"Matters of the Heart" was written by Jon Lipsky and developed by the Museum of Science, Boston for A Science Odyssey.

"Matters of the Heart" is a fascinating drama about the effects of changes in medicine and technology on one twentieth-century family. This moving 20-minute play spans the century, the continent, and several lives, examining developments that have made transplant surgery a reality and a second chance for thousands of people each year.

The script and stage directions for the play can be printed from the screen and used in your classroom, club, church, library or home. The play can be performed by as few as three actors in any quiet space in your organization, or with as many as seven or more actors using different sets and costumes.

The educational goals of the play, some helpful references, and a few frequently asked questions are also included. These may serve as a springboard for engaging the actors and audience in further discussion about the topics of medicine, technology, transplant surgery, and more. Because the play deals with sensitive topics, WGBH suggests it for an audience of fifth graders and above.

When performing "Matters of the Heart", please include the following language on any related signage (e.g., programs, invitations, fliers, etc.):

"Matters of the Heart" was written by Jon Lipsky and developed as part of the national A Science Odyssey™ Project. Major funding for A Science Odyssey is provided by the National Science Foundation. Corporate sponsorship is provided by IBM. IBM is a registered trademark of IBM Corporation. Additional funding comes from public television viewers, the Corporation for Public Broadcasting, The Arthur Vining Davis Foundations, Carnegie Corporation of New York, and Becton Dickinson and Company. A Science Odyssey is a production of WGBH Boston. Educational Goals
The main goal of this play, "Matters of the Heart", is to inspire audiences to look more deeply at the discoveries, inventions, and innovations that have transformed our society over the last 100 years. While it centers on a medical 'miracle' -- organ transplants -- the story depicts a much wider range of phenomena. Indeed, its' characteristic litany of necessary scientific and technological developments -- "without the heart/lung machine, a Japanese fungus, a fax machine, psychotherapy, the computer chip, the combustion engine . . . this story would never have happened" -- could be applied, with different specifics, to any number of important changes in our lives. In the end, it is the range of innovations and not the details that, hopefully, will move audiences to a greater curiosity about our remarkable era.

With this goal in mind, the play was designed to whet audiences' appetite for the more in-depth exploration of the twentieth century that is found in the PBS Project, A Science Odyssey. Details of discoveries and inventions have been left out in an attempt to capture viewers' imaginations with a fast-paced story, an emotional roller coaster ride through a technological and ethical terra nova. In the end, we hope that audiences will come away saying: "Wow! -- look at all the amazing breakthroughs we take for granted in modern life! How did all those things come about?" Luckily, the answer to that question can be found in the wide diversity of educational materials that make up A Science Odyssey.

Style of the Play
This play is a dramatic narrative, often spoken out to the audience. It is also often a rhythmic collage of voices.

Suggested Props

• large world map
• poncho
• beeper
• surgical masks
• small medicine cups
• Book (Carl Jung's Man and His Symbols)
• lab coat
• stethoscope
• manila folders
• notebook
• glasses
• tallis, a Jewish prayer shawl
• yarmulkah
• plane ticket
• duffel bag
• powdered milk
• bottled water
• instant soup package
• photo album

Cast of Characters

• Rosie, a thirty-year-old woman
• Joey, a twenty-year-old man
• David, a forty-year-old man
• Jorge, great-grandfather of Rosie as a young man
• Doctor, Rosie and David's physician
• Therapist, Rosie's counselor
• Rabbi, officiates at marriage and death

Note: Joey and David can be played by the same actor.

Jorge, Doctor and Rabbi can be played by the same actor.

Characters are defined by a prop or costume piece.

To the audience

This all started in another time in a world far away. There was a young woman with a sick daughter in a small hut on a dirt floor. And a young man on a straw mat with a large map and a dream.

Marta, mi corazón, don't cry. Marta, I have a plan. Next month the canal opens. The date has been set. I carried the telegraph message from Señor myself. Every ship that used to go around Tierre Del Fuego will be passing through Panama. We can get to New York in only eight days! Think of it, Marta -- New York! -- with gas lights and streetcars and skyscrapers twenty stories high. In New York we can find someone to help Rosalita. They have invented something called an x-ray that can look right through you. Maybe they can look right through Rosalita to see what's wrong with her heart.

