Waiting Game: College student bides his time until a healthy heart arrives

By CHRISTINA COOKE
Photos by Juliette Coughlin
The Chattanooga Times Free Press, Feb. 16, 2005

Adam Swafford, a 17-year-old Chattanoogan, lies in bed on the seventh floor of Vanderbilt University Medical Center in Nashville waiting for a new heart.

When he arrived at the hospital, his heart, which should be the size of a human fist, had swollen to the size of a cantaloupe. Dr. Frank Scholl, his cardiac surgeon, said that it was one of the largest he has ever seen.

Adam’s heart still beats, but his blood flows through the four canisters of a mechanical pump that enter his body at his abdomen. The canisters click and shudder as the machine vacuums blood from the main chambers of his heart and delivers it back through his circulatory system.

Dr. Scholl said that nobody knows what caused Adam’s heart to swell, perhaps a viral infection. The doctors only know that he needs a heart transplant as soon as they can find a suitable donor.

Though he has battled many complications over the past two months, Adam’s condition has sta- bilized in the last week, Dr. Scholl said. “He can wait indefinitely at this point in time,” he said.

Cindy Swafford, Adam’s mother, has not left his side through the entire ordeal. “She’s my roomie,” said Adam.

Mrs. Swafford stays with her son every day and sleeps on the foldout cot under the hospital room’s window. “We don’t really sit and talk that often,” he said. “We have just a kind of understanding, I think.”

A couple of weeks ago, Adam lay awake in the middle of the night while his mother slept on the cot five feet away. He gazed at the collage of photographs taped to the wall at the foot of his bed. One of the photographs captured him at Tri-State Bowling Lanes, body crouched low, arm swung back, preparing to release a ball.

Staring at that photograph, he allowed the reality of his situation to sink in for the first time.

“I just started crying,” he said. “I stayed up for three hours just staring at that picture.”

ON A NIGHT BEFORE CHRISTMAS

Adam felt the first symptoms of his illness a few weeks before Christmas. “It started one night when I went to sleep,” he said. “When I laid down, it felt like something was in my chest.” The doctors first diagnosed him with pneumonia.

On Dec. 18, he was supposed to go to an early-morning doc- tor’s appointment before Christ- mas shopping with his family. But he realized that things were not normal.

“I would open my mouth to talk,” he said, “but nothing would come out.”

Later, at the doctor’s office, he slipped into a bathroom to figure out what was wrong. He braced both arms against the sink and looked in the mirror. “I tried to say ‘no,’ but I couldn’t do it,” he said.

In the examination room, the doctor handed Adam a napkin and pen. “I can’t speak,” he willed himself to write, but his mind scrambled the message and he wrote, “I went to sleep,” instead.

He spent the next 11 days at T.C. Thompson Children’s Hos- pital recovering from a stroke. The doctors saw in his chest X- ray that his heart had swollen to fill his entire chest cavity, and they knew it was beating 150 times a minute. To support the overworked organ, they installed a balloon pump.

On his 17th birthday, the day after Christmas, the hospital staff allowed 25 of his friends to pile into his room. Out of respect for the other patients, all 25 whispered the “Happy Birthday” song.

WISE FOR HIS AGE

Adam has a thin face and chin-length hair he often covers with an army-green toboggan. Facial hair lines his upper lip and jawline — not because he wants it to, but because the blood thinners he is taking make shaving too risky.

Mrs. Swafford describes her son as positive and laid back. “He’s very accepting of everyone,” she said. “He’s not judgmental. He has always been wise for his age. He thinks deeper than a lot of kids do.”

Adam’s girlfriend gave him a puppy two months before he got sick. Adam keeps a framed picture of the border collie, Apollo, beside his bed in the hospital. Apollo visited Adam a couple of weeks ago, and Adam noticed the dog had changed a lot since the last he saw him. “I wish I could have seen him grow up,” Adam said.

Every day after school, Adam and his friends used to meet at the Red Bank Waffle House to hang out, smoke cigarettes, drink coffee and eat hash browns “smothered and covered.”

