What’s your prognosis?
I get asked this all the time. When did this become socially acceptable? Luckily, I’m an open book with a loud mouth. I’m inquisitive. And I have been trained to think scientifically.
I’m an emergency medicine resident. In December, I suddenly and unexpectedly learned that I needed a heart transplant at the age of 30 because of a rare genetic anomaly. In January, I was reborn with a new heart thanks to a selfless and incredible donor.
When people ask me about my prognosis, I can go through many different percentages. According to a paper published by Anelechi Anyanwu, MD, in 2003, 20% of heart recipients die within a year of the transplant operation. Afterward, the death rate is 4% per year for the next 18 years, so that 50% of patients can expect to be alive after 10 years and 15% after 20 years.
Or I can take a stroll through downtown Philly (with my Nikon in hand) while taking photographs of the skyscrapers that overlook the city that I’ve called home for the last three years. During this stroll, there is a small chance that I will get hit by a car.
Life is fraught with risk
According to national statistics, there is a 1 in 572 chance that I will die after getting hit by that car. It will likely be from blunt force trauma. I will hemorrhage internally, and die a fast or slow death (depending on which organ has been lacerated).
I can carefully search the internet for the descriptive statistics regarding heart transplants—the medians, the maximums, the minimums, the averages of life expectancy. I can educate myself about our mortality rates. My own mortality rate.
According to UpToDate, the median survival for heart transplants between 1982 and 2015 was 11 years for adult recipients. Many adult patients die about a decade after transplant. Younger patients usually live longer than that. I can anxiously look up the definition of “young” in peer-reviewed articles.
‘Tackle my next feat’
Or I can take the time to tackle my next feat. I have always wanted to get my pilot’s license. I was going to do it at some point after my medical training was complete. So, I can sign up for a course and start flying through the horizon, checking off another one of my life’s ambitions.
But there’s a chance I’ll die while conquering this goal. According to Statista, 561 people died in air crashes around the world last year. So my plane may crash from some sort of incorrect measurement, perhaps the plane’s fuel will be miscalculated. Most likely (55% of the time), it will be from pilot error—my own ignorance. I will die from penetrating trauma or pressure-related injuries, and my body will burn, slowly, into charred nothingness.
I can ask my doctor about my future co-morbidities. By the sixth year after transplantation, most heart transplant patients will have high cholesterol. About a third will have failing kidneys. A third will suffer from coronary artery disease. A fifth will have experienced some sort of cancer.
Or I can call my parents. I can talk to them to pass the minutes because I just can’t seem to fall asleep. I can listen to their voices telling me to make sure that I eat, make sure that I stay warm. There is a chance that an unknown someone will then barge into my apartment. I will tell my parents to hold on, and I will open my bedroom door to find a person burglarizing my home.
That person will then kill me, most likely with a gun. A gunshot wound to the head, or maybe (more likely) a gunshot wound to the chest. According to 2014 national databases, there are 15.9 homicides per 100,000 residents yearly in Philadelphia, one of the most dangerous cities in America. So I will become a fatal statistic. Random home invasion, random homicide. Cause of death: (most likely) gunshot wound to the chest.
I can Google the longest someone has lived with a heart transplant: 33 years. That can’t be right. I can Google it again. 33 years??? Perturbed, I can then think about how I won’t even make it to 65. Holy s&%#.
I can look up the fancy prognostic indicators, the things that put me at risk for early death. Or I can go for a jog, feeling the early spring wind against my face. Feeling every muscle in my body slowly get stronger after months of being deconditioned. However, there is a chance that I will suddenly die during this invincible jog. In medicine, we call it sudden cardiac death.
I will begin experiencing an arrhythmia that my transplanted heart was statistically more prone to than a healthy native heart was. I will clench my chest, fall over, and die. Someone will find me in a few minutes. They will try to save me. But, according to national prehospital data, I will likely be dead upon arrival to the ER.
Life is finite
I can spend hours upon hours meticulously punching in the numbers, searching the resources in our medical libraries, asking the cardiologists and the epidemiologists—what exactly is my prognosis?
Or I can take the time to breathe. To live. To laugh. To cry. To love.
To write my thoughts out and think about the beauty of life, the irony and the mystery of this thing that I’ve been given (twice actually, technically).
To smile. To be grateful. To be happy. To be angry.
To remember that, for all of us—not just for me—life is finite.
The scientific values and prognostic indicators and the what-if’s and why-not’s don’t change this one thing that we all have to remind ourselves (unfortunately) more often than we should: