We are so excited to announce that after nearly 10 months of being out of the office, our Managing Partner, Megan Harrington-Johnson (aka. “Mighty Mack’s Mom”), is back in the office and back to work full time! Mackenzie, who has been fighting cancer for the past 10 months is currently in remission and doing so well after undergoing a Bone Marrow Transplant in January, that her doctors have given Megan and her partner Bronson the all-clear to return to their offices!

We have missed Megan a lot and are delighted at Mackenzie’s progress and so we asked Megs to give us a brief breakdown of what she has been through with Mackenzie over the past year and also to provide an update as to her progress. This is what she had to say:

“On Saturday 8 May 2021, our lives changed forever, when our 4 month old little girl, Mackenzie, woke up slightly miserable and with a bit of a temperature – she was diagnosed with cancer only 2 days later. Little did we know that we would be living with her in the hospital for the better part of the next 10 months: only being able to return to work and “normal life” on 28 February the following year.

That Friday, 7 May 2021, had been like any other normal day - I had gone into the office after dropping Mack at my in-laws for a sleep-over so that I could do an early morning Mountain Bike ride (my first since falling pregnant with Mack), the next day. I loved being back on my bike and when I left the race I called my mother-in-law, Colette to say I was en-route to fetch Mackenzie. Colette told me that Mack had woken up a bit miserable and that she thought she might have a temperature. I wasn’t too worried and thought maybe she was just teething, but took her to our GP, Dr Colin Kahanowitz, anyway. Colin couldn’t see anything wrong with her aside from the temperature of 38 and told me to just watch her overnight and bring her back in the morning if we couldn’t break the temperature. That night her fever got quite bad, but by Sunday morning 9 May 2021, (my first Mother’s Day), it seemed to be much better. Despite this, after going for our Mother’s Day breakfast, something told us to take her back to Colin. On noting that she still had a slight fever Colin suggested that we take her to see the on-call paediatrician at Sandton. His exact words to us were “I cant see any signs of infection but something is just not sitting right with me”. We went straight to Sandton clinic and were checked in for “cautionary bloods” to be taken.

On Monday morning, the 10th of May, our paediatrician, Dr Dance, came into our room, closed the door and said “Mommy and Daddy, please come and sit down, I need to show you something on Mackenzie’s blood results”. Without even thinking I responded asking if it was Leukemia and she said “How did you know”. In that moment our world came crashing down. I don’t remember much of the rest of this conversation but what I do recall is we were told that we needed to get her into the Donald Gordon Oncology Unit to start chemo as a matter of urgency. We were moved to DG the next day, more tests were done and it was confirmed that she was suffering from Acute Myeloid Leukemia with a genetic subvariant called MLL M5. We soon learned that of the various types of Leukemia this was one of the worst that you could get and it meant that in order for her to have a chance at survival she would need a Bone Marrow Transplant (for which we needed to find a donor as neither of us were matches). First, however, we had to start chemotherapy as a Bone Marrow transplant cannot be done unless a patient is in remission – our doctors also warned us that with her particular variant of AML, remission would be very hard to achieve and as she was so small it was very possible that the required chemo could kill her. Despite this warning we definitely underestimated just how hectic the chemo was actually going to be….

On Wednesday 12 May 2021, Mackenzie started her first round of chemo (at just 4 months and 1 week old). We were warned that with chemo one of biggest risks is infection as chemo destroys a patient’s immune system completely and as such (and also because Covid was running rampant at the time), Bronson and I were told that if we left the hospital we wouldn’t be allowed back in as no visitors were allowed: we both elected to remain in hospital with her (all 3 of us sharing a very small private room with one bed and a sleeper couch). Little did we know that Bronson and I were not to leave the hospital again until the 26th of June when we tested positive for Covid and had to go home for 10 days) and Mackenzie was not to come home until the 5th of September - some 4 months later.

