June 27, 2008

Team effort leads to success for young transplant patient

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Michael Nelson shares a moment with his daughter, Michayla, after her surgery. (photo by Neil Brake)

Team effort leads to success for young transplant patient

The surgical team transplants a new liver into Michayla Nelson. (photo by Neil Brake)

The surgical team transplants a new liver into Michayla Nelson. (photo by Neil Brake)

Before her procedure, Michayla Nelson plays doctor while Child Life Specialist Jaime Bruce looks on. (photo by Neil Brake)

Before her procedure, Michayla Nelson plays doctor while Child Life Specialist Jaime Bruce looks on. (photo by Neil Brake)

The Nelson family got the call of a lifetime at 9 a.m. on Tuesday, June 17. A liver had become available for their daughter, Michayla, 7, and they needed to come to the Monroe Carell Jr. Children's Hospital at Vanderbilt from their home in Lebanon as soon as they could.

“I felt my heart fall to the floor,” said her father, Michael Nelson. “I couldn't believe it was the day.”

It was a day they had been waiting for since Michayla was “listed” in January to get a liver transplant. After years of struggle, Michayla's badly scarred liver was giving out. At the tender age of 6 months, she had been diagnosed with a hepatoblastoma — a form of liver cancer. Surgery and chemotherapy saved her life, but her liver never fully recovered.

“In the last year, Michayla has had several life-threatening bleeds,” said Lynette Gillis, M.D., medical director of Pediatric Hepatology and Liver Transplant. “She would begin vomiting blood and her family had to rush her to the E.R. These episodes were incredibly frightening for Michayla and her family.”

After the call came, Rachel and Michael Nelson packed up a few belongings and Michayla's favorite white plush poodle and headed for the hospital with a daughter, who — on that day — looked and felt great.

“A lot of people who would meet Michayla couldn't believe she is sick,” said her father. “But this was the only way to save her life.”

In the hours before surgery, Michayla was surrounded by her mother, father, older brother, aunts and cousins. Doctors and nurses came and went, explaining what was to come.

Michayla was in good spirits, especially when the X-box wasn't being hogged by the boys, and after Child Life Specialist Jaime Bruce brought a doll that was nearly as big as she was to help explain the transplant surgery.

The doll, affectionately named Billy Rubin, had a tube in its chest, called a central line, and his front opened up to show where the liver was and what the scar might look like.

Michayla already had the scars to prove she'd survived the first round of surgery for a body that needed fixing. Today, with a liver that no longer could do its job, she seemed to be okay with going for round two.

But, of course, this was no ordinary surgery.

By 5 p.m., Michayla was rolled into the operating room, at that same time that the donor liver arrived to meet its match in the hands of transplant surgeon Beau Kelly, M.D.

The anesthesia team made Michayla comfortable with a warm, air-filled mattress, extra pads at each elbow and knee, and medications to lull her to sleep.

Nearby at the “back table,” Kelly, who co-directs the Pediatric Liver Transplant Program with Gillis, was bent over the pinkish-tan and plate-shaped donor organ, carefully sizing and preparing four crucial vessels: one artery, two veins and the bile duct.

“It's like landing the space shuttle, in the sense that so many moving parts have to work together within our team,” Kelly said.

Once the donor liver was prepared, the surgery to remove Michayla's diseased liver and replace it with the new one lasted about 3.5 hours.

“It was a true testament to the efforts of the team that the surgery went so well, but I'm most proud of Michayla. She has handled this so well,” Kelly said.

On the second day after her surgery, he came to see Michayla and she was up playing her favorite computer games. “I was overjoyed when I saw her,” he said.

Watching her patient spring back from surgery has been a pleasure for Gillis as well.

“It has been great, a fantastic team effort, and I am thrilled to be part of this,” Gillis said.

“And Michayla couldn't be surrounded by more people pulling for her; everyone has asked about how she is doing, it's a revelation to see how many people are watching her recovery.”

Michayla is doing very well. Her recovery has surprised even her parents.

“Right after surgery, in the recovery room, she understood questions I was asking her and reached out to me. That blew me away,” said her mother, Rachel, “Here she is now, sitting up and playing already. It's amazing.”

Michayla is not the first pediatric liver transplant patient for the new program. The first patient, an infant named Sarah Brimm, died several days after surgery.

“I think of her every time I do a transplant, whether it is on an adult or a child. I will never forget her,” Kelly said.

And there is still another family that will never be far from the Nelsons' mind: the donor family, of whom they know next to nothing.

“We thank them. We wish more people would consider donating. By giving your organs, you give life,” Michael said.