Yes, yes. I have a way to pay for our passage. I have something better than a third class ticket. Carlos, in the telegraph office, showed me how to work the wireless, how to fix the wireless, how to send messages through the air. Every big ship passing through Panama will have a wireless and by the time they get to Panama half of them will be broken. And I'll repair them. And it will not stop there. The telegraph is a thing of the past. The wireless will reach to the far corners of the world. And on that wireless . . .

I will search the world for someone who can make the heart of Rosalita well again.

The x-ray, the wireless, the Panama Canal; without these this story would never have happened.

Jorge folds up his map

What luck we have to be living in these times.

She looks back, Jorge is gone

See, my mother had a bad heart, and my grandmother before her, and I had a bad heart and I was waiting to die. Actually, I was waiting for my beeper to ring. 'Cause those were my only two choices. Either my beeper would ring or I would die. My mother never had this choice, nor her mother before her. They didn't even have beepers.

Pause. She looks at her beeper. Picks it up.

Lucky me. Without the beeper, this story would not have happened.

Joey appears

He freezes in an image of flying

Higher and higher --

Without the hang glider . . .

Higher and higher --

. . . this story would not have happened.

Higher and higher. Up! Up! Up! You're really soaring now.

This is a purely twentieth-century story.

Ludwig Beethoven, Isaac Newton, Alexander the Great never did this!

And I am purely twentieth-century phenomenon.

This is the life! This is the life! This is the --

Joey crashes

Where's that CAT scan. Where's that CAT scan! We're losing him. We've gotta get more drainage. There's still too much pressure on his brain. I'm going in again. Come on, come on, come on . . .

So I'm lying there. Hooked up to monitors.

Without the heart monitor.

Unfeeling. Unconscious.

Without the respirator.

Unaware even of these intricate machines.

Without the EEG.

Waiting and waiting.

'Cause I look okay. My cheeks are pink. I breathe easily.

Waiting and waiting.

But the flat line from my brain stem has signed my death warrant.

This is the question you hate to ask. Some doctors won't even do it. The question didn't even exist when I went to med school.

They ask for my heart, my lungs, my liver, my kidneys, my eyes. This is the hardest part for my mom. When they ask for my eyes.

But if they don't ask those questions, this story never happens.

How do you decide that someone's dead? When his breathing stops? When his heart stops? When his brain stops? When you pour ice water in his ear and there's no reflex reaction?

Six months ago we made a tentative decision who would be on the top of the waiting list for a new heart. We laid out our priorities like this:

Throwing files down

Case number 52 is real sick and could die soon, but we have to stabilize him before we give him a transplant. Case number 12 is younger, she'll use the heart longer, but she's stable and probably could wait awhile. Twenty-four would be perfect, but he's a kid who showed up recently in the emergency room with fresh track marks on his arm. Case number 49's a popular TV star who's offered to give us lots of dough if we break our rules and give him special treatment. But of course that's out of the question. Everybody gets the same shot. And then there's 33, a history teacher, who's got a history of heart disease going back three generations. She's strong, committed, and desperately in need. If her blood type and heart size match up, we're going with number 33.

Looking through records

It's a match.

To Rosie

Ring her beeper.

The beeper rings. And rings. And rings

The propeller!

Rosie closes her eyes, breathes deeply

It will only take about four hours, less time then it took to harvest my body parts. That's what they call it: "harvesting" the body parts. They put you in a sleep so deep you may stop breathing. The machine keeps your blood circulating, feeds you oxygen, lowers your body temperature twenty degrees. The blood vessels are the hardest part. They have special tiny sutures to reconnect them. And then, with warm blood, the new heart starts throbbing.

Heartbeat

Ta-Tum! Ta-Tum! Ta-Tum! Ta-Tum!

The next thing I know there are colors all around me and I'm flying.

Flying . . .

But Nana's too sad and old to fly, too heartsick, so she shouts, "come down, come down."

Suddenly I wake up from my dream in a hospital bed pulling tubes out of my arm.

Out! Out!

Pause

Oh! Whoever invented the I.V. and the catheter must have been a sadist.

Rosie puts on a surgical mask. The actor who played Joey changes into David and puts on a surgical mask. They both listen to the Doctor.

Ladies and gentlemen, let me remind you your body has been invaded by the very thing keeping you alive.

