Eastpointe — Destinee Hayes is alive and home.
Neither was a given as the 14-year-old survived an illness so severe that she remained on a ventilator in a coma for two-and-a-half months and required at one point an extracorporeal membrane oxygenation machine, known as ECMO, to pump her blood outside of her body to a heart-lung machine to sustain life.
But exactly six months to the day after her admission to DMC Children's Hospital of Michigan, here she was Thursday: surrounded by loved ones who burst into tears of joy that their Destinee was not another victim of Multisystem Inflammatory Disorder in Children, known as MIS-C — a rare and potentially fatal condition that occurs only in children who've had COVID-19.
"I'm happy because I'm home," the girl explained after her arrival.
Those words were cause for celebration of a joy rarely seen this year. Her mother, Jaquinta Breham, brought her daughter to the emergency department with a high fever, neck pain and a cough early on New Year's Day. Just days earlier on Dec. 29, Breham took Destinee to be vaccinated, but the teen was unable to get the shot because she was running a fever.
Destinee was admitted to the pediatric intensive care unit on Jan. 2.
"They told us she wasn't going to be able to speak because she had a massive stroke, she had two brain surgeries, she was on dialysis, she flat-lined for 14 minutes," said Jaquinta Breham, her mother. "And we're talking about a kid who was healthy, my daughter was so healthy."
Dr. Ajit Sarnaik, a pediatric intensive care physician who treated the Eaton Academy eighth-grader at Children's Hospital on the Detroit Medical Center's Midtown Detroit campus, said Destinee had severe trouble breathing when he first examined her and was suffering kidney and heart failure.
"She had a very high fever and rash, and difficulty breathing that was specific to her poor heart function," Sarnaik said.
Her condition quickly went from bad to worse, and she was placed on a ventilator. Then came the ECMO machine.
"The big monkey wrench in all of this is that she had a massive brain bleed, which is a complication of ECMO — because in order to put someone on ECMO you have to really severely thin their blood, which can cause bleeding," Sarnaik said. "That and the fact that she had a cardiac arrest — that's why she was in a coma for a long time after that."
Courtney Wagner, a Children's Hospital of Michigan occupational therapist who began working on Destinee's recovery when the teen was still on a ventilator and in intensive care, said her fight and recovery have been remarkable.
"It's been amazing to see the progress that she has made," said Wagner, who came to Destinee's room to bid her farewell Thursday morning, jokingly asking the girl if she would please stay at the hospital, to which Destiny replied "No."
"There was no response to anything (early in Destinee's recovery)," Wagner said. "And to see her communicating — it's amazing."
Moments later, dozens of doctors, nurses, rehabilitation therapists, family members and friends erupted in cheers when Destinee appeared in the hospital's lobby with her mother, ready to go home.
"We've probably had more than 50 (MIS-C patients) who have survived — and this is by far the sickest patient who's survived," said Sarnaik, noting there have also been "one or two" MIS-C deaths at the hospital.
"You can't get any sicker than needing ECMO, the heart-lung bypass, which is what she required."
She suffered from a disease that nearly 300 children in Michigan have been diagnosed with during the pandemic, according to state data.
According to information on the Michigan Department of Health and Human Services' website, MIS-C affects children and adolescents younger than the age of 21, causing multiple organ systems to become inflamed or dysfunctional. Children with the condition may have a fever or a variety of symptoms, including abdominal pain, vomiting, diarrhea, neck pain, rash, bloodshot eyes or feeling extra tired.
Telltale signs of MIS-C
Like many children who come down with MIS-C, Destinee didn't test positive for the coronavirus in January, but she'd been ill with COVID-19 in November, the doctor noted.
"She actually did not test positive for COVID but had had the infection earlier," Sarnaik said. "That's what we see with the multisystem inflammatory syndrome in children — they have COVID remotely several weeks prior and they get over it, but then they get this inflammatory syndrome that's related to COVID.
"You think you've gotten over COVID, and COVID usually doesn't cause really bad things in children as it does in adults. But this is a totally different thing that is not seen as often in adults."
Researchers with the federal Centers for Disease Control and Prevention conducted a study published last year in JAMA Pediatrics that found in more than 1,000 cases, 75% of the patients did not experience coronavirus symptoms. But two to five weeks later, they became sick enough to be hospitalized.
Sarnaik said MIS-C has some similarities with Kawasaki Disease, a condition that causes inflammation in the walls of some blood vessels and is found mostly in infants and young children. It can also resemble toxic shock syndrome, a rare but life-threatening complication associated with some bacterial infections. But it's not the same.
"It's unique, and the world has only seen this the last two years," Sarnaik said.
Michigan had 299 cases of MIS-C from April 24, 2020, through May 4, according to Michigan health department data. The children range in age from birth through age 20, with 192 children or 64% of the cases being admitted to intensive care.
Fewer than five of the children died, according to state data. The state won't be more specific due to privacy concerns.
"We do not yet know what causes MIS-C. However, many children with MIS-C were infected with the virus that causes COVID-19, or had been around someone with COVID-19," the state health department says on its website.
Nationally, there have been 8,525 MIS-C cases with 69 deaths, according to the CDC. The median age of patients with MIS-C has been 9 years old.
'It really was a miracle'
Following Destinee's brain bleed, Sarnaik's prognosis for her was poor. She remained in a coma for more than two months. Then suddenly, one day, Destinee woke up.
"She wouldn't follow commands, she couldn't even regulate keeping her body still. She has these kinds of spastic movements of her extremities. She wouldn't know that her mom or dad were there. She couldn't talk. ... She wasn't even breathing, and it wasn't just her lungs that were the problem," Sarnaik said.
"We take care of a lot of children with brain injuries, and the longer period of time that goes by without really waking up from the coma, the less likely it is for them to recover.
"You won't hear me or many other doctors say this, but it really was a miracle, the likes of which I have never seen in 13 years or so of doing this. It was almost like out of a movie or a TV show, where she just all of a sudden snapped out of the coma."
Sarnaik credited Destinee's steady recovery since she awoke from her coma to the girl's determination, and the strong support of her family, including her mother, father, Albert Hayes, and many siblings, cousins and other family members.
Getting ready for her discharge on Thursday, Destinee was sassy and sweet, calling her occupational therapist "baby" as her mom and sister-in-law fussed over her hair.
Breham noted her daughter was one of the top students at Eaton Academy in Eastpointe, and officials have decided to promote her to the ninth grade, despite her time away from the classroom.
Friends and family attended a welcome home party at Destinee's home on Thursday, along with members of Peace & Goodwill Baptist Church in Harper Woods, which the family attends.
"Her spirits go up and down because she wants to walk again," the mother said. "It is our belief and our intent and she will. We're going to continue to persevere with her through this whole journey — and I don't just call it a journey, I call it a victorious journey.
"She is the most humorous, delightful, sweet, loving, smart, energetic child that you'd want to meet. And she's ready to come home and be with us."