Cassie Stanley was in the cardiothoracic intensive care unit on a bright February afternoon. Five tubes snaked from her body and, more than 30 pounds underweight, she could barely walk around the room. Lunch was ice chips. The night before she slept only about four hours.
And in so many ways, she couldn’t have been more fortunate.
Stanley wasn’t expected to survive long when she was admitted to the hospital a week earlier. Then a new life was given to her, in the form of lungs transplanted during a 10-hour, overnight surgery.
They are her third set of lungs in a sometimes harrowing life odyssey. After the first transplant in 2007, her body slowly began rejecting the organs and she became desperately ill. The latest chapter, detailed by the Tribune in January, was a 26-month wait for another donor.
Now, Stanley, 27, of Elburn, is among the less than 5 percent of lung transplant patients who have received a second set of lungs. She said she would like to attend Cubs games again; see Las Vegas; walk her dog; dance.
“I’m getting stronger every day,” Stanley said barely above a whisper four days after transplant surgery at Loyola University Medical Center in Maywood. “I hope to go home very soon,” she said, adding that she got “all my strength from my family and friends.”
Stanley’s journey to this second chance started Feb. 8, when her parents brought her to Loyola. Carbon dioxide was building to such high levels in her system that she was becoming disoriented. Doctors placed her on a ventilator and hoped for a donor. Without one, the hospital likely would be her last stop.
On Feb. 11, her prospects turned encouraging and yet frightening. A woman about the same age who lived in another Midwestern state had died. She shared Stanley’s blood type, and the lungs were a similar size. Doctors declined to disclose more.
Around 1 p.m., Dr. Robert Love, who has performed about 700 lung transplants, walked in to Stanley’s room and asked if she was bored.
When Stanley answered yes, he asked whether she would like new lungs that day.
‘All or nothing’
About the same time, as nearly 20 relatives and friends crowded Stanley’s room, Loyola’s lung procurement team headed to Midway Airport for a flight to the medical center where they would remove the donor lungs, review them a final time and communicate to surgeons at Loyola.
Stanley was talkative. She said she was hungry. She texted. She joked with close friend Bruce Conrad to sit on the lap of her stepfather, Tim May.
“I’m really happy but I’m also scared to death,” Stanley said. “I just thought that this was the end, and I’m definitely not ready for this to end. I’m ready to start over again. I’m not ready to give up at all.”
Still, she was very weak and her breathing extremely labored. The obvious question was simple, ominous: Would she survive to see Sunday morning?
Stanley tried to maintain a courageous front while she said goodbye to visitors. Nurses and technicians prepared to move her to surgery. It was 5:24 p.m. A line formed around her bed, and everyone hugged her.
“Grandma, I’m so glad you made it,” Stanley said to Maxine Eulberg, who flew in from Scottsdale, Ariz. Both of them wept. “I’m going to do this. We’re going to do this together. OK?”
Close friend Kristen Louras told Stanley she loved her, gave her a fist bump and said, “You got this, Cass.”
Tim May said, “It’s going to be good. You’re a pro at this.”
Conrad told her “You’ll be fine. Let’s do this.”
Then came her mother, Rhonda May. The two embraced, and when May finally pulled away, Stanley reached out to her.
“Mommy,” she cried out, and the two hugged again.
“It’s going to be good,” May told her daughter through tears. “We’re going to go on our trip — to see Grandma.”
Before being wheeled out, Stanley regained her composure, called her brothers Joshua, 11, and Connor, 7, to her bedside and told them to be nice to their parents.
“We’re going to go on vacations now,” she said. “OK?”
In the hall, Love, who performed Stanley’s earlier transplant and would perform this one, called the surgery “an all or nothing proposition.” Once surgeons make the clamshell incision in her chest, “we’ve got to make it work,” he said. “We’re on a one-way street then.”
Less than a half-hour later, Stanley was wheeled into a brightly-lit operating room. Her family and friends moved to a first-floor lounge to begin a long vigil.
