MACKENZIE’S MISSION:
the inspiring parents turning loss into hope
Losing a child is the worst thing that can happen to a parent and for Rachael and Jonny Casella it was both devastating and a turning point. Their beautiful daughter, Mackenzie, was seven months and 11 days old when she left this world on October 22, 2017. But even though her body failed her, baby Mackenzie’s legacy is proving to be immortal.
Rachael believes that Mackenzie chose them to be the guardians of her soul. And despite everything, she says baby “Kenzie” has taught her to be a better person, to choose love over conflict, gratitude over struggle and most of all, to have a perspective that serves her every single day.
Rachael couldn’t protect her baby girl from her fate, but she wants to protect future babies and parents from going through what her family endured.
She can foresee a future that is better and fired by profound and precious memories of Kenzie, she has spearheaded a crucial change to the genetic testing protocol, while personally never giving up on her dream of being a mother again. Rachael’s battle for a new genetic test available to all is called Mackenzie’s Mission, which is also the name of the courageous memoir she has poured her heart into.
“I wasn’t really sure how to process everything that was happening with us, and I found myself writing,” Rachael tells me. “It was a cathartic way of getting things out. It evolved into writing Instagram pieces and a blog and the book happened from there. I found I had so much that I wanted to say.”
The book is raw, real and heartbreaking with additional commentary from Jonny and Rachael’s parents, but it’s also vital and inspiring. And as we start to talk, I can see how Rachael the mum became Rachael the activist; how love and hope have come from torment and tragedy.
Childhood laughter
Rachael was raised in a family that was always laughing. Her Canadianborn mum, Wendy, “was big on feelings” while her “hero”, English-born dad, David, “is one of the funniest people I have ever known”. The family moved from Queensland to Canberra when Rachael was five years old and together with brother Chris, she recalls a happy, carefree childhood, camping, hiking and having fun.
Above all, Rachael’s parents taught her to have empathy and “to use words
to solve problems”. Talking through issues and speaking up were Rachael’s life-lessons which, on what turned out to be a tortuous road ahead, have served her well. “People have told me that I’m not really afraid of conflict or bringing up difficult topics. I think I got that from my parents because we were taught to talk everything out, even if it meant an argument.”
As a girl, Rachael told her family and friends that she wanted to be “a defence lawyer by day and a rock star by night”. She had a strong sense of justice and “karma” which she thinks “ended up making things even harder when everything fell apart for us”.
“I think what appealed to me was playing a part in making sure that wrongs are righted as much as they could be and the people who were to blame punished. In my childhood mind, I always knew that I wanted to be on the side of the good guys,” she explains.
Rachael did end up working with the good guys, though not as an advocate. After doing a science degree with a major in anthropology and forensics at university she joined the Australian Border Force as an intelligence analyst first in Canberra then in Sydney and moved to the Australian Crime Commission in 2010. She took a postgraduate diploma in forensic science and applied for a position with the Australian Federal Police. The process took a while but eventually she was selected and it was at police college in 2013 that she met her husband, Jonny. He was one of her trainers, and even though they both noticed an immediate connection, they had to abide by the rules and wait until Rachael graduated before they could follow their hearts. “Jonny says that he knew as soon as he saw me.” He was actually engaged with a wedding just a couple of weeks away and, floored by what he felt for Rachael, he called the wedding off. “He realised that if he was feeling that way, it wasn’t right to continue,” says Rachael.
Ticking clock
Although she felt the same, Rachael was cautious. She was coming up for 30 and her biological clock was ticking … loudly. If she was falling in love, and she was, she had to be sure Jonny wanted the same things she did. Rachael was always going to be a mum. “It was just a given,” she says. “Right from early on I used to have those conversations with boys when I started dating. I said if you don’t want kids, you may as well not stick around.” With Jonny she initiated that conversation on their second date!
