Tag Archives: cenocepacia

MARCH 12–Four ♥ Stories & A Big Loud Meow

Update needed, as Caitlin used to say.

♥ Story 1, JESS:

Nick and I are on St. John. The night before we left, we had dinner with the incredible Jess in Boston. She had been cleared by her oncology team to go to Kenya for two weeks.

Once in Nanyuki, she was able to finally lay eyes on what she has brought into being:  The Leo Project in Honor of Caitlin O’Hara.

This resource center for children, which is her promised tribute to Caitlin, is now a reality. Construction began in January and the walls rise daily.

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The Leo Center, rising

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Future stage for performances

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Side view

Last July, when she announced Phase 1 of her project, with a goal of raising $200,000 to buy land and construct the center, I asked, “What happens if you don’t raise all the money?”

She smiled at me in her calm, steady way. “But that won’t happen,” she said.

It didn’t. Phase 1 fundraising is now complete. Construction will be complete by May.  Fundraising is now into Phase 2: a $40,000 goal for set-up costs that include a perimeter fence for security, computers, supplies for pilot programs, furniture, a sustainable garden, and initial staff salaries.

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Jess on-site with Mungai, her general contractor

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Fred the foreman and one of his cheerful workers

♥ Story 2, ANDREW: 

Last Friday, Andrew texted me a photo and asked, “Is this still standing?” The photo was of a mini-mart on the other side of the island. At first, I didn’t realize Caitlin was in the picture. Then I picked out her fierce little presence, and realized that it also happened to be International Women’s Day.

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Andrew has never run a marathon but he’s been training all winter. On April 15, he will run the Boston Marathon in honor of Caitlin. John Hancock provided Jess with a number  for the Leo Project; Andrew will be their official entrant. Every dollar he raises will go to the Leo Project, but he has to commit to raising $10,000 in exchange for the official number. Please read his story and support him: Andrew’s Boston Marathon for Caitlin & the Leo Project

♥ Story 3, MALLORY & DIANE: 

I’ve written before about the incredible Mallory Smith, who followed in Caitlin’s footsteps, relocating to Pittsburgh (from LA) for a lung transplant. Mallory was empathic and bright, a straight-A Stanford grad, avid surfer, passionate writer. She got her transplant in September of 2017 and celebrated her 25th birthday that October. A month after that, she succumbed to a raging infection.

Mallory became another cystic fibrosis tragedy, but today, March 12, we are celebrating her  beautiful soul with the publication, by Penguin Random House, of her posthumous memoir, Salt in My Soul, An Unfinished Life. It is on sale everywhere and I urge you to run to your favorite independent bookstore and buy a copy.

From the LA Times review:

The day of Mallory’s memorial, Diane opened up the electronic journal that Mallory had kept secret for 10 years. It was 2,500 pages long. Mallory wanted it edited and published, and she trusted only her mother to read it raw.

“I spent two to three hours a day holed up in my room laughing and crying while I read it,” Diane said. “My husband needed to see a grief counselor after six months, but this was my grieving process.”

Very quickly, Diane, a veteran publicist, understood she had a book on her hands, one that could inspire people facing impossible situations, that could help medical professionals better understand and deal with their patients, and raise money for cystic fibrosis research.

She found an editor and then a publisher, who gave her a healthy six-figure advance, none of which she will keep.

She already has more than 60 talks planned around the country to promote the book — at hospitals, universities, law schools, medical schools, high schools, tech companies and the New York Public Library.

Nick and I will be hosting a celebratory hour for SALT IN MY SOUL on July 11 at Framingham Country Club at 6:30 in the evening, and we will welcome everyone who wishes to attend. Diane will be talking about Mallory, and Jess will be on hand to show us photos from Kenya, as the Smiths are generously donating all book sale proceeds to the Leo Project.

♥ 4, St. John:

So here we are, Nick and I, back on St. John, the place our family loved best. As I’ve previously written, “boat day” was always the highlight of our vacations here. On boat day, we would go out with a captain and visit a few of the British Virgin Islands. We’d enjoy the wind and water, do a little snorkeling. Pop into a couple of the various beach bars for conch fritters and painkillers.

On Sunday, the two of us did boat day with Captain Cleve, a St. John native who is an all-around wonderful person and great captain. In the morning, he texted Nick to say that he’d decided to use the bigger and newer of his two boats for our trip.

We boarded at 8:30, went through customs on Tortola, then headed up to Norman Island, which we hadn’t visited since 2013 with Caitlin and Andrew.

It was beautiful, but as we plowed through the waves, I was wondering if I even wanted to do this anymore. There are memories in all of these islands, and those memories are  bittersweet.

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I looked at the empty spot beside me, where Caitlin would have been sitting, and wondered, Are you really with us?

At Norman Island, we moored and jumped into the water. At hull level, we noticed Cleve’s lively logo then saw the “33”– a number which has become Caitlin’s “signature” “sign” to us.

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Seeing that 33 delighted us.  It felt like a little hello from Caitlin and we spent the rest of the afternoon feeling upbeat.

