Gift of Gratitude: Woman returns to cherished horses after cancer and transplant at Mayo Clinic

By Mayo Clinic staff

Let’s start at what should be the end of this story. Paula Quinn died on May 21, 2020.

“It was a pivotal moment,” says Rohan M. Goswami, M.D., an advanced heart failure and transplant specialist at Mayo Clinic. “She holds a special place in my career because she was somebody who we learned a lot from.”

Paula already had a complex health history — leading-edge treatments from a clinical trial had cured her aggressive cancer but caused a rare complication that damaged her heart and eventually caused her to require a transplant.

“In the operating room, she passed away,” Dr. Goswami says. “And the team worked very hard to resuscitate her. We had to make a decision on the fly — do we think she would survive the transplant?

“Our surgical team, our medical team, our anesthesia team all came together and felt that she was sick enough to take that risk to continue to pursue that transplant. And we were confident that we would be able to manage any complications that came after.”

After the team worked to resuscitate Paula, the surgery continued. The results were better than anyone expected.

“She actually did great,” Dr. Goswami said.

Eventually. But her journey wasn’t quite over.

Timeless Moments

If there’s one place that holds a special place in Paula’s heart — it’s the stables.

“I think that most people have something in their life that gives them a sense of peace and a sense of connection,” she says. “And that's what I feel with the horses, especially in quiet times when there's not a lot of action in the barn on cold days. You can see their breath and just hear the small noises they make in the stall, the way they greet each other, the way they greet you, just walking through the barn.

“You see the sunrise and the sunset with their lives; the beauty of seeing the green grass and the mist across the pastures and seeing the horses run across the pasture with the little babies running behind.

“It's just peaceful. And there's a connection with the world and nature that I just find comforting. I love it.”

Paula and her husband, Jim, of St. Augustine, Florida, invested in horses in 2004 and did a little bit of everything — breeding, show jumping, racing and more.

“Paula is just brilliant,” Jim says. “She has an absolutely brilliant mind, and she is a loving, kind and just gracious woman. I was very fortunate to marry up as far as I did.”

Life was good until 2011, when Paula developed an unexplainable rash and fatigue that wouldn’t go away. She and Jim thought maybe she had pneumonia. Instead, the hospital sent in the chaplain to talk to them before a doctor delivered a diagnosis.

“I asked Jim after the chaplain left, ‘Why did they send the chaplain in?’”

“Oh, they just do that,” Jim replied.

“They didn’t do that when I broke my toe,” Paula quipped at the time.

The subsequent news would send them into despair. Local physicians determined Paula had an advanced, aggressive form of non-Hodgkin’s lymphoma.

To determine exactly what kind of cancer they were dealing with, her local care team sent Paula’s samples to Mayo Clinic in Rochester, Minnesota, for evaluation.

“I looked at Jim and said, ‘If they have to send the sample to Mayo to figure out what it is, I want to be treated there,’” Paula remembers.

Saving Paula Once

Paula called Mayo Clinic in Jacksonville, Florida, and received an appointment with hematologist James M. Foran, M.D.

Dr. Foran recommended a clinical trial that Mayo Clinic was leading. The clinical trial wasn’t without risks, including a rare complication — chemotherapy-induced cardiomyopathy.

“We discussed that with Dr. Foran, and he said, ‘I hate to say this, but let’s hope you live to have heart failure, because the consequences of not having the treatment is that you will die,’” Paula says. “And so, when you put it like that, that becomes a secondary problem.”

When Dr. Foran first met Paula, he was immediately concerned because she had a very large mass in the center of her chest, compressing her heart, along with blood markers that showed aggressive features of non-Hodgkin’s B-cell lymphoma.

“We had just opened a clinical trial led by my colleagues at Mayo Clinic in Rochester. Hematologist Grzegorz S. Nowakowski, M.D., wrote the study, giving intensive chemotherapy with curative intent, but adding an additional agent to it,” Dr. Foran says. “We were worried we may not have gotten Paula into complete remission, but we did.”

However, Paula was unlucky — somewhere around 2% of patients can develop a heart side effect of chemotherapy.

“When it was discovered Paula had this heart problem caused by the chemotherapy drugs, Dr. Foran was devastated,” Jim says. “He was weeping with us. There's just no other way to describe it.”

As the first integrated, multidisciplinary medical practice in the world, Mayo Clinic not only is an elite institution for cancer care through the Mayo Clinic Comprehensive Cancer Center, but also has one of the top cardiology programs and transplant programs in the world.

“Paula was initially sent to us in 2015 for consideration of transplant by her cardiologist, Leslie T. Cooper, M.D.,” says Parag C. Patel, M.D., chair of the Division of Advanced Heart Failure and Heart Transplant at Mayo Clinic in Florida. “With medical therapy and with an improvement in her lifestyle, she actually was able to feel better despite having a weak heart.”

Paula also acknowledges she had “delusional” hope that powered her.

“When I was first diagnosed with the diminished heart function, I knew there are some cases where it does rebound, so I was sure that it would rebound. And after a certain time passed and it didn't, I still thought it would get better,” Paula says. “There was a period where my heart function did get better, and it was to the point where I could have lived with that.

