They had been preparing for this.
a team of 100
Guided by G.R. Scott Budinger, MD, the Pulmonary and Critical Care teams — including Elizabeth S. Malsin, MD, and Rade Tomic, MD — recognized that while Mayra could be saved, it would take drastic action and cross-departmental collaboration. They brought in thoracic surgeons Ankit Bharat, MD, and Rafael Garza Castillon Jr., MD, to consult on Mayra’s options. As chief of Thoracic Surgery and surgical director of the Northwestern Medicine Lung Transplant Program, Dr. Bharat took the lead on Mayra’s prognosis. After extensive review, the team’s decision was unanimous: To save Mayra, they would have to give her not one, but two new lungs.
Including the nurses and all the staff working with her, her care team likely numbered close to 100 people. That's what is required to save a life in this very difficult circumstance.
Saving the sickest person in the COVID-19 ICU.
Before Mayra arrived at Northwestern Memorial Hospital, Dr. Budinger’s team had been treating COVID-19 for weeks. The disease had been spreading quickly across Chicago, and each day, specialists in the nationally recognized Pulmonology and Lung Surgery Program at Northwestern Memorial Hospital* were discovering new ways in which the disease was affecting lung tissue. The timeliness of their discoveries ultimately paved the way for Mayra’s procedure.
We were able to perform this transplant because we had managed excellent care for patients with COVID-19 up to the time of Mayra’s procedure.
*U.S. News & World Report, 2020-2021
Before Mayra could be considered for a transplant, she would have to beat the virus that had so far debilitated her and brought the country to a standstill. Guiding her stabilization was Dr. Malsin, who monitored Mayra’s care while she was kept alive with an extracorporeal membrane oxygenation (ECMO) machine. The ECMO machine took over the work of her lungs, adding oxygen to her blood, while the rest of her body battled COVID-19.
For many days, she was sicker than anyone else in the COVID-19 ICU, and possibly the entire hospital. There were so many times, day and night, when our team had to react quickly to help her oxygenation and support her other organs to make sure they were healthy enough for a transplant if and when the opportunity came.
Alongside a ventilator, Mayra’s ECMO machine would serve as both her heart and her lungs for nearly six weeks. Meanwhile, Dr. Malsin, plus a team of respiratory therapists and ICU nurses, remained close to her bedside nearly 24/7, monitoring her body’s fight against the virus.
Finally, by early June, a sample of Mayra’s bronchial cells tested negative for COVID-19. By that point, it was clear that her lungs had irreversible damage. Now, Dr. Garza was tasked with identifying a lung donor, traveling to remove the organs and returning with them safely. Donor procurement is a complicated exercise because blood type, age and several other factors all have to align for a successful transplantation.
Typically, once a patient’s name is added to the transplant waiting list, it takes 30 days for us to find a match. For Mayra, we found a match within 48 hours.
When Dr. Garza wasn’t serving as a lifeline for Mayra, he was providing compassionate support to her family. His ability to speak Spanish offered Mayra’s loved ones critical information and comfort during trying times. Though her family was quarantined in North Carolina, Dr. Garza made a tangible impact, especially on Mayra’s mother.
I know that my mom really appreciated Dr. Garza. He speaks Spanish and my mother speaks Spanish, and he would always give her news in a manner that, even if it was bad news, would still give her some hope.
There is no silver lining to the tragic losses brought about by COVID-19, yet Dr. Bharat saw in deceased patients a way to save others. At its onset, Dr. Bharat had made a point of examining the lungs of organ donors who passed from COVID-19 in order to gain insight about how the virus affected the body. His relentless quest to provide better care would ultimately lead to discoveries that would help save Mayra’s life.
I think Dr. Bharat is an angel. He's everything to me, and I really value his courage, his ability to be so self-confident and to save my life by taking the risk of performing this procedure as the first doctor in the nation to do so.’
With donor organs received and approved, it was time for Dr. Bharat and his surgical team to operate. First, they opened her chest cavity, which confirmed Dr. Bharat’s prognosis: Mayra’s lungs were “completely plastered to tissue around them: the heart, the chest wall and diaphragm,” and the lung tissue was nearly dead.
As a result of COVID-19, she had formed these cavities inside the lung, and those cavities had become infected, and that bacteria was driving sepsis. She was so sick. In fact, I can say without hesitation, she was sicker than any patient I've ever transplanted.’
Over the course of 10 hours, Dr. Bharat carefully cut off the airways to both diseased lungs, removed them and placed the donor lungs in her body. Upon reattaching the airways and blood vessels, the transplantation was complete, but Mayra’s recovery was just getting started.
One of the foremost concerns with transplantation is that the body will reject its new organs. In addition, in Mayra’s case, Dr. Tomic was concerned that a reoccurrence of COVID-19 might devastate her recovery entirely.
We were very concerned that COVID-19 might come back, but fortunately, it did not. Still, it’s our job to anticipate and prepare for every possibility.’
With Mayra still weakened and at risk of multiple-organ failure, Dr. Tomic’s team delivered the delicate care she needed to return to consciousness and stable health, fending off infection and the effects of months spent in a hospital bed. Slowly, Mayra recovered enough to leave her hospital bed for the first time since April.
Even though she had survived COVID-19, Mayra’s road back to a normal, independent life was just beginning. Her first steps would come with Northwestern Memorial Hospital Physical Therapist Rebecca Gabaldon, MPT, and Occupational Therapist Tara Nykiel, MOT.
I liked how chipper and how enthusiastic they were. It really motivated me to do well and get better.’
Across more than 30 sessions, their personal approach to Mayra’s recovery offered her the reassurance and human contact she hadn’t had in months. They learned about things she liked, painted her nails, braided her hair and provided other forms of self-care that she was still relearning to perform for herself. Due to their commitment, Mayra eventually grew strong enough to walk, finally stepping outside of the hospital that had become her home for several months.
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Every Victory Offers Hope
In the face of a global pandemic, Mayra’s care team continued their relentless quest for better medicine, paving the way for more patients to survive and thrive despite battling COVID-19. Already, in the four months that followed Mayra’s double-lung transplantation, Northwestern Memorial Hospital is believed to have performed more COVID-19-related lung transplants than any other hospital in the world. And the team fields inquiries from other leading hospitals on a regular basis.
This procedure is for the sickest of the sick. It’s a real opportunity to save a life, and we are happy that we, at Northwestern Medicine, opened up opportunities for patients and for other lung transplant programs across the country.