Patient care service aid Maribeth Santos takes a look at Davik Teng's scar with her mother, Sin Chhon, four days after open-heart surgery to repair a VSD (Ventricular Septal Defect).Check out 'Davik's Heart' A Multimedia Presentation click here (Jeff Gritchen / Press-Telegram)Davik leaves hospital to start new life
By Greg Mellen Staff Writer
03/29/2008
LOS ANGELES - The ear-to-ear smile on the face of Davik Teng nearly matched one etched deep in her newly repaired heart.
As Davik was being wheeled Friday from the hospital where she had surgery four days earlier, patient aide Maribeth Santos cheerily chanted, "Say, bye bye, Childrens Hospital, bye bye."
Unseen was a small Dacron patch with a good luck symbol sewn into the 9-year-old's heart to seal a defect she had struggled with since birth.
After Dr. Vaughn Starnes, the world-class surgeon who performed the open heart surgery, cut out the patch for the heart, he sketched a little smiley face with a bit of blood from his scalpel.
Starnes said it was something he always does in such operations.
Just a day after being patched up, literally, Davik could barely contain her giddiness. Davik and her mother, Sin Chhon, smiled and bowed repeatedly to Santos.
Then they piled into the back seat of a friend's car for the drive to Long Beach and the start of a new life.
Davik will recuperate in Long Beach and undergo further checkups before she is pronounced completely fit. For the moment, doctors are optimistic.
"Honestly, Davik has done better than any of us expected," said Dr. Mark Sklansky, the lead cardiologist in Davik's case.
In just over a month, Davik has gone from a girl with little hope but to die young in a remote village in Cambodia, to a child with a surgically repaired heart and the support of an entire community far from home.
Davik was born with a hole in her heart, known as a ventricular septal defect. For nine years she suffered from fatigue, shortness of breath and other maladies.
At night she would moan and cry while her forlorn mother sat helplessly and hopelessly by. Sin had tried over the years to get doctors to help her daughter but had failed. She had resigned herself to a lifetime of watching her child suffer, never knowing when the last tortured breath would come.
When Davik met Chantha Bob and Peter Chhun, the founder of Long Beach nonprofit Hearts Without Boundaries, which he created to help children in Cambodia, she got a new lease on life.
Bob (Bobby) and Chhun, meanwhile, found a cause and someone who gave meaning to their efforts.
Hearts Without Boundaries paid to bring Davik and her mom to Long Beach and are paying their expenses while here. Childrens Hospital Los Angeles donated its facilities and surgical staff.
That Davik was released so soon after her surgery was something of a surprise. Doctors had initially considered letting her out a day earlier, then thought of keeping her through the weekend and finally arrived at the Friday date.
Getting better
Recovery is rarely a linear process. In the days following major surgery, a patient can alternately feel wonderful and terrible, healthy and feeble.
Doctors, too, may draw very different conclusions and weigh different factors while monitoring the same patient and data.
So it went in the days immediately after Davik's surgery. She was in good spirits the morning after her Monday surgery, but in misery that evening.
By Wednesday evening, she was much better and had been moved out of the intensive care unit. At that time, she was scheduled for a Thursday release.
However, pediatric cardiologist Sarah Badran, while reviewing echocardiogram results, suggested a more conservative approach.
Badran explained and Sklansky later confirmed that Davik's heart showed what they called "depressed function," meaning it was not pumping the blood out as strongly as they would like.
After nine years of shunting blood through the hole, the muscle was not accustomed to the effort needed to push all the blood out to the body, as a normal heart will do.
Doctors predict the muscle will strengthen as it adapts to the new requirements, but it is something they will continue to monitor.
Sklansky says heart function can improve markedly overnight or within days, or it may take several weeks.
The setback was not entirely unexpected.
"This was a very high-risk surgery so it was too good to be true," Badran said of a three-day recovery.
Whether leaving the hospital Thursday, Friday or Monday, doctors were thrilled at the success of the surgery and Davik's recovery.
"She's still doing very well," Sklansky said, adding that even in optimum circumstances, a three-day recovery would have been a minimum.
"That she's doing so well shows the inner strength she brought with her," Sklansky said.
When he listened to Davik's heart through a stethoscope, what Sklansky heard, or didn't hear, thrilled him.
"Before surgery her heart was beating out of her chest," Sklansky said. "Now it's quiet and soft. There's not the murmur she had before."
It seemed hard to believe that in about 100 hours, the lives of Davik, Sin, Bobby and Peter could change so drastically.