Whilst we were warned that induction chemo for infant AML is one of the harshest chemo courses a person can undergo, and that we were to expect the worst (including her possible death), Mack initially seemed to be “sailing through” her first 10 day course. What we didn’t know is that chemo has a cumulative effect and generally only hits a patient towards the end of the course or the week thereafter. Towards the end of the 10 day course the vomiting and diarrhoea hit her hard and for 3 days she couldn’t keep any fluid or food in. On the morning of Friday 28 May (the day we had been scheduled to move into our new home which we had bought the week before she was diagnosed) she was rushed to ICU as she had gone into Acute Renal Failure (Kidney failure) and was placed on a ventilator.

This day was by far the most terrifying day we had experienced thus far and I remember clearly the team of approximately 5 ICU doctors rushing her crib downstairs to the ICU. At one point Bronson (very panicked) asked the doctors why Mackenzie was foaming at her mouth and one of them responded “because she’s in really deep trouble” and told us to go wait outside in the waiting room as they were going to have to ventilate her…. Brons and I sat on the couches outside for more than 2 hours: not knowing if our baby was going to live or die. When they eventually came to fetch us we were told that she was stable but that we should prepare ourselves for the fact that she had been placed in an induced coma and was on a ventilator – the truth is that nothing can prepare you for that sight – nor the fact that you are not allowed to sleep with your child in the ICU and have to leave her down there while you are given somewhere else to sleep. Thankfully, the infection that she had been diagnosed with cleared up relatively quickly and by 1 June she had been taken off the ventilator and all oxygen and we were back with her in the normal ward while we waited for her counts to recover so that we could start her next round of chemo.

During this next round of chemo she got very sick. At one stage Bronson and I were up with her every night battling fevers of circa 40 degrees and heart rate spikes in the 220’s which would hit like clockwork around 1am and this continued for longer than a week. Eventually on 18 June, the decision was made to once again move her to the ICU for “close monitoring”. Initially things seemed to be going alright and she seemed to be relatively stable, but on Father’s Day, 20 June, at around midnight, the decision was taken to once again place her in a coma and put her on a ventilator as the doctors said that her body was under too much strain fighting the various infections. The doctors were very explicit with us in stating that “this time was not going to be like the last time and that we were to anticipate a much longer period of being ventilated”. Around this time we also got the results of her latest Bone Marrow Biopsy which sadly revealed that she was NOT in remission – ie the chemo, even though it had nearly killed her, had not been strong enough to kill off her cancer cells and this meant that she could not proceed to transplant even if she came off of the ventilator. At this point, her consulting doctors in the US said that they actually didn’t believe she would ever be able to achieve remission and so Mackenzie’s outlook looked very bleak. In any event she was still too sick and weak to even attempt more chemo and so once again we had no choice but to wait and pray that she got well.

This time around though, Mackenzie just seemed to get more and more sick…. as it turned out, the infection had actually gotten into her Bone Marrow and each day that went by she just deteriorated. She also began to look less and less like our little girl (people don’t tell you this but patients that are sedated and on a ventilator land up becoming extremely bloated and swollen and Mack was quickly turning into the Oros Man in front of our eyes).

On 23 June the seizures started. No one knew what was causing these and because she was too sick to do a CT Scan, we had to just hope and pray that they weren’t related to any tumours in her brain or infection in her spinal fluid and that the seizures weren’t doing any long term damage to her brain either – this was an extremely dark time for me. Bron was able to sit outside her room while these were happening (we weren’t allowed into the room as the slightest movement or noise would trigger a seizure) but I took to locking myself in our room upstairs for hours on end as I just wasn’t able to face what was going on in the ICU. During this time, x-rays revealed that there was a mass of some sort on her right lung but again she was too sick to take her out of ICU and so they couldn’t do further investigations to determine what this mass was – everyone’s biggest concern was that it was a cancerous tumour. I desperately wanted them to at least do a biopsy to determine what we were dealing with but we were told that she was far too sick to undergo any procedures or operations and that same would likely kill her – and so, once again, there was nothing to do but wait ….

