One For the Heart

A UN of doctors saves a little American from ventricular septal defect

He's our skinny one, and he has no idea what he's in for.

That's part of what makes it hard. Seeing him looking so healthy, watching him swing on the monkey bars. He gets his legs going like a crooked pendulum, lets go with one hand and stretches forward, skips a bar, and grasps. That gives him more momentum and he skips two. Covers the whole stretch in three grabs, like a furless gibbon. Turns around and comes back. He'll do it for a few minutes, back and forth, before dropping onto the sand. Mothers at the park watch him admiringly, often say kind things ...

Joseph Giacomo Mine is a lean little six-year-old. Secco (Skinny) in his mother's idiom, Marchigiano, from Adriatic central Italy. His build has always distinguished him from his two brothers, Bruno and Tobias, one a year older, the other a year younger. Those two were chubby, robust babies and are little muscular guys now. No fat on either of them, but plenty of solid meat.

Joe was born thin, in Antigua, Guatemala, five weeks premature. He looked reptilian, or like an old man. A gangly homely loose-skinned guy was prime minister of Italy at the time, Lamberto Dini. Joe looked like a miniature version of Dini, and we -- my wife Nicoletta and I and Joe's godfather Rodolfo, who came from Italy for the baptism -- called him Lamberto sometimes.

Now he's beautiful, Joe is. He's got big round brown eyes and very long, thick eyelashes. When he was three and learning how to swim he'd go underwater and come back up and open his eyes and his upper eyelashes would be stuck to his cheek and he'd be looking through these lines of stuck eyelashes until he'd blink a couple times, unsticking them. You probably think that's bushwa, a doting father's sentimentalism ... It's true.

He was an ugly baby, though. "Madonna, come e brutto [Holy Mother, how ugly]," Nicki would laugh. It was funny for us, because Bruno had been so angelically handsome since the day he was born. But we lovedour little frog. Maybe even more so, because he had a little something wrong with his heart.

It's called VSD, ventricular septal defect. Congenital. A tiny hole in the wall between the ventricles. The doctor who examined him after birth heard it as a murmur. It's a loud murmur in Joseph's case, and that's good. It's loud because the hole is so small, less than two millimeters in diameter and you can hear it easily, without a stethoscope. You put your ear to his chest and you hear the thump of the heart and between beats a "fsssst," which is a jet of blood shooting through the hole from the left ventricle into the right. It's under a lot of pressure, because of the hole's extremely narrow diameter.

The pediatric cardiologist in Guatemala was named Guillermo Gaitan. We took Joseph up from Antigua to the capital a couple times in the first two years of his life to have him examined. Shortly after Joe's birth, Dr. Gaitan told us that in about half these cases, the hole closes by itself during the first eighteen months of life. So we were encouraged by that, thinking it would probably close.

It didn't. But that was okay too. Gaitan said not to sweat it. The hole was so small it barely diminished the efficiency of the heart. That we should have it looked at every couple years, an echocardiogram, just to make sure it continued to be benign, and that it probably would never cause him any problem. Joseph did remain flaquito(thin), but not alarmingly so. On the charts. Gaitan said that with something like this, the heart has to work slightly harder than does a perfect one, and that uses up some calories, and sometimes these babies tend to be thin.

We weren't worried. The boy ate and grew and ran and played. He seemed fine. Nicki's father had been thin his whole life, with narrow shoulders and stick legs. That was Joseph's type. We looked at it as an inheritance from Nonno Livio (Grandpa Livio).

Toby was also born in Antigua, and several months later we moved from Guatemala back to Italy, where Bruno had been born. After we'd been there a while we took Joe to a cardiologist. He checked him out with the echo, the same apparatus used to examine a fetus in the womb. This Italian doctor had a daughter, at the time eighteen years old, with a tiny VSD very similar to Joseph's. He told us about how his daughter had always been an outstanding athlete and was a member of the regional volleyball team, a serious competitor who played in tournaments all over the country, and that this was nothing to be concerned about.

"You'd do better to not even consider it a pathology. You can practically forget about it. He can do whatever he wants, even become a marathoner," he said.

"Should we have it looked at every couple years?"

"You can have it looked at every two years, every five, or every ten years. It's all the same."

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