A Broken Heart
by Mike Litrel, M.D.

God. He began to cry softly, awakening his startled family, and it seemed the perfect beginning to a beautiful young life.

Ten days later, he died.

An infection was listed as the final cause on his death certificate, but Tina's son died of a broken heart. His heart was made wrong. It's called Transposition of the Great Vessels - the large blood vessels are connected to the wrong heart chambers. Throughout Tina's pregnancy and labor, there had been no indication that anything was wrong. But after her little boy was born and had to rely on his own body, not hers, for survival, the secret of his broken heart was revealed. He never really became vigorous.

He was transferred to Eggleston Children's Hospital for a corrective surgery called a switch procedure - the aorta and vena cava are disconnected from the heart and the vessels switched around. It sounds complicated, and it is. But in the hands of an expert pediatric cardiothoracic surgeon, nine out of ten babies survive. But one does not.

Losing a child can shatter a mother's life and often does: emptying her soul of joy for the rest of her years. And certainly, Tina was devastated at the loss of her son. But in the coming months, she arose from her depression, bearing witness to the unbroken clarity of her faith. I don't know why some people attain spiritual courage. As I watched her fight her way through her grief, I was filled with admiration, and perhaps a bit of fear - that when my time comes, I may not be so brave.

We don't have a choice about how God makes our bodies; we cannot choose the physical framework of our heart. But we are free to choose its spiritual makeup. My patient chose to trust God - both the pain and the joy that He had given her. I have seen many others fixate only on their suffering, walking through the rest of their lives like the victim of a violent crime, jumping fearfully at every noise.

I jumped fearfully when a year later Tina's pregnancy test was positive. For nine months I hardly let her out my sight. Ultrasound after ultrasound revealed a perfect heart inside her baby. But the memory of her loss still terrified me. So for 40 weeks she had one uptight doctor, and now that she was in labor and the baby's heart rate was less than perfect, she had to put up with my feeble jokes about her epidural.

I helped pull out her baby - another angelic boy. As his strong cry filled the room, I knew that not only the mother, but the child, too, was blessed with a strong healthy heart.

Later while I filled out the paperwork, her five-year-old lost interest in the miracle of birth and turned once again to the television set. It was another episode of Sponge Bob Square Pants. The boy's laughter filled the room at the antics of this goofball character.

I thought about Tina's second child and her emotional trauma, and of her third and the pain of the labor. It would be useful to be like Sponge Bob - made of sponge and impervious to all pain, taking punch after punch from life with an oblivious smile on one's face.

The worst blow of all is grief. But when we extend our hearts in love, we don't just risk terrible suffering - we guarantee it. Our time here together will end. But whether we are here ten days or ten decades, our life on Earth is a mere moment when held up to eternity. Yes, the body is mortal, but the soul lives on. So as frightening as it is to love, to risk loss and the terrible face of grief, it is the only choice. And when you choose faith, only then, will you hear the immortal heartbeat of the soul.

Dr. Litrel is in practice at Cherokee Women's OB/GYN in Woodstock and Canton and is a Clinical Assistant Professor at Emory University School of Medicine. He lives in Towne Lake with his wife Ann and their two sons Tyler and Joseph. (mikelitrel@attbi.com)

Last week in a Labor and Delivery Suite with my patient Tina, I watched her five-year-old boy stay glued to the television, while his mother went through all the travails of labor in the bed just behind him. He seemed oblivious to the fact his younger sibling was about to appear in the world, and that his mother was in unbelievable pain.

The show he was watching: Sponge Bob Square Pants.

For the uninitiated, Sponge Bob is a cartoon sponge who wears, well - square pants. He lives in an undersea community with his fellow invertebrates. In this particular episode, Sponge Bob was being threatened by a bully. Quivering with fear, Sponge Bob closed his eyes in expectant terror. But when the bully's blow came, Sponge Bob - whose body is made of, well - sponge - didn't feel a thing. The bully persisted in his futile and increasingly frantic efforts to inflict pain, punch after punch, until he finally passed out in exhaustion, while an untroubled Sponge Bob went about his normal daily activities. Tina's son squealed with laughter.

Tina had another contraction. As it built up, she began to cry out in agony. The epidural wasn't working too well. "This is my last pregnancy - I'll never do this again - I can't believe how much this hurts!" She had been complaining about a hot spot and was acutely tender on one side - it made her labor feel like a branding iron being applied. "I can't stand this - why does it hurt so much this time?" she asked plaintively. "Oh, you wanted an epidural on BOTH sides of your body?" I said in feigned confusion. It's the kind of comment I'll remember years later when I'm sitting by myself wondering why all my patients have stopped coming to see me. But Tina smiled half-heartedly at my joke, and the truth is, we both needed the distraction - she from the pain, and for myself to provide some objectivity in the face of the baby's heart racing - which showed that the baby was not happy.

Tina and I knew each other well. Three years ago, I had delivered her last baby after a perfect labor. By "perfect," I mean her baby's heart rate was reassuring throughout, and that Tina was never in significant pain. In the early hours of the morning, she delivered her baby without making a sound, in fact, not even rousing her family, all dead asleep around her in the room.

Tina hadn't wanted to awaken anyone. She smiled mischievously, like a child opening Christmas presents without permission. When I protested that at least a family member should cut the cord, she volunteered. So I handed her the scissors and for the first - and only - time, had the mother cut her own umbilical cord.

It was a beautiful baby boy, with an angelic face. Looking into those clear eyes was like peering through a window into the heart of