- Elaine McDevitt needed a heart transplant — and received one — amid the ongoing global coronavirus pandemic.
- She entered the hospital on January 27 when there were only five COVID-19 cases in the US, and she left on April 6, when the US was experiencing the worst outbreak in the world.
- Over her two-month stay — when the drugs she took to prevent a heart rejection put her at-risk for a COVID-19 infection — McDevitt saw how the virus changed the hospital, from a moratorium on visitors and hugs to widespread use of protective gear.
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Elaine McDevitt was going to die.
“I thought heart failure was something old people had when they were dying,” the 59-year-old of Cumru Township, Pennsylvania, told Business Insider. “I didn’t know you could walk around with heart failure.”
In 2014, after a string of misdiagnoses that lasted 18 months, McDevitt was diagnosed with Sarcoidosis, a rare autoimmune disease that often affects the lungs. In McDevitt, it was causing her heart to fail, which was even rarer.
As time went by, things became more serious. Finally, last August, doctors told her it was time to be evaluated for a heart transplant. They needed to conduct tests to make sure her body was otherwise well enough to receive a heart transplant such as not having cancer or her bones needing to be strong enough — despite years of steroids meant to reduce the more serious effects of her illness — to withstand a transplant.
McDevitt waited to be approved and on January 27 — her son’s birthday and a day before she was scheduled to be admitted to the hospital — she reached her breaking point: her constant pain and exhaustion sent her to Thomas Jefferson University Hospital in Philadelphia, about 60 miles east of the home she shares with her husband, Tom.
“My numbers were very borderline,” said McDevitt who was moved to a more urgent status on the list of people in need of a transplant.
That day she was admitted, the novel coronavirus was still mostly constrained to China, though it had begun to spread around the globe. It had only killed 106 people and just five people had been diagnosed with the virus in the US. No instances of community spread had yet been reported on US soil.
“I had never even thought about it,” McDevitt said of COVID-19, the disease caused by the novel coronavirus.
But when McDevitt finally left Jefferson on April 6 — more than two months after she first walked through the hospital’s doors — the world was different.
The virus had infected at least 1,390,511 and killed 80,759 globally. The US now had the worst outbreak worldwide. The city of Wuhan in China’s Hubei province, where COVID-19 is believed to have originated, was just two days away from relaxing the city’s strict lockdown after 76 days.
“When I walked through the halls I could tell which rooms the coronavirus patients were in because of the PPE that the people had on, so I would know,” McDevitt told Business Insider of her stay in the hospital. “Because of HIPPA, nurses didn’t tell you anything. But I knew what the costumes were.”
Frontline heroes Like most hospitals nationwide, things at Jefferson changed quickly
“I always say I came into the twilight zone by myself on the 27th and since then everyone has joined me,” McDevitt joked.
At the beginning of her more than two months in the hospital, it was business as usual at Jefferson. But in early March, things began to change as US health officials started to offer serious warnings about the possible impact of the novel coronavirus in the US.
First, visitors were no longer allowed, McDevitt said, recalling that the restriction was put in place around her birthday, on March 11.
McDevitt said her husband, Tom, and daughter, Elyse, still visited her to celebrate her birthday as she wouldn’t see them for weeks while she remained in the hospital. She would be alone as she waited for her new heart, when she was rolled to the operating room to have her heart removed from her body, and when she woke up post-surgery, confused from her drug-induced nightmares that the transplant had been ineffective.
Her son, Mark, who at the time worked for a Massachusetts congresswoman on Capitol Hill, had already stopped making the trip from DC to Philadelphia to visit his mother even before the hospital officially banned visitors, describing his workplace as a “natural disease vector.”
“It was obviously the right call, and in a way, it was comforting to know they were taking drastic measures,” Mark told Business Insider. “It’s not a low-risk procedure.”
Soon, masks became the norm for all patients and hospital staff.
“Even the people who bring you your food wore them,” McDevitt said.
Dr. René Alvarez, the cardiologist who diagnosed McDevitt with Cardiac Sarcoidosis, told Business Insider that Thomas Jefferson University Hospitals were fortunate in that they weren’t facing an imminent shortage in N95 masks, gowns, or other protective equipment needed to protect patients and medical workers from infection.
The same can’t be said for many hospitals around the country, particularly in areas that have experienced severe outbreaks of the virus. In New York City, for example, which has faced the most severe outbreak of COVID-19 in the US, some hospital staff were told to reuse N95 masks until they were “soiled” or damaged.
Nurses, also in New York, have reported shortages of other Personal Protective Equipment (PPE), including gowns and were thus advised to use garbage bags to protect themselves and their patients.