Complications
Stanley had her first lung transplant two days after Thanksgiving 2007, after cystic fibrosis had so damaged the organs that they nearly stopped functioning. After several months of rehabilitation, she led a relatively normal life until her body began rejecting the lungs in May 2009.
The first transplant now presented complications for the second procedure. Scarring from the previous surgery would make the failing lungs more difficult to get to and remove. The scarring also would challenge surgeons’ efforts to attach the new lungs.
“This one will be tough,” Love said. “They’ll be really stuck. But that’s just the way it is.”
That Stanley even had a shot at a second lung transplant was the result of a complicated, somewhat controversial national lung-procurement formula adopted in mid-2004. The system considers many factors — age, disease diagnosis, even the distance between patient and donor — to prioritize prospective lung recipients by a numerical score.
Known as the Lung Allocation Score, the system is designed to get lungs to people with the most pressing need.
When the lungs became available to Stanley on Feb. 11, two other prospective recipients had a higher score, but medical teams determined the lungs would not be an ideal match for either of them, Love said.
At 7:35 p.m. he entered the lounge and told Stanley’s friends and relatives that she was “just going to sleep now,” and that the surgery would continue “well after midnight.”
Rhonda May listened in silence, weeping. Stanley’s brother Connor said he thought the surgery would be over already.
The doctors started about 8:30 p.m. and took three hours to remove Stanley’s lungs. Once those lungs were out, Love said, surgeons attached the new organs to the heart’s pulmonary artery, the trachea’s pulmonary vein and the airway, known as the bronchus.
During these highly precise procedures, family and friends in the lounge stared off in the distance or chatted. Others bent over and tapped their cellphones. Some watched “iCarly” on the flat screens. One cousin completed his tax returns on a laptop.
“I’m glad it’s happening,” Tim May said, “but at the same time, I’m nervous. There’s not much I can do now. It’s just a long waiting game, but it’s better than the alternative.”
Stanley’s friend Conrad said he didn’t know what to expect.
“For her,” he said, “you kind of feel like it was a last resort.”
About 11 p.m. Conrad made a run to White Castle and returned with two packs of 30 sliders. At 4 a.m., Conrad and Tim May drove to a Dunkin’ Donuts for bagels.
Complications arose early in the morning. The surgery ended about 6 a.m. Love called the lounge about 7 a.m. and said Stanley was bleeding internally more than doctors preferred and they were having difficulty making it subside.
Doctors decided against closing the incision in case additional surgery to reduce the bleeding was needed later Sunday.
But the family also received encouraging news. Stanley’s oxygen level was climbing, prompting nurses to reduce the amount of oxygen from the ventilator to 60 percent.
Shortly before 10 a.m., Rhonda and Tim May were the first to see the patient, who was unconscious, her face swollen. Rhonda May was apprehensive.
“We’re more aware of what can happen now, after the first time,” she said, “and that makes it a lot harder.”
Bright, uncertain future
But Stanley’s condition continued improving. She started moving on Sunday night, and on Monday morning, Love closed the incision. Later that day, she responded to questions.
Her dependence on the ventilator continued dropping, and by Tuesday she was breathing on her own, sitting in a chair and talking.
She walked around her room twice Thursday. On Friday, doctors said she could start eating yogurt and Jell-O. Love said she was “looking really good,” that she was two or three days ahead of schedule and that her prognosis was “good.”
He also said that she might return home by Feb. 27.
Even with the near-remarkable progress, Stanley faces an uncertain future. Love said Loyola’s five-year survival rate for lung transplant patients is 65 percent. Nationally the rate is about 50 percent. For the short term, doctors will monitor how her lungs remove carbon dioxide as well as her kidney function and signs of infection. A critical long-term issue is whether her body rejects the lungs.
Third lung transplants are extremely unlikely, Love said.
Stanley and her family are focused on the future. In addition to reclaiming a social life, Stanley said she would like become a dental hygienist.
In the hallway outside her room, Tim and Rhonda May were smiling, saying they were “thrilled” at her rapid progress and looked forward to Stanley starting in on a “bucket list” of accomplishments.
“We just have to get her home,” Rhonda May said, “and get her doing things.”