At the end of the trip, back on St. John, we were docked at the fueling station when the peace was suddenly broken by someone’s super loud ringtone playing that old Meow Mix jingle. Meow meow meow meow  🎶  meow meow meow meow 🎶 meow meow meow meow, MEOW meow meow meow.. 

I mean, super loud.

We whipped our heads around to see where it was coming from. On the boat behind us,  the embarrassed captain was laughing apologetically and scrambling to answer/quiet his phone.

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Nick said, “Look at the name of the boat.”

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You can’t make this stuff up.

Meow.

 

10 JULY– “She feared that her purpose here on Earth was to teach lessons to others.”

That summer–2014–Caitlin was newly listed for transplant and had settled in to wait. She couldn’t leave Boston because she had only a four-hour window if “the call” came.

Four hours to get herself to Pittsburgh.

So there were no more trips to Andy’s place on the Maine coast. No more Vineyard. Sometimes we went home to Ashland to swim in the pool, but always with packed bags and extra oxygen tanks, ready to scramble and pray that one of the few medical jets available to us would be able to come.

That summer, she especially missed Jess, who had, as long-planned, left a lucrative job in finance to try and make a meaningful life for herself in Kenya.

Kenya is a place that has called to Jess’s soul her whole life. I’ll let her tell the next part:

Jess: “The thousands of miles between us felt more expansive than ever and I was desperate to be in constant communication with her. I started sharing the stories of the kids that I was spending my time with at the Children’s Home that we had started.

Simba was one of them. In Swahili, Simba means lion. Although he had never celebrated a birthday, he was a self-proclaimed ten year old with dewy brown eyes. I connected the two as pen pals and they sent handwritten letters back and forth to one another. They shared an affinity for tiny winged creatures and their correspondence often included an illustration or two.

Recently, I searched through Caitlin’s phone for some photos I just knew had to be on it. 

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Jess: “On June 20th, 2014, Caitlin emailed me: ‘Can’t WAIT for Simba’s letter to arrive. Thinking about him and all your little kids a lot. And you smiling at them. It hurts my heart.'”

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“Jess teld me you like birds.”

The next summer–2015–Jess visited Caitlin in Pittsburgh, where we had relocated, and where she was still waiting. Watching them together, I couldn’t help but muse on the physical contrast between them. Jess was training to do a marathon and literally glowed with health. Then autumn came.

Jess: “We were 31 and 32 when I was diagnosed with breast cancer. She knew more about medicine than most and she researched everything. I sent her all of my labs, my side effects, my questions. She was a well-curated vault of medical knowledge. She would have been an incredible doctor. I sent her screenshot after screenshot when a new drug was added to my regiment or I was deciding to taper off of something. She would talk me through each concern.

We talked about everything but when we were both sick, our conversations took on a new level of depth. We talked about death and about reincarnation; we talked about our purpose and spiritual inferiority.

On the evening of her 33rd birthday, we talked for hours and hours. I had just had another surgery and was tethered to my bed. She feared that her purpose here on this earth was to teach lessons to others. “No. No,” I said because I needed her here with me.

The idea that she was here only to teach other’s things was too much to bear.”

Now it is nearly three years later. Jess has spent the past 33 months coping with cancer, unexpected healing issues (13 surgeries), and the unbearable loss of her closest friend. With her oncology team’s okay, she has gone back to Kenya as often as possible, where she has been in the process of procuring land and builders for a non-profit she has established:  THE LEO PROJECT in honor of Caitlin O’Hara.

Caitlin had planned to do a lot of things post-transplant, like her CF friends who were and are living full lives after their successful surgeries. At the top of her list was visiting Kenya with Jess. Meeting Simba. Instead, she seems to have been right—-that she was here, at least in part, to teach lessons to others. I’ve heard from people around the globe who have been moved and changed by her story, and by her fire & wisdom.

Now, the Kenyan children that Jess loves so much are going to know Caitlin, too. Just in a different way than we all hoped.

PLEASE CLICK RIGHT HERE TO HELP JESS WITH THE LEO PROJECT 

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Caitlin in Ireland on her 30th birthday, always up for adventure. 

“You think all this is important,
but all that really matters is loving people and being kind. —Caitlin O’Hara

 

 

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My ‘random’ tarot pick today.

 

 

DECEMBER 16–A Matter of Ethics

 

Many people rightly wonder why Caitlin couldn’t be transplanted at home, in our world-class medical city, Boston. The answer is disturbing, and points to a flaw in the medical system. It’s a fight she was gearing up to fight, one she plans to continue after transplant. Here is a draft of a letter she was working on in October of this year:

I grew up outside Boston, and have been a patient at Children’s since I was diagnosed at age 2 with CF, in 1985. Once an adult, I transitioned to inpatient treatment at Brigham and Womens Hospital (BWH).

In spring of 2006 I was still “too healthy” for transplant, but I began the process at BWH at my doctor’s urging. BWH was one of the hospitals who transplanted cenocepacia patients like me — along with UPMC, Cleveland Clinic, Duke, and a handful of others.  “Better to get started early” was the thinking, “so that when you get really sick, you are ready to be listed.” I began the evaluation as an an outpatient and completed a significant amount of its required tests.  I continued to remain fairly stable in my health.

