Seven years and addiction to a lethal drug marked the distance between the frail form laced by tubes and wires to a hospital bed and the Makenzie Taylor Bourdelais who should have been.
There still were echoes of the beautiful and talented "niecster" Tracy Kelley had known, a thoughtful kid who loved animals, art and making people happy, who always got the last word by saying, "I love you more."
And that was, perhaps, the hardest part of watching her die.
"I could still see that same face - she was still there - but she was just destroyed, inside and out," Tracy said. "It just felt like such a waste of a life."
Makenzie had been a popular student, a cheerleader at Falcon High School, academic stalwart and saxophone player in the band, the kind of gifted and gracious teen who calls into question any stereotypes you might have about the in-crowd.
Her senior year, though, she tried heroin. The drug opened a door she would spend the rest of her short life struggling to close.
"She told my mom she knew the very first time she tried it that she was addicted," said Tracy, whose parents, Herb and Judy Bourdelais, were Makenzie's primary caregivers from the time she was 1 and legally adopted her when she was 6.
At first, Makenzie smoked the drug, but she graduated to injecting it. That act, and most likely a dirty needle, introduced bacteria that traveled through her bloodstream and found purchase on a valve of her heart, flourishing into a life-threatening inflammation known as endocarditis.
Makenzie died July 5, at age 25, after the infection overwhelmed her heart and spread throughout her body.
Though endocarditis is a diagnosis once rarely seen in younger patients, hospitals in Colorado and nationwide are noting a discouraging trend as more otherwise-healthy IV drug users arrive needing emergency treatment for a heart condition that, without medical intervention, invariably is fatal.
Gateway to addiction
Heroin is reaping the sinister benefits of the nation's prescription painkiller epidemic. Among a class of "opioid" drugs - highly addictive legal and illegal chemical cousins, of varying potency, that relieve pain primarily by triggering euphoria in the brain - heroin use has risen fivefold in the past decade, and doctors are in general agreement as to why.
"What we're seeing in our community and throughout the country, patients have normal lives and they have an incident or develop a condition and a well-meaning physician puts them on a pain medication for a while," said Dr. Scott Ross, a pain management specialist and anesthesiologist with Penrose-St. Francis Health Services. "Over time, they start taking more and more of the medication and the drug is now being used because it makes them feel better rather than for pain relief. They become dependent on it."
With more states, including Colorado, aiming to throttle the crisis at its source by enacting sweeping changes to the way doctors prescribe drugs and track patients who receive them, feeding a pharmaceutical addiction, legally, is tougher than ever.
"These folks find another way to get it, on the street. They find a cheaper alternative, and unfortunately heroin is making a resurgence as an alternative," Ross said. "That's becoming more and more common. It's very sad."
In 2016, the number of people dying from traditional opioid painkillers, including oxycodone and hydrocodone, dropped - from 259 to 188, the lowest it has been in at least six years, according to the Colorado Department of Public Health and Environment. That same period, however, also saw a 23 percent rise in fatal heroin overdoses in Colorado.
And overdose isn't the only way the drug, and a user's method of introducing it into the body, can sicken and kill.
El Paso County Public Health blames an increase in IV drug use among people age 20 to 39 for a spike in the chronic hepatitis C diagnoses among that population, a number that has doubled since 2015 and shows little signs of slowing.
When an IV drug user develops endocarditis, as Makenzie did, the prognosis isn't good, said Dr. John Mehall, director of Penrose-St. Francis' Cardiac and Thoracic Surgery Associates.
"I think when young people get an infection of the heart valve, even the best-case scenario is bad," he said.
In younger patients, endocarditis might be caused by bacteria from an untreated abscessed tooth or ruptured appendix. Such cases aren't the norm, though.
"People that don't use IV drugs rarely get heart valve infections. It's not impossible, but it's unusual," Mehall said. "Obviously you have to ask those questions and drug test their urine and look for other causes, but certainly you'd have a high risk of suspicion if you saw endocarditis in someone in their 20s, without some other illness that might have caused it."
For a growing number of patients - IV drug users who've already undergone surgery to repair or replace a damaged valve - the odds of survival are especially bleak.
"It's something we see regularly: People coming in initially with an infected valve. And we see them coming back, sometimes three to six months after the first operation, with a reinfection," he said.
That's where things get even sadder - for patients and the physicians who must inform them and their loved ones that an ethical impasse has been reached.
Ending up in the life
Judy Bourdelais began to suspect the granddaughter she'd raised since infancy might be using drugs before she discovered the folded-up squares of burned tinfoil, covered in a black tarry substance, in her purse. At first, Judy assumed it was pot.
