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t m c » p u l s e | d e c 2 0 1 7 /ja n 2 0 1 8 25 25 25 "It really takes a huge community," Wright explained. "It's kind of like duck, duck, goose. You tag a person who tags a person. … There's a lot of text messaging and questions like: Can somebody bring a meal to the hospital? Is somebody available to visit them?" Participating physicians and medical practices contribute 100 percent of their fees and services to HeartGift. In Houston, HeartGift works with doctors affiliated with Memorial Hermann Health System and The University of Texas Health Science Center (UTHealth). This year, Ilhan was HeartGift-Houston's fifth patient. Floppy and listless The morning after Ilhan and Maryan arrived in the U.S., Wright brought them to the office of John P. Breinholt III, M.D., chief of pediatric cardiology at Children's Memorial Hermann Hospital. Ilhan had to be measured and weighed before seeing the doctor: She was 43 inches tall and 33 pounds. Maryan sighed audibly when she heard just how little her daughter weighed. A test to show the amount of oxy- gen in Ilhan's blood revealed she had half the amount she should. While they waited in Breinholt's office, Maryan sat with her daughter at a child-size table, pulling up a low chair so Ilhan, listless and floppy, could lean against her. Before long, Ilhan folded herself into her mother's lap so swiftly and effortlessly that it was obviously a familiar, go-to position. Maryan cradled her as if she were an infant. Translator Abdirisaq Abdulle stood by to help them communicate. When a technician came to give Ilhan an EKG, the young girl cried out in fear when she saw all the cords. It was the first sound she had made since arriv- ing at the doctor's office. Maryan leaned over the examining table to comfort her daughter as the translator explained that it wouldn't hurt, that there would not be any blood. When Breinholt arrived, he took Ilhan's medical history and asked about the tet spell on the plane. "Hello, beautiful," he said to Ilhan, carry- ing her over to the examination table where he felt and listened to her heart. "I'm feeling for a right ventricular heave coming up and pushing the chest wall," said Breinholt, an associate professor and director of the division of pediatric cardiology at McGovern Medical School at UTHealth. "When you examine the heart, there's a pal- pation element; there are murmurs you can feel. I can hear a gallop—an extra heart sound. Tetralogy means it's a constellation of four findings. They're actually all interrelated. It's not like I would even call them four defects. One kind of causes the other." Tetralogy of Fallot denotes a problem between the two pumping chambers of the heart, also known as a ventricular septal defect. Additionally, the aortic valve is enlarged and appears to rise from both ventricles; the pulmonary valve is narrow and inhibits blood flow from the right ventricle to the pulmonary artery; and the walls of the right ventricle are thicker than they should be because the right ventricle is pumping at such high pressure—working overtime, all the time. In patients with this condition, blood flow to the lungs is usually restricted and oxygen-poor blood is shunted from the right ventricle to the rest of the body. This oxy- gen-poor blood is darker than oxygen-rich blood, which is why the lips and skin of patients with tetralogy of Fallot appear blue. (continued) Rachael Wright, left, executive director of HeartGift- Houston, holds a welcome sign for Ilhan and greets Ilhan's mother, far right.