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With All His Heart; All George Dickson wanted was a chance at simple things, like swimming or playing catch with his daughter. A transplant could make that happen, but would his hopes be fulfilled before time ran out?

THE BALTIMORE SUN

George Dickson never had many choices in life. His damaged heart wouldn't permit them.

After rheumatic fever struck at age 8, he couldn't play tag or race friends down the street. He sat on the sidelines during high school sports events. His heart weakened further with age, and by the time his daughter Shannon was born, just climbing steps was a struggle.

Dickson had grown used to his limitations by then, but depriving his daughter caused him fresh pain. I'm sorry, but I can't play catch with you, he said when she approached with her child-size baseball glove. I can't take you on the roller coaster, he said when a carnival arrived near their Kent Island home. I'm sorry, Shannon, I can't swim with you in the ocean.

As sick as it was, though, Dickson's heart outlasted his doctors' predictions. They'd said it would fail by his 21st birthday, but he was a graying man of 53 when congestive heart failure landed him in the University of Maryland Medical Center.

Once there, doctors encouraged him: A healthy heart could be transplanted from a donor, and finally he could experience everything he had been denied. He could dance with his wife, Jan. He could take Shannon on any ride she wanted. All he needed was patience -- to wait for a heart compatible with his type O blood and 6-foot, 235-pound body.

He entered the hospital on Oct. 10, 1997, confined to the Critical Care Unit because the medicine dripping from his IV forced his exhausted heart to squeeze, but it also increased the chance of a heart attack.

From his third- floor room, though, he could hear a sound that carried hope: The soft whup-whup of approaching medical helicopters. From his window, he watched them land on the roof of Shock Trauma next door and wondered: Was his new heart on board?

Fall eased into winter. Spring dragged by, then summer arrived. Other heart transplant patients came and went -- one received his heart in just two weeks -- but Dickson's turn never arrived. The donor hearts were always the wrong blood type, or too small.

The waiting got harder. Being cooped up in his small, sterile room made him feel like exploding. And his medicine was losing its effectiveness, leaving him so weak that he clutched the sink and gasped while shaving.

But the worst part was losing the one thing his heart had never before denied him: time with his family. His wife and daughter drove the two hours round-trip to see him several times a week. But he had missed Christmas, his wedding anniversary, Shannon's 19th birthday. He hadn't been there to fix things, like the waterbed that leaked and ruined the carpet. He hadn't been there when Shannon just needed to talk.

As October approached, his nurses compared notes. No patient in recent memory had waited so long. Surely a heart would come before Dickson's one-year anniversary at the hospital.

Dickson felt he could endure it if he knew for sure a heart would arrive. But statistics told him his fate was uncertain: One out of five transplant patients died waiting. Since he had entered the hospital, four other patients had received new hearts and gone home. After all this time, would he be the unlucky one?

The decision came to him with a swift certainty: On Oct. 10, 1998, he would leave the hospital, ready to rush back the moment a matching heart was found, if one was found. For now, he wanted to breathe fresh air again. If his time was limited, he wanted to spend it with Jan and Shannon.

Dr. Ronald Freudenberger, director of the heart transplant program, was strongly disapproving. Dickson couldn't survive without his powerful but risky medicine; at home, there would be no monitor to alert nurses if a heart attack struck. The danger was too great.

The doctor urged him to hold on a little longer. He knew Dickson was slipping; even talking was an effort for him now. But if a perfect heart didn't come soon, they could try to buy time other ways. The doctor knew, however that he couldn't force his patient to stay.

George Dickson, a man unaccustomed to choices, finally had a crucial one to make.

He'd arrived at the hospital with such hope. A few months and he'd be home again, a new man. He'd filled the days with elaborate jigsaw puzzles and "The Price is Right." He'd traded e-mail with colleagues at the Annapolis Capital newspaper, where he worked in the composing room.

To the bulletin board by his bed, he had tacked a photo of Shannon proudly holding up a fish. Years earlier, he'd been able to teach his daughter to fish, and some of their best times together were spent aboard his tiny boat. The photo was a reminder of the past, and a promise of the future.

