LONG BEACH — Some days, James Mosso can't decide if he's waiting to die or waiting to live. One recent gray morning, he seemed to believe the worst as he talked about his sandy-haired 7-year-old son.
"He's beginning to ask detailed questions. . . . At this point he just knows that his father's heart and lungs aren't working right and he needs an operation to get better.
"I've been tempted many times, when I've been depressed, to commit suicide," Mosso quietly confessed. "But I can't do that. I just would never voluntarily take myself away from him."
The diagnosis is pulmonary hypertension. Clots in the weblike vessels of Mosso's 43-year-old lungs have raised his blood pressure and strained his heart, the way a faulty generator slowly saps power out of an automobile battery.
His condition is terminal and all the more difficult to accept because he is a Long Beach neurosurgeon, practiced in the most intricate medical art and a saver of lives that once, too, were on the brink.
But what especially frustrates Mosso is the knowledge that a delicate heart-lung transplant could miraculously turn his condition into one of nearly complete recovery--if doctors can find healthy organs from someone of similar size and blood type. After 10 months, however, he is still waiting, along with a dozen other patients on a list at Stanford University Medical Center, knowing that statistics expect him to die before he gets a second chance at life.
Mosso blames the dilemma in part on physicians like himself, who haven't done enough to tell families how one person's death can mean new life to another. It's not that there aren't enough people dying with harvestable hearts and lungs, it's that not enough doctors, patients and family members are prepared to face the donor question at the moment of death.
Better Patient Than as Doctor
"Unfortunately, I didn't do (as a doctor) what I'm doing now (as a patient)."
Married, a devoted father and prospering physician back in April, 1983, Mosso suddenly ran out of breath one day while bounding up a stairway heading for his rounds at Long Beach Community Hospital.
"I knew there was something dreadfully wrong," he said.
Two days later he suffered a minor stroke, and ever since has been in and out of hospitals between bouts of pneumonia and severe chest pains, each time gradually growing weaker. On almost a daily basis, his emotions sway between optimism and despair.
"This last hospitalization (over Thanksgiving) was--well, they weren't sure that I was going to survive. And they began to tell me in rather direct terms for the first time that if I didn't get a transplant soon I wasn't going to survive. They were talking about months.
"This just knocked me over . . . I felt, 'My God, I had this hope and there's this answer waiting out there, and I can't get it.' It seemed like such a waste."
Keeps Diary of Thoughts
These days, Mosso occupies himself by researching medical issues and scrawling a nightly diary of his thoughts. He stays inside his fashionable condominium near the Cal State Long Beach campus, usually sitting with a container of oxygen at his feet. A plastic tube trails up from the apparatus and loops over each ear before passing under his nose, where two tiny holes allow air to escape, hissing as if someone were blowing gently through a straw.
When he asks his local doctors how much time he has left, they answer with the question, "What do you hear from Stanford?"
While the Stanford center is renowned for performing more heart-lung transplants with greater success than any of about 10 similar facilities in the world, "There's nothing we can do sometimes to bring about a donor," explained Marguerite Brown, donor coordinator. Mosso's predicament, she said, is not unusual. "The majority of our candidates will die on our waiting list. It's very difficult, obviously, to have them think there is something that would save their life if only they could get it."
Since the program began at the Palo Alto school in 1981, 40 heart-lung transplants have been performed, medical center spokeswoman Mary-Nelson Campbell said. The first recipient was an Arizona advertising executive also plagued by pulmonary hypertension, and she lived a reasonably healthy five years. Twenty-one of the patients who followed remain alive and, in many cases, are virtually normal. One Texas man resumed his job as a high school football coach, still able to bench-press 300 pounds.
3 Months Between Donors
And last year was the center's most active with 11 operations, almost double the year before. But until a woman in her 20s received a transplant on Dec. 18, doctors went three months without finding a single suitable donor.