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George Caceres' smile is contagious. Just ask his Mayo Clinic care team, who came to know him well during his 165-day stay after a liver transplant.
"He was so pleasant to visit," says Lyda Velez, his case manager. "Even on days when he didn't feel well and didn't take off his [sleep] mask, he would give us little fist bumps."
George arrived at Mayo Clinic in Arizona on Dec. 8, 2019, for preliminary appointments for liver disease. He never imagined he wouldn't return to his home in Portland, Oregon, until halfway through 2020.
"George was one of the sickest patients we have seen," says Bashar Aqel, M.D., a transplant hepatologist who oversaw George's care.
George was fortunate to be in the right place at a difficult time.
In hindsight, George says he underestimated how ill he was. Before his transplant, he endured a nearly three-hour morning routine getting ready for work because he would become fatigued and need to rest among the tasks of showering, getting dressed, eating breakfast and letting his dog outside.
"Basically my organs weren't getting sufficient oxygen," Caceres says. "I was consistently short of breath. I could barely walk a block without feeling like I was going to pass out. Doctors asked me, 'How can you function on 40% oxygen?' I didn't realize how bad off I was."
George was diagnosed with severe hepatopulmonary syndrome, a rare complication for someone with advanced liver disease, according to Dr. Aqel. "Sixty-two percent of the blood was bypassing the lungs," he says.
Other places wouldn't have taken his case. We had the team and the resources to make him well.Bashar Aqel, M.D.
George was placed on the transplant waiting list on Dec. 24, 2019, and underwent a liver transplant on Dec. 31.
"We got lucky because he qualified for extra MELD (Model for End-Stage Liver Disease) score points," Dr. Aqel says.
But the short turnaround for surgery belied what was in store.
"Hepatopulmonary syndrome doesn't reverse itself immediately," Dr. Aqel says. "That was the reason he was in the hospital for the first few weeks. He was slowly getting better."
But as George was recovering, he started to complain of headaches with increasing frequency. This triggered a CT scan of his head that confirmed a pituitary tumor. George was rushed to surgery to remove the tumor, which was benign but was causing serious compression on vital structures in the brain.
After surgery to remove the tumor, George's oxygen levels improved slowly, Dr. Aqel says. It became a matter of time to get him stronger.
Then coronavirus struck.
Close friends from Portland had traveled to be George's caregivers, helping with meals, administering his medications, filling his oxygen tanks, accompanying him to medical appointments and providing companionship. But when COVID-19 visitor restrictions were enacted in March, George was alone in Arizona, with his friends, family and support network 1,300 miles away in Portland.
George says he came to appreciate the safety protocols imposed by the COVID-19 coronavirus pandemic, however.
"I realized I'm in such a fragile state," he recalls. "I'm one of the most vulnerable people here, but I'm in the safest place I can be."
I realized I'm in such a fragile state. I'm one of the most vulnerable people here, but I'm in the safest place I can be.George Caceres
George says he didn't feel alone because the Mayo staff on his floor became his adopted family. He went as far calling Maria (MJ) Cook, a transplant/medical-surgical nurse, his second mother when he nominated her for a Daisy Award for outstanding nursing care.
"I honestly feel that her continuous care helped me get through this," George wrote in the nomination. "My mother passed away 3.5 years ago, and I truly believe M.J. was placed in my life as a second mother. Thank you, M.J., from the bottom of my heart."
Cook was one of his first nurses when George transferred from intensive care, and she cared for him after transferring from different hospital floors during his lengthy stay. Fittingly, she was the nurse who discharged George on his last day at Mayo.
"I was his mama bear," Cook says about caring for Caceres for nearly six months.
Dr. Aqel says George's resiliency despite the numerous setbacks during his recovery was inspiring.
"Even when he was extremely ill, the team always heard appreciation from George. It just made my day," Dr. Aqel says. "He always had a smile on his face. You enjoyed going to his room and seeing his positivity."
Dr. Aqel says the seriousness of George's illness cannot be overstated.
We were his only chance. He was willing to be on this journey.Bashar Aqel, M.D.
"Other places wouldn't have taken his case," Dr. Aqel says. "We had the team and the resources to make him well. Mayo Clinic is one of the few places where this can happen. Other places would say he's too ill, we can't do it."
George's determination to get well can't be overstated either.
"We were his only chance. He was willing to be on this journey," Dr. Aqel says. "Even with his complications, his resiliency made his case a success."
George's room number was West 5E86, but to everyone who worked there, it was better known as "the party room." It was festively decorated for Easter and later, Cinco de Mayo, since the staff wanted Caceres to feel at home as much as possible.
Velez remembers George "was such a foodie. He loved everything. He would order from restaurants ― Vietnamese, Thai, Salvadoran, Filipino, food from all over the world," adding that she would bring him Colombian cuisine to sample.
Cook says every turning point was celebrated. "I remember the little milestones, like putting his compression socks on by himself and the first time he could walk one whole lap around the unit," she says.
But the best party was saved for his final day, on June 13. The staff ordered a cake and presented George with gifts of clothes, a duffel bag and a memory book.
We all want the best for our patients. It was so touching to see everyone come together medically, emotionally and in every other way.Lyda Velez
"It's important to know that the whole team came together to support him," Velez says. "We all want the best for our patients. It was so touching to see everyone come together medically, emotionally and in every other way."
As George left his room for the last time, staff lined up on both sides of the hall, clapping and cheering as Cook escorted him out in his wheelchair.
You can watch the staff's farewell in this video.
"It was such a surprise," George says. "I wasn't expecting it at all. I started to cry. I'm starting to cry right now, thinking about it again."
George, who worked for a social services program at an elementary school until he became ill, has returned to college for a degree in elementary education. He's also considering pursuing a graduate degree in education leadership.
Known as "the Godfather of Salsa" in Portland, where he's taught dance for 20 years, including 10 years as artistic director of Sabor Latino, George hasn't returned to dance instruction yet. But he's undergoing physical therapy, and he recently was able to stop using supplemental oxygen.
"I'm taking it one day at time, but I feel like a new person," he says.
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