On 26 June I started feeling quite sick – sore throat and temp etc – and quickly asked the doctors to do a Covid test on me (at this point we were being super careful but Covid was rampant in the hospital and had already killed a couple of the ICU patients - bizarrely Mack was deemed safe from Covid because she was on a ventilator and not breathing the room air). The results came in and I did in fact have Covid. I was very quickly sent home and Brons (who had tested negative) was placed in isolation in his room in the oncology ward while Mack was left alone in the ICU. For me this was gut wrenching. 2 days later Bronson started feeling sick too and was also sent home with Covid. Fortunately for us, my mother-in-law was allowed to sub in for us and she moved into the hospital to be there with Mack for the next 2 weeks. The doctors would video call us every day to keep us updated, but by this stage Mackenzie was incredibly ill. On the morning of 2 July, when the doctors called us, they gave us devastating news: the mass in Mackenzie’s lung had grown a lot and was now pressing against her heart. They had no choice but to try to operate to remove it (despite still acknowledging that she was likely too sick to survive such a severe operation – an operation which we were told was called a Thoracotomy).

We thought we would have some time before this was to be done and that they would only operate once we were well and back in the hospital but were quickly told that this was extremely urgent and would be happening that afternoon. They asked us to get dressed immediately and come in – they were going to let us in in full PPE (while Covid positive), to say goodbye as (in their words) they wouldn’t forgive themselves if she died on the table and we didn’t get to see her before the op. That drive to the hospital felt like a nightmare. I just remember playing the Elevation Worship Song, Million Little Miracles, on repeat the whole way there.

When we were let in to see her I just sat in the corner and sobbed while holding her hand. I put my fingers in my ears whilst Bronson talked to the surgeon about the risks of the surgery as I just couldn’t face hearing it but because I had Covid I also wasn’t allowed to leave the room - it was a special kind of torture. It was clear that nobody expected her to make it through the surgery. After they wheeled her out of the room to take her to theatre, we were escorted back outside and for the next 6 hours we waited in the parking lot while they operated on our daughter. During these 6 hours we received only one message from the anaesthetist which simply said “we’re in”. I don’t remember much of this wait but do recall the surgeon phoning at around 10pm to say that they were done and had managed to remove the mass but in doing so had had to remove the middle lobe of her lung too (they had had to perform a Lobectomy). She was back in ICU but this time she was on an Oscillator (an even more severe form of a ventilator) and we had to pray that she survived the night. I do not know how we got home that night as, once again, we had to leave our little girl behind.

By some miracle, she did indeed survive the night and each day she actually seemed to get that little bit stronger. The results from the biopsy of the mass also came back and it wasn’t cancer! As it turned out, the mass had been a fungal ball that had been caused by a fungal infection and now that it had been removed she was slowly starting to get better. By 15 July her condition had improved enough for her to be moved from the Oscillator to the ventilator and she was also slowly brought out of her coma. She opened her eyes for the first time on the 16th of July and at this point we were also allowed to move back into the hospital (albeit sleeping in a different room to her). By 22 July, she had been extubated (taken off of the ventilator) and was placed on CPAP oxygen and we were allowed to hold her for the first time in nearly two months! She was extremely weak from her time in the coma and had to relearn how to suck a bottle and even to hold her head upright on her own.

The biggest miracle of all occurred around this time when on 29 July we got the news that she was now in remission!! The doctors were all flabbergasted at this result as she had not had chemo for more than 2 months and despite having gone into the coma with cancer cells in her marrow, she had now somehow managed to kill them off herself (whilst not on chemo and whilst in a coma and fighting for her life).

Now the preparation for transplant needed to begin in earnest but her lungs were still very weak and so she remained in ICU and on Oxygen until 15 August when she was finally moved back to the normal ward (more than 9 weeks after being admitted to the ICU).

As we did not yet have a donor for her we knew that we would need to keep doing chemo until we could get her to transplant as the doctors were very scared that she would relapse. On 25th August 2021, my birthday, we received the incredible news that DKMS had found her match and she now had a donor! Words cannot express this feeling. She was, however, still sick and so we stayed in the hospital for another 12 days, finally being allowed to take her home for the first time on 5 September. Mack had, by this stage, spent 119 days (nearly 4 months of her 8 month life) living in the hospital.

Being at home after so long was incredible but also overwhelmingly terrifying: her 6 hourly medication schedule (which included chemo that we had to administer ourselves) was intense and it was scary having to be on such high alert with her all the time. We also had to remain in isolation for this period (and until after transplant, which at this stage was scheduled to happen in December).