“I actually turned 30 at police college and I remember going down to the lake after class on my own and I cried. I felt very much not in the life stage that I was expecting. I really wanted to be married with kids. So, with Jonny, when we met, we had all those big conversations really quickly. I needed to know if this was going to be worth the long distance.”
Jonny wasn’t fazed at all; in fact, it only made him more certain Rachael was the one. They started a longdistance relationship between Canberra and Sydney and in that time their conversations were deep and in tune. “Our values are the same. We’ve never come across a time where we’ve ever disagreed on anything that’s important, and that has been vital for us.”
Jonny proposed in 2015 in Venice. “We went out for a romantic dinner on a canal and he had a Tiffany’s ring and got down on one knee. It was amazing. And then on February 12, 2016, we had our fairytale wedding.”
In the six months between proposal and wedding Rachael started planning their pregnancy. “Being a Type A [Alpha female], I didn’t want to leave anything to chance,” says Rachael. She came off the pill, and both she and Jonny underwent a barrage of pre-pregnancy blood tests. Together they worked at improving their general health and nutrition and even looked to traditional Chinese medicine. They had fertility
tests, including checking Rachael’s egg reserves. She was taking no chances.
When she didn’t fall pregnant on their honeymoon, Rachael had her ovulation cycle tracked and, armed with the facts, the couple tried again. “We got pregnant the very next month,” she says. But at six weeks Rachael miscarried. That early loss gave Rachael a reassuring glimpse of Jonny’s “inner strength and his emotional intelligence”. They were in this together. Rachael wanted to name the lost baby, but was nervous about mentioning it to Jonny. “I thought he might think it was weird,” she says. “But he replied ‘I had already thought about it. We should call her Hope’.”
In the book, Jonny writes, “I named the baby Hope, as it would serve as a reminder to both of us that even in what we feel is our darkest time, we should always hold on to our optimism and hope. I had no idea then what the next few years would bring, but I like to think Hope was the early building block of the resilience we would need to survive.”
As she grieved, Rachael started to research. She learned that approximately 20 per cent of pregnancies end in miscarriage. They decided to be open and honest with friends and family, and most of all they decided to carry on trying for a baby. A month later they conceived Mackenzie.
“Being pregnant was the happiest I’ve ever been.”
Baby love
“We were very excited, but very cautious. We feel like Hope was the only pregnancy that we have had out of all of our pregnancies where we got to experience that ‘looking at the pregnancy test’ pure joy, that sort of thing that you see on all of the television ads. It was the only time where our joy didn’t come with a side feeling of dread or fear. But once we got to 12 weeks, we let go and just loved it.”
Rachael revelled in her pregnancy. “I loved looking in the mirror at my bump,” she says. “And the feeling once the baby started kicking, that was unreal. It was the happiest I’ve ever been in my entire life.”
They had every test offered, including a gender test, and at 10 weeks found out they were having a girl. “I told Jonny and he got very teary.” They chose the name Mackenzie before she was born, with a proviso that if it didn’t fit when they met their daughter they would change it. The labour was long – 40-plus hours – and painful and ended up in a C-section, but Rachael was in raptures. “I loved my birth,” she says. “I get very frustrated when women get upset when the birth doesn’t go the way that they wanted. I think we’ve become too complacent and we forget that birth is supposed to have that one function and that’s to get the baby here healthy and safe. I think we get a little bit greedy … I was excited, even when I was in pain. I got her, our beautiful Mackenzie. It was just great. I have videos and photos of when she first was pulled out, and there’s this look of pure shock on her face from all the bright lights. She was a little bit squished. But I just felt complete. I never expected to feel that.”
Jonny was at the birth and was equally smitten. “He got to hold her first, to swaddle her. He was ridiculously in love with his little girl.”
For the next 10 weeks the couple was on cloud nine. Jonny had eight weeks off work and the new family of three were in their own bubble of love. “I wish that I could relive that time.