When had his hope started to dim?

In February, maybe. February had been a bleak month.

It happened around Valentine's Day. A ringing phone made Shannon sit upright in bed in the middle of the night. It was her father: They had a heart for him at last. Shannon and Jan sped down the highway, too excited to talk.

They knew Dickson would be in the operating room by the time they arrived, so they went to the Cardiac Care Unit to wait. As Jan neared her husband's room, she glanced through the open door. The bed that was supposed to be empty wasn't. She stepped inside and saw him staring at the ceiling, tears rolling down his cheeks.

The donor heart, after passing tests for AIDS, hepatitis and syphilis, had failed the final one. When a doctor reached into the donor's chest to retrieve it, he discovered it was bruised.

After that, Dickson told the nurses to take his puzzles to the children's ward. By changing his habits, he hoped to change his luck.

He grew even more determined to ready his body for the transplant. The doctors said exercise was good, so every morning, dragging his IV pole, he walked slow laps around the horseshoe-shaped care unit. He fought to reduce his weight, substituting salads for his beloved cheeseburgers.

As he tried to increase his own chances, he couldn't keep away the disturbing thought: His hope hinged on someone else's death. One of his favorite nurses, Judy Idzi, helped ease his guilt. You're not causing someone else to die, she told him. And the donor's family may be helped by knowing another person was saved.

Dickson was shy by nature, but he had grown comfortable confiding in Idzi. He shared his worries about his wife, Jan, who was working two jobs, as a school bus driver and liquor store clerk. He felt terrible that she also was burdened by what had been his chores around the house. And he was absent for what might be Shannon's final year at home.

Idzi reassured him that it would all fade into a bad memory once he left the hospital. But as spring gave way to summer, as an entire building rose from the ground outside his window, it became harder to stay optimistic.

In an e-mail to Idzi, Dickson wrote: "I guess I'm only thinking of myself, and I get disappointed it wasn't my turn. [The other patients] had the right match and right size. I know that. What I keep asking is, What did I do to God that was so awful that you are making me wait so long? But he doesn't answer."

It was harder now for him to push away his fear, too. What if he died on the operating table? What if he didn't even make it that far? He tried to keep his worry from his family, and they hid theirs from him.

Like her father, Shannon was shy and rarely expressed her feelings, but Dickson knew how badly his hospitalization had upset her. Years earlier, when his heart valves had failed, he underwent surgery to have them replaced with plastic valves. Shannon, who was only 11, came to visit and saw her father lying in bed, surrounded by scary-looking machines. She had run from the room and vomited.

After that, she developed a fear of hospitals. Yet week after week, she came to see him. As she sat by his bed, she could also see proof of how ill he was: Just above his head, a monitor tracked jagged peaks that sometimes dropped from 120 beats a minute to 60. She could hear proof, too: An unsteady ticking caused by the artificial valves. It sounded like a clock ticking -- a constant reminder that Dickson's time was running out.

Soon there were other signs, too. Dickson was usually walking laps by 5 a.m, but when Idzi arrived at work at 6: 50 a.m. one day, his door was shut. Then it happened again.

"Been pretty winded today," he wrote in an e-mail to Idzi. "Didn't move around too much." Soon, his laps were a thing of the past, and he lost interest in food.

Though he never showed it, Idzi knew Dickson must be scared. One day, she asked him: Are you afraid of dying?

He thought for a moment. No, he said. He'd already been given more time than he ever expected. But he did have one regret: Missing out on so much while Shannon was growing up. He felt he had failed her.

That was why a few weeks later, when it finally became time for him to make a choice -- time at home with his family, or his best shot at a future -- he made it quickly.

No matter what happened, his wife and daughter would know he hadn't given up.

He chose to stay.

Dickson rarely left his bed now, and the peaks on his heart monitor grew even more erratic. Every time he heard a medical helicopter, he tuned his radio to the news, listening for details of any accident. He couldn't think of what else to do.