So I was sitting at a lecture on the transplant floor when a man walked in who seemed oddly familiar.

Your new heart, your new kidney, your new liver is as dangerous to your body as any deadly microbe.

He had the most intense brown eyes.

So your bodies naturally fight the foreign invader.

For the first weeks after I got my liver all I saw were people's eyes.

What makes this all possible is Cyclosporin.

And there was one pair of hazel eyes.

A drug first discovered in a Japanese fungus.

I noticed him watching me at "the cocktail hour." That's what we called our little ritual on the transplant floor, "the cocktail hour."

This drug makes it possible to suppress those cells in your body that would attack your transplant, leaving the rest of your defenses more or less intact.

Don't forget to take it.

The elixir of life!

As my father would say, "L'chaim! To life!"

They drink together

Why are you always staring at me?

The same day?

Are "soulmates." You are, literally, flesh of my flesh.

Well, I have these recurring dreams that I . . . I'm flying with a young man.

So my flying dreams . . .

My counselor tried to bring me back to earth.

-- back to earth.

-- an expression of euphoria.

. . . born of my revived libido.

-- revived libido.

-- new obsessions.

. . . were related to unconscious desires . . .

-- unconscious desires.

. . . that had been repressed for a long time because of my illness.

Maybe you're falling in love.

No.

Your shrink's been reading the wrong books, Rosie. All those Freudians and neo-Freudians. You should be reading Carl Jung. The Jungians believe there is a collective unconscious. A kind of universal, symbolic memory that resides in all of us. The heart, for instance, was the symbolic reservoir of nobility and courage in the medieval world. Think of Richard the Lion Heart.

A symbolic connection? You are out of your mind.

Well, we argued.

And argued.

Every night we argued. Was it all projection?

Or did our body parts have "soul?"

Without the feud between Freud and Jung --

Jung and Freud. This story would definitely not have happened.

Because one night . . .

Late at night . . .

. . . he resolved the argument.

So, will you marry me?

For better or for worse,

For richer or poorer.

Our wedding took place on our first anniversary.

To the audience

Not our wedding anniversary but our transplant anniversary -- when our rules were relaxed and we had more freedom.

'Till death do you part.

'Till death do us part.

David crushes a glass in a napkin.

They embrace. David slips her an envelope

What's this?

She opens the envelope

They sit on a plane together

David starts laughing, looking in a duffel bag

And David is laughing at me . . .

To David

Why are you laughing?

Powdered milk, bottled water, packages of noodle soup . . .

Without my powdered milk and noodle soup, this story doesn't happen.

We said we would only eat our own food. If we got "the runs -- "

And something about the way he said it should have warned me that he wasn't thinking clearly.

He lays a feast before them. Rosie and David look at one another

. . . The more they looked at us like we were some kind of freaks.

Pause

to hell with it -- "L'chaim. To life!"

He drinks the fermented sugar cane

-- and downed their liquor and their grub.

Jorge drinks and embraces David. Rosie just stares. David eats a tortilla with gusto. And puts it down when he notices that Rosie is staring at him

And that's when I knew he had lost it.

On the plane ride back she wouldn't speak to me.

To Rosie

Listen. Rosie, so I ate tortillas. Is that such a crime?

Isn't anything sacred? You have the gift of life. How can you abuse it?

She walks off in a fury

Most newlyweds in the back of their minds fear rejection. Only for me and for Rosie, rejection can be fatal.

Two days after we landed, they rushed him to the Intensive Care Unit.

Pause. Doctor enters, shakes his head.

I couldn't forgive myself for not seeing the danger of his fantasies sooner. As his liver began to fail, I could feel my heart breaking.

V'yisgadal, v'yisgadesh, shmae rabo.

V'yisgadal, v'yisgadesh . . . I-I won't be able to do this.

"One bright morning when the world is over,

I'll fly away.

To that land on God's celestial shoulder.

I'll fly away."

V'yisgadal, v'yisgadesh, shmae rabo.

His last request was one of joy. He wanted me to visit the mother of our hang glider, to thank her for the gift of life.

When I die, by and by,

I'll fly away."

David exits

So, a few months later I go to visit the boy's mother.

She is sitting by the fire with the old photo album.

And I knock on the door.

