Lying on her hospital bed, with a blanket pulled over her pregnant belly, Candice Cruz thought she was dying.
His vision was blurry. His hearing felt off. And even as machines pumped 100 percent oxygen into her lungs, each breath was a desperate suck for air.
Earlier that day doctors told Candice she had pulmonary hypertension, a rare condition caused by narrowed arteries in her lungs that forced her heart to work dangerously.
To survive, the 37-year-old would need new lungs. And medical guidelines recommended that doctors terminate her 21-week pregnancy to save her life.
But first, before considering any of those last resorts, surgeons at Toronto General Hospital had to put Candice on a sophisticated life-support machine to get more oxygen into her lungs.
Colin Cruz tried to allay his fear by holding his wife’s hand. He ran from his home in Midland, a town 50 km north of Barrie, to town, leaving his then 12-year-old daughter with the family.
Now, seeing Candice struggling to breathe, he wondered if they would all be together again.
“I didn’t think it would be that great,” he said, recalling the moment Candice was rolled into the operating room. “I thought I was going to lose him.”
Candice survived that April surgery. It was the first of many frightening nights and the beginning of a medical case that will test the skill and courage of a medical team ready to push the boundaries to save the lives of a mother and her unborn child.
Doctors at Toronto General, Mount Sinai Hospital and Sick Children’s Hospital believe Candice’s case is the first in the world, where a pregnant mother with advanced pulmonary hypertension received a unique heart-lung machine and a series of other With the help of safely continued your pregnancy. Life saving technology.
Machines that oxygenate her blood allowed Candice to carry her son for an additional eight weeks; Cameron was born 11 weeks early but was otherwise healthy. A month later, after 14 hours of transplant surgery, Candice had new lungs. Now both mother and child are at home. Cameron is rarely out of sight of Candice.
Doctors associated with this case say that this is the most challenging phase of his career. With no other like it in the world, they had to map their own course, relying on their collective expertise, to expand the boundaries of what had been done before.
The case came to the fore during the height of Ontario’s third pandemic wave, when the hospital’s intensive care unit was crowded with COVID patients, which makes their success even more remarkable.
Candice, whose own mother had pulmonary hypertension and died at an early age, hopes her story will help others facing a similarly dire diagnosis.
“One of the hardest parts was not knowing if it would all work out,” she said. “I was always so scared.
“I really wanted this baby. I could feel him moving around; I was attached. But I also had to make sure I came to my daughter’s house. I didn’t want to leave her behind, I Didn’t want him to be without mother.
Candice first suspected something was amiss in January, just weeks after learning she was pregnant.
She was unusually tired and often felt dizzy at the end of her workday cleaning homes and cottages in the Georgian Bay community. Twice, her heart pounded so fast and so fast that she went to the local hospital. But both the times the doctors said that she was suffering from anxiety and asked her not to worry.
Her obstetrician, too, attributed her worsening symptoms to pregnancy fatigue.
But by April, Candice was breathless as she walked from the dining room to the kitchen sink. She called her family doctor when her lips turned blue.
“It was the first time I was taken seriously. He said: ‘I want you to go to the emergency department, and I want you to go now.’”
She was about 21 weeks pregnant.
Doctors at Georgian Bay General Hospital made the decision to transfer Candice to Mount Sinai’s high-risk pregnancy unit. In the ambulance, paramedics struggled to keep her oxygen levels from falling.
Shortly after arriving at Mount Sinai, Candice was taken again, this time across the street to the Cardiac Clinic at Toronto General, part of the University Health Network. After several tests, doctors found a small hole in his heart and confirmed that he had pulmonary hypertension.
A respirologist and director of UHN’s Pulmonary Hypertension Program, Dr. John Granton said it is rare to make a diagnosis like this during pregnancy and to see a patient decline so rapidly. He tried to be humble while giving the news to Candice.
“I told him that his life was in danger; that we might have to terminate the pregnancy; That he will have to go on life support and may die,” he said.
“So, three hits, and he just took it, and said: ‘I understand; let’s just do what we have to do.’”
