All was fine.

Due to the bypass delay, her new heart was actually not harvested from the donor until later in the morning (the donor was at WHC).  The longer a donated organ can remain viable in the donor’s body, the better it will be when it is placed in the recipient’s body.  

The transplant actually didn’t take place until late morning – much later than we all thought.  The transplant went fine – the heart fit in and functioned beautifully, Dr. Najjar said.

Regina’s chest was buttoned up and she was stabilized.  Then, something happened in Regina that happens in a small percentage of patients.  The condition has a long name, Dr. Najjar said, but basically a condition arises where blood quits clotting.  Instead of clotting taking place as would normally happen in healing, the blood simply does not clot.  So, at new cuts and connections, the blood seeps into the body’s open cavities.  Literally, a patient can bleed to death.

This is what happened to Regina.  She began to “weep bleed”, we had been told.  Uncontrollable bleeding.

Unfortunately, Dr. Najjar said, there is not yet a therapy for completely controlling this kind of condition nor is there yet a method to determine if and when a patient will experience such a condition.  The protocol today is to simply begin massive amounts of blood transfusion – which is what happened.  And while this can give doctors time to tighten up leaking spots, blood that is transfused is something that the right ventricle in a heart does NOT like – especially a new heart.  So, the massive amount of new blood caused Regina’s new heart to fail.  She likely experienced cardiac arrest mid-day or early afternoon.  Doctors were able to get her heart running again but the fear (as we had been told) was that some of her primary organs may have been damaged due to lack of oxygen and blood. 

As this was transpiring, it was decided to put her on the breathing and heart machines – which she lived on for about a week.  Being on machines would give doctors time to assess the damage, if any, and determine what needed to be done, if anything could be done.

The rest is pretty much what we know.  Actually, a few days later her blood began clotting and she began healing.  Ironic, I guess.  As she was kept viable on machines, many tests were done on her organs all of which resulted in inconclusive determinations. Of course, she never really woke up again either.  

I asked Dr. Najjar – when did Regina probably pass.  He said probably when her new heart failed.  He pointed out that Regina was completely under and did not feel or experience any discomfort or pain during all of this.  But he believes – as I had felt – that we probably lost Regina a few hours after she had received her new heart.

On the following Wed, staff realized that the only remaining option was to take Regina off of machines and put her back on her own and be prepared to help her if she was able to pick up the load.  It was high risk but she, obviously, couldn’t continue indefinitely on machines.

Of course, she was unable to pick up the load.  It did seem that she probably had experienced significant organ damage the prior week.

And that is that.  

Dr. Najjar apologized several times.  I assured him that I had no anger or regrets and I thanked him profusely and often for his work and the work of the staff – I had never seen anything as amazing in my life.  Nor, likely, will I ever see it again.

He encouraged me to call him anytime – or his staff.  I offered to help him in any way that I might – he said he might invite me up sometime to talk about the “journey”, as he called it.

One more note.  I told him that I had a picture of Jessica preparing the plasma bags for Regina on the morning of the transplant.  Dr. Najjar was in – it was probably 4am or so – wearing tennis shoes.  He literally was pacing the floor in Regina’s room.  It was obvious that he was nervous.  Anyway, I told him I would send him the picture.

But I also told him that I had framed Regina’s new heart beat strip – it tells such a compelling story.  He asked if I could send him a picture of the framed strip, too.  Of course, I said.

And I will send the pictures in the next day or so.

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