Por Denise Grady
The last thing Mayra Ramirez remembers from the emergency room at Chicagos Northwestern Memorial Hospital is having called her family on the phone to tell her that she had COVID-19So they were going to hook her up to a respirator and she needed her mother to make medical decisions for her.
Ramirez, 28, did not wake up for more than six weeks. She later learned that on June 5, she had become the first COVID-19 patient in the United States to receive a double lung transplant.
She was released from the hospital on Wednesday.
Ramirez is among a small but growing number of patients whose lungs have been destroyed by the coronavirus and whose only hope of survival is a lung transplant.
“I’m pretty sure that if I had been in another facility, they would have just ended the care and left me to die,” she said in an interview on Wednesday.
This operation is considered a desperate measure, exclusively for people with irreversible and fatal lung damage. Doctors don’t want to take anyone’s lungs out if there is a chance they will heal. Overall, only about 2,700 lung transplants were performed in the United States last year.
Patients must be sick enough to need a transplant, but strong enough to survive the operation, recover, and get on with their lives. With a new disease like COVID-19, doctors continue to learn how to achieve that balance.
“It is a very big paradigm shift,” said Ramirez’s surgeon, Ankit Bharat. “Lung transplantation has not been seen as a possible treatment for an infectious disease, so people need to get more used to that idea.”
On July 5, he performed a similar surgical intervention on another COVID-19 patient, Brian Kuhns, 62, from Lake Zurich, Illinois.
Kuhns was connected to life support machines for 100 days before receiving the transplant. Before he got sick, he thought COVID-19 was a lie, his wife Nancy Kuhns said in a statement released by the hospital.
“If my story can teach you anything, it’s that COVID-19 is no joke,” said Brian Kuhns.
Two more patients at Northwestern Memorial Hospital are awaiting transplants, one from Chicago and the other from Washington DC, said Bharat, chief of thoracic surgery and chief surgical officer of the lung transplant program.
A patient from Seattle is expected to arrive next week, and the Northwestern team is advising on another case from a medical group in Washington. Other transplant centers are considering similar interventions, Bharat said.
Last Friday, a COVID-19 patient who was transferred from another state underwent a double lung transplant at the University of Florida Health Health Hospital in Gainesville, said doctor Tiago Machuca.
While other centers have preferred to refer cases to other institutions, most patients had other serious medical problems that ruled them out, the doctor said.
In some cases, Bharat said, it seemed that hospitals were waiting too long to recommend a transplant. A patient who had been referred to his center seemed to be a good candidate, but then he had severe bleeding in the lungs as well as kidney failure, so it was no longer possible to undergo surgery.
“I think people have to recognize when this is an option and at least start talking about it before it gets to that point,” said Bharat.
Since extensive lung damage in COVID-19 patients makes transplant surgery especially difficult, most patients would be referred to the major transplant centers that are best equipped to perform risky operations and provide intensive aftercare. that patients need, surgeons said. Brian Kuhns was transferred to Northwestern from another health system.
Before falling ill, Ramirez, a legal assistant at an immigration law firm, worked from home and ordered groceries at home. She was in good health, but had an autoimmune disease, neuromyelitis optica, and was taking medications that suppressed her immune system that perhaps made her more vulnerable to getting coronavirus.
She was ill for about two weeks, so she called a COVID-19 helpline and mentioned what her symptoms were. At some point, she prepared to go to the hospital, but then returned without having entered. She was afraid of being admitted and told herself that she would recover.
But on April 26, her temperature reached 40 degrees Celsius and she was so weak that she fell when she tried to walk. A friend took her to the hospital. When doctors told her she needed a respirator, also called a ventilator, she had no idea what that meant. She thought they were referring to some kind of normal fan.
“I thought I would only be there for a couple of days, at most, and return to my normal life,” he said.
But she was hooked up to the respirator for six weeks, and she also needed a machine that would supply oxygen directly to her bloodstream.
The disease was relentless. Bacterial infections spread, scarring his lungs and gnawing at them. The lung damage caused circulatory problems that began to affect his liver and heart.
Doctors told her family in North Carolina that maybe it was time to go to Chicago to say goodbye, and her mother and two sisters came to see her.
But Ramirez held on, removed the coronavirus from her body, and was placed on the transplant list. Two days later, on June 5, she underwent a 10-hour surgery.
She woke up with scars, bruises, desperately thirsty and unable to speak, “with all these tubes coming out of me, and I couldn’t recognize my own body.”
The nurse asked if she knew what day it was. She thought of a date in early May but it was already mid-June.
He was not told that he had received a lung transplant until several days after he woke up.
“I couldn’t process it,” he said. “I was having trouble breathing, and I was thirsty. Several weeks passed before I could feel grateful and realize that there was a family out there who had lost a loved one. ”