For those of you who have read A Message from the Heart, consider this the prequel:

On December 30, 2013, my father had a left ventricular assist device implanted in his chest.  An LVAD is a battery-operated mechanical pump that functions as portable life-support for folks in end-stage congestive heart failure.  When the heart becomes too weak to work on its own, the LVAD manually pumps blood from the heart to the body via an external battery pack that connects to a port passing through the individual’s abdominal wall.  The intervention is often used as a “bridge procedure” for heart transplant candidates who have exhausted their treatment options and anticipate long wait times on the transplant list.  This extraordinary device saves lives by not only allowing candidates to live long enough to receive a match, but also to wait for their transplant from the comfort of their homes rather than the confines of the ICU.

While the LVAD was miraculous in many ways, my family understood that it came with a laundry list of risks, and it was merely the first step in my father’s journey to receiving a heart transplant.  Prior to receiving clearance to have the bridge procedure done, he had been in the ICU for thirteen weeks and his condition was rapidly deteriorating.  He had coded more than once when his doctors tried to perform far less invasive procedures, so his doctors weren’t confident he could tolerate a 6-hour open heart surgery.  Even if he survived the operation, his risk of life-threatening complications such as stroke, GI bleeds, and thromboembolism became greater the longer he had the LVAD.  His health would obviously be far more stable with the LVAD than without while waiting for a transplant, but his projected wait time on the transplant list was up to four years, so we still weren’t sure if the device would buy us the time he needed.  Moreover, while we were hopeful about his quality of life improving enough to go home, we realized there were many unique considerations that went into making accommodations for him once he left the hospital.  We would need to buy a back-up generator for our home in case we lost power so his batteries wouldn’t die.  We would need to have his clothes altered to thread his tubes through his shirt so he could conceal his heavy batteries in his back pockets.  We would need to buy a special showerhead, washcloths, and buckets so that he could learn to wash himself without getting his batteries wet.  We focused on the wonderful prospect of my father receiving the gift of life, but couldn’t deny feeling overwhelmed that no amount of planning could prepare us for the uncertainty of the road ahead.

The night before the operation, I sat with my father at the foot of his hospital bed.  Although he was hooked up to over a dozen IVs and could hardly sit up, I remember him pointing to a bridge outside his window and telling me how grateful he was to have such a beautiful view of the New York City skyline from his room.  He always managed to find small joys in his day.  Despite spending so many months in the hospital that he began referring to it as his “NYC office” to his colleagues, I don’t think he ever actually identified as a patient.  He tried so hard not to look sick in front of me, which always made me feel guilty because I knew it drained him of the little energy he had.  But on this night, I saw his irrepressible spirit soften for the first time.  He propped himself up in bed to shred passwords to his confidential work files.  He wrote down where his assets were located and compiled a list of people for my mom to contact “just in case”.  It was hard to believe that this was the same man who used to toss my chubby little seven-year-old body a thousand feet in the air at the lake where we used to swim together, even after the thousandth time I begged him for just one more turn.  This was the same man who, when I was eleven, lifted up two teenage boys by the backs of their shirts at the mall when they tried to steal my Bath and Body Works shopping bag full of bubblegum scented body glitter.  The same man who, when I was 23, taught me that in times of conflict, strength in character will always prevail over physical strength.  Though I was disheartened knowing there wasn’t anything I could do to change my father’s circumstances, I knew I could give him strength by reminding him why he was fighting.

There are three things my father loves more than anything in the world: his family, his job, and puppies.  Knowing that the first thing he would do if he made it through surgery would be to check his iPad to respond to work emails, I made a deal with him that night.  If he promised to survive his operation, I promised to email him a picture of a cute puppy first thing in the morning every single day between his LVAD and his heart transplant.  That way, no matter how weak he felt on any given day, no matter how frustrated he was that his quality of life was restricted, and no matter how anxious he was that the next time he raced to the hospital would be for a stroke rather than a transplant, he would have at least one reason to smile waiting for him when he woke up.  In a situation where I had so little control over the future and couldn’t be by his side each step of his recovery, this would be my way of showing him that no matter the circumstances, he was the first person I thought of when I opened my eyes each morning.

On December 30, 2013, my father followed through on his promise, and I followed through on mine.  So by the time he received his new heart on December 4, 2014, I had spent nearly a year making a routine of hitting the snooze button on my alarm, rolling over to grab my phone, and queuing up his “Puppy Pic OTD” email.  It had become such a habit that I decided not to stop after his transplant.  Now, exactly 900 days (and 900 puppies) since his LVAD surgery, I have not missed a morning.  Though my puppy pictures are a minor and admittedly insignificant gesture that have no implication on his health, they continue to serve as a reminder that his family will always help him find strength when the going gets “ruff”.

If you have a puppy you would like to be featured as his “Puppy Pic OTD”,
please email me at kayla.mantegazza@gmail.com!