FRONTIERS: A NEW BEGINNING

Roxanne heard the beeper go off for the last time on New Year's Eve. Doctors gave her a beeper to notify her when they found a lung donor. She described carrying the beeper as similar to sitting on dynamite. Roxanne, a 34-year-old from South Philadelphia who asked not to be identified fully, had been suffering from emphysema in both her lungs for several years. Her condition made even everyday tasks a chore, and doctors had determined she needed a lung transplant. The beeper increased the anxiety Roxanne felt as she waited. There were many false alarms, each one raising her hopes and then shattering them. The events of her life, she said, hinged upon the immediacy of finding a lung donor. "I had to live like this -- it was hard," she said. But on New Year's Day, her life changed when she received the first isolated -- or single -- lung transplant ever performed in the Deleware Valley at the Hospital of the University of Pennsylvania. The transplant marked a new beginning for both Roxanne and for HUP's surgical program. "I always believed in miracles," Roxanne whispered as her eyes grew wide with wonderment. "Now I know what one is like." · Before the transplant, Roxanne needed help doing basic tasks, such as walking and talking, that many healthy people take for granted. She was unable to raise her children and barely able to take care of herself. But although her throat was sore from tubing inserted after her operation as standard procedure, she had no difficulty expressing how elated she felt and describing her experience. "I was very scared knowing that I needed a transplant," Roxanne said. "I began preparing myself through support groups [and] I got a lot of help from people. It put my priorities in order." One of the people who helped Roxanne through her illness was her mother, who became visibly emotional when speaking about the experience. "I watched my daughter dying," whispered Roxanne's mother, as tears welled in her eyes. "Every day I was crying inside." But as Roxanne glanced over at her, she replied hypnotically: "Now she's alive with a new life, and I say praise God and thank the doctors and nurses that took good care." During a press conference held at HUP, Roxanne looked like a woman reborn as she and her mother recounted the past few years in front of several reporters from local and national media. "It used to be hard for her to talk," her mother said assuredly. "She had to carry an oxygen mask with her everywhere she went. Now she won't shut up." Roxanne explained she had been moved from state to state for nearly two years in order to increase her chances of receiving a new lung from a donor. Her mother said that she had seen a miracle before her eyes. "At 12 o'clock we all said 'Happy New Year,' and by nine o'clock [that morning] I was in the O.R." Roxanne whispered as she leaned forward. During the conference, the nurses perpetually interjected, asking Roxanne if she needed to lie down. Each time she responded slowly with a twinkle in her smile and said she was fine. · On New Year's Day, while many people were preparing for a day full of football and parades, doctor Larry Kaiser was busy, helping the Hospital of the University of Pennsylvania gain new recognition. At approximately 9 a.m. January 1, Kaiser embarked on the first ever lung transplant in the Deleware Valley area. Yet it was not the first one he had ever performed. Kaiser was brought to HUP from Washington University in St. Louis to help set up a program for lung transplants as well as to direct the thoracic surgery department. Before moving to Philadelphia, Kaiser trained under doctor Joel Cooper in both Toronto and St. Louis. Kaiser explained that Cooper had done revolutionary work with airway healing in 1981 and 1982, performing the first successful lung transplant in Toronto in 1983. The actual surgery Kaiser performed on Roxanne involved the removal of the damaged lung and the transplantation of a new lung by reattaching the bronchus, the pulmonary artery, and the left atrium. But apparently his work still amazes him. Kaiser, a tall, mustached, self-confident man, shook his head as he sat down beside Roxanne on the couch, muttering to himself "incredible." · "They [the doctors] are very optimistic," Roxanne's mother confided. "They can't believe what they see." Kaiser described Roxanne's state nine days post-operative as "fairly amazing." He explained that Roxanne was doing well after an operation of such magnitude. Roxanne said that a great burden had now been lifted now that she had received the transplant, saying she was nervous right up until the morning of her operation. "It was the hardest decision I ever had to make," she said. "I am glad that I went, and that I don't have to make any more decisions like that." Kaiser said that Roxanne's life would change radically after the four-hour surgery. "The survival rate is 75-80 for one year, up to the age of 60," Kaiser said. "I think there is every indication that she will be able to lead a normal life. [However] she must be followed by doctors and take medication on a daily basis." Kaiser also speculated just after the surgery that Roxanne would be able to return home after two weeks in the hospital -- a week earlier than standard recovery for this type of operation. Yet Kaiser grew solemn when he talked about Roxanne's long-term prognosis. Despite the routine use of anti-rejection drugs, he said, there is always a chance that the body will reject the lung. Although Roxanne and her mother say they are excited and thankful, she is still in a period of transition. After answering several more questions at the press conference, Kaiser said that he had to go home. The cameramen asked Roxanne to walk toward her mother, and they embraced for a long time. A nurse who helped Roxanne through her surgery joined them for one last picture, then placed a surgical mask around Roxanne's face and helped her sit down in a wheelchair. As Roxanne's mother gave the camera the 'thumbs-up', the three exited the conference room quietly through white double doors. · Lung transplantation is a very recent procedure, and Roxanne's successful transplant marks HUP's entry into an exclusive group of medical centers that can perform the operation. Few hospitals have the facilities to support this procedure. And only a few specialists are trained in this area of transplantation. Kaiser said that in 1990 only 300 lung transplants were performed in the United States. Kaiser explained that HUP is the only facility in the Deleware Valley with both the funding and state permission to perform these lung transplants. He added that HUP is one of the only facilities in the country with the capability to facilitate all five solid organ transplants; namely heart, lung, kidney, liver, and pancreas.

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