Agnes Doolittle is breathing easy these days.

She’s fond of sitting on the porch swing at her farm in Stanton, Michigan, watching the hummingbirds and orioles swoop in and out of her flower beds.

But there were plenty of times her family doubted they’d have her home again.

In February of 2019, doctors at Spectrum Health diagnosed her with the early stages of idiopathic pulmonary fibrosis. Her mother had also had it and she lost her brother to the illness just the year before. But she had relatively few symptoms.

Then, in the summer of 2020, Doolittle contracted COVID-19, leading to severe pneumonia.

That put her in the hospital in Alma, Michigan. While doctors pronounced her well enough to go home after a week, the virus worsened her underlying condition.

“I had never had trouble breathing before I got COVID,” Doolittle said. “But by the time they sent me home, I needed supplemental oxygen.”

Back on the farm, she tried to keep up with her husband, Ladd, and the chores. She struggled to stay in pace with their large family.

When her 68th birthday came in mid-August, things had grown difficult.

“I had to admit I wasn’t doing too well,” she said. “It was tough to breathe.”

But her granddaughter had planned to get married at the farm on Aug. 21. Nothing, Doolittle said, could get in the way.

When her daughter arrived to help get ready for the event, she could see Doolittle struggled to get enough air.

“She called my pulmonologist, who said I should go to the emergency department,” Doolittle said.

So she did—but not until the last of the food had been served to the wedding guests.

“Then I changed my clothes and off we went to Spectrum Health in Greenville,” Doolittle said.

Losing lung function

Agnes remembers the first three weeks. At first, she seemed to improve, Spectrum Health transplant coordinator Jennifer Hartman, RN, CPTC, said.

“We had already completed the initial stages of preparing for a lung transplant,” Hartman said.

Doctors transferred her to Blodgett Hospital for rehab, and Agnes recalls the exciting moment on Sept. 12, when she learned the transplant team had a pair of lungs.

But those turned out not to be usable, a fairly common event in lung transplant cases.

Things quickly got bleaker. By Sept. 15, she needed to be placed on a ventilator, and by the following day, she deteriorated further.

“She had a sudden decline and went immediately to the intensive care unit at Butterworth Hospital,” Hartman said.

By the morning of the 17th,  Agnes struggled so much to breathe that the team called Ladd to tell him the ventilator wasn’t enough. They needed to put Agnes on a machine called ECMO, short for extracorporeal membrane oxygenation.

Details of those days are hazy in her mind.

“But even when she was in the coma, the nurses would say, ‘She can hear us.’ I’d be holding her hand and she would squeeze it,” Ladd said. “It was emotional and great to know she could respond to me.”

Doolittle has foggy recollections of emerging from the coma, “like I was trying to climb out a deep dark hole.”

“But I do remember them waking me up on the morning of Sept. 19, and telling me they had new lungs for me,” Agnes said. “And I remember being wheeled into surgery.”

Staying strong

Marzia Leacche, MD, the cardiothoracic surgeon who put Doolittle on the ECMO machine and performed the transplant, said her case is exceptional in several ways.

Traditionally, people 65 and older aren’t considered candidates for lung transplants.

Doolittle had just turned 68.

“But that’s never been our policy at Spectrum Health,” Dr. Leacche said. “We look at each patient as an individual.”

Second, anyone sick enough to need an ECMO machine is gravely ill—thus, high risk for transplantation.

“But before we went into the operating room, we evaluated her,” Dr. Leacche said. “And she was considerably stronger than we expected, despite being very ill.”

While the Spectrum Health lung transplant team has performed the procedure more than 200 times, Doolittle’s procedure marked the first time transplantation was used in a case involving COVID-19 at Spectrum Health.

It’s one of only a handful of such cases in the U.S.

“The ECMO indeed made her a higher-risk patient,” Dr. Leacche said. “But she has done extremely well.”

Post-surgery challenges

Doolittle has been pleased with her progress. Her care team at Spectrum Health is impressed with her diligence in keeping up with the demands of post-transplant life.

Few people realize the challenges, such as the bewildering regimen of anti-rejection drugs.

“Agnes is on many medications,” said Megan Gates, RN, lung transplant coordinator at Spectrum Health.

“These are important because rejection can happen, especially in the first six months,” Gates said. “There can be different ways to prepare the medications and multiple different times during the day to take the medications. It’s a lot to stay on top of.”

Through it all, Doolittle has been a consummate good sport.

“We appreciate how matter-of-fact she is,” Gates said. “She’s an ideal patient.”

There are restrictions. Doolittle isn’t allowed to garden, since digging in the dirt creates a risk of infection.

She has given away her houseplants.

While she still gets winded sometimes, she feels better all the time. And she and her entire family are thankful to the donor’s family, and the lungs that now keep her alive.

Three other grandchildren got married recently. She got to be there for it.

“We have two baby showers coming up, too,” Doolittle said, “for two new great-grandkids on the way. I’m so glad I’m still around.”