Beating the odds
age pregnancy, a heart transplant
and a high-risk pregnancy. And now,
Sarah Mack is a proud new mom!
When Sarah Mack, a heart transplant recipient, went into labor last November, excitement rippled through the team assembling at the Sacred Heart Birth Place. Her pregnancy was far from ordinary … in fact, her whole story is rather extraordinary.
Miracles have shaped Sarah’s life for nearly two decades. In 1990, while most of her 14-year-old classmates in Coeur d’Alene were enjoying their first year of high school, Sarah was too tired to care. That’s when her doctor discovered leukemia.
A regimen of chemotherapy began the very next day. Sarah lost her blonde hair during the first round. Two rounds later, a highly intense course of chemo was too much for her body to handle, and Sarah slipped into a coma. After a month, doctors gave up hope and suggested her family terminate life support. Then Sarah awoke.
Too weak for a bone marrow transplant, Sarah received a low dose of chemotherapy to keep the cancer from returning. By age 16, tests showed that her heart was dangerously enlarged from the chemo. Not knowing whether she would live or die, Sarah decided to take a path of her own, to experience as much as she could, as fast as she could. By 17 she was pregnant and faced a fork in the road that would take her down yet another winding path.
Cardiologists told Sarah her heart was functioning at just 11 percent of its capacity and gave her a one in 10 chance of surviving the delivery. A determined girl, she took the risk. She carried the baby to 28 weeks, when it had a reasonable chance of survival.
Faith was born April 6, 1993. Sarah immediately fell in love with the tiny 3½-pound baby who had changed the course of her life. Unfortunately, while Faith grew strong in neonatal intensive care, Sarah learned that the pregnancy had further weakened her heart and she needed a transplant … soon.
“I was scared to death when they started to talk about transplant,” Sarah remembers. “I’d meet all these people who were waiting for their hearts or had already received one and I just thought they were crazy.”
Sacred Heart’s transplant program had been up and running for just three years. The surgeons had never performed a transplant on a teenager, and donor hearts were in very short supply. Would they take a chance with a girl whose cancer might return? Would they trust her to make better choices in the future and follow the medical requirements after the transplant? Twice, the committee voted no. But Timothy Icenogle, MD, head of the transplant program, saw a new hope in Sarah, combined with a deepening faith and a love for her new baby.
He overturned the decision.
Less than three months later, the call came. There was a heart for Sarah.
“I couldn’t believe how much better I could breathe after surgery,” she says. “I had all this energy. All of a sudden, I was doing physical therapy so my body could actually catch up with my heart.”
Along with her new heart—a generous sacrifice on the part of an anonymous donor—Sarah received an unforgettable message from her doctors: “Your heart is a gift from God and you need to take care of it.”
And God did get Sarah’s attention through the dramatic changes her life would see over the next several years. She married Schon Mack, and together they raised Faith, while developing their own “faith” through church affiliations.
One goal remained for Sarah: she wanted more children. Unfortunately, when she received her heart transplant, doctors told her she could not risk the strain of pregnancy or childbirth, and her tubes were tied shortly after surgery.
Eight years later, cardiologists gave her the go-ahead to reverse the tubal ligation. And in the spring of 2007, Sarah and Schon spread the happy news: they were going to have a baby girl.
Nine months of cautious care
While Sacred Heart’s maternal-fetal specialists watched the health of both mom and baby during this high-risk pregnancy, cardiologists carefully monitored Sarah’s heart. The baby would be delivered by Cesarean section two weeks before her due date in early December.A comprehensive care plan was developed for the delivery of the Macks’ daughter. In mid-November, staff representing multiple specialty areas at Sacred Heart began working on the details for the big day, scheduled for November 26. Just in case Sarah went into labor early, a phone tree was developed to immediately notify the OB hospitalist, perinatologist, cardiac surgeons, the transplant coordinator, operating room staff, neonatologist and anesthesiologist. Plus, the Birth Place staff would need to alert the Cardiac Intensive Care Unit (CICU), where Sarah would be cared for after the birth, and the Neonatal Intensive Care Unit for the baby.
The care team also made arrangements for a private waiting room for the family, as well as Birth Place nurses who would transfer to the CICU to help care for Sarah. And of course, there was a care plan ready for the baby as well.
Sarah recalls thinking, “I don’t even know what a ‘hospitalist’ is!” She says, “I was not expecting all the extra care … but I felt really secure. I knew if I had an issue, they would know what to do.”
That draft of the care plan was completed on November 15. And that very day, Sarah began to have labor pains. While she and Schon made the one-hour drive from their home in Worley, Idaho, the team at Sacred Heart assembled.
Thirteen people—the Birth Place techs and anesthesia staff who normally attend a Cesarean section and the neonatal experts on hand whenever there is a high-risk delivery, plus the heart surgeon and operating room staff—were assembled in the cardiac surgery suite to ensure the best care for mom and baby. Thankfully, the delivery went smoothly, and relieved staff members joined the proud parents in welcoming a new baby girl into the world.
Baby Mack weighed in at 5 pounds, 15 ounces. She was born in the same cardiac surgery room where her mother was given a new chance at life by a heart donor 14 years before.
“Being in that room again was pretty special,” Sarah says. “But my favorite part was hearing the chimes ringing on the overhead system to announce her birth. How appropriate that her name is Melody.”
And reflecting on the whole experience, she quietly and thoughtfully says, “What special docs.”
Drs. Icenogle and David Sandler not only gave her great care when she got her heart, but they helped her with personal issues, too, during a challenging time as a new mom. It’s not surprising, then, that when she delivered her first baby post-transplant, Dr. Sandler, who had remained by her side, called Dr. Icenogle and dxclaimed, “We’re Grandpas!”
Sarah and Schon both agree that one more child, perhaps a boy, would be great. But in the meantime, they are cherishing every moment with their miracle girls. They even say it’s a joy to do those nighttime feedings with Melody.
The proud miracle mama says, “She has turned my world upside down.”
—Danita Petek
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