Because of her high chance of relapse, during the next 3 months Mack underwent 3 more rounds of chemo in hospital, so that we could try to keep her in remission, and on each occasion she was hospitalised with me for approximately 10 days at a time. During one of these rounds she again got very sick and started experiencing seizures once more and again landed up in ICU. As it turned out the seizures were thankfully not related to any brain tumours and were simply being caused by ongoing infection and a lowering of her seizure threshold. Thankfully there was no long term damage from any of the seizures that she experienced.

We were scheduled to move back into the hospital to start her Bone Marrow Transplant on 24 November 2021, and we were on tenterhooks waiting for this day to arrive-every time she was at all miserable, or a little off her food, or even just a bit more tired than usual we would panic and immediately assume the cancer was back. It was an extremely anxiety ridden time. On the 19th of November she went back into hospital to have a line fitted into her chest (which would be used for bloods and chemo during transplant) and also to have one of her ovaries removed for Cryopreservation (as we had been warned that the chemo which she was having in Transplant would likely render her infertile). She recovered so well from this surgery that we were allowed to go home on the 21st so that we could have a couple of days at home before coming back for the big Transplant.

The plan for Transplant was that Bronson would go into the hospital with her for the first 7 days of chemo as I was by this stage pregnant with our second little girl and the doctors had warned that it would be too risky for the new baby to do the planned chemo on Mackenzie around me. On Monday 22 November, Brons woke up with a bit of a snotty nose and when he went to see Dr Kahanowitz, it was decided to do a viral panel on him. The next day, Brons results came back: he had tested positive for Rhinovirus (the virus that causes the common cold). The medical team quickly decided that it would be too risky for him to be around Mack during Transplant and so plans were once again made for Granny to sub-in for him for the initial 7 day period. Before this could happen, Mackenzie had to also be tested (incase she had picked it up from her Dad) and as it turned out, even though she was totally asymptomatic, she was also positive for Rhinovirus. We only got these results on the Wednesday morning as we were packing the car for the trip to the hospital. The team quickly scrambled to figure out the best course of action but when it was determined that her risks of mortality going into transplant with Rhinovirus were increased by 50%, it was decided that this was a greater risk than that of relapse and a decision was made to delay transplant by 6 weeks. This was crushing and we were all devastated (and understandably anxious).

As it turned out however, the Omicron variant of Covid had just hit SA and over that weekend all travel to South Africa was effectively banned: which would have meant that if her donor was international (which we still don’t know), we would not have been able to get the cells to her on the following Monday (after already having started the irreversible and possibly deadly chemo). As it turned out this delay was actually a God Send. Even though it meant that we had to go and do another round of chemo in hospital during December (to try prevent a relapse), we eventually settled back into the routine of isolation at home and were able to celebrate Christmas together as a family. There were some very special times that December and celebrating her first birthday at home on 5 January was also a huge highlight. Brons and I also used this time to catch up on some much needed sleep, which is pretty non-existent when living in a hospital room with a sick baby.

The day after her First birthday, 6 January 2022, Mack and Dad moved back into hospital for her pre-transplant chemo which was to start the next day, Friday 7 January 2022. We had spent so many months building up to transplant that it was hard to believe it had finally arrived. Having seen how sick she got and how many times she nearly died as a result of the induction chemo, it was also extremely terrifying to contemplate: especially the fact that we felt that we were essentially choosing to subject her to it (with chemo which was apparently going to be more hectic and more dangerous than the induction chemo had been). In any event, we knew we had no choice if we wanted her to survive and so we had a very emotional goodbye once they were settled in the ICU. For the next 7 days I would only be allowed to see them through a window.

Notwithstanding all the warnings, the chemo actually seemed to go pretty smoothly – she didnt have any adverse reactions and she didn’t get sick at all. Day 0 (Transplant Day – Friday 14 January) very quickly arrived and I was finally allowed back in to see Mack and Brons. The transplant itself was actually a bit of an anti-climax. The life-saving cells arrived with a courier and were simply infused into her using her chest line. The whole thing took about 40minutes (we were both in the room with her and the rest of the family drank champagne at the window and watched her being given her second chance at life).

