Fred Dickey's Island of Human Drama
Physician specializes in heart-to-heart talks
Physician specializes in heart-to-heart talks
By Fred Dickey San Diego Union-Tribune April 10, 2017
Hirsch Mehta is a member of a team that helps people pull free from the grasp of death — usually.
The underside of “usually” is “not always,” so let me first tell you about that.
The worst part of cardiologist Mehta’s job is to walk down the corridor, hesitate, take a deep breath and then open the door to uplifted, strained faces. Then he has to watch those faces dissolve in tears as he tells someone in the room they’re going to die.
Well, not in those words, of course. But gently saying, “I’m sorry, there’s nothing more we can do” is a thin cushion for a hard reality.
When the truth is anvil heavy, there’s no good way to lift it. When the news is irredeemably bad, someone still has to give it, and the job sometimes falls to Mehta. There comes a time when the bottom line bottoms out.
Telling people they are going to die is not why he became an M.D. However, there are many other patients at the point of designing their tombstone who have walked out of the hospital to resume a life they had given up on.
Let’s say you’ve been seeing the same cardiologist for several years, but lately you’ve noticed fewer upbeat words, thinner smiles and a trace of a frown as your tests are examined. The dismay is in the body language.
Finally, your doctor says, “I’m going to recommend you see Dr. Hirsch Mehta. He’s a specialist in advanced care.” More is said, but you half-hear it, as patients often do.
Later, you Google the name. You are shocked to read that Mehta’s job description is “heart failure specialist.”
Failure? Reality becomes the landslide you have heard rumbling in the distance, but it’s suddenly on top of you.
Once the shock wears off, you go back to the Internet and learn that Mehta is a member of Sharp Memorial Hospital’s heart transplant team.
The Sharp team consists of two other cardiologists, four surgeons and about two dozen additional medical professionals. Since 1985, Sharp has performed 414 transplants.
At 36, Mehta is young for his position. He had earned coveted advanced training with Scripps Health and Stanford University. Those posts are not rewards for staring out the window during class.
Soon, you’re waiting in Mehta’s exam room. Waiting for — what?
Finally, the door opens. In comes this young guy with an embroidered name on his white coat that you struggle to read across the folds. Yes, he’s the heart failure guy, and he’s smiling. You force a return smile.
That’s the start of the relationship. Mehta has seen your chart and is already thinking about employing resources that a few years ago would have been science fiction.
Mehta talks about transplant as a possibility. He also says they have balloon pumps, mechanical rotors, full heart-lung bypass and new drugs.
“But if it comes down to it, we won’t quit on you,” he says.
As he talks, you get a sense of this man. He’s an approachable young guy who’s not stuffy and talks straight in plain English. He’s regular, probably a football fan. He seems the type who will remember your name.
You’re right, he is down-to-earth. He’s settled into the young-family life on the edge of Del Mar with his wife, Neha, and their baby daughter. If he were making a Saturday run to Home Depot, he’d call across the yard to ask a neighbor if he needed anything.
He has the happy, look-’em-in-the-eye personality of the salesman, which he is. Which all of us are, because we all have something to sell. He’s selling new leases on life — with no guarantees.
Failing hearts. For a doctor, being good with that title would be like a pitcher saying he prefers to pitch with the bases loaded.
Why would a physician want that? There are plenty of appendectomies to go around.
To answer the “why,” Mehta’s reply is seva, which comes from his heritage. That’s the Hindu doctrine of service to others without expectation of reward.
I don’t know him well, but here’s my quick study of the man: I see a soft side, an old soul. I see him taking the hand of a patient with a short time to the end and hoping the caring he feels warms the touch.
It’s a grandiose way to say it, but to his patients, Mehta and his peers are the presence of hope, even of forlorn hope.
He’s also a robustly confident young man, admittedly a bit cocky, which I’m sure occasionally vexes his older colleagues. However, no one wants an indecisive navel gazer listening to the stethoscope.