Within hours, Candice was taken to an operating room to be placed on ECMO, or extracorporeal membrane oxygenation. This version of life support removes carbon dioxide and adds oxygen to the blood that has been drawn from the patient’s vein near the groin. It then pumps the oxygenated blood into another vein near the patient’s heart, essentially replacing the lungs.
The machine is commonly used to buy time for critically ill patients awaiting a lung transplant, or to allow a patient’s lungs to heal after being severely damaged by an infection. goes.
For Candice, that wasn’t enough.
In the days that followed, his blood pressure repeatedly dropped to alarming levels. At times doctors thought she would die.
“Someone with pulmonary hypertension can die suddenly because their heart simply fails,” said Dr. Laura Donahoe, thoracic surgeon at UHN. “That’s what we worried about Candice; we needed to ease the pressure on her heart.”
But as doctors planned their next move, Candice made it clear she wanted to stay pregnant for as long as possible.
Generally, patients with pulmonary hypertension are advised not to become pregnant. The stress of the growing fetus puts a lot of pressure on an already strained circulatory system, putting the lives of both the mother and her unborn baby at risk.
When patients are diagnosed with the condition while they are already pregnant, doctors sometimes recommend terminating the pregnancy if the potential for death is too high for the mother to continue nursing the baby.
After an hour-long conference call, the team of experts overseeing Candice’s case decided they would try to prolong her pregnancy by implanting a unique artificial lung device called Nowlung in her chest. He believed this was his best chance of keeping her pregnant. They also knew that there was no guarantee that it would work.
“It was really hard; there was no such case in the medical literature,” Donahoe said. “We talked to other experts around the world, and no one was aware of a similar situation.
“We had to use all of our collective expertise to make the best decision possible.”
Dr. Shaf Keshavji, surgeon in chief at UHN, thought that Nowalung would help Candice stretch her during her pregnancy because it was a life-saving device that would put the least strain on her heart. This was an important consideration; As her pregnancy progressed, her heart would have to work harder to pump an ever-increasing amount of blood to her growing baby.
“We can adapt Nowalung to her pregnancy,” said Keshavji, director of the Toronto Lung Transplant Program at the hospital’s Ajmera Transplant Center. “And if it doesn’t work, if she becomes unstable at all, we can go back to the original plan to terminate the pregnancy.
“At 21 weeks of pregnancy, if the child was aborted, she would have died. But if we can get her 23 or 24 weeks pregnant — or even longer — before she’s unstuck, at least we were giving the baby a chance, which is what Candice wanted.
Donahoe and her team connected Candice to Nowlung during a long, open chest surgery. When Candice awoke from the anaesthetic, she saw two blood-filled tubes coming out of her chest. One drew blood from the pulmonary artery on the right side of his heart, feeding it into Nowlung. Another used the device to send oxygenated blood back to the left side of his heart.
This time life support worked. Candice’s condition stabilized and she was soon able to sit in bed. Earlier she was so weak that she could not write her name.
Still, there were setbacks. His blood pressure was often irregular. The team had to constantly adjust medications and Nowalung to keep up with her growing pregnancy. Often, Donahoe worried that Candice’s heart would fail.
An obstetrics team at Sinai monitored her growing baby. Each passing week increased his chances of survival. Amazingly, he continued to perform well.
Through it all, Colin came to the Toronto General daily. He was on leave from his job as a swamper – a construction worker who guides tower cranes from the ground – with the staff building the new research tower at the Hospital for Sick Children.
Colin slept in his car for several nights to be with Candice. They parked outside gas stations and convenience stores, avoiding the hospital’s underground lots; If the hospital called to let her know that Candice was in trouble, she needed a reliable cell signal.
When he was not in her bed, Colin spoke to Candice on the phone. The couple – married for 14 years and together with an additional four – found it difficult to separate.
“We’d leave our phones on all night,” Candice said.
“That way,” Colin said, “we would still feel like we were together all the time.”
After 48 days in the hospital, Candice was 27 weeks pregnant and old enough to go out. Her physiotherapist sits her on the sidewalk and surprises her with a small cup of chocolate gelato.
“That was the best day ever. I just sat down and took it all. I’ll never forget it…