The Atlanta Journal-Constitution
Young man dying of COVID-19 defies odds
THE STORY SO FAR
Doctors prescribed aggressive treatments for COVID-19 patient Blake Bargatze. Still, his condition wasn’t improving.
They determined that only a double lung transplant could save him.
PART 3
Blake Bargatze was sick of the hospital beds, sick of the monitors, sick of the tubes, sick of the medicines, sick of his failing lungs and utterly sick of COVID-19. He was desperate to resume life outside the walls of his intensive care room and ready to get on with any treatment that would let him do that.
But on that day, a doctor at the University of Maryland Medical Center had shared with the 24-year-old a heartbreaking calculation. Taking into consideration Bargatze’s blood type, his immune response to blood transfusions, how rarely usable lungs came along, he was probably looking at another two months or more in the hospital as he waited for a double lung transplant — time that he might not have.
For a young man who already had spent more than eight weeks in three hospitals, almost always on the verge of death, the words were unbearable.
They were still ringing in his ears that evening when his mother, Cheryl Nuclo, left the hospital to return to her nearby extended-stay hotel.
As she sat down in her room to unwind, she found that she, too, was deflated. Then, just like that, everything changed.
As Nuclo was eating takeout, her cellphone rang. Dr. Robert Reed told her he’d received notice of a possible organ donor match — “a miracle match,” as he described it.
The transplant team would still need to inspect the lungs, Reed said, but he was optimistic.
Nuclo couldn’t believe what she was hearing. She was deliriously happy, though she was also torn. Should she wait until doctors knew for sure that the lungs were a match before saying anything? Should she share the news with her son right then to give him the lift he so badly needed?
She was still debating what she would do as she grabbed her things and rushed back to her oldest child’s side.
‘The million-dollar question’
Bargatze’s COVID-19 battle began in late March. He attended an indoor concert in South Florida, where he was living at the time and was not yet eligible for the vaccine.
He started to feel ill within a few days and tested positive for the virus. About a week later, he started to feel dizzy and struggled to breathe. His mother, who lives in Gwinnett County, where he grew up, pushed him to go to the emergency room at St. Mary’s Medical Center in West Palm Beach.
Doctors there found his blood oxygen level was dangerously low. Bargatze was placed on a ventilator, yet his condition only became more dire.
He needed to be hooked to a life-sustaining mechanical system called extracorporeal membrane oxygenation that could do the work of his lungs, so he was transported to Piedmont Atlanta Hospital. His lungs didn’t heal, though. Not only was he unable to breathe on his own, but he could also no longer walk and could barely lift his arms.
Dr. Peter Barrett, medical director for Piedmont Atlanta’s cardiac intensive care unit, determined in late May that only a double lung transplant could save his patient.
Barrett contacted eight transplant hospitals. Only the University of Maryland Medical Center accepted Bargatze as a lung transplant patient.
Though transplant centers follow strict criteria to determine whether to accept a patient for a lung transplant, Reed said his team in Maryland prides itself on taking a more nuanced assessment. The team had arranged a video call with Bargatze.
“We prefer to meet someone, get to know the person,” said Reed, medical director of the Lung Transplant Program. “We make decisions informed by science and data but do our best to integrate the information into our understanding of the patient to answer the fundamental and simple question: Will transplant likely help this person?”
Medical experts still don’t fully understand why the constantly adapting virus led to irreversible lung damage in Bargatze, while in many of his peers, it causes only mild symptoms.
“It’s the million-dollar question,” said Reed. “I’ve seen some families where one person has it and nothing, and another person in the family is terribly sick. And I’ve seen other cases where, within a family, every family member is horribly ill.”
The pandemic has been equally erratic. In the few first months after Bargatze was diagnosed with COVID-19, infections in the U.S. and Georgia dropped to lows not seen since the pandemic’s beginning. Now the numbers are soaring again, threatening to reach the highest level yet.
The supercontagious delta variant is casting such a wide net that those who once seemed impervious to serious illness from the virus — people 49 and younger — now make up nearly half of the coronavirus patients filling the nation’s hospital beds. These also are the people least likely to be vaccinated.
‘It’s going to happen’
By the time Nuclo arrived back at the medical center, the hospital staff had started early preparations for the surgery, which would go forward the next morning if the lungs got final approval. Nurses, doctors and technicians were filing in and out of Bargatze’s room. It was obvious something big was happening.
Nuclo held her son’s hand and looked directly into his slate blue eyes. “Blake, we got the call,” she said. “They have some lungs they think are going to be a match for you.”
“Are you kidding me? Are you kidding me?” Bargatze asked.
She gave him all the warnings she had been given: It was still possible the lungs might not be a match. The lungs still needed to be inspected.
“I’m not worried,” said Bargatze, crying. “It’s going to happen.” The next morning, on June 28 at about 7 a.m., as a team of nurses and doctors wheeled Bargatze to surgery, he broke down in tears again. A nurse asked him if he was scared.
“No,” he said, tears streaming down his face. “I’m not scared. I’m just so happy.”
Bargatze entered the operating room as one of the nation’s youngest lung transplant patients due to organ damage from COVID-19.
The University of Maryland Medical Center has performed four lung transplants on COVID-19 patients. Reed said three survived and are doing well. One died of transplant-related complications not directly tied to COVID-19.