"I just thought, she can't be using heroin. Makenzie and her friends were so clean-cut," said Judy, 72, who said she remained in "denial" even after her husband, an El Paso County sheriff's deputy, had a sample lab tested. "I didn't even know that heroin was around then."
While neither Herb nor Judy had addictive tendencies, they weren't strangers to the disease. Their daughter, Tammy, struggled with alcohol her adult life, cut short by throat cancer in 2014. Addiction was the reason they were raising Tammy's daughter.
"I know that she loved her; she just couldn't get her act together," said Judy, sitting in the sunny living room of the split level on the northeastern fringes of Black Forest where Makenzie grew up.
Emotion thickened her words as her mind drifted, again, to the dark irony that now overlays the difficult decision she and Herb felt compelled to make two decades ago.
"I didn't want Makenzie taken away from them, but - the way they lived - I did," Judy said. "What really hurt us the most is we ended up getting her because her parents didn't do well in their lives. We thought we were taking her out of that life and she ended up living in it anyway when she decided to try drugs. We tried to give her everything . "
Today, the horses are long gone and the chicken coop empty. When Makenzie lived here as a child, though, the Bourdelais' property was a "5-acre playground" and menagerie, said her aunt, Tracy Kelley.
"I would have loved to grow up there and have horses," said Tracy, who was almost 25 and married when her parents took in Makenzie, the kid-sister and niece who grew up referring to Tracy as her "auntster" and Herb and Judy as "Ampa" and "Emma."
"I think it was always a little confusing for her, with her friends, saying 'grandma' and 'grandpa' so she made up her own names for my mom and dad," Tracy said.
When Herb and Judy brought home a mother horse and her offspring, 11-year-old Makenzie devoted herself to training the animals using a lunge line.
"The horse was stubborn, but Makenzie was more stubborn. She'd lunge him, make him go 'round in that pen and stay on 'em. She was the 'horse whisperer,' " recalled Herb, 71, who introduced Makenzie to football fandom and a powerful, shared passion for the Denver Broncos.
Petite and strikingly pretty, Makenzie felt equally at home mucking out a horse stall or at the top of a cheerleading pyramid.
"She could be a cowboy or a girly girl," Judy said. "She was good at everything she ever tried."
'I don't want to be like this'
The first semester of her senior year, Makenzie fell during cheerleading practice and suffered a tear to her ACL.
Tracy doesn't know whether that injury, and its treatment, played any role in Makenzie's addiction, but it was after the accident that her behavior started to change.
"I don't remember what medications she was prescribed, but I now look back and wonder if it was opioid medications," Tracy said. "But it seemed like after that, my parents just started having trouble that they'd never before had with her. She just seemed upset and angry all the time. She would argue with them and wouldn't come home when she said she was going to come home. They knew something was going on, but we had no idea what."
Judy said she believes her granddaughter's nature as a "people pleaser" is partly to blame.
"I think she said 'No' the first time but she eventually said 'Yes,' " Judy said. "And that one time is all it took for her."
After high school, Makenzie drifted further from her family, living with a boyfriend in Pueblo and then moving to Oregon, where a stint in rehab - her longest and most successful - came to an end prematurely when she checked herself out. Back in Colorado, the out-of-character behavior continued to escalate, with a series of bad living situations and run-ins with the law.
By then, the drug had become the axis of her lifestyle and identity.
"Nothing in her life came before heroin," Judy said. "There's nothing more helpless than wanting to help your child and not being able to."
Still, there were times when the "old Makenzie" would reach out. On one of those occasions, she showed up at Judy's door looking tired but clear-eyed and sober. They sat on the couch in the living room and watched a movie, and Makenzie spoke candidly about her struggle.
" 'I just don't understand why I'm like this. I don't want to be like this,'" she told Judy. "I said, 'If you can just get clean, this could be the happiest time of your life.' "
Makenzie was barely conscious when friends brought her into the hospital last summer, when the endocarditis was diagnosed for the first time. After a month of inpatient treatment, though, her family was guardedly optimistic. The infection was under control and, though she would need open heart surgery to replace the damaged valve, her chances of recovery were good.
Makenzie promised to go to rehab and stay off drugs, keep taking her antibiotics and return for surgery.
She did none of those things.
'We don't trust them'
The infection that causes endocarditis sometimes can be treated successfully with antibiotics. More often, a "vegetation" of bacteria must be removed, or the heart valve is mechanically damaged and starts leaking, which can cause blood to flow backward and, ultimately, the heart to fail.
"When either of those situations happens, surgery is required to repair or replace the heart valve," Mehall said.