About 10minutes after the Transplant Mackenzie had an allergic reaction to one of the Transplant drugs and she became very mottled and red and screamed blue murder for an hour or so. As terrifying as this was, the doctors were monitoring her closely and she seemed to settle relatively quickly.

All too soon it was time for us to say goodbye to Bronson who was swapping out with me for the rest of Transplant. Whilst I was anticipating at least 40 days in ICU post-Transplant while the donor marrow engrafted, Mackenzie actually just seemed to sail through it all.

Our only scare happened around 24 January 2022 (Day +10) when she spiked a fever and started having rigors and it became clear that she had picked up an infection. When the blood cultures came back we were told that the bacteria she had picked up was actually an antibiotic resistant super bug! From behind the glass of our isolation room I watched the various doctors and microbiologists outside her room all morning, discussing amongst themselves what was going to be done. Eventually they decided on a particular S21 drug (which essentially means a drug that is not yet approved) that had been having good results worldwide with this particular bug. It was also decided that the line in her chest had to be removed as it was possible that this was the source of the infection.

For the first time in 17 days Mack and I left the little isolation room we were living in and went up to theatre to have her line removed – me covering her in a blanket and dressed in full PPE because she had no white blood cells and we were so terrified of further infection. Unfortunately when she came back from theatre (her 10th operation since starting this process), her new line wasn’t working. Due to the urgent need to administer the new drug, the ICU doctors decided to put in a CVP line themselves under mild sedation in ICU. This turned into a bit of a nightmare as the drugs they were using were not strong enough to knock her out (after her months and months of being in a coma) and for 3 hours I sat in the room next door listening to her screaming while they were trying to sew a new line into her. Eventually they gave up and put 3 drips into her hands and foot. Our poor baby was so traumatised after this that she cried the entire night while lying on my chest. I was pretty traumatised too.

The next day she was taken back to theatre for surgery number 11 where they put a proper line into her neck using radiological guidance.

Her recovery from thereon out was pretty miraculous and on Day +19 (2 February 2022) Mack was deemed fully engrafted and released from hospital. At the time Mackenzie was the youngest transplant patient this team had ever had and she had also broken the record for the shortest hospital stay post-Transplant! As one of her ICU doctors said: she had had her share of rough times and was due some smooth sailing!

We have now been at home for just over 3 weeks and whilst it is still frightening (and tiring – especially trying to get a 1 year old into any type of routine after living the majority of her life in a hospital where there is no day or night and sleep is only possible in 2 hour stretches), each day it seems to get just that little bit easier. On Thursday last week we were told that her white blood cells were now at the same level as a normal healthy one year old and that, as such, Brons and I could go back to our respective offices! Something that we hadn’t done since May of the previous year.

We still need to wait until her 100 days (22 April 2022) to do her Chimerism test to check that her marrow is now 100% donor marrow and so until then we have to be relatively careful about what she is exposed to but after many, many months of living in the dark, without any hope of light at the end of the tunnel, we are now finally starting to feel what a normal life with her can be like. Of course there will be many more hospital visits, bone marrow biopsies and check ups with Dr Nadia in the years to come but we truly believe that the worst is behind her!

I want to take this opportunity to thank everyone who has been a part of this journey – from her incredible team of doctors to the people who delivered meals to us every day, to our families who did our laundry and ran her social media campaigns, to her hero of a donor, to my business partners who carried my work load: to all of you – We will never have the proper words, but thank you from the bottom of our hearts.

We can only hope and pray that Mack continues to go from strength to strength and that she never hears the dreaded C Word again. To all of you fighting the Cancer fight – we hope Mack’s story brings you strength and hope: you are all warriors!”

Whilst Megan is an admin queen and is the Managing Partner in charge of all firm admin, she is also seen as the “go-to” attorney for her extensive client base of high-net-worth and high-profile individuals. She subsequently represents the first port of call for her clients in all legal issues in both their private and commercial capacity and as a result also acts as a type of “in-house” counsel for various large companies and listed entities throughout Southern Africa. She also still takes on Family Law Matters - on a case by case basis. She can be contacted on megan@hjw.co.za