“But my niece who is a physician assistant for a transplant surgeon kept counseling me that it was not going to get better. There were only two outcomes — death or a heart transplant.”

While spending time at the barn in 2017 and 2018, Paula noticed things were getting worse. Her ability to do what she loved diminished to the point she could only ride a small pony named Cowboy.

“He was a lot of fun. But he grew too old to ride in 2018. And when that happened, I thought I would never ride again,” Paula says.

Jim realized that changes were ahead too. Paula began staying more and more at the hospital in Jacksonville as her health declined, and Jim would drive home alone to St. Augustine.

“One night in July 2019 I came to the realization that I was going to have to begin praying for the donor family,” Jim says. “I just began weeping uncontrollably and pulled into the rest stop until I was able to get myself back together again. And to this day, I mean, I still do that every morning when I read my Bible and every night before I go to bed. I think about them and our life.

“I understand how close we came to Paula not surviving. And I cannot imagine the devastation of the family that lost their loved one.”

Saving Paula Twice

Mayo Clinic doctors placed Paula on the list for a transplant in January 2020. By March, she was running out of time — and each opportunity for a transplant yielded a heart not quite right for her. She was admitted to the hospital late in April 2020.

“When you see patients like Paula starting to lose muscle mass and having difficulty taking a shower, in my mind, it is almost too late for us to think about transplant,” says Dr. Patel.

Paula says that by mid-May she felt close to dying. She dwindled to just 85 pounds.

“I read someplace that a grateful heart is a magnet for miracles,” Paula says. “And I believe that. In the hospital, waiting for my heart, I was thankful every day for the nurses and for the beeping that was keeping me awake — from the machines to the doctors.”

On May 21, 2020, Paula was wheeled into surgery. And just before the transplant began, her heart stopped beating.

Warmth and Comfort

Awake. That’s the next thing Paula recognized.

Intubated, Paula couldn’t feel the beat of her new heart, but the monitors clearly showed her it was vibrant and active. The next sensation was just how good she felt for the first time.

“Instead of being cold, I felt warm,” she says. “You can feel that your face is flush. You have color, and it’s immediate. It’s immediately like you’re a different person.”

Says Dr. Goswami: “I remember talking to her afterward in the hospital, joking with her, ‘If you really wanted all that attention, you didn’t have to be all that dramatic.’

“I can laugh about it now with Paula.”

Reflecting, Paula and Jim feel a deep sense of gratitude rooted in their faith.

“I feel like I have a second life,” Paula says. “Paula 2.0, we sometimes call it.”

The Anonymous Giver

For Mayo Clinic teams, there is always someone next as the organization fulfills its primary value daily — the needs of the patient come first. Sometimes, the knowledge that patients are waiting for care or pass away during treatment or awaiting a heart transplant challenges even the strongest teams.

One day a letter showed up for Dr. Patel.

“It stated somebody had given to Mayo Clinic in honor of our team,” Dr. Patel says. “We go through this day in and day out, pushing to fight for our patients. It really is touching for our entire team, to say the least, to hear that people are contributing on behalf of what we've done.”

The gift came from a charitable organization the Quinns were active in establishing and have volunteered with over the past 20 years.

“They wanted to honor me and thank Mayo for the part they had played,” Paula said as she choked back tears. “Jim and I realize how we've been blessed, and we are very grateful that the organization decided to make a contribution to Mayo because those funds not only will help support ongoing infrastructure and staffing, but also ultimately will benefit someone in a situation like mine.”

Riding Again

After the transplant, Paula got stronger and healthier. And she began spending more time at the stables.

Still, she was nervous being around horses, living in fear of heart failure and the potential to be seriously hurt or sick again. When asking for a small bit of advice from Dr. Goswami about being near horses, he told her something else — she could ride again.

“I can ride?” she queried, surprised.

“I thought you would have already done so by now,” Dr. Goswami replied.

The thought stuck in her head, but surely she couldn’t. When she relayed the story to Jim, he asked her if she wanted to do it. And Paula wasn’t quite sure. She put the thought aside. She hadn’t ridden in years. There were too many unknowns. Too many “what ifs.”

But then, her niece’s two young sons asked about going to a barn to ride a pony. So Aunt Paula dutifully arranged a riding session.

“When the little boys got off riding the pony, I said to myself, I’m just going to get on.”

She faltered. Again, doubt flashed through her mind. Would she be strong enough to get on? What about getting off? The safer thing was not to ride. To leave instead and go back home to Jim.

But those horses — those beautiful, magnificent creatures — remained an irresistible draw.

She came back to the barn a few days later and talked to Ryan, the man who trains and rides her show horses about her desire to ride a horse nicknamed Vali that he had been working with.

“Do you think it would be safe?”

He nodded.

Vali was the perfect horse at the perfect time. After Ryan finished with Vali for the day, Paula put her hands gently on the peaceful animal.

Then she mounted Vali’s smooth leather English saddle, and they moved forward together, as the tears rolled down Paula’s cheeks.

This story was originally published in Mayo Clinic Magazine.