[heart monitor beeping]
- Hi, my name is Ram Devkota.
I'm 30 year old.
I'm born in Nepal
and came over here 2014 in the United States.
[beeping accelerates, ambulance sirens blaring)
- When I first met Ram, he was in the intensive care unit
in severe endstage heart failure.
- So what we learned was that Mr. Devkota
has something called end stage or burnt out hypertrophic cardiomyopathy.
Hypertrophic cardiomyopathy is a genetic, inherited condition
that oftentimes results
in the heart muscle getting very thick and very stiff.
- I don't think he had a way out of the hospital
that would prolong his survival unless he got an outlet.
Left Ventricular Assist Device, or LVAD,
is a mechanical heart pump.
It's surgically implanted into the left ventricle
which is the main pumping chamber of the heart
that pumps to the rest of the body.
So it kind of takes over for the failing pumping chamber.
- And there's wires that come out from the pump
and the wires come out through the abdomen,
which are connected to a controller or a little computer
and that little computer needs to be connected to a power source.
- LVADs have really been a great medical resource for us
because hearts available for transplant
are not readily available.
There's not that many of them.
So, when patients are very sick,
you really need to support their heart in that acute setting.
What we've done here at Yale certainly
is we've built a really remarkable LVAD program
which is one of the highest volume
and best quality centers in New England.
- We think about so many different things
when we're trying to evaluate somebody for a heart transplant
or left ventricular assist device implant.
Medical things, but then a lot of social things as well.
When we first met Mr. Devkota,
we knew that he was very sick and he was quite young
and there were many of us that wanted to think
about what we could do to try to help somebody
like this over the long term.
Things that were of concern to us,
that were probably of concern to the other center
where he was evaluated prior to seeing us was:
One, he did have this issue with alcohol dependence
but secondly, he didn't have a whole lot of social support.
- So when I came over here,
I'm alone.
I have a, you know, the habit like,
the after work I need to drink every day.
- The LVAD pump was the solution to his heart failure.
We knew that, but you don't wanna put a pump in
in someone who isn't going to be successful with it.
You do more harm than good.
So how can we get him to the point
where he's going to be successful with his therapy?
And that's where all the other members of the team come in.
- We assess the patient
for more than just the medical piece.
We look at the psychosocial whole.
For Ram, it was just
kind of taking care of the basics first.
Where was he gonna live?
How was he gonna support himself?
Helping him deal with his substance use
so that he was able to support himself to some degree
because he really had limited other supports.
- After LVAD, I feel like it's normal,
you know, same like you, like other people.
This is a miracle.
This is my second life.
- From the moment he was feeling better,
That, that exact moment he started
kind of working on everything himself.
So, he had a lot of drive and initiative
and that's amazing.
- He was able to feel good enough physically
that he started to feel good enough mentally.
- We don't just take the perfect cookie cutter candidates.
We really try and work with anyone who needs us
to really make them into a good candidate.
- As we were taking care of him after his LVAD
and he was following up with appointments
he was following up with his addiction services.
He was taking all of his medications.
He was doing everything.
He was like the perfect patient.
We're like, oh, wow.
Like, you know, he would be really successful with a transplant.
- I'm in the list, transplant list.
Yeah. I have a...I have a big thinking.
So after the transplanting success
and then I'm, you know, back to normal, I get married.
My girlfriend is waiting for me.
- Takes a village to be able to offer these therapies to to our patients.
Our team works really closely together.
We're always talking to one another
and we're always thinking creatively
for how can we expand access to these therapies
to the patients who need them and
in a way that they can derive the most benefit.
- There's very few things in medicine
that can take people who are essentially
have days to live and you give them a therapy
that can keep them alive for decades.
- To help that person,
and then when they come back, see them in the future
and they look like any other person out there on the street.
It's an amazing thing.
It really is.