Mark Landau cringed when doctors said his wife needed a new heart. Six years earlier, he had been wheeled into the operating room at Cedars-Sinai Medical Center in Los Angeles for a heart transplant.
Wasn't one per family enough?
Mark was more worried about his wife's transplant than he had been about his own.
Would she have the stamina to get through the operation? he wondered. What about the shakes and hallucinations he had suffered when his body tried to reject the new organ? And the weight gain? And the hair that grew in the wrong places?
But after her initial trepidation, Sandra was as calm as someone in her situation could be. She had seen this movie before, and it had a happy ending. She'd have the same hospital, the same cardiologist, the same surgeon. Besides, it beat the alternative.
"I've never seen anyone so happy to have her heart ripped out," said the Orange County couple's 30-year-old daughter, Sarah.
Nearly 40,000 heart transplants have been performed in the U.S. since South African surgeon Christiaan Barnard pioneered the procedure in 1967. Doctors at Cedars-Sinai say the Landaus are the only husband and wife known to have had the operation.
No other married couple have experienced the parallel courses of roller-coaster emotions. Sandra and Mark each knew the despair of a dying heart and the surging hope for a renewed life. Each braced for the other's death. Each felt the stress and joy of nursing a partner back to health.
Ultimately, their marriage survived, even thrived.
The role of nurse fell first to Sandra. After Mark's transplant, she helped him shower, cleaned his bedpan and prodded him to walk. Then it was Mark's turn, and he had to learn how to iron and use the washing machine and dryer.
Seven years after Mark's operation, and a year after Sandra's, they still prepare each other's daily panoply of pills.
There are red ones, white ones, blue ones, green ones. There are pills to fight organ rejection, pills to build muscle, pills to fight the side effects of other pills. There are diuretics and antacids, supplements such as calcium and magnesium, and vitamins -- 24 pills a day for Sandra, 32 for Mark.
Sandra, 60, complains that the medicines make her an emotional mess and cause her hands to shake so badly that sometimes she can't write, put food in her mouth or drive. She hopes that when she stops taking the anti-rejection drug prednisone Feb. 1, the shaking will end.
Mark, 54, complains that the medicines make his face so oily that he has to wipe it several times a day. Both say they sleep only an hour or two at a time, despite the slew of sleeping pills they have tried.
But it's the price they pay for new lives. The Landaus spend more time together. They joke more and fight less. Once angry at life, Mark is more optimistic and carefree and worries less about money.
"We're mellow," Mark said. "She's keeping me alive. I'm keeping her alive. I realize it's not worth it to get aggravated. Perfection is in the imperfect mind."
The Landaus moved to Orange County from New York in 1988. They live in a two-bedroom apartment in Rancho Santa Margarita. A painting above the living room couch symbolizes their newly relaxed attitude toward life. It shows a calm, sparkling-blue ocean with palm trees swaying in the wind.
The transplants were hardly the first challenge in the couple's 32-year marriage. The variety store they owned in suburban New York was ruined in a flood, forcing them into bankruptcy and onto welfare and food stamps. They moved across the country to escape the wet and cold and start anew. Mark got a job as a paint store manager; Sandra sold shoes.
Doctors think a virus damaged Mark's heart. Each winter in New York, he would catch the flu. His heart function would decline. Fluid would build up in his chest. He would become short of breath and end up in a hospital. Three times, he nearly died.
In California, his health improved dramatically -- until he caught the flu again and doctors told him he needed a new heart.
The diagnosis: idiopathic dilated cardiomyopathy, which meant that his heart was enlarged and pumped poorly; the precise cause of the condition was unknown.
"I was stunned," he said. "I thought I'd solved all my problems. I was in good health all that time."
He was placed on the national transplant list Oct. 3, 1996.
"Your whole life spins in front of your eyes," Mark said. "Everything you've worked for seems to come to an end."
When he told his wife that only a transplant could save him, she burst into tears. He broke the news to son Larry, then 20, and daughter Sarah, then 22.
"Everything went silent for a minute or two," Larry recalled. "Then emotions broke out. I was the first to go. Then my sister started crying. Then my dad."
The hospital gave Mark a pager so it could get in touch with him when a donor heart was ready. The first time it went off, he shook so hard he couldn't press the buttons on the phone; he asked a co-worker to call the hospital.