Another Chance

October 21, 2019

rivera-family-outdoors

A young mother’s heart was failing when she arrived at Saint John’s. The cardiac team was ready.

Written by Shari Roan
Photographed by Monica Orozco

Josefa Rivera, 34, was on a happy visit to her native Guatemala in March when the trip took an unexpected turn. The Maywood woman, a stay-at-home mom to 15-month-old son Josue, began having nausea and diarrhea so severe she grew weak and dehydrated.

That was the start of a 10-week medical odyssey that took her to three other Los Angeles-area hospitals before she ended up receiving lifesaving care at Providence Saint John’s Health Center. Rivera, with her chest still open from cardiac bypass surgery and connected to a device to keep her alive, was transported to Saint John’s on May 10—near death from heart failure.

Throughout her ordeal she kept one thing in mind: “I have to live for my son and my husband,” Rivera recalls telling herself. “I struggled so much to have my son. My son is too small for me to die. He’s a baby and can’t be without his mom.”

Rivera didn’t know it at the time, but a team at Saint John’s led by Raymond Lee, MD, were not about to let that happen.

Ready for Anything

Rivera is one of the scores of patients with serious heart conditions who can now be treated at Saint John’s. Under a partnership with Keck Medicine of USC launched in 2018, Saint John’s provides a level of sophisticated care typically only found at academic medical centers. The program ensures that patients in need of cardiac surgery at Saint John’s have around-the-clock access to cardiac surgery and will receive state-of-the-art treatment. Also under the arrangement, Saint John’s will have a direct conduit to the Keck Medical Center, transferring patients with special cardiac surgery needs there to get the highest level of cardiac care available, if needed.

dr-leeSince assuming leadership of the program, Dr. Lee, a Keck School of Medicine of USC faculty member and medical director of cardiac surgery, has ramped up cardiac surgery care and added new technologies to support these advanced services. “There’s been a tremendous growth in the program,” he says. “We’ve increased our cardiac open-heart surgery volume by about four to five times from the previous levels. We can perform a variety of procedures now. It’s a very exciting time.”

Among the additions to the program are extracorporeal membrane oxygenation (ECMO) and ventricular assist devices (VADs). ECMO is technology that provides respiratory and cardiac support. First used in very ill infants with heart or lung conditions, it’s now increasingly utilized for adults in respiratory or cardiac failure to provide support during or after some cardiac procedures. It works by removing blood from the body and filtering out carbon dioxide while providing oxygen to red blood cells. 

Ventricular assist devices are implanted in the body to help the heart pump blood from the lower chambers to allow the body to rest. VADs are used when the heart is failing, giving the organ time to recover, or for people awaiting a heart transplant surgery.

“For us to be able to provide the best possible care, we have to bridge out,” Dr. Lee says. “Any heart program wants to continue to provide increasingly higher levels of care. Heart patients are getting sicker and sicker. There is more heart failure. The only way to do surgery safely is with devices that help rescue patients.”

Emergency, Lifesaving Care

Ill in Guatemala, Rivera saw a doctor who diagnosed an intestinal infection and gaveher medication. She improved but still felt weak. “I didn’t know what was going on,” she says. “I thought I was feeling fatigued after being so sick.”

Upon her return to the United States a week later, her husband, Edwin Xulu, grew worried. His lively wife was not the same. The couple went to a restaurant, but while walking inside Rivera felt her body go numb. Xulu rushed her to an L.A.-area hospital where doctors began to run tests. Eventually they told Rivera she had ischemic cardiomyopathy (a weakened heart) and was in heart failure. 

Heart failure is typically caused by coronary artery disease. Blocked blood vessels cause the heart muscle to die, leading to the inability to pump blood effectively. The symptoms of heart failure are fatigue, shortness of breath and swelling of the ankles or legs. Rivera had diabetes and was likely at high risk of heart disease due to genetics, Dr. Lee says.

“A lot came to my mind especially because my mom had heart failure and died when she was 58,” Rivera says. “I said, ‘I can’t go through what my mom went through.’ It was shocking.”

josefa-rivera-after-surgeryShe was transferred to another hospital and underwent cardiac catheterization to look closely at the vessels in her heart. Five were blocked. 

“They said, ‘We have to do surgery,’” Rivera recalls. “I was scared of it. I said, ‘Isn’t there anything else you can do? Medication?’ They said medication would not completely cure me.” 

Rivera was sent home with medication, however, and underwent tests while awaiting a date for cardiac bypass surgery. The surgery was performed on May 9. During the procedure, the medical team informed Xulu that everything was going fine. But just before the surgeons were ready to close Rivera’s chest, her heart stopped. She was put on ECMO and transferred, her chest open, to Saint John’s for a higher level of care.

At Saint John’s, Dr. Lee and John M. Robertson, MD, washed the chest wound and weaned her from ECMO to a ventricular assist device. Rivera was in a coma for three days—sort of. She said she could often hear voices.

“I told my husband later that I could hear everything,” she recalls. “People were talking. I used to hear him when he was there. It was like I couldn’t open my eyes and couldn’t move. The nurses would say, ‘Wiggle your toes,’ and I would do it. But I felt like I was blindfolded.”

Finally, on May 12—Mother’s Day—she awoke. Xulu brought Josue to see his mother. “Everything hurt. I was weak,” Rivera says. “But I got to see him.” 

She went home on May 23 but developed an infection and had to return to the hospital for another week, leaving again on May 31. She is taking medication, moving around as much as possible to regain strength, eating healthy food and looking forward to raising Josue.

“She has recovered so well,” Dr. Lee says. 

“The doctors were great, and the ICU nurses were awesome,” Rivera says. “They told me I was doing great. They said, ‘It’s amazing you have gone through so much, and your recovery is awesome.’ Dr. Lee is an amazing person. He’s pretty young! But he’s a really good doctor.”

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