Surgery day
On the day of her operation, Davik, her mother, Peter and Bobby left the small apartment on Lemon Avenue shortly before dawn.
A waning near-full moon hung in the southwestern sky as they made their way toward Childrens Hospital.
Davik and Sin were excited and animated.
Although Davik was grouchy when first awakened, when she was told this was the day she would get her "new heart" as Peter and the family are calling it, she suddenly became alert and happy, like a U.S. child at Christmas.
On the drive to the hospital, mother and daughter oohed and aahed at the lights of the highway and the city and the mountains emerging like a lunar landscape in the chilly dawn.
In a country that in some ways is as foreign as the moon, no one could begrudge the mother and child a sense of awe at the events of the past month.
Davik was not an ideal candidate for the surgery. Far from it. Ideally, the surgery would have been performed when she was a toddler. Instead, for years her heart had ineffectively labored away. Her lungs had been stressed, yet remained remarkably resilient. The hole in Davik's heart was perilously close to her heart's electrical system. Any mistake could require Davik needing a pacemaker inserted.
And yet, here she was getting closer all the time to her new life.
Davik and her mother called Davik's paternal grandparents and older sister Davin.
Davik, Sin, Bobby and Peter entered the hospital lobby where several public relations personnel, a reporter, two photographers, two producers and two film crews, including one from NBC, awaited.
The television producers and crews, being big on "capturing the moment," hustled the foursome back outside to film them re-entering.
Followed and sometimes led by the media train, Davik was taken to a pre-operative area where she traded in her winter jacket, jeans and favorite "Hello Kitty" boots for hospital garb.
Soon she was scrunching her face as she took a liquid sedative. As anesthesiologist Bryan Harris prepared to wheel her toward the operating room, Davik shared final hugs with Bobby, Peter and Sin. Then she hugged a stuffed bunny and was wheeled away.
In preparation for surgery an adhesive sheet, called a sterile drape, was laid over Davik's chest.
With a circular saw, doctors cut through her sternum and exposed the chest cavity. The rib cage was kept splayed by two large clamps.
Inside her chest, Davik's small heart beat with the same jackhammer rhythm she has known since birth.
Davik's heart ailment, a ventricular septal defect, is the most common of congenital heart defects and one of the easiest to repair. Unless you come from an impoverished country such as Cambodia, where even seemingly benign conditions can be fatal.
And for all its commonality, the hole in Davik's heart was large.
The ventricles are the two lower chambers of the heart and the wall between them is called the septum. The defect is the hole between the chambers.
In a properly working heart, unoxygenated blood from the body flows into the right half of the heart, through the right atrium into the right ventricle, which pumps the blood to the lungs to absorb oxygen. From the lungs, the oxygenated blood returns to the left half of the heart where it is pumped out to the body.
When there is a hole, oxygenated blood is shunted from the left ventricle, where pressures are higher, back to the right. The mixed blood then recirculates into the lungs. This means the heart is overworked, pumping a greater volume of blood than needed.
In Davik's case, Starnes said she was pumping four times more blood than needed. This meant her heart had to pump faster to get the blood to where it's needed. Also, Davik's lungs were wet from excess blood, which caused her fatigue and forced her body to expend calories to keep her breathing that could have otherwise helped her grow.
Eventually, the left ventricle can work so hard it fails. Blood returning to the heart can back up into the lungs, causing pulmonary congestion. Also pressure can build in the lungs, called pulmonary hypertension.
During an echocardiogram several weeks before surgery the whoosh of blood through the hole in Davik's heart was audible and Sklansky pointed to the defect on a machine that displayed the heart's functions and blood flow.
The left side of the heart was dilated, or expanded, from the extra work it had to perform.
Overlapping the hole in the heart was a flap of tissue, like a small pressure relief valve.
Normally, that tissue would have bonded over the hole and Davik's heart would have worked perfectly. In about 25 percent of children born with the defect Davik has, the heart repairs itself.
`Rolled their eyes'
There was considerable concern about attempting the heart surgery on Davik. There was just no way a 9-year-old with such a large hole in her heart could not have escaped without significant and irreversible lung damage. That was the popular theory.
"People rolled their eyes, thinking she'd have lung disease," Sklansky said of a common reaction among colleagues he told about the planned procedure.
However, the flap of tissue that was the cause of Davik's heart ailments was also the thing that saved her. That fluttering piece of tissue prevented even more blood from shunting between the chambers.
