Sometimes doctors dash people's dreams. Sometimes they help restore them. And sometimes they have to strike a balance between the two.
This thought struck me last month when I called Kelly Perkins. I needed permission to tell her story. But I also wanted to retract some advice I once gave her. Two years ago, it seemed sound. Since then, I've changed my mind.
I met Kelly and Craig Perkins in 1998 when they came to my UCLA Tropical Medicine Clinic. Relaxed and fit, they were a charming couple in their 30s. They needed shots for a possible trip to east Africa. They hoped to climb Mount Kilimanjaro.
Then came the bombshell. Three years earlier, Kelly had undergone a heart transplant. Watching my eyes widen, she quickly added that she would be OK, really. Since her surgery, she had already climbed Mount Whitney and Mount Fuji.
But now she was talking rural Tanzania! I cringed, keeping to myself the thoughts of dusty clinics with broken X-ray machines and pharmacies in broom closets. What if she needed serious medical attention?
I then launched into my usual overseas spiel--immunization, mosquitoes and malaria, diarrhea--and discussed some travel issues related to transplantation. One problem was that Kelly could not receive the yellow fever immunization--a live-virus vaccine recommended for east Africa. Since she was still on immuno-suppressive drugs to prevent rejection, the shot could be dangerous.
Finally I said: There are lots of scenic places in this world. Why risk your new chance at life thousands of miles from home on Kilimanjaro?
That was the moment I later regretted. For one thing, I didn't listen for an answer. Also, in voicing my fear, I forgot Kelly's courage.
Growing up near Lake Tahoe, Kelly Perkins always skied. Later, she added hiking, running and kayaking to her outdoor passions. She shared those passions with Craig, whom she met in college and married at age 25. But despite her active life, a few years later, Kelly suffered chest palpitations. She had several negative electrocardiograms.
Finally, one day before a trip, her tracing showed ventricular tachycardia, a dangerous heart rhythm. Think of it as a speeding train about to derail into cardiac arrest. At first, Kelly thought: Great! We've got the answer. Now just give me some pills--I'll be fine in a week. She didn't yet know how sick she was.
But soon, the pumping action of her heart weakened and blood backed up into her lungs. Eventually, Kelly's heart was squeezing out a mere 15% of its capacity. That was barely enough blood to fuel her body and brain.
The former 40-mile-a-week jogger was sleeping 18 hours a day and shuttling in and out of the hospital. Kelly's disease was cardiomyopathy, a rare degeneration of heart muscle. In adults with normal coronary arteries, it's the most common reason for a heart transplant. Although critically ill for two years--dependent on rhythm-stabilizing heart drugs, diuretics to wring fluid from her lungs, and an emergency resuscitation device surgically sewn into her lower left side--in the end, Kelly was lucky.
In 1995, she was air-lifted to UCLA for a transplant. She knew she might wait weeks--if she survived at all. But still she had faith in God and her doctors. Forty-eight hours later, she had a new heart.
Now let's return to 1998. Leaving my office, Kelly and Craig promised to rethink Kilimanjaro. Months passed with no word. By then, I figured, they had simply let go of their dream.
But sometimes, for no special reason, Kelly would spring to mind. One day my recollection of her was so strong, I called her cardiologist to check on her. Doing great, he replied.
Maybe that's when I started thinking about Kelly the person versus Kelly the patient. After all, she was hardly a thrill-seeker. Instead, she was a trained mountaineer with a strong new heart. And climbing Kilimanjaro was not about scenery and snapshots--it was Kelly's way of saying thanks to God, her heart donor and the many people who had helped along the way.
Finally, it was also a way to celebrate a second chance at life. A lesson for us all. Today, Kelly and Craig still don't know when they're going to Africa. Right now, their lives are pretty full. But if they do decide to climb Kilimanjaro, I'll support their decision. Because, for me, guiding people's choices and sharing in their dreams is the best part of doctoring.
Claire Panosian Dunavan is an internist and infectious diseases specialist practicing in Los Angeles. She can be reached at firstname.lastname@example.org. The Doctor Files runs the fourth Monday of every month.