This teen was given a third chance on Earth. Here's why she's using it to teach art therapy.

When you're given three chances at life, how do you make the most of it? 

It's a question Paulina Nieto has had to grapple with for years. 

After undergoing a heart transplant at age 2, her donor heart gradually began to fail. By the time she was 16, she again found herself waiting for a heart at Riley Hospital for Children.

At a time when many teens are worried about school, friends and cars, Paulina's life was upended by a weeks-long hospital stay. So Riley doctors introduced her to art therapy, a form of psychotherapy that encourages art-making as a form of self-expression.

"My transplant, it was life-changing for me," she said, "and it also really helped me become more inspired and more creative." 

Being creative gave her an outlet for her feelings, but it also inspired a new life mission.

Now 19, Paulina is studying psychology at Indiana University-Purdue University Columbus with the hope of becoming an art therapist so she can use her experience to pay it forward.

"Because I think that if I was put on this Earth for a reason again," she said, "then I have to do something that can help other people.”  

A bittersweet blessing

Paulina was born with cardiomyopathy — a heart muscle disease that causes the organ to become enlarged and arteries to narrow — which necessitated a heart transplant when she was a toddler.

Being so young, she would likely need another transplant in adulthood, her parents and doctors knew. But in Paulina’s case, the antibodies in her heart gradually began attacking the graft, causing her arteries to narrow.

By the time she was 16, her second heart was giving out.

The decreased flow of blood and oxygen left her exhausted and unable to keep up with friends. Once admitted at Riley, she met other heart transplant hopefuls who had been waiting months for a match. She dreaded the possibility of having to do the same.

Unlike with the first surgery, which she was too young to remember, awaiting the second was  emotionally taxing.

"Since I was 16, I was more aware of things and like had to actually, you know, be in the moment and actually had to experience things," she said. "But, yeah, it was just mainly shock. Kind of depressing for a bit."  

She was told to look more like the 'Little Mermaid.' Years later, she still weighs food.
Real news, brought to you by real Hoosiers. Support our local journalists.

Knowing that she had long been interested in art and often drew in her free time, doctors suggested she begin art therapy as part of her treatment, a way to work through her fears and frustrations by putting them on paper.

It was a perfect fit.

“She obviously was very talented, and she expressed herself very easily through art-making,” said Cassie Dobbs, Paulina’s art therapist. “It was just natural to her.” 

At the beginning, Paulina said, she and Dobbs would sit together and draw. Gradually, the relationship grew and created a space where Paulina could verbally and artistically explore her feelings.

“I mean, I’ve always been a very open person, but … I could calm down and draw and do something that I could really enjoy,” Paulina said. “And having to talk with somebody that understands what I’m going through or could process it in a more psychological way just helped me to be more relaxed and more calm.”  

After two weeks on the transplant list, Paulina received a second heart — a bittersweet blessing, her father, Ramiro, told IndyStar.

“You want her to be right and to be good, right, to be healthy?” he said. “But at the same time, you don’t want people to lose life for her.”  

'It helped me improve my emotions'

Riley’s art therapy program, launched in 2008 and chaired by former Indiana first lady Karen Pence, is entirely donor-funded via the Riley Children’s Foundation. The program employs two master-level mental health counselors who incorporate art-making into their therapeutic relationship with patients. 

Art-making is inherently therapeutic, Dobbs said, but it’s also a way for patients who might be unable to articulate feelings to channel that energy into the creative process. Making the choice to participate in art therapy also allows patients some agency when it may seem like doctors and parents are making every decision for them.  

“It’s that relationship and building that trust and that support person that you know when they come into the room that they’re there for you," Dobbs said, "they’re there for your well-being."

Paulina experienced that firsthand.  

“I started working with Cassie, and she did a really awesome job of having to help me process the emotions and just having an outlet for me to draw and actually not be bored in the hospital,” she said. “It helped me improve my emotions a lot and helped me organize my thoughts more, and I became a better artist, as well.” 

Dr. Randall Caldwell, Paulina’s cardiologist, said nontraditional therapies are “critical” to creating a holistic approach to treatment. Research has shown art and music therapy can decrease a patient’s stress, the medications required to treat them and their overall length of stay.  

“It also, just the fewer medications we have to use to help them, if they can do it on their own with them coping, it gives them a coping mechanism that they can continue to use when they’re home or when they go back to school,” he said. “So it’s something they can carry with them for the rest of their life.”  

Save a life:Here’s how to become an organ donor

But nonmedical therapies don’t see the same level of support as other forms of treatment, Caldwell said. 

“Unfortunately, if you look at health care reforms, there’s not money budgeted for this type of treatment,” he said. “And so these are resources that really are dependent upon donors through the Riley Children’s Foundation and other programs to help support this, because if we didn’t have that type of resource, we wouldn’t be able to support this and help these patients.” 

The beauty of life

Flipping through the stack of paintings she keeps in the bedroom of her Columbus home, Paulina described how each piece represented a step of her journey. 

“Before, my art was kind of bland,” she said. “Afterwards, I like using a lot of colors, kind of just shows the liveliness of life and the beauty of it.” 

On her desk sat an unfinished painting of a heart crowned with flowers. She is blossoming, she said. 

There was a painting of her church. A Frida Kahlo-esque self-portrait, displaying an anatomical heart on her chest in a celebration of both her Mexican heritage and her transplant.

Mostly, though, there were flowers. Landscapes with big, blue skies. 

The things she missed when she was hospitalized.  

“When I was in the hospital, I mean, I had a window, but I could barely see outside," she said.

"I think (the sky is) something that should be not taken for granted that you can see every day." 

Wise beyond her years, Paulina believes life is a gift not to be wasted.

“I’ve become more outspoken, more extroverted," Paulina said. "Before, I was very introverted, very insecure of myself. But having that life-changing experience was very eye-opening for me.

"So, you know, you kind of realize that you have to live in the moment and be aware of your surroundings and be happy every moment.”

Call IndyStar reporter Holly Hays at 317-444-6156. Follow her on Twitter: @hollyvhays.