Then, in 2008, an administrative assistant from BWH called me, out of the blue, as I was getting ready for work, and told me they would no longer be able to offer me a spot for transplant because of my cenocepacia.  Things spun for a minute — “No, I argued, “You already know I have cenocepacia, we’ve been over this, your program takes cepacia patients.”

There had been a change in policy, the woman said.

I wasn’t sure what to think. I was confused before I could be upset. The woman said I should have received a letter.  I hadn’t, although it did arrive in the mail, weeks later — simple and boilerplate — another baffling link in the chain of events.  Soon, almost all of the other hospitals began to deny transplant to cenocepacia patients. I grew panicky.

Eventually, I worsened and did my evaluation at UPMC. I was listed on April 24, 2014. Because I would need to reach UPMC in four hours, we set up emergency jet service (which is never a guarantee), and began to wait. When December came, my mother and I moved to Pittsburgh to “wait out the winter.”

Winter passed. May of 2015 found me sick and in the hospital. It made no sense to go home at that point, and surely I would be called soon, was the thinking. We reluctantly signed a new lease on an apartment.

A year passed.

I have now been listed at UPMC for 2 ½ years. It’s taken an incredible emotional and financial toll on my family. I own an apartment in Boston, right around the corner from the hospital, that sits empty while I wait here.

So why did all of this suddenly happen?

A study in the American Journal of Transplantation in 2008 concluded this :

Cooperation between CF treatment and LT centers will hopefully provide new insights into virulence, transmissibility and treatment regimens for this unique and challenging pathogen. More specifically, further studies to identify which specific strains of B. cenocepacia may be more virulent, the mechanisms behind the virulence in such strains and investigations to tease out what host factors might influence progression of the infection in the CF population
should be a priority. Until then, we recommend the careful screening of all CF patients for BCC and excluding from LT those harboring B. cenocepacia, regardless of susceptibility profile.

That conclusion, and recommendation, was made despite the fact that the study was based on  a very small group of people with cenocepacia – 7.  Of those 7, 3 died of Burkholderia-related complications, 2 died of other transplant complications, and 2 were …alive.  The data of these 7 individuals was taken from groupings of people who were transplanted between 1992-2002, a time span that began 16 years prior, when many programs were just beginning to offer transplants, and ended six 6 years prior to the study’s date of publication.  The group of non-burkholderia CF patients used as comparison was a study of 59 patients.  9 cultured other forms of BCC, and as mentioned before, 7 harbored cenocepacia.

Being that there are so few studies on cenocepacia and their outcomes, and even fewer at the time the article was written in 2008, the conclusions drawn cast a wide net across the transplant community.  I personally was immediately removed from the transplant list at Brigham and Women’s.  I was upset, but it would still be a couple of years before the reverberations of this decision were truly felt, when I got much sicker.  For some, they were already being felt, and for others they meant the arrow pointing towards death was now certain.

This situation is a serious matter of ethics.

The blanket exclusion of one very small group of people from almost all centers, based soley on the organism that they culture, is ethically wrong.  Not only is the data presented about cenocepacia and transplant anecdotal and outdated, but the process of eliminating one very small minority group like this on that outdated evidence is directly in contrast with the typical “case-by-case basis” methodology of evaluating patients at most centers.

Transplant centers certainly must reserve the right to evaluate and accept, or reject, transplant candidates. But it should be on a case by case basis.

Where is the logic in being pointed in the direction of certain death, because the risk of possible death is too great in the other direction? Is that what lies at the core of medicine? Balancing risk, but to a fault?

To those who say “it’s a complicated issue,” I say, “It’s not, its a simple issue, with a complicated story.” At 33, I have end-stage CF that ends with certain, early death.  There exists a potentially life-saving surgery available, but because this surgery includes a risk of death, I am being denied opportunity for it by nearly every center in the country.  When a man is drowning, does the man on shore say “I can’t save you, we could both drown?” Sometimes he does and he has to live with himself, because that person will certainly drown without help.  This is even simpler than that.  No surgeon will die if I die, no doctor or caregiver.  Is my chance at a year, or two, or five at life, worth less than someone else’s? Who gets to ‘decide’ who uses organs “to the fullest?”  I challenge you to ask anyone who has had a transplant if they’d do it all over again even if they knew they would die after only a year, and you will hear a resounding, unanimous, YES.
UPMC Pittsburgh practices real medicine. This transplant team is not in the business of cherry-picking the candidates they deem most likely to survive, in order to improve their statistics. Instead, they accept high-risk, last-resort patients like me, in an attempt to save our lives. I am grateful to my team: my compassionate pulmonologist, Joseph Pilewski, and the brilliant surgeons, Drs. D’Cunha, Shigemura, and Hayanga.

—Caitlin O’Hara

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“It’s part of why the idea of souls makes sense to me. This place is just like a ropes course for souls. A learning center. It never changes and the collective body of humans can never sustain their progress too too much or else there is not enough to challenge the souls. Imagine all the people living life in peace ✌️ John Lennon – well that wouldn’t really work if you believe we need to be challenged to grow.”  —Caitlin O’Hara

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Christmas, 2012