Fixing a Broken Heart: From Acoma Pueblo to Portland

The stark landscape where Miriam Salvador lives and farms. The prairie surrounding the mesa where she lives is at 6,400' elevation.

Life on the Acoma Reservation in northwestern New Mexico is rooted in tradition. After all, it’s one of the longest continually occupied communities in America.

But when Miriam Salvador found herself too exhausted to walk from her small farm back to her house on top of a 350-foot mesa, she knew her health was in danger -- her life was in danger -- and she needed outside help -- and fast.

“I couldn’t get rid of my cough and I was constantly tired, and I just didn’t know what was wrong,” says Salvador, a vibrant 78-year-old Acoma elder, who serves as head mother to all of her Eagle Clan. “Why am I so tired? Why can’t I just continue doing what I’m doing?”

Salvador’s niece rushed her to a hospital in Albuquerque, an hour’s drive from her home. Doctors there diagnosed her with a mitral stenosis, a hardening of the mitral valve. Blood was backing up in her lungs.

“I said, ‘What is a mitral valve? How do you fix it? What do you do with it?’” remembers Salvador.

Dr. Thomas Molloy, a heart surgeon at Portland Adventist Medical Center, explains:

“Oxygenated blood comes into [the left atrium], goes through the mitral valve, and in her case, the mitral valve didn’t open, so the left atrium becomes massively dilated,” says Dr. Molloy. “If that valve doesn’t open, obviously that’s not compatible with life.”

The mitral stenosis stemmed from Salvador’s childhood battle with rheumatic fever, a disease where the body tries to attack an infection from a rare strain of strep throat, and ends up attacking its own organs and tissues. The strain of strep that causes rheumatic fever is very rare, and these days is usually only found in Third World countries, and on some Native American reservations.

Salvador doesn’t remember even being sick.

“The doctors and everybody kept asking me, ‘Did you have rheumatic fever?’ and I said, ‘I don’t even know what that is!’” exclaims Salvador.

She asked her aunt, a nurse who’d been on the reservation for decades.

“I said, ‘Do you remember either an epidemic, or any of us kids were sick like that?’ She said, ‘I don’t remember anything like that.”

But remember or not, Salvador’s heart wasn’t working right. It had contributed to a stroke, and her life was in danger. Still, she didn’t want a doctor to saw her sternum in half and open up her chest to get to her heart and replace the calcified valve.

“My daughter and my son-in-law were talking to me about it. There’s another way to do this. Minimally-invasive,” recalls Salvador. “So we started doing research, looking on the internet.”

Salvador has two daughters who live in Oregon, and she’d planned to move in with them for a while so she wouldn’t be home all by herself. It was then that she and her family discovered the robot-assisted heart surgery department at Portland Adventist.

“We do minimally invasive valve surgery almost every day,” says Dr. Molloy. “We have the busiest robotic surgery program in the Northwest.”

Instead of needing to open up a patient’s chest to get to their heart, Dr. Molloy uses a machine developed, coincidentally, by one of his medical school classmates, Dr. Frederic Moll. The Intuitive Robot does the fine surgical work, but it’s guided by Dr. Molloy’s hand.

KATU asked Dr. Molloy if it was like a video game. He says he doesn’t play video games, so he can’t be sure, but:

“You actually have your hands at a console. You are playing off of a screen, so I guess it’s like a video game in that sense,” he smiles.

And in mid-August, Dr. Molloy robotically inserted a new valve made from bovine tissue into Salvador’s heart. Less than a month later, she’s walking and talking comfortably, and shows very little evidence of the lifesaving procedure.

“A few scars here on the right and up here on my neck a little bit,” she points out. They’re barely visible.

And she was out of the hospital in half the time it takes most open-heart patients.

“The biggest difference is the recovery time at home,” Dr. Molloy says, “because since there’s no bone to heal, we don’t have any restrictions on lifting when the patients go home.”

Salvador’s family had expected her to be confined to bed for a long time.

“My son-in-law bought trays so they could serve me in bed, but I didn’t have to be served in bed,” she says matter-of-factly. “I just got up and went to the table for dinner.”

Her family returned the trays to Amazon, unopened. Miriam was off pain medicine within a couple of days.

And she says she feels like herself.

“I’m totally surprised, because people kept saying, ‘Oh, you’re gonna feel so much better after surgery!’ because everybody thought I was going to have the open-heart surgery,” she says. “And I thought, ‘Wow, I really can’t believe that I’ll be feeling that well so soon.’ And I was just really surprised and amazed that I was able to get up and walk around.”

In the first week, she put her walker away. Another week or two, she didn’t even need her cane. Now, she’s chomping at the bit to get home.

“All my relatives there, they can’t believe what I’m telling them,” she says. “’We have to see you! We have to talk to you!’”

They’ll have to wait, but not for long. Miriam should be cleared to head home to her farm in a couple of months with a heart that now works the way it was intended to all along.

“I can’t say enough about Dr. Molloy and the people here,” she says. “They have been nothing but good and kind to me and my family.”

The experience has touched Dr. Molloy, too.

“She’s quite an interesting character,” he remarks. “I’m privileged to do surgery, particularly on patients that are so appreciative as Ms. Salvador.”

And Miriam says she’ll be taking what she's learned from this experience back home to the people on her reservation.

“I feel blessed, because coming from a Native background, we’re very spiritual people, and we pray often and we don’t just accept things because they’re given to us,” she says. “There’s got to be a reason.”

“Part of this has to do with my having to give back to my people, to my community, to let them know that there is another way possible. There are other ways possible,” she says. “And that there are people you can trust.”

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