It’s not just New York, either. Hospitals in Wisconsin on Friday reported having less than a one week supply of goggles, gowns, face shields, N95 masks, and paper medical masks — all worn to protect healthcare workers and their patients from infectious diseases, like COVID-19.
Nurses at Jefferson continued their close contact with patients like Elaine, though nurses were assigned to a set group of patients, limiting potential exposure as they were “constantly wearing gloves and changing them,” McDevitt said. There was also a moratorium on hugs in the hospital, she said.
At Jefferson, doctors no longer came to their patient’s bedside unless it was absolutely necessary. Instead, they stood in the doorway to talk to their patients. On March 25, McDevitt was told doctors had found a potential organ donor. Her transplant specialist told her the good news from the doorway of her hospital room while she sat in her hospital room ready to eat lunch.
“He was on the phone, and he gestured to me and said ‘don’t eat your lunch,'” McDevitt recalled. “Right away, I knew what that meant. I had tears in my eyes.”
Still, McDevitt didn’t want to get her hopes up. It wasn’t the first time doctors provided a similar heads up. At the end of February, McDevitt’s medical team told her they had found a potential heart. They eventually passed on the organ because the donor had recently traveled to a country experiencing a COVID-19 outbreak.
Because of issues with COVID-19 testing in the US, her medical team worried the organ donor could be infected by the virus and her doctors didn’t want to put her at risk.
“You have individuals that — clearly — they can’t wait,” Dr. Howard Massey, the surgical director of cardiac transplantation at Jefferson University Hospital told Business Insider. “There was no way Elaine could wait to get a heart transplant. She was going to die and that was very evident. If there had been any way possible to delay this in her, we would have, but that was just not an option for her.”
Frontline heroes Despite the threats posed by the disease, doctors still work to provide essential care
“We are delivering this care to individuals similar to Elaine on an ongoing basis to the best of our ability,” Massey said of the numerous organ transplants that occur at the hospital.
Still, he noted, hospitals have made efforts to free up beds for potential COVID-19 patients and to limit the number of other patients in the hospital who could be exposed by other patients or staff.
“There are certain risks in coming into the hospital environment, and certainly we are doing everything we can to protect individuals within the hospital,” Massey said. “Infections and risks like that are inherent within the hospital, so we don’t want to potentially expose someone to a perceived risk unless we absolutely have to.”
McDevitt had eventually undergone her transplant surgery on March 26. She was intubated and placed on a ventilator, which is common for patients after a transplant operation, amid a nationwide shortage of ventilators needed to help the most serious COVID-19 patients.
Despite her successful surgery, McDevitt faced a new risk: the immuno-suppressive drugs she needed to continuously take to avoid transplant rejection and reduce the risk of infection put her at high risk for COVID-19.
“I said to my doctors, in tears, ‘Am I going to be able to survive the heart transplant and the virus?” McDevitt recalled.
Her doctors – both her cardiologist and transplant specialist — told Business Insider that she can survive amid the pandemic, but there are still risks.
“If you were to look at the risk of having serious infections related to COVID-19, she would fall in one of the high-risk groups,” Massey said, adding “their immune systems are altered from the medication we utilize, but it’s still intact and they still have the ability to fight infections.”
“There are some medications we can utilize to help with that, but it is a balance,” he continued. “Unfortunately in transplantation today, it’s the balance between too much immune suppression versus too little.”
Alvarez, McDevitt’s cardiologist, said patients and doctors are continuing to adjust medical procedures to protect against the virus.
For McDevitt, these changes have meant completing post-op physical therapy in her room and avoiding unnecessary trips in the hallway. Normally, recovering patients are encouraged to walk the halls and take the stairs at the hospital as a means of physical therapy. That could put McDevitt at risk, so her exercises were confined to her hospital room.
She also had a virtual conference — typically held at her bedside — with a nurse coordinator and a transplant pharmacist to discuss the new medications she needed to take, Alvarez told Business Insider.
Temporary changes like these, he added, could lead to permanent shifts in medical care as the coronavirus pandemic has shown the effectiveness of telemedicine.
“I think this COVID pandemic will teach us a lot of things. One, that telemedicine and virtual care works and patients are engaged, and it has been very effective,” he said.
“It’s concerning for Elaine, and it’s concerning for all transplant patients,” Dana Gonzales, one of McDevitt’s nurses said the day McDevitt was released from the hospital. “Of course. I worry for everyone and anyone. But we do all the practices and guidelines the CDC put out, and we just do the best we can do.”
Luckily, a self-described homebody, McDevitt has no plans of leaving the home she returned to on April 6 and is isolating with her husband. Her home is currently closed to visitors — doctor’s orders — despite occasional visits from a traveling nurse and physical therapist.
She still hasn’t seen her kids.
“I miss them,” McDevitt said, “but they are super conscious of my condition and we all are thankful for FaceTime.”