Jamell Baca-Cazer, 38, opened the front door to her East Valley house, something she hasn't been able to do in months. She pushed her family's dog away from the door, tucked her long blond hair behind her ear and walked over to the couch to sit down. She seemed like a healthy, normal mother and grandmother. But underneath her shirt is a healing incision protecting a new pair of lungs that allowed her to celebrate Christmas with her family.
"It's like I got a second chance," Cazer said with tears in her eyes.
Cazer was diagnosed with idiopathic pulmonary hypertension, an extremely rare illness with unknown causes that affects the arteries in her lungs, six years ago. It has 50 percent mortality within about two years of diagnosis. Cazer was fitted with a pump that constantly injected her with medicine and she was also on oxygen.
"I was so used to always being out of breath," Cazer said despite the treatments.
The disease had sent her in and out of the hospital about four times a year, but in September, it wasn't a short stay.
Very quickly, what seemed a routine stay turned into a critical illness. Cazer's body started to retain fluid, which put a lot of strain on her heart, said Dr. Rajeev Saggar, her transplant surgeon. Soon, her heart, kidneys and liver were starting to fail.
The condition became so bad that the physicians treating her didn't think they could do anything for her. As a last ditch effort, her pulmonologist reached out to the doctors at St. Joseph Medical Center's lung transplant program where Saggar works, he said.
The program was started four years ago, a program that is unusual because the hospital is not affiliated with a university medical school, as many similar programs are, Saggar said. Before this program, people had to go to California to get lung transplants.
Cazer had tried to be considered for a lung transplant last January, but was told she wasn't sick enough, she said.
This time, she was too sick. While they knew she needed new lungs, she wasn't well enough to survive the surgery. The team from St. Joseph's transported her to the hospital in an ambulance, unsure if she would even survive the move, Sagger said.
"I had a feeling I could optimize the situation," Sagger said, believing that his training could help save Cazer's life. "Her chances of recovery were going to be a lot better than they looked on paper. We were willing to take the chance on her - otherwise she was going to die."
The transplant program had begun to take more difficult cases to help them learn how to treat even the sickest of patients, Saggar said, even if that means treating patients who have a higher risk of mortality.
First the doctors had to make her transplant ready, a time that Cazer barely remembers.
They took liters of fluids out of her body, allowing the stress on her heart to be reduced. "We told her it wasn't the best pair of lungs," Saggar said. "They were solid, but not the best."
On Oct. 27, Cazer finally had the lung transplant that would hopefully save her life.
In Cazer's case, the team took a proactive approach rather than a reactive approach when it came to her treatment.
The doctors assumed everything would go wrong, so they prepared for every medical failure.
They anticipated problems with Cazer's heart, and during the surgery, her heart failed instantaneously, Saggar said. They pumped about 30 units of blood into her.
"There were a lot of ups and downs," Saggar said, describing how Cazer's team of doctors, mother and husband Rudy sat by her bedside for 60 hours, not expecting her to pull through. But she did.
And every day she gets a little bit stronger.
She finally left the hospital on Dec. 6. With new lungs, her heart, kidneys and liver have returned to normal.
At first, she couldn't even reach her hand up to her face. Regaining strength has been one step at a time.
"I have to relearn how to breathe again," Cazer said, and while she breathes sharply and deeply, it's barely noticeable.
"Her voice gets stronger every day," said Jazzlena Baca, Cazer's 19-year-old daughter.
She's also able to walk when she goes to the store, instead of relying on the motorized carts like she did before the surgery.
"I don't get dizzy when I bend down anymore," Cazer said.
With her new lungs, Cazer hopes to live a more athletic life.
"I just want to run in the park," she said with a smile. "I want to hike. I want to travel."
She and her husband plan to take a trip to San Diego early this month. The way Cazer puts it, running and hiking are the next goals.
"I don't have any doubt that she will do just that," Saggar said. Many of his other patients who had lung transplants have trained for marathons or triathlons to take advantage of the second chance they were given.
So far, she hasn't shown any signs of transplant rejection, a good sign that the transplant has been successful.
While she won't live a "normal" life, since she can get sick at any time, it's a lot healthier than she has been, Saggar said.
For those who have lung transplants, living five years after surgery is beating the 50/50 odds, he said.
"Lung transplants are one of the most difficult," Saggar said. "They're not as robust as other organs, like heart or liver."
That being said, Saggar still remains positive about Cazer's chances.
"With a lot of medical work and a heck of a lot more luck, she'll live out a successful life," Saggar said.
It's a life that Cazer doesn't take for granted.
"This is probably the best Christmas I've had," Cazer said as she watched her grandson play. "The baby's finally old enough to enjoy it."
Cazer wants to make sure that the family of her donor knows how grateful she is for their gift.
"If you can save someone else's life ... what a legacy," Cazer said.
She intends to write the family a letter to be delivered one year after the transplant.
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