As he charted his patient's decline, Dr. Freudenberger worried about his own choice -- to turn down hearts that weren't ideal. Now he wondered: Had they held out too long?

On the morning of Sept. 28, 1998, at 7 o'clock, more than 11 months after he entered the hospital, Dickson awoke to find Idzi and two other nurses standing by his bed. They were smiling.

"Today's the day, George," Idzi told him.

After all his time spent staring out the window, the heart had arrived while he was asleep. It came to Shock Trauma in the fatally injured body of a young man whose family wanted him to be an organ donor. So did he: It said so on his driver's license.

Soon Dickson's room was full. Jan and Shannon were there, of course, and so were Dickson's mother, sister and brother. Everyone else in Room C320 was eating pizza and hugging, but Dickson was quiet. The heart, from a healthy, 26-year-old man, sounded ideal, but doctors couldn't be certain until they opened the donor's chest.

Late that afternoon, Dickson told his family goodbye. Idzi wheeled him to the seventh-floor operating room. "This is a new birth for you," she said, kissing him on his cheek.

In the building next door, the surgical team carefully sawed through the donor's sternum and separated the ribs. Now the powerfully beating heart, kept pumping by machines, was exposed. Dr. Joshua Sonett performed the final test: He let it thump against his hand as he felt for bruises or hardness that would indicate coronary disease.

He reached for a phone: "It's a go."

In the crowded waiting room, Shannon couldn't sit still. She asked her cousins to accompany her on a walk. They circled the hospital, then headed toward Camden Yards. As Shannon stared at the darkened stadium, she thought about all the games her father, a devoted Orioles fan, had missed this year.

When she was a child, his limitations made her angry. But by the time she was a teen-ager, she felt only sadness for him. It wasn't until she was about 16 that she realized the extent of his illness. They were fishing together when he silently handed her his rod. He could no longer reel in his catch.

At 8 p.m., Dr. Stephen Downing attached Dickson to a heart-lung bypass machine. Then his scalpel moved to cut the old heart free. For the first time, the full extent of the damage was visible: The flabby heart was double normal size, and shot with black where small attacks had struck.

The new heart, chilled in a cooler, was hurried along the corridor connecting the two buildings. Painstakingly, doctors connected it to Dickson's veins and arteries, using hundreds of delicate stitches. A little after midnight, they turned off the bypass machine and watched the heart as it began to move.

Jan Dickson gripped her husband's hand as he lay in the recovery room. She couldn't stop staring at the monitor above his head, showing steady, even, perfect peaks of green. "It's over, George," she said again and again.

Judy Idzi stopped by her patient's room frequently during the next few days. He was recovering beautifully. Already, his ventilator had been removed and he was taking a few steps. One day, Idzi looked in the doorway and saw Dickson lying in bed, with Shannon at his side. Her head rested on her father's chest, and the two were silent.

After a moment, Shannon noticed Idzi. She smiled shyly.

"I'm listening to my dad's heart," she said.

When Dickson was finally home, he remembered his final days at the hospital. How Idzi had hugged him goodbye and turned away to hide her tears. How that first gulp of fresh air had tasted.

So many surprises awaited him on the drive home: the sign at the Elks Lodge -- "Welcome Home, George!" -- and the gas station that had sprung up on a once-empty corner. Parked in their driveway was the school bus Jan drove, filled with dozens of helium balloons.

There were special dinners, and visitors bearing flowers, and the telephone seldom stopped ringing. It was wonderful to know so many people cared. But Dickson found himself craving something else.

All he had ever wanted was to be ordinary. And to keep a promise made long ago.

On an unseasonably warm winter afternoon, he and Shannon left the house and walked across the street, onto a nearby grassy field. They spread apart until many yards separated them, then turned to face each other.

Shannon raised her arm and threw a softball to her father. He caught it and sent it back. Under the bright sunlight, the ball arced back and forth.

Pub Date: 2/08/99

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