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Originally published April 1, 2022
Last updated September 30, 2025
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When Fernando Fleischman, MD, met Natalie Ciebrant, she had already been diagnosed with an aneurysm and seen physicians at two major hospitals. Despite the gravity of her condition, she couldn鈥檛 find a doctor who would treat her.
But within two weeks, Dr. Fleischman and the team at 喵咪社区 鈥� which includes the 喵咪社区 Comprehensive Aortic Center and offers 鈥� were able to bring Natalie back to the recovery room to begin the rest of her life.
Natalie is a Jehovah鈥檚 Witness, which means that she could not receive a blood transfusion and stay true to her faith. For many surgeons, this is beyond their expertise, but Keck Medicine offers a full program dedicated to providing patients with advanced care and without blood transfusions.
鈥淗ad I known that Keck Medicine has a program like this, they would have been my No. 1 pick,鈥� Natalie says.
In January 2021, Natalie was rushed to an emergency room in Upland with trouble breathing and high blood pressure. She was terrified because she was at the hospital in the middle of a pandemic surge and coronavirus precautions barred her husband Ray from going in with her.
After a CT scan, the surgeon told her she had a large aneurysm and needed surgery that very day. When Natalie explained that she couldn鈥檛 receive a blood transfusion and stay true to her faith, 鈥淗e threw up his hands,鈥� she remembers.
The surgeon told her that the procedure would be impossible without a blood transfusion and that she would die without it. He told his staff to get her blood pressure down and when she was discharged the next day, they told her to avoid salty foods.
鈥淭o be told you鈥檙e not going to live is the scariest thing,鈥� she says. 鈥淣o surgeon in my area could take this on.鈥�
When she received a referral to a surgeon who could repair her aneurysm without a transfusion, it took nearly three months just to get all the insurance approvals. In the meantime, Natalie鈥檚 circulation became extremely poor.
鈥淚 knew I was dying,鈥� Natalie says. 鈥淚 can take a lot of pain, but for almost a whole year, people told me my skin was blue.鈥�
Natalie finally was scheduled for an initial procedure with the other surgeon in April 2021, but because the surgeon was the only one at the hospital who could perform the procedure, it was canceled the day before, three times in a row.
鈥淚 wanted to give up,鈥� Natalie says. 鈥淚 had no energy. I said, 鈥業鈥檓 going to die. Just let me go.鈥欌��
But her husband Ray had no intention of letting her go, and in the meantime they learned about the transfusion-free program at Keck Medicine 鈥� a full, integrated program with staffers who are experienced in transfusion-free procedures.
The transfusion-free program was started 25 years ago with Jehovah鈥檚 Witnesses in mind. Initially, the program was for transplant recipients, but the program has grown to include a full range of surgical procedures, with caregivers who are trained for and experienced with transfusion-free protocols.
Ray called the manager of transfusion-free services at Keck Medicine, who had worked with many patients who are Jehovah鈥檚 Witnesses and was knowledgeable about their needs. He worked to get Natalie into Keck Medicine鈥檚 喵咪社区 Cardiac and Vascular Institute, where she could be seen by the clinicians at the 喵咪社区 Comprehensive Aortic Center quickly.聽
As it was, though, Natalie was exhausted. 鈥淚 couldn鈥檛 breathe. I couldn鈥檛 walk. I thought we had waited too long,鈥� she says. But the 喵咪社区 Comprehensive Aortic Center鈥檚 Sophia Lam, MSN, CNS, ACNP-BC, wouldn鈥檛 let her give up.
鈥淪ophia was like my little conscience on my shoulder,鈥� Natalie says. 鈥淚 was scared, but she kept saying that I could do this, and I was going to get better. She said I had such a good doctor, and that I would be all right. Everyone in the office was so wonderful.鈥�
When Dr. Fleischman, co-director of the 喵咪社区 Comprehensive Aortic Center and associate professor of clinical surgery at the , first saw Natalie, he knew it could be a challenging case.
But the center has a dedicated team of specialists who treat all aspects of aortic disease, including aneurysms and emergencies like aortic dissections. The center鈥檚 caregivers are used to taking complex cases from other institutions across Southern California.
Dr. Fleischman鈥檚 expertise allowed him to discover something the other doctors had not: Natalie鈥檚 aortic root was damaged. It was under pressure and pulling away from her heart, which was why Natalie felt like she couldn鈥檛 breathe 鈥� her condition was drastically reducing her blood flow.
Natalie鈥檚 case was serious, especially under transfusion-free constraints.
Dr. Fleischman is the best doctor! He told me, 鈥榊ou鈥檙e going to make it. You鈥檙e going to feel good again. Natalie Ciebrant, patient, 喵咪社区
Dr. Fleischman is the best doctor! He told me, 鈥榊ou鈥檙e going to make it. You鈥檙e going to feel good again.
鈥淗eart surgery is by definition a blood-intensive surgery,鈥� Dr. Fleischman explains. But he was also moved by Natalie鈥檚 story, which is typical of Jehovah鈥檚 Witnesses, who often get turned away from several hospitals before they are able to find advanced care.
鈥淚 knew she was high-risk,鈥� he says, 鈥淏ut I also knew that I have the skills and experience to do a procedure like this, and I have our whole program here to support me. Not everyone has that. If I turned her down, where was she going to go?鈥�
鈥淒r. Fleischman is the best doctor!鈥� Natalie says. 鈥淗e was so calm. He told me, 鈥榊ou鈥檙e going to make it. You鈥檙e going to feel good again.鈥欌�� Dr. Fleischman walked Natalie through the procedure and gave her an exact list to go through with her church elders to make sure every aspect was in line with her beliefs.
Natalie also completed a form with the transfusion-free services program so that she could make her wishes known about, for example, blood substitutes or products derived from blood components.
Physically, Natalie prepared for the surgery by taking blood builders, a bone marrow stimulant and a 鈥渃ocktail鈥� of iron, folic acid (vitamin B9), and vitamin B12 to raise her blood count and correct any anemia.
After her blood was optimized, Natalie鈥檚 blood volume was deliberately decreased to reduce potential bleeding. And then, Aug. 2, 2021, she was finally scheduled for her open-heart surgery.
Dr. Fleischman worked cautiously and meticulously, using surgical techniques to prevent bleeding and avoid the need for transfusion. He repaired the aneurysm and replaced Natalie鈥檚 aortic root with a graft. The procedure went well.
鈥淚 knew it was going well because there was no bleeding,鈥� Dr. Fleischman says, 鈥渂ut I waited 8 to 10 hours and checked in to make sure that her blood was flowing well.鈥� He was pleased with how the procedure went.
鈥淚 just remember waking up and I could breathe!鈥� Natalie says. 鈥淚 can take a deep breath and breathe the air. I can walk now.鈥� Natalie is back to work now, and she can enjoy her favorite pastimes: shopping, watching movies and cooking. Weekends are the best 鈥� she and Ray like to take a drive and enjoy the beach or a walk outdoors.
鈥淭hey saved my life,鈥� Natalie says. 鈥淚 had so much fear in me and everyone there put me at ease. They made me believe that I was going to live.鈥�
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