Whenever possible, surgeons try to repair the patient's existing valve. If that's not an option, it can be replaced with a mechanical valve that will last "forever" but requires the patient to commit to a strict, lifelong regimen of daily blood thinners and medical monitoring, Mehall said.
The other option is replacement with a biological valve, usually fashioned from cow tissue - a fix requiring less long-term oversight but that can last, at most, about 20 years.
"To put a (mechanical) valve in someone who has a propensity to abuse drugs and ask them to take meds every day and have that medication and their blood monitored is probably unreasonable," Mehall said. "So that creates the dilemma, of either getting them a valve that needs a blood thinner or getting them a valve that will not last them the rest of their life, and then they would have to have another operation."
Almost always, in young people who have endocarditis from drug use, surgeons will choose a tissue valve, Mehall said, primarily because "we don't trust them to take blood thinners and manage it safely."
Ideally, surgery is the wake-up call that makes them "get off drugs, get their life in order and then in the future have another operation - most likely a mechanical valve," he said.
If not, and the patient returns to IV drug use and reinfects the valve, most surgeons will not reoperate. The policy is one that doctors make sure their patients fully understand before the first surgery, Mehall said.
"That's generally agreed on within the profession. We'll do this, but if you reinfect it by using IV drugs, you'll have a hard time finding a surgeon who will reoperate on you and give you a new valve, which means most likely you will die from it," Mehall said. "Could we do it? Yes. But it's not reasonable putting a patient through the risk of an operation - open heart surgery - and the resources, time and money of providing care for them when they've clearly demonstrated they're not going to be responsible in their behavior."
Nothing left to do
Makenzie never got healthy enough for the heart valve surgery that might have saved her.
After leaving the hospital in 2016, she stopped taking her antibiotics and relapsed on heroin.
A second hospitalization, in June, ended when a nurse told Makenzie police were on their way up to arrest her, and she fled.
The third hospitalization, July 4, would be her last.
As she sat vigil in a chair by her niece's bed, Tracy Kelley watched through the window as Independence Day fireworks exploded above Memorial Park.
She thought about how quickly good times can vanish.
The following morning, doctors arrived with the awful news: Makenzie was too far gone to survive surgery.
"Her heart, instead of being black in the center and empty like it should have been, was just full of infection," Tracy said. "Her kidneys had shut down. The doctors said, 'We can't do surgery on her; it'll kill her.' They basically said there's nothing left we can do."
Makenzie was removed from a ventilator the following day.
Tracy believes the drug desiccated her niece's spirit, to the point she could no longer access hope.
"I think she felt like she had destroyed so much, she could never get it all back . but I don't think that's true," Tracy said. "I think she would have been changed forever by that experience she went through, but I think we could have gotten her back. She was only 25. She still had a lot of years left to fix all the things that were wrong."
As she drove from Colorado Springs to her home in Fort Collins, Tracy debated how to break the news to the rest of the family. Her two teen sons knew about Makenzie's battle with heroin, but the in-laws, what were they going to think?
"Their kids had grown up with Mak, how was I going to tell them she died because of heroin? But then I was like, you know what? I'm going to stop the secret," Tracy said.
Makenzie's life was wasted on a drug. Her death, Tracy decided, would go a different way.
The pretty girl who died
When she got home, Tracy sat down in front of her computer and wrote, through angry tears, about Makenzie and the drug that led to her death. She posted the message to Facebook, along with a portrait of Makenzie taken her senior year at Falcon, and one Tracy took in the hospital before she died.
"I wanted people to see that contrast. She looks like a girl who has everything going for her - and she did - and look at what happened to her a few years later because of a stupid drug," Tracy said. "I want some kid to walk into a party or have their boyfriend hand them something and have them say, 'Gosh, I remember that pretty girl who died, and I'm not going to do it.' "
Within days, Tracy's post had been shared more than 8,000 times, and she'd received so many responses and friend requests from strangers worldwide she decided to create a separate Facebook group, where the community discussion could continue.
Knowing that Makenzie's story is out there, and reaching the audience Tracy had hoped, is something of a comfort.
"One woman who contacted me said, 'I've been using heroin for six years, and I had no idea you could get a heart infection from it,' " Tracy said. "I hope she gets checked. She might think, 'I've got this under control. I've been doing this for years, and I'm not going to OD.' But that's not the only reason people using heroin die. I didn't know that either until it happened to Makenzie."
Editor's note: Vietnam veteran and retired El Paso County sheriff's Deputy Herbert "Herb" Bourdelais lost his battle with prostate cancer Aug. 23. The family celebrated his life in early September with a Broncos-themed memorial service in Colorado Springs.
Contact Stephanie Earls: 636-0364