August 18th: Two weeks ago I went to see Heather in the hospital just after she came off the vent again. It gave her parents time off to leave the place, and she and I visited for 12 hours or more. It was good to catch up on things, and I helped her with lunch and a back rub. Some med was making her really itchy, and she could not get enough scratching in places she could not reach!
I was warned by her mom that she had a large pressure ulcer on one cheek, from the endotracheal tube holder. I thought that odd, I have never seen that in my years of work, and why only on one cheek? It was a large, black, oozing scab on the right, rather ugly and obviously itchy. Wound care nurse came in to look at it. Also, the Infection Control docs were in to take a sample. Bad news - it was analyzed as mucormycoses, a virulent fungal infection that attacks those with bad immune systems, diabetes, or lots of steroids on board. Usually the compromised inhale it and it grows in the sinuses, but this had settled on her cheek. With that diagnosis, things started to move very fast there. The food tray I was feeding her from was taken away abruptly as she was going to be back in the OR that night to have the fungal areas removed. This is a bad infection - if it gets into the blood stream it is generally fatal within days. The docs wasted no time getting it off. There was a CT scan to make sure it was not in the facial bones, a scope down her nose to look for the black fungus, but thankfully none there. That would have been imminently fatal, with spores having access to the brain. I left to come home about 10pm as she was wheeled to the OR to have the Plastic Surgeon who came in specially to see her remove all the affected tissue.
Her mother called me to say that the operation was a success, but that the Plastic Surgeon estimated another ten operations to fill in the crater she now had on her face.
Next morning, her mother calls to ask me what bipap settings to use - Heather is having trouble breathing and her lungs are wet on the xray. By afternoon she was intubated again. A bronchoscopy showed no sign of fungus in her lungs, but there was an infection and signs of rejection damage. A day later there was another operation for some additional fungus on her cheek. She had received dialysis for non-functional kidneys, and then they gave her infusions of IVIG, a horrifically expensive med to take over her immune response. That seemed to work for a few days, but then again her white blood cells were out of control and she had a high fever, needing lots of oxygen support.
And so....
Today Heather died at 3pm. I was there with her, and her family and a couple of school friends. Nothing more could have been done, and her parents decided that it was time to withdraw care. She peacefully went to sleep, her heart slowed and stopped. I had arrived early enough to spend some time with her. She was unconscious, but I held her hand and talked to her for awhile. She still had the rosy cheeks I remember after her transplant, a wonderful colour on her. I looked at the vent and saw by the readings and measurements that her lungs were in extreme distress, the type that has us call in families where I work.
I am glad to have a week off work, because I do not think I can function at this time. I will instead walk the hills, sit by the river and heal. Her service is next Saturday, and I will be playing a jazz waltz on guitar that I wrote for her, simply called 'Heather's Waltz'. Fortunately she heard it in the hospital weeks ago. I had hoped to play it at her wedding reception...
I will still be teaching her eight-year-old daughter Mackinzie guitar lessons, and two weeks ago I promised Heather that when the time came, I would pay to get Kinzie the needed braces and orthodontic work so she can have her mother's smile. I hear that can be pretty spendy, and the grandparents who now have Kinzie aren't quite that flush, so I better start saving now!
It has been a roller-coaster four months, and you have seen it all. Despite our painful outcome, I know Heather would not want it to discourage anyone considering this big step. It did not turn out as we wanted, but she had days to be outside with her daughter in the fresh air with no nasal cannula or inhalers. She knew there was a risk here, and went into it enthusiastically. For all you out there waiting, I wish you wonderful success and years of health...