The surgeons who performed Bargatze’s surgery have discovered that the already-complex procedure has additional challenges with COVID-19 patients.
Though a typical lung transplant takes about six hours, operations on patients with COVID-19 lung damage can take about twice as long. COVID-19 patients have scar tissue in the chest that is actively inflamed, and they tend to bleed a lot. Bargatze required about 10
‘I didn’t have fear. I felt so grateful for what everyone had done for him.’
Cheryl Nuclo, mother of Blake Bargatze
units of blood in the operating room compared with about 5½ units of blood for a typical double lung transplant recipient.
A birthday with special meaning
During the nearly nine hours of surgery on her son, hospital staff gave Nuclo regular updates that things were going well.
“I didn’t have fear,” Nuclo said. “I felt this overwhelming sense of gratitude. I felt so grateful for what everyone had done for him. People had gone out on a limb for him. And here was this organ donation — such a selfless action helping people.”
At about 3:30 p.m., a surgeon told Nuclo the surgery was over. Right away, the signs were encouraging: Blood tests, chest X-rays and other assessments all indicated the new lungs were being accepted by Bargatze’s body and functioning well.
He was expected to spend about eight weeks in the intensive care unit, where he could be weaned off the ventilator. However, in late July, he celebrated a major milestone: He moved to the inpatient rehabilitation unit.
“The day after surgery, I couldn’t lift my hands off the bed,” said a smiling Bargatze in a recent video he took of himself standing. “A week ago, it took two people to get me on my feet, and, granted, I still have to use a walker, but I will be up and dancing sometime soon.”
On Aug. 9, Bargatze celebrated his 25th birthday. He completed a physical therapy session and spent a few minutes outside on a warm and humid Maryland day.
His mother brought him a vanilla cake, balloons and the one gift he asked for: a black onyx cross to replace the one lost somewhere along the way during his stays at three hospitals. In his long days and nights in hospital rooms, Bargatze’s faith in God helped sustain him.
“My birthday was a very special day because I was alive for it, and the biggest gift was a new pair of lungs,” he said.
Friends, family and nurses from the University of Maryland, as well as Piedmont Atlanta and St. Mary’s hospitals, called and sent birthday wishes.
He has impressed the medical staff with his can-do attitude as he continues to work on his recovery.
Every day, between taking more than three dozen pills, he works with therapists to train his body to walk again and climb steps again and perform all the functions it did effortlessly just months ago.
At night, he connects with family and friends by text message. He’s granted several media interviews via video calls so that he can encourage others to get vaccinated.
Bargatze, who was vaccinated at the hospital in Maryland, said he knows many young adults don’t feel a sense of urgency; he was one of those young people.
“Originally, I was skeptical of the vaccine,” he said, his voice thin and raspy. “But it is very important, and I don’t want people to make the same mistake I made. Too many people are losing their lives to this virus, and there is something that can help.”
In his interviews, he also stresses the importance of signing up to be an organ donor. And he discourages vaping, a habit he had before his illness. Though Dr. Barrett said vaping doesn’t explain why Bargatze got so sick, he also said it certainly didn’t help his patient.
In such polarized times, reactions to Bargatze’s messages have been mixed. Many commenters on social media have said his story changed their minds about getting vaccinated. But some have been harsh: They assume he’s an anti-vaxxer, say he deserved to get sick or insist his case is a hoax.
Heroic efforts helped in fight
In the rehab center, Bargatze is learning a complicated, new lifelong medication plan to prevent organ rejection, which is a constant threat. Organ transplant recipients, who have compromised immune systems, always need to be careful to avoid germs. And Bargatze will need to be even more cautious during a pandemic with an evolving virus.
Only about half of the patients who receive lung transplants are still alive after five years, though there are cases when people have lived 10 years or more. The longest surviving lung transplant recipient lived 32 years after the operation.
“With Blake so young, I would guess he is likely to do quite well,” said Reed.
From Piedmont Atlanta, Barrett stays in touch with Bargatze’s mother so he can follow his former patient’s progress.
“I saw that fight, drive and determination in Blake,” said Barrett. “You have to want it. You can’t sit there and be, like, ‘Why me?’ This was a big operation, and you have to have an inner drive to get through it.”
Bargatze recognizes how valuable it is to have a devoted mom. She left the rest of their family — his brothers and stepdad — in Gwinnett County and took time away from her job as an anesthesia physician assistant to fight for him and be his voice when he couldn’t speak for himself. She, too, has moved to Maryland to be with him while he’s recovering. That’s expected to take at least six months.
The two of them have no idea what kind of world he’ll reenter. When Bargatze contracted the virus back in March, it was rare to see a person his age become so ill from it. But in the five months since, the faces in COVID-19 hospital wards have been getting younger.
He and his family credit his survival to the heroic efforts of three teams that are still fighting, daily, the menace of COVID-19: staff at St. Mary’s, who found Bargatze an ECMO machine in Georgia when one wasn’t available in Florida; those at Piedmont Atlanta Hospital, who went to get him in Florida, watched over him for 50 days on ECMO and found a transplant center willing to take him; and the team at the University of Maryland Medical Center, who saw him through his transplant surgery and will preside over his recovery.
But Dr. Barrett said he believes something even greater than dedicated health care workers and an extraordinary advocate in his mother enabled Bargatze to survive.
“What happened was a miracle,” Barrett said. “It was providence that he was given a second chance.”