Adam loves playing the guitar and plans to pursue a music- related major in college. He said he hopes his heart will recover in time for him to attend the Bonnaroo music festival in June.

Dancing in the mud at Bonnaroo last year, he said, “was one of the best times of my life.”

Adam said he tries not to think about what he is missing at home. It’s not because he doesn’t care though. “Maybe it’s because I care too much,” he said.

THE FLIGHT TO NASHVILLE

Three days after his birth- day, Erlanger doctors decided they had administered all the care they could. A Life Force crew strapped Adam to a stretcher and helicoptered him to the roof of Vanderbilt Hospital in Nashville.

The doctors there tried to wean him off the balloon pump so his heart could start beating on its own. His heart rate jumped, his blood pressure plummeted, his legs swelled, he felt nauseous and he couldn’t breathe.

“Up until that point,” said his mother, “we kept having hope that his heart would recover. But when removing the balloon pump did not work, that’s when I knew a transplant was inevitable.”

On January 10, Adam went into surgery. Dr. Scholl removed the pump and replaced it with the clicking, beating ventricular machine. “He was in excruciating pain coming out of there (surgery),” said Mrs. Swafford. “Even touching his hand hurt him.”

Since then, though, he has recovered to the point where he requests not to take any med- icine other than an occasional Ibuprofin. “He doesn’t like to be out of it,” explained his mother. “He wants his creativ- ity to be there, and it isn’t under pain medication.”

Mrs. Swafford admires the grace with which her son has faced his condition. “He has accepted it from the beginning,” she explained. “I can tell there are times when he’s afraid, but he doesn’t complain. He doesn’t voice any worries.”

“There’s only been a couple of situations when I’ve had to scream in pain,” said Adam. “Those are the only times I think, ‘Why am I here? Why is this happening to me?’”

THE WAITING GAME

Dr. Scholl said during the past week, Vanderbilt has received three calls from hospitals with possible donor hearts. The doctors turned them all down, though, because the hearts belonged to people with high-risk behaviors or health problems. Adam can afford to wait, they said.

Once the hospital does find a suitable match, the transplant operation will last about four hours. Afterwards, Adam will remain in the hospital for about a week to allow doctors to monitor his body’s reaction to the new organ.

Dr. Scholl said once Adam receives a new heart, he will feel much better. Nevertheless, he will have to take immunosuppresant drugs for the rest of his life. The biggest risk he will face, said Dr. Scholl, will be long-term coronary artery dis- ease. For now, the only thing Adam can do is wait.

And so he lies in his bed on the seventh floor, his mother at his side. He watches daytime TV, listens to his CD collection and messes around on his lap- top, waiting for the hospital to receive word that a healthy heart is on the way.

Getting a new start: Chattanooga teenager matched with ‘perfect’ donor heart

By CHRISTINA COOKE
The Chattanooga Times Free Press, March 20, 2005

Adam Swafford, 17, has been awaiting a heart transplant at Vanderbilt University Medical Center since late December. The Chattanooga area native was diagnosed with an enlarged heart and is currently on a ventricular assist device.

Minutes before his son, Adam, is wheeled into the operating room at Vanderbilt University Medical Center for transplant surgery, Tim Swafford leans over to comfort him. Adam, 17, had been at the hospital since Dec. 29, 2004, awaiting a new heart, which he finally received on March 11. Sister Jennifer Richards, 21, stands in the background.

Adam Swafford, a 17-year-old from Chattanooga, is recovering from the heart transplant he received on Friday, March 11, at Vanderbilt University Medical Center in Nashville.

He had been awaiting the transplant since Jan. 10, when the doctors determined that his own heart, which had inexplicably enlarged to the size of a cantaloupe, could not sustain him.

For more than two months, Adam lay in bed, his blood circulating through the four canisters of a mechanical pump that entered his body at his abdomen.