But when I look at the photos now that should have this big ray of sunshine over them, I see shadow because I can see it probably as early as two weeks after she was born. I don’t know how I couldn’t have seen it back then.”
Beginning of the end
At around nine weeks Mackenzie started crying when she was feeding. Rachael wasn’t overly concerned but decided to take her to the hospital. The nurse noticed that the baby seemed “floppy”. She pointed to a baby boy who was on his tummy pushing his chest off the ground with his arms. This, she said, is where Mackenzie should be at. “My stomach sank,” writes Rachael. “Kenzie hated tummy time.”
Over the next few days Rachael began to realise something wasn’t right. And just 10 weeks after giving birth she and Jonny were given terrible news. “The paediatrician was a gruff, older man and he said it fast with little feeling. He believed Kenzie had spinal muscular atrophy [SMA] type 1. We had never heard of it … so we asked the obvious question: what is the cure? He said flatly, ‘There is none. It is terminal’.”
The word terminal hung in the air and Rachael felt her body shutting down. Kenzie was lying on the doctor’s bench quietly holding her hands up, staring into her mother’s soul. “I don’t even know how I processed it. Initially, we definitely didn’t believe it. We thought there was a mistake,” Rachael whispers. To make matters worse the doctor’s response to Rachael’s panic was an abrupt: “Calm down, missy,” as he phoned a neurologist.
SMA type 1 is a motor neurone disease which Rachael later discovered is the number one genetic killer in babies under two. She and Jonny were both carriers. The disease would see baby Kenzie unable to use her muscles and result in her wasting away, losing the ability to swallow and ultimately to breathe. And at the same time the couple learned about Mackenzie’s diagnosis they were told that any future children they had may also have SMA.
As the brutal truth sunk in, the doctor offered a lifeline: there was a clinical trial of a new drug which some were calling “the miracle treatment”. Rachael and Jonny clung on to that thought as they drove home. “The only thing I remember saying on that drive was that we had to fight together, we needed this horrible situation to bring us closer together as a couple,” recalls Jonny.
In the days that followed Kenzie’s condition was confirmed. But the so-called miracle drug, a medication called nusineresen, a lumbar puncture injection administered four times a year, was not what they were hoping for. The best case scenario in babies was to make symptoms less severe and slow down the progress. “They would still never walk … would need significant breathing assistance and would eventually pass away at a young age,” notes Rachael.
She and Jonny decided not to put their baby forward for the trial. It was the hardest decision they had to make because they would have dearly loved more time with Kenzie, but they chose to concentrate on quality of life for the short time they had with their daughter.
Baby bucket list
Instead, they made a baby bucket list of wonderful things they wanted to do as a family. “It was magic,” says Rachael, smiling. “We just got to forget that she was sick. It was as if we were a young family off on holidays. And she didn’t know anything. She didn’t know what was happening. She had two parents around her 24/7, giving her everything that she wanted. Playing with her, entertaining her. And then most of the time, she also had grandparents and everyone. She didn’t want for anything.”
Travel was the couple’s passion and they wanted Kenzie to experience it too. They couldn’t secure insurance to go overseas so instead they went on multiple trips around Australia, from the dry heat of Broome to the humidity of Far North Queensland, Byron’s rainforests and snow in Canberra. “You could see when the warm air hit her skin or when a snowflake hit her tongue, she was so expressive. It was beautiful. Those memories are everything to us,” says Rachael.
When the end came it was sudden and terrifying. Kenzie was having trouble breathing and they rushed her to hospital. Over the next few days she lost her battle. “We were lucky. She could have been in and out of hospital for months, struggling and slowly losing. But before this she was perfectly well. And then all of a sudden she wasn’t.”
Rachael carried Kenzie down to the morgue herself and laid her on some blankets as she and Jonny kissed their baby girl goodbye. Afterwards they held each other howling in pain.
