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Introduction

Stephanie Zimmerman was eight years old when she was diagnosed with Ewing's sarcoma, a rare childhood bone cancer that required aggressive treatment. The experience inspired Stephanie to pursue a career as an oncology nurse-practitioner, but it also wreaked havoc on her heart.

In her thirties, Stephanie discovered that the lifesaving chemotherapy and radiation treatment that she'd received as a child had damaged her heart tissue. The potential consequences were unknown. Although she and her husband, John, were aware that having a damaged heart intensified the ordinary risks of childbirth, they welcomed their son, Abel, into the world. Over the years, Stephanie felt that something was changing—she was experiencing fatigue at a new level. Her doctors found that her heart was not pumping efficiently. Too little oxygen-bearing blood was getting to her tissues.

When Stephanie was 38, her heart began to show signs of failing. She traveled from her hometown of Atlanta to Cleveland Clinic to have two of her heart valves repaired. The surgery was successful and relieved her symptoms. A few months later, however, her symptoms reappeared: intolerable fatigue, shortness of breath, and fluid retention. The damage to her heart had gone deeper than the valves. "The surgery had unmasked the fact that the chemotherapy drug I had as a child did damage to the left ventricular muscle," Stephanie recounted. "Once the valves were repaired, the damaged left ventricle could not handle the extra pressure, and I spiraled into heart failure."

After three months, her heart function had worsened, and she learned that if she did not get a new heart, she would die. A local hospital turned her down for a transplant, considering it too risky based on her complex medical history and recent surgery. Cleveland Clinic accepted her as a candidate for transplant, and two months later she was airlifted to the hospital with end-stage heart failure.

Dr. Randall Starling, section head of heart failure and cardiac transplant medicine at Cleveland Clinic, was on call when Stephanie arrived. He informed the family that she might live only a few hours and had to go on the transplant list immediately. Twelve hours later, they found a heart that was a perfect match. Cardiothoracic surgeon Dr. Nicholas Smedira performed the successful transplant surgery, which took nearly 12 hours. "When I woke up," Stephanie recalled, "I could feel the heartbeat, and it was so strong. Before the transplant, I couldn't feel my heart beating because it was so weak and inefficient."

Because of her compromised immune system, doctors had to keep Stephanie intubated for 42 days. Four large teams took care of her for more than a year, including heart, kidney, lung, and intensive care unit doctors, infection specialists, and a support staff of nurses, technicians, and physical therapists. There were hundreds of people in total.

"My team was huge," Stephanie said. "I watched ...

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