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Transposition of the Great Arteries

Recently there was a boy who came to the hospital who really pulled at my heart.  Dr. Isaac and I attended the boy, and it only took a quick glance at 12 year old Miguel to know that he has a congenital heart defect.  This means he was born with an abnormal heart, and in his case it is ‘Transposition of the Great Arteries.‘  TGA is when the arteries of the heart are connected to the wrong ventricles (pumps).  This causes the blood to bypass the lungs, which is normally not compatible with life.  However, Miguel must have some additional defects that are allowing him to compensate.  He likely has some holes in the walls of his heart which allow mixing of the blood, some of which is oxygenated.

Miguel’s lips are blue, his body is smaller than average, and he cannot even walk because he is so weak.  His fingers are clubbed, which means they look like little sausages (see the pic), and his legs are swollen.  We had to draw some labs on him and put him on oxygen, which caused him a lot of fear.  He was crying and anxious, and he looked so feeble as he was laying there on the stretcher in the emergency department.  I  rubbed his arm, and told him not to worry.  But as we assessed his situation, I realized that this little guy likely has less than a year more of life.

In the states, this kiddo would have had surgery on his heart within a week or two of his birth.  But Miguel doesn’t have access to that kind of care, or the resources to pay for it either.  So his body has compensated for the defects over the years.  Consider this:  His baseline oxygen saturation is in the 75-80 percentile (your’s is likely 98-100%).  What would that look like for us?  It would be like living at an elevation of 19,685 feet/6000 meters (roughly the height of Mt Mckinley in Alaska, or Kilimanjaro in Africa).  His body has compensated by making more red blood cells, so consequently his hematocrit (blood level) was 82.  An average man has a hematocrit of about 42.  This means that his blood is incredibly thick, making him susceptible to a stroke at any time.

It doesn’t happen as often anymore for me in medicine, but I had to stifle back a sob as I soaked in his suffering.  Before he left, I remembered that we had a box of coloring books and small toys brought to us by a recent team (thanks Dr. Tram and Herman’s), so I took him back to the goody box and let him pick out his heart’s desire (actually, his big brother carried him.)  His big grin was heart-warming.  I asked him if he knew Jesus, if he knew He was with him always and was his Best friend, and He assured me He was.  We had very little to offer him in the way of his health this day, but I hope he saw that we truly cared for him.

We’d like to give a big thank you to Pastor Cindy Shively and Dr. Norm Shively from our Home Church, Grace of Christ, in Yakima WA, who came and visited us for a week.  It was truly wonderful and humbling to have them travel all the way down here to help serve with our ministry, and encourage us in our work.  Dr. Norm was able to share his skill by performing several surgeries while he was here, as well.


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