“When people come to us, they have end-stage heart failure. Our job is to prolong their lives if we can through transplant or any other method. But even if somebody is destined not to make it, I honestly believe I can make them more comfortable, and with less pain in their final days than they otherwise could have if I wasn’t there. I truly believe that.”
People are pretty good at blocking out any bad news, but a prediction of impending death? Brain freeze.
We admit things to ourselves at different levels, according to our mind’s openness to reality. Accepting brutal truth is like eating horseradish — never by a spoonful.
Mehta says shock is the common response because “sometimes people feel pretty good and don’t fully grasp how sick they are. After that, the next most common reaction is anger. Sometimes it’s directed toward me, sometimes toward other people on our team, sometimes even toward their own family in the room with them.”
How does that anger make you feel?
“You can’t hold on to that. If I do, it’s short-lived. By the end of the day, when I go to the parking lot, it’s gone because I know they’re not really angry at me. I’m just the bearer of bad news. When I next see them, there are tons of apologies that come my way.”
Tensions can even arise among members of the team and have to be worked through. Mehta and his colleagues have to make tough decisions. Their ethical and moral obligation is to be super selective about who gets a heart. They are acutely aware that any available heart could go to a dozen desperate recipients.
To the patient, it comes down to: Do I get a heart or not? Do I live or do I die?
However you care to describe that tension, it’s an understatement.
The team shields itself by being as scientific as possible. “You can’t argue with data,” Mehta says. “We’re all scientists, and decisions have to be medical.
“If somebody is not a candidate for a transplant, the reason can be something as clear-cut as they have cirrhosis of the liver or bad lung function. Those are not candidates.”
You say that to them?
“Oh, yeah. Straight. You have to. Honesty is the most important thing. Good or bad, I will always tell you the truth.”
To humanize the point, he tells of a San Diego man in his mid-50s who sought a transplant. They put him on a wait list and then observed his attitude and conduct. The transplant recovery regimen is tough, and the team wants to make as certain as possible that the heart will not be wasted on a recipient unwilling to do the work.
The team watches for indicators that seem deceptively simple: Did he keep records as instructed? Did she make appointments on time? Did he show up for his blood draws? The abuse of alcohol or drugs means a certain rejection.
Mehta tosses the ball to them and is aware if they drop it.
The San Diego man failed. He didn’t follow the program. “I had to tell him, point blank, and he was upset,” Mehta recalls.
Did he say to you, “Tell me how I can change your opinion?”
“He did not ask that. If he had, we would have listened.”
Another San Diego man of a similar age applied for the program. He was a long-time abuser of alcohol.
Mehta says, “I told him, ‘You have end-stage heart failure, and the likelihood of you dying within the next 12 months is about 50 percent. However, I can help you, but you have to quit drinking cold turkey.’
“He was withdrawn, embarrassed that his life had come to this. He looked at me with a kind of shame. He said, ‘I understand I’m going to die, but I can’t do this. I can’t do what you’re asking.’
“We wheeled him out of the hospital on some medications. He didn’t do well. He died within a month and a half. Later, I met his wife. I think his alcoholism over years had become a burden. She was in some ways relieved that he passed.”
You say “passed.” It’s a soft word.
“Yeah, it is a soft word, because if I said ‘die’ all the time ... well, I mean, it is a harsh word that drags the spirit down. I say ‘passed’ for my own well-being and because we want to be sensitive to people’s feelings.”
In his specialty, Mehta is a member of a team tasked to save hearts that are beyond the help of others. They want as many patients as possible to walk out of the hospital with a new (to them) heart, and a new chance at life. That’s almost biblical.
Put in historical context, 50 years ago Mehta’s job wouldn’t exist, because very few of those patients would still be alive to seek out a specialist like him.
By the time Mehta’s hair turns gray, he believes many more of his patients will be.
Next Monday: It may not be your heart, but you’ll take it.
Fred Dickey’s home page is freddickey.net
He believes every life is an adventure and welcomes ideas at [email protected]