Impatient Heart

San Diego — "I was in Bangkok six years ago and picked up some kind of hepatitis-family virus — they couldn't isolate it — and it infected my heart muscle and left me with cardiomyopathy. So now I'm waiting." Transplant candidate Vern Smith has been waiting two years and seems patient enough to wait forever. But he doesn't have forever to wait for a new heart.

A former pilot for Northwest Airlines, Smith realized he was in trouble "about two weeks after I got sick — it didn't take long. I've had physicals every six months for my whole life, so I knew what was going on. Initially, I was treated for congestive heart failure. Then as it progressed — that's where it ends up. Very few people actually recover from major cardiomyopathy."

A Montana native, Smith, 64, worked his way into the airlines by crop-dusting, a job he began at 16. He also maintained a cattle ranch in Wyoming and worked long hours when he wasn't flying. "I worked for the airlines about 34 years. The last few years I was a 747 captain — partly to get my retirement up, because we're paid based on the size of the airplanes. The bigger the airplane, the more you get paid. I still made my home in Wyoming and commuted, but at least I didn't have to do it every morning at eight."

The reality of heart failure soon changed everything. "The symptoms of heart failure are classic. Y'know, the swelling in the legs, the fluid retention, shortness of breath and on and on and on. And it goes on all the time." Smith speaks plainly about his condition. "It's an emotional thing when I realize it, but so is the whole 'program.' The program results in death as the end of it, so you're either going to do that or have a transplant. So the transplant is the least of your worries."

The irony is, Smith says, that he has always taken care of himself. "I've always been 'Mr. Clean.' I never smoked, never drank. And I'm one of these people that was just blessed with low cholesterol, so I never had my arteries plugged up. In fact, my arteries are squeaky-clean right now — thank heavens, or I'd be dead."

Like other transplant candidates, Smith has experienced a heightened awareness of his body and environment since he's been on the list. "I've been thinking about my illness since I was sick, and it hasn't changed at all since I've been on the transplant list. I'm aware of it every minute of every day anyway. What else can you do?"

Holidays and holiday weekends also have new meaning for Smith. "You obviously think about that stuff, you know. Every time it's Labor Day weekend or something like that. You figure somebody's going to have an accident or what have you. It's in the back of your mind, but you just hope it doesn't happen for their sake, because they don't want to go through it either. It does that with your mind."

As a former pilot, Smith finds being on the transplant list somewhat like being in a holding pattern where he's waiting for instructions to land. "It's a major thing, because you're so restricted. You're definitely restricted where you can go -- I couldn't even go to my daughter's wedding. You miss a lot of family things. I have to be within two hours of San Diego, in case they get a match."

Married for 43 years, Smith also has a son and two other daughters. "My wife's okay with [the transplant]. She's hangin' in there with me."

Family ties, fortunately, brought Smith back to San Diego. "Our first son was born here, and my folks used to live here. We came back here when I retired for the weather, the golf, the ocean, and the high taxes." Unlike other parts of the country, San Diego has three transplant centers, which gives Smith a choice. "The only people in San Diego who do heart transplants are Sharp and UCSD. I'm with Sharp."

Smith's easygoing manner can't hide the frustration that health limitations have placed on this once-active man. "I hope my life improves and I won't be as restricted as I am now. That's the whole point of getting a transplant. There was a lot of physical work when I had my ranch. We had about 43,000 acres. We raised cattle and enough horses to chase 'em with. We also farmed enough land to raise feed for the cattle. I had to have a ranch manager because I was gone a lot. It's hard work. People think you just ride off into the sunset and smoke a Marlboro, and that's not the way it is! You get up at daylight and work until dark, go to bed, and then get up and do it again. Every day. Christmas, Thanksgiving... I was lucky because I could get away from it for a while. I'd be gone for ten days or more over in the Orient, so I could take a trip and rest up. If I had layovers, like in Japan, I would always try to walk and stuff like that. I was exercising all the time. I was a pilot for the money, but the cattle business -- you might as well go to Las Vegas, because that's better odds!

"People need to think about the fact that waiting for an organ is a major mind game -- you're thinkin' about dyin'. You've got to come to grips with that and realize that this might be it. If you can handle it that way, you'll be okay. The other thing is, it can turn you into a major hypochondriac. I don't think this has happened to me, but I'm thinking about it all the time! Every time you have a little pain here and there, you think you're gonna die, whereas before, it wouldn't have entered your mind; you'd just keep right on goin'. That's one of the things you also have to deal with so you don't turn into a couch potato or hypochondriac. In my case, I just have to push as far as I can push every day. My doctor hasn't said how much time I have to live without a transplant. Historically, you tend to go downhill, but who knows how fast?

"I try to play golf whenever I can. Sometimes I go out there when I'm just bone-achy, weary, tired. But I feel better after I do it. I have a boat, and I'll go out on the ocean and fish when I can because it's not a real physical thing. I just try to do everything that I possibly can do. But you have to watch every step you take. There's days when you just can't do it.

"I'm a Latter-Day Saint [Mormon]. I think a good belief in Christ is a major, major help. I think people who don't have that -- atheist types -- I don't know how they deal with it. Because they have nothing to look forward to."