In the operating room, Davik's heart registers strong and steady on the monitor.
Sklansky and Harris exchange small talk as they check the machines.
Sklansky tells Harris part of Davik's story.
"She's from a village with no electricity and no running water," Sklansky says.
"No kidding," Harris says.
"Her mom makes a dollar a day. When she was turned down (for surgery in Cambodia), I knew Starnes was the first person I needed to ask."
"Fantastic."
Almost on cue, Starnes enters the room.
After the surgery, Starnes would say he found Davik and her mom's story compelling and felt happy to do the surgery.
The chair of cardiothoracic surgery and a distinguished professor at USC's Keck School of Medicine and the director of the Heart Institute at Childrens Hospital, Starnes is at the top of his field.
The conversation dies as Starnes steps up to Davik's right side. Her head and lower torso are covered with blankets and all that's visible is the "field of surgery" in which her large heart pumps, seeming almost too big for the tiny chest.
The only sound is the heart monitor beeping steadily in the background. An array of tubes seems to sprout from the chest as several sets of hands work with thread, clamps and tweezers in the small chest cavity.
"We're going to cool the body to help preserve the body," Starnes says.
The two film crews are taping the surgery.
The tubes have been inserted in preparation to stop the heart and transfer functions to the heart-lung machine.
"It's a big heart, isn't it?" Starnes says, "All that blood flow through the years ... ."
A producer asks Starnes, "What are you doing now?"
"Nothing but heart surgery," Starnes says with laughs all around.
The heart has been chilled and the beeping of the heart monitor has been replaced by a swishing sound from the heart-lung machine.
"Now we're going to operate on the heart and look for the hole," Starnes says.
Soon he pauses.
"You can see the hole now. It's about the size of a quarter, or what's the currency in Cambodia?" Starnes says as he allows the cameras to get a bit closer.
A sheet of Dacron is passed and the patch is quickly cut out and decorated.
"Now we'll just sew the patch in place," Starnes says.
His hands move with quick, practiced precision. Within several minutes, it's done.
As the heart begins to beat on its own again, the beeping of the heart monitor becomes uneven.
Sklansky would later admit this worried him.
"It is in arrhythmia," Starnes explains calmly.
Quickly the heart defibrillator is brought out and Starnes shocks the heart back into rhythm and the monitor returns to its steady beat.
Starnes returns to the heart and probes for any residual leaks. The echocardiogram confirms the hole is closed.
At about 9:15 a.m., about an hour after Davik went into surgery, Starnes says Davik is ready to have her chest closed.
Where is everyone?
There is a brief flurry of panic. Sin, Bobby and Peter, believing the operation would take two or three hours are not in the hospital.
A producer chastises Peter for leaving the premises. The TV crews apparently won't be getting their "moment" when Starnes tells Sin, Bobby and Peter the good news.
Starnes moves on to his next case.
Eventually, Peter, Bobby and Sin arrive. It will still be awhile before Davik's chest is closed and she leaves the ER.
Then the tears begin.
"I never thought we'd get this far," Sin says through translation. "I never thought we'd get this second chance.
"Every day I'd hear (Davik) moan and groan in her sleep. I wanted to tell her, but there was nothing I could do to make her better. I never had hope until today."
When Sklansky comes to deliver the good news, Sin steeples her fingers and bows.
"Ah, kun. Ah, kun," (Cambodian for thank you) she says over and over.
"You saved my daughter's life, I'm so happy," she says through translation. "Today is the best day in our lives."
When Davik is wheeled out of the operating room, her mother is allowed to spend a moment with the unconscious child.
With tears streaming down her face, Sin cups the small child's face. There are no words. There is no need.
Bobby and Peter stand at her side. They too are crying.
A little later, the three sit in a waiting room waiting to join Davik in the intensive care unit.
"It's like a dream," Peter says. "It feels like I just met (Davik) yesterday. Today, it's real. I just don't know what to say. I'm just so happy for her."
Sin starts to talk rapidly. Bobby says, "She's thanking us for giving her daughter a second chance."
Then he stops and tries to compose his thoughts.
"Maybe I'm the one who owes her daughter something," Bobby says.
He knits his eyebrows still working on the thought.
"I never thought of getting something back in payment," Bobby says. "In Buddhism, we believe in reincarnation. We, Peter and I, we feel like we owed Davik something in a past life. This was our chance to give it back."
Then there are hugs and ah kuns all around.
Monday, March 31, 2008