And a strange woman comes to my mother's door and says --

I have the heart of your son.

And there on her lap is a Polaroid of a boy in flight.

And the boy's mother looks at me and says, "May I?"

May I? And somehow you know exactly what she means.

So I cradle her head in my hands and place it on my chest, and let her listen to the heart . . .

To the heart of the boy . . .

To the heart of the boy she called . . .

Ta-Tum. Ta-Tum. Ta-Tum. Ta-Tum.

Joey.

She falls asleep with Joey in her arms. Pause. Suddenly, the sound of an alarm!

But at breakfast, all upset, you make your apologies.

I'm sorry, I'm sorry.

You've been throwing up all morning.

I've been throwing up all morning.

Pause

Oh, no!

Doctor appears.

Pause

Oh!

Joyously

The sonogram. Whoever invented the sonogram. I want to shake their hand. You can actually see the image of your baby moving . . . If not for the sonogram, you couldn't see . . .

Looking at the sonogram

Oh, she's beautiful. I named her Joey, of course, as soon as I saw her little heart, beating, beating, beating, beating . . .

Ta-tum. Ta-tum. Ta-tum. Ta-tum Etc.

The hang glider. The beeper. The respirator. A Japanese fungus.

And I thought -- who knows? -- By the time she grows up, there may be some kind of gene therapy for this kind of heart disease.

Gene therapy, or maybe . . .

The fax machine. Psychotherapy. The computer chip. The picnic cooler.

The helicopter. The sonogram. The jet engine.

Antibiotics. Anesthesia. CAT scan imaging.

The x-ray. The wireless. The Panama Canal.

After all, if we think about all the changes in the last hundred years --

Come fly away . . .

Just think of what it's going to be like for her....

Come fly away . . .

As she flies off . . .

Fly away home!

. . . into the twenty-first . . .

. . . into the twenty-first . . .

. . . into the twenty-first century.

End of play

Dowie, Mark. "We Have a Donor". St. Martin's Press. 1988.

Gutkind, Lee. "Many Sleepless Nights". W.W. Norton & Co. 1988.

Massachusetts General Hospital Organ Transplant Team and H.F. Pizer. "Organ Transplants: A Patient's Guide". Harvard University Press. 1991.

Starzl, Thomas E., MD, PhD. "The Puzzle People: Memoirs of a Transplant Surgeon". University of Pittsburgh Press. 1992.

Transweb. <http://www.transweb.org>
Links to several transplant sites.

United Network for Organ Sharing Home Page. <http://www.unos.org/>
Helpful site for yearly statistics of donors and recipients by organ.


Frequently Asked Questions

1. What difference would one donor make?
Approximately twenty-five different organs and tissues can be transplanted including the heart, lung, liver, kidney, pancreas, bone marrow, cartilage and cornea.

2. How many people in the United States are on a waiting list for an organ and how many people die each year while waiting?
There are more than 48,000 people waiting for organs in the United States. Approximately 2,800 people each year die while waiting for an organ. That's about eight people each day!

3. Who gets the organ?
When patients are placed on a waiting list for an organ their medical profiles are entered and stored in the United Network for Organ Sharing (UNOS) computer. Each patient enters a "pool" of patient names and is not ranked at that time. When a donor becomes available the computer ranks each patient according to several medical and scientific criteria: tissue compatibility, blood type, heart size, length of time on the waiting list, recipient's distance from the donor hospital, and current medical status. Each donor generates a different list of recipient patients. Recipients selected must be available, healthy enough for major surgery and willing to receive their transplant immediately. (Data from UNOS Web site)

4. Why is Cyclosporin so important?
The introduction of Cyclosporin, an immunosuppressant, in the 1980s increased the survival rate for all transplant patients. Heart transplant surgery, especially, was greatly affected. In the years after the first heart transplant, performed by Christiaan Barnard in 1968, the six-month survival rate of a heart transplant patient was only twenty-two percent. Now, survival rates for the first six months are up to ninety percent and the ten year survival rate is as high as sixty percent!

5. How long can major organs be preserved?
* Heart: 4-6 hours
* Liver: 12-24 hours
* Kidney: 48-72 hours
* Lung: 4-6 hours

Many other questions, answers, and statistics about transplants can be found on the United Network for Organ Sharing Web site <http://www.unos.org/>.