Faith, Family, and Revolutionary Teamwork Save Noah Langlois’ Life at Holtz Children’s Hospital

By: Miranda Torres

When Michelle Ramkumar Langlois welcomed her first child, Bruce Noah Langlois, on November 29, 2020, she never could have predicted what the next few years of their lives would look like. Noah, born prematurely at 25 weeks and hardly weighing more than a pound, spent his first 207 days of life in a neonatal intensive care unit in Ft. Myers.

Almost seven months later, Noah was finally discharged, but the celebrations were short-lived. Four days later, Noah’s father, Bruce Langlois, unexpectedly passed away.

“His dad was an amazing guy and I think Noah gets a lot of his spirit from him,” Langlois said. “His dad was very outgoing and extroverted and Noah is that in spades. I think he gets his sweetness and his kindness from his dad for sure.”

Despite the heartbreak Noah’s family was experiencing, Langlois was determined to give her son the best life possible.

On his first birthday, she found a strange lump on his stomach. One week later, it was determined that the lump was a tumor that occupied 90 percent of his liver – also known as a pretext 3 hepatoblastoma since it was in three zones of his liver.

“When we got the diagnosis of hepatoblastoma, I was just so concerned for his future,” Langlois said. “I was thinking, ‘What is my little guy going to go through?’”

Noah’s oncologists told Langlois that his treatment options included chemotherapy with the hopes of shrinking the tumor, and eventually a liver transplant or resection. After four rounds of chemotherapy in Ft. Myers, Noah’s tumor did not shrink.

His care team contacted Jennifer Garcia, MD, medical director of pediatric transplant services, adult and pediatric intestinal rehabilitation, and intestinal transplant at the Miami Transplant Institute (MTI), an affiliation between Jackson Health System and UHealth – University of Miami Health System.

Dr. Garcia meet with Noah and his doctors via telehealth one month after his diagnosis. They decided Noah should be transferred to Holtz Children’s Hospital at University of Miami/Jackson Memorial Medical Center on March 24, 2022.

The night before his scheduled transfer, Noah went into cardio-pulmonary arrest. While he was quickly resuscitated and intubated, the Ft. Myers team didn’t think Noah would survive the transfer. Thankfully, Juan Pablo Solano, MD, a pediatric critical care specialist at Holtz Children’s, was the attending physician in the pediatric intensive care unit at the time and approved his transfer.

On March 29, 2022, Noah was airlifted to Holtz Children’s. Upon arrival, he was battling respiratory failure due to a sepsis infection and effects of his recent cardio-pulmonary arrest. His tumor was pressing against his diaphragm, making it difficult for him to breathe and eat. He mainly survived on parenteral nutrition (TPN) for a year.

He spent six months in the pediatric intensive care unit undergoing more rounds of chemotherapy. Noah’s mom and grandmother moved into the Ronald McDonald House, which is conveniently located on the Jackson Memorial campus, allowing them to spend their days alongside him.

“Noah and God gave me the strength to keep going every day,” Langlois said. “It’s hard to stay in a state of sadness and despair when this little guy is saying, ‘I’m not giving up, I’m still here, and I’m still fighting.’”

Noah’s care team reached out to Prasoon Mohan, MD, a UHealth interventional radiologist, who researched whether forms of a Y-90 embolization could be safely performed on a patient of Noah’s age and size.

A Y-90 embolization is a minimally invasive procedure that combines embolization and radiation therapy to treat liver cancer. Dr. Moha’s research found that this procedure had never been performed on such a young patient.

Noah’s family and the rest of the medical team decided to move forward with the experimental treatment. The results showed the liver was indeed responding. Dr. Mohan then treated Noah with two rounds of bland embolization, and the tumor significantly reduced in size, making him eligible for transplant.

“I want to stress that this kind of success can only happen at a place like Jackson, and that is because of the wide-range of expertise that we have here,” Dr. Mohan said. “The expertise of the different specialists and the trust we have in each other allows us to work as a team. We really do make miracles happen here.”

“You pray for months and months for these things to fall in place, but it’s a hard thing to pray for because you know what it means for someone else,” Langlois said. “I prayed that no matter how it happened that God would provide a way for Noah to have a long, healthy, beautiful life.”

On December 29, 2022, Langlois received the call that would forever change their lives – a donor had been found for Noah.
“He has come out of so many very difficult situations before his transplant, which showed us he would be able to overcome a transplant surgery,” said Akin Tekin, MD, liver, intestinal, and multivisceral surgeon at MTI.

Vighnesh Venkatasmy, MD, transplant surgeon at MTI, travelled out of state to procure the donor liver. Gennaro Selvaggi, MD, transplant surgeon at MTI, cut down the liver to fit Noah’s small frame. .Dr. Tekin then performed the transplantation of the new liver into the young boy.

While Noah was undergoing his transplant, his family rallied together in prayer. “Noah is a fighter; he was born fighting and he hasn’t stopped yet. He is an inspiration not only to us, but to so many people that have come to know him,” said Molly and Albert Ramkumar, Noah’s maternal grandparents.

Post-transplant, Noah underwent his two final rounds of chemotherapy. In April, he officially rang the bell on the oncology floor of Holtz Children’s, signifying the end of his cancer treatment, and marking the eminent end of his chapter as an inpatient.

“The past two years have been a rollercoaster, but I would not have missed this time with Noah and Michelle for anything,” said Stacy Langlois, Noah’s paternal grandmother. “We have been a part of every procedure, surgery, chemo treatment, infection, sleepless night, devastating news; but also a part of his smiles, love, his effect on everyone he meets, and his love for life.”

A year and three months later, Noah and his family are preparing for discharge. Before he heads home, he is undergoing physical, speech, and occupational therapies.

“This child has such a desire to live and play and be social from such a young age that he motivates everyone around him to do more and help him improve,” said Heidy Carbot, a pediatric physical therapist at Holtz Children’s.

The family plans to split his follow-up care between Holtz Children’s and a local hospital closer to their home in Ft. Myers.
“When we got here a year ago, we didn’t know if we would be leaving Holtz Children’s with Noah, ever. Chances were so high we that he was not going to survive this,” Langlois said. “But here we are at the end of this journey, and it is because of the team here at Holtz Children’s who never gave up on him and the care he has received. ‘Thank you’ is not adequate, but it is all I’ve got.”

Jennifer Garcia, MD

305-355-5000

Prasoon Poozhikunnath Mohan, MD

305-585-1891

Gennaro Selvaggi, MD

305-355-5000