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News / Opinion / Columns

Estrich: The miracle and trials of transplants

By Susan Estrich

Published: May 22, 2023, 6:01am

I felt like I knew her, even though I never met her, because I read every word Amy Silverstein wrote.

Her first book, written after her first heart transplant in 1988, when doctors gave her two weeks to live, was entitled “Sick Girl.” In it, she chronicled both the joy — and the misery — of life with a transplanted heart. The endless round of medicines, infections and biopsies, emergency room visits, all that I understood from my dear friend Pam who, like Amy Silverstein, had not one but two heart transplants. Mine was not idle curiosity; Amy helped me understand what Pam was living through.

Silverstein’s second transplant, in 2014, led to a second book, this one focused on the friends who made a spreadsheet so that, for a three-month hospital stay, she did not spend a single night alone in the hospital. That book was entitled “My Glory Was I Had Such Friends.” I have tried to be such a friend to Pam.

Silverstein’s final article foretold her death from cancer. She wrote in The New York Times: “Today, I will explain to my healthy transplanted heart why, in what may be a matter of days or weeks at best, she — well, we — will die. I slide my hand across my chest and speak aloud, palm to my heart’s crisp beating. ‘I’m so sorry, sweet girl.’ She is not used to hearing me this way, outside my head, beyond the body we share.”

Silverstein achieved the triumph of a heart transplant patient: not a pat of butter, not a sip of alcohol, she managed to keep that heart healthy, even as the rest of her body suffered from the crude transplant science that kept her alive, the anti-rejection medicine that plays havoc with your immune system, the skin cancers and infections that plagued her for decades, the 90 biopsies that snipped a piece of heart muscle.

Heart transplants are a miracle, no question about it. Thanks to those miracles, Silverstein became a lawyer and a mother. Thanks to those miracles, and the generosity of those donors, my friend Pam has held her grandchildren in her arms. Miracles.

But miracles like these are hard-earned and hard-won.

They depend in the first instance on the most precious and most selfless generosity of the donors and their next of kin. Silverstein received both her hearts from 13-year-old girls whose lives ended too soon and whose parents were able to see through their grief to give someone else hope. Can there be a greater gift?

“Sick Girl,” Amy’s first book, generated a huge response. Some of the response, from other transplant patients, was very positive, especially from those who recognized Amy’s pain as their own. And some of it was very negative: hate mail for her criticism of the health care system. She called it the “gratitude paradox” that arises from the fact that “organ transplantation is mired in stagnant science and antiquated, imprecise medicine that fails patients and organ donors,” leaving those with transplants feeling sick almost every day.

When I’m tempted to complain, I think of Silverstein, and of my friend Pam, and of what they endure to stay alive, and of the precious gift of life. Imperfect miracles to be sure, but miracles nonetheless.

Silverstein lived for nine years with her second heart. She died this week, at the age of 59. Hopefully, her courage and her honesty may make life easier for those who will walk in her shoes in the future.

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