Mackenzie’s Mission
In the weeks after Kenzie’s diagnosis Rachael was a mess, but most of all she wanted answers. Why had this happened? As she started to research the facts about the disease and the drug trial they were being offered she was struck with “a blinding realisation”. If she and Jonny were carriers why didn’t they know? Why hadn’t they been screened along with all the other pre-birth tests? In Rachael’s mind it was simple. “It was like a type of math equation and we were coming up with an obvious answer, but the rest of the world wasn’t. We could see that, okay, everyone carries genetic faults that they can pass on. There is currently a test that exists which tells you what faults
you have and what your chances are. But this is not offered to everyone. We’d done more than most people when it came to having a healthy child. So to know that this test exists and it wasn’t offered made us so angry.”
After consulting the medical community, Rachael wrote a letter to parliamentarians asking for free routine genetic carrier testing. Now she knew she was a carrier, testing any future foetuses for SMA would be a given for her and she wanted that to be an option for all prospective parents. “I don’t even know what I was expecting. I really thought that this was going to be a long campaign, fighting. But I felt it had to be done and even though I was already exhausted at the idea of doing it I couldn’t stop.”
Just a month after Kenzie’s passing, Rachael received a letter from the Health Minister, Greg Hunt, asking to see her. “The positives happened so fast. It was like the stars aligned. We had these amazing medical professionals advocating it and universities that were talking about the financial implications of genetic conditions in Australia. And then we had our story and Mackenzie’s face.
“Back then I really hated it when people said things like, ‘you were meant to do this’, ‘Mackenzie was meant to die for this’ or ‘everything happens for a reason’, but now time has passed, I can see that it really was the time for it to happen. That doesn’t mean I think my daughter should have lost her life for it, but it was time for things to change.”
Four months after Kenzie’s death, at the invitation of Minister Hunt, Rachael headed to Canberra. She’d already consulted investigators working on the Australian Reproductive Genetic Carrier Screening Project who fully backed Rachael’s idea. She also had the support of an ABC journalist who was filming Rachael’s campaign for the 7.30 program. As she spoke to Greg Hunt, Rachael placed photographs of her baby on the table. “I wanted Mackenzie to be there, looking at us all.” She handed her draft paper and, with tears in his eyes, the Minister listened.
In May 2018 they were back in Canberra for another meeting. As she walked in, Rachael held her breath. Greg Hunt told her that in a few hours the largest health initiative in Australia’s history, a $500 million ‘Genomics Project’, would be announced. “It would be a four-pronged attack. Firstly it would provide genetic carrier testing as a routinely offered screen and subsidised for all. Secondly, it would raise awareness among medical professionals. Thirdly, it would focus on research and treatments. And finally it would increase access to IVF and preimplantation genetic diagnosis (PGF) for people like Jonny and me.”
The first pilot was to be a $20 million project which he called “Mackenzie’s Mission”.
The future
When Mackenzie was diagnosed, Rachael and Jonny were told that to avoid a future child of theirs being born with SMA, they had two choices. They could conceive naturally, test the foetus at three months and make a very tough decision based on the results. And they could go through IVF to test the embryos in the lab before implantation. “Jonny initially was really scared of the idea of having more children. But in time that changed. We both feel strongly that Mackenzie has made us parents, but we just want to hold her sibling.”
So the couple is now on a painstaking journey to parenthood. In late 2018 they conceived baby Bella naturally only to find she too had SMA and so made the agonising decision to medically interrupt the pregnancy. “To date we’ve done eight rounds of IVF and are about to start our ninth. We’ve had multiple chemical pregnancies [miscarriages] and two other pregnancies, one natural, one IVF [both ended after 14 weeks]. And they are excruciating. We don’t get pregnant and get excited. We get scared. But the only way that we keep going is knowing that not doing it would be worse. We’ve seen the negatives of genetics, but we’ve also seen the positives in that our genes made this incredible little human. We just want to see Kenzie’s genetic siblings. We’ll do whatever it takes to be parents again.” AWW