I first met Brittany Clayborne in July 2015 as her attending physician while she was hospitalized on the University of Texas Southwestern (UTSW) advanced heart failure service. She had developed peripartum cardiomyopathy five years earlier and, despite optimal guideline-directed medical therapy, had a deteriorating course with multiple hospitalizations, ICD shocks, and progressive symptoms. It was clear that she was heading towards heart transplantation. Despite being hospitalized and separated from her son, Brittany had an upbeat, infectious personality. As the visit went on, the conversation evolved with bantering back and forth, as if I were speaking with a quick-witted friend of many years. As I was leaving the room, she asked me what she should do, now knowing that her own heart would not recover and that she would require a heart transplant after a suitable donor could be identified. Maybe it was because our conversation had been somewhat casual at times, or perhaps because it already was clear to me that I had just met a person with unusual talents, I turned back with a smile and said, “Do something amazing” and then exited to continue my rounds.
Little did I know that those three words would have such an impact on Brittany's life. The first time I appreciated that was the day after we first met when I returned on rounds to find her grinning, eager to show me what she had accomplished. In the intervening 24 hours, Brittany had set up a website to promote organ donation. The website included a map of the United States, and by clicking on a state, you were taken to its organ donor registration page. She created this, all in one day while being treated for acutely decompensated heart failure. She then looked at me, also with a smile, and said, “And what did you do yesterday?”
Brittany's health continued to deteriorate, and she subsequently required implantation of a left ventricular assist device and then heart transplantation. She has become a motivational speaker, describing her experiences during this journey and the gratitude she feels for the gift of life. She has given back by speaking with groups of health care professionals involved in organ procurement so they can see tangible results of their hard work. She also has made testimonial videos supporting organ donation.
She speaks to the first-year medical students at UTSW Medical Center during their cardiovascular didactics, where her inspirational comments have been known to bring students to tears. She also now serves on the Patient Committee of the Heart Failure Society of America. Most recently, she completed a Doctorate in Psychology in counseling over a virtual platform during the COVID-19 pandemic. Clearly, she has done many amazing things since that first day we met, despite facing a life-threatening health condition.
Dr. Clayborne subsequently has told me these three words, “Do something amazing” were meaningful by signifying to her that I believed there was hope for her.
She felt that had I believed otherwise, I would have offered a very different reply to her question, such as telling her to call her family to relay this worrisome news and ask for their support. Communication is at the very center of the patient-physician relationship, and the words clinicians use can have a powerful influence on patients. As a physician treating patients with advanced heart failure, this is particularly true, given the frequency of conversations that address profoundly serious issues, including mortality. In this circumstance, her insights reinforced the importance of nurturing the flame of hope in patients, especially at moments when things seem dark.
Dr. Clayborne also told me that she took those three words as a challenge. Even while knowing that she could die, she needed to live, to take advantage of whatever time she had, and to make the world a better place, leaving a legacy, if you will. In the darkness, while bearing the burden of advanced heart failure, recurrent hospitalizations, and ICD shocks, and simultaneously raising a small child, one easily could go a different route, focusing inwards, solely on oneself and family. Yet, she chose a path of helping others—in her case by promoting organ donation throughout the country. I can't help but wonder which path I would have chosen under similar circumstances. Would I have the resiliency and grit she exhibited? Do any of us who have not faced tests of comparable adversity really know?
She asked, I replied, “Do something amazing,” and she did. Her actions have inspired me and many others. These events also demonstrate that it is not just the physician who can powerfully influence the patient; rather, it a bidirectional exchange. Furthermore, this a wonderful example that I, too, get to do something amazing: be an advanced heart failure/transplant cardiologist.