Margaret Daugherty’s husband, Brian Younglove, has her back as she takes a walk at the VCU Pauley Heart Center. photo by Jay Paul
Margaret Daugherty's room is quiet. The constant churning noise from the portable machine that powered her artificial heart, the machine to which she was tethered for 223 days, is gone. The artificial heart is gone, too, replaced by the heart of an unknown woman, a donor about whom Daugherty knows little, except that she was a perfect match.
Daugherty also senses that she was someone who liked Labradors and spending time at the ocean. "The only thing I woke up wanting was a Corona and a lime, and a Labrador dog, and to be on the beach," she says with a smile, sitting up in an easy chair beside her bed at the VCU Pauley Heart Center. "Those were my impressions after I came to. A chocolate Lab and a yellow Lab were in my dream."
The fact that Daugherty woke up at all, that she's telling this story, is something of a miracle.
Before she received her artificial heart on Dec. 20, 2010, and before her heart transplant on Sept. 1, Daugherty had been close to dying from heart failure twice in her life. The first time, at age 25, the Army veteran had arranged for a funeral and a plot in the family cemetery before physicians determined she was a candidate for a heart transplant. Eighteen years later, when that transplanted heart was failing, plans were in motion for her to fly from Nashville, Tenn., where she was being treated, home to Lexington, Ky., for hospice care. Instead, after a series of phone calls between doctors in the U.S. Veterans Affairs system, Daugherty was flown to Richmond, where McGuire V. A. Medical Center surgeons partner with VCU 's cardiothoracic surgery division.
Since March, Daugherty has been living with her husband, Brian Younglove, and their 15-year-old son, Colin, at Richmond's Hospital Hospitality House while awaiting a donor heart. It was possible for her to leave the hospital because she participated in a clinical trial for the Freedom Driver, the portable device that powers the SynCardia-made Total Artificial Heart.
However, gall bladder attacks put her back in the hospital for surgery on Aug. 22 to have her gall bladder removed. Daugherty was still at VCU recovering from that surgery on Aug. 31, when she learned at 5:45 p.m. that a donor heart was available.
Dr. Vigneshwar Kasirajan, chairman of VCU's cardiothoracic surgery division, says the donor had a similar genetic profile, which the medical team compared with the antibodies in Daugherty's blood in what's called a cross-match. Finding a close match reduced the chance that Daugherty's body would reject the new heart. Kasirajan notes that McGuire's chief cardiac surgeon, Dr. Gundars Katlaps, procured the organ and participated in the transplant surgery.
After going through a plasmapheresis, a process that "washes" the blood of antibodies by separating plasma from blood cells, she was taken to the operating room at 11 p.m., Younglove recalls.
"The first incision was at 1:22 a.m. on Sept. 1," he says. With the surgery expected to last six to eight hours, Younglove left the hospital to get a little rest. When he returned at 5:20 a.m., he says, nurses directed him to Kasirajan.
"Nobody looked happy," Younglove says. Kasirajan told him that the transplanted heart inexplicably was not beating on its own, and that Daugherty was being kept alive on a heart-lung machine.
"At the end of surgery, everything looked good," Kasirajan says. The heart was beating, but its rhythm became irregular. "All of a sudden, the heart stopped working. We had no idea what happened. We assumed it was a rejection."
Kasirajan told Younglove it appeared unlikely that his wife would survive.Knowing how Daugherty felt about being on life support, Younglove told the surgeon, "You need to stop the machine because that's not what Meg wants."
After Kasirajan left, "I fell apart," Younglove says. He remembers thinking, "She's gone and there's nothing I can do."
But Kasirajan returned about five minutes later with a sparkle in his eyes and some astonishing news: The latest electrocardiogram reading showed movement. The heart was beating.
"He came back up and said, ‘All bets are off,' " Younglove says. "He didn't leave for a day and a half."
Daugherty wasn't out of the woods, though. Artery constriction (or coronary vasospasm) was preventing adequate blood flow to her new heart. But once it was clear that her body wasn't rejecting the organ, the spasm was fairly simple to treat with medication, Kasirajan says.
"It was touch-and-go for a couple of days," Younglove says. Daugherty was kept under sedation until three days after the surgery, when she opened her eyes and shook her head in response to questions from her husband.
"The most terrifying thing, when I finally woke up, was that from my shoulders down, I couldn't move," Daugherty says. "It was like being in a trench full of mud."
Since then, her progress has been slow but steady. "She made a dramatic recovery," Kasirajan says. "I'm still kind of amazed by the whole thing." He also credits the medical team's skill: "We had three cardiac surgeons, the whole ICU team, cardiologists. There were probably close to 100 people taking care of her."
Daugherty got her voice back about three weeks after the transplant surgery, when breathing tubes were pulled from her throat. By the end of October, she was able to walk down the hall using a walker.She was looking forward to her 45th birthday on Nov. 3 and making plans to go visit family and friends during the Thanksgiving holiday. "It's wonderful to be on the up-and-up," she says. "I'm punching my way out of here. I've got fly-fishing to do, family members to see … I've still got a long life ahead of me."