At times, Adam missed his friends and his life at home, but he said he tried not to get hung up on those thoughts. For the most part, he awaited a transplant without self-pity or complaint. “I’ll get a heart when I need a heart,” he said a month before the operation.

On the morning of March 11, Adam’s surgical team received word that a donor heart was available. The hospital had received such news several times before but had rejected the donor hearts because they were not in ideal condition.

This time was perfect,” said Dr. Frank Scholl, Adam’s cardiac surgeon. “The perfect size match and perfect function.”

And because it belonged to an adolescent in Tennessee, it could reach Adam within four hours of leaving its original body.

The heart became available just in time, said Dr. Scholl. Though Adam had remained stable for months on the mechanical heart, during the week preceding the call he had developed an infection in the tissue surrounding one of the tubes exiting his body.

“It was making him pretty uncomfortable and fairly sick,” said Dr. Scholl. “Once you get a device-related infection, you really need to think hard about getting the device out, because that’s really the treatment for it.”

Adam’s father, Tim Swafford, described the news that the doctors would proceed with the transplant as “bittersweet.” He was overjoyed that his son would receive a healthy heart but saddened by the loss that he knew the donor’s family was experiencing.

In the future, the Swaffords can pursue contact with the donor’s family. According to Tennessee Donor Services, an organ recipient can forward a letter to the donor family through Donor Services. The donor family can then decide whether or not to respond. A few weeks before his operation, Adam said that if he had a trans- plant, he would like to meet the family who gave him the heart.

Around 7 p.m., Adam was taken to the operating room, where the doctors put him under anesthesia. Once the iced and sterile cooler containing the donor heart was brought into the room, Dr. Scholl made his first incision.

During the operation, Adam’s parents and about 25 of his relatives waited in the hospital lobby.

“We were on pins and needles,” said Mr. Swafford. “All the staff in the lobby had gone home, so they really couldn’t call and update us, so we really didn’t hear anything at all for several hours. It was a long night.”

By 2 a.m., the surgical team had sewn the new heart into Adam’s chest. Once connected, said Dr. Scholl, it began to beat immediately. An hour or so later, the doctor proclaimed to Adam’s on-edge relatives that the operation had been a success. Everybody was relieved and excited, Mr. Swafford said.

The hospital allowed Adam’s parents to visit him in the intensive care unit for a few minutes that morning.

“It was great to see him with- out the life support,” Mr. Swafford said. “That was a good feeling, but he still was in a critical situation, so it was a little scary, too.”

Adam said that it felt weird not having the mechanical pumps on, his father reported. He had gotten used to the constant clicking and quavering of the canisters at his abdomen.

Post-operation, he spends most of his time sleeping. “He’s doing really well mentally and physically, but he’s very tired,” said his mother, Cathy. He is still in a lot of pain.

Though the operation went very well, Adam’s recovery will take time, said Dr. Scholl. Adam and his family will remain near the hospital in Nashville for about a month so that he can return for regular clinic visits and biopsies. Once he returns home to Chattanooga, Dr. Scholl predicts that Adam will return to normal activity within two to three months.

Nevertheless, Adam will have to take immuno-suppressant drugs for the rest of his life in order to keep his immune system from attacking the foreign organ. Long- term coronary artery disease is the biggest risk he will face, said Dr. Scholl. Throughout his ordeal, Adam has impressed everybody with his grace and composure.

“Adam from day one has accepted all of this and been really strong, amazingly strong,” said his father. “From the inside out, he just amazed uswith his courage.”

TO BECOME AN ORGAN DONOR

Each day in the United States, about 70 people receive an organ transplant. But because of the shortage of donated organs, 17 people die each day waiting for transplants.

To become a donor: 1. Indicate your intent to be an organ and tissue donor on your driver’s license. 2. Carry an organ donor card. 3. Most importantly, discuss your decision with family members and loved ones. For more information or to download a donor card, visit www.organdonor.gov. To con- tact the Chattanooga branch of Tennessee Donor Services, call 756-5736.