FIGHTING CHANCE
Beating cancer was just the beginning of an epic battle for Elliott Cox, who underwent a lung transplant before fighting his way back to good health
Achant reverberates inside a hospital intensive care unit room: “Ell-i-ott, Ell-i-ott, Ell-i-ott.” Elliott Cox, a one-time semiprofessional soccer player for the Logan Lightning Football Club, south of Brisbane, is gravely ill. His parents Brian and Julie, and younger siblings Oliver and Evie, surround his bed at the Gold Coast University Hospital. They hold hands and cheer him on as they did from the sidelines during his goalkeeping days. “You can do this,” they tell the then 22-year-old.
Doctors are running out of medical options for Cox. His lungs are scarred so badly from years of treatment for aggressive Hodgkin’s lymphoma, a form of blood cancer, they are barely working. He desperately needs a new pair. Cox’s only hope is to be put on a life support machine until he can receive a transplant. But he’s so weak his medical team is unsure he will survive the uncertain wait for new organs and, if he does, whether he will have enough strength left to recover from the operation. It’s after midnight on June 17, 2020 and the Gold Coast family have been called in to say their goodbyes in case it’s the last chance they have to speak with their much-loved son and brother.
Three years earlier, scans showed Cox was
finally free of his cancer. But he had just “five seconds of joy” after learning his Hodgkin’s lymphoma was in remission before facing his next gruelling medical challenge. The same scans that showed his cancer was gone also revealed he had a hole in his left lung. Toxic chemotherapy and radiation that had successfully treated a tumour “the size of a soccer ball” inside his chest, and a smaller one in his neck, had irrevocably damaged his lungs – an unusual, but recognised complication of the life-saving treatment he had received.
“I was a bit out of breath but I just thought I was deconditioned from the cancer,” Cox says. “In reality, my lungs were very brittle. To use a metaphor, the lungs should be like tissue paper, mine were like cardboard.
“I’d just been through this journey of fighting the deadliest disease known to man – cancer. Now I was being told my lung’s gone bad.
“I never got to do the normal things you do when told you’re cancer-free. I never got to go out and celebrate. I was thinking: ‘Who the hell is trying to play games on me? Who’s controlling this movie? If there’s a God, what the frickin’ hell is he or she on about’?”
Cox spent the next three months in hospital as doctors tried unsuccessfully to treat his lung disease. His condition continued to deteriorate after he returned to his home at Runaway Bay on the Gold Coast. Eventually, he needed a wheelchair to get around, unable to walk more than four metres before having to sit down.
“I didn’t get off the couch practically all day,” he says. “I couldn’t shower myself, I couldn’t dress myself. I couldn’t go to the bathroom by myself. Other 22-year-olds were having kids, or getting degrees, or moving out of home. I was sitting on a couch watching crappy Netflix shows not even being able to go to the toilet by myself.”
A lung transplant at the time was considered “a last resort”, given he was still not yet five years cancer-free.
But in June 2020, Cox took a turn for the worse. His parents had to call triple-0 when he started turning blue. “He just looked really strange and went very limp, very weak,” mum Julie recalls. “His lips went blue, his fingers were blue. He was really cold. It was very scary.”
Inside the Gold Coast University Hospital ICU, Cox continued to decline. Intensive care specialist Dr James Winearls and his team were left with little choice. Their patient needed a machine to breathe for him. But Cox’s lungs were too stiff for mechanical ventilation to work. Instead, Winearls attached him to a hitech extracorporeal membrane oxygenation machine – or ECMO machine – which pumps blood from the body to an artificial lung.
Oxygen is added and carbon dioxide is removed before the blood is sent back to the patient. Cox was in the right place at the right time. The Gold Coast hospital had introduced ECMO five years earlier – one of only a handful of Queensland facilities that had the technology and the specialist staff needed to operate it. Without them, he would have died. “His lung function deteriorated very quickly and very dramatically to the point where he needed an urgent lung transplant,” Winearls says. “His lungs were so sick they were no longer able to sustain life.”
However, before he could receive new lungs, Cox had to be accepted for a transplant. Given the demand for donor organs, Queensland’s only lung transplant unit – at The Prince Charles Hospital at Chermside, in Brisbane’s north – needed to be satisfied he was mentally and physically fit enough to rehabilitate after the operation. Surgeon Dr Doug Wall drove to the Gold Coast to assess him. Cox’s youth and general physical fitness from his time as a soccer player were in his favour – and, crucially, his emotional resilience.
“It’s extremely important having that mental strength to be able to go through what he’s been through,” Winearls says. “He’s only in his early 20s and he’s been through life-threatening cancer, all of the therapies and unpleasant treatment associated with that.
“That’s a huge amount for anyone to deal with, let alone a young man. To have the mental and physical strength to get through all of that and pull through the other side and still be such a positive, driven, motivated young man is extremely important.”
Cox was placed on the transplant waiting list and transferred to The Prince Charles Hospital two days after being connected to the ECMO machine. Wall went on two weeks holiday expecting his patient to have new lungs by the time he returned. When he got back, and Cox was still waiting for donor organs, he was fearful. “I didn’t think he would make it,” Wall says. “He’d been lying in bed too long. Lots of people, same circumstance, wouldn’t have made the grade. But he was young.”
As days of waiting turned into weeks, Cox’s devoted mum admits there were times she had thoughts she may lose her elder son. But preferring to focus on positive energy, she pushed them aside. “I still had Elliott and I was like: ‘No, he’s not going anywhere,’” Julie says. “I thought: ‘I’ve seen him go through worse than this. I’ve seen him bald, I’ve seen him with tubes coming out of here, there and everywhere.’ And so I was like: ‘No. No. No. I’m not losing him. We’re fighters.’”
Day after day, Julie and her husband Brian sat by Elliott’s bed, holding his hands and talking to their son. “Come on Elliott, you’ve got this,” Julie told him. Even though he was in a medically induced coma, they would speak to
HIS LIPS WENT BLUE,
HIS FINGERS WERE BLUE. HE WAS REALLY COLD.
IT WAS VERY SCARY
I STILL HAD ELLIOTT AND I WAS LIKE: ‘NO, HE’S NOT GOING ANYWHERE ... NO. NO. NO. I’M NOT LOSING HIM. WE’RE FIGHTERS’
him about what was happening in the world and play his favourite music – Arctic Monkeys, Oasis, Dune Rats and The Beatles among the diverse bands on his playlist.
Finally, almost three weeks after he was connected to the ECMO machine, the Coxes were called back to the hospital late one night – donor lungs had become available. Wall operated on their son the next day, describing the 11-hour surgery as a “bit tricky”, given the “carnage” inside his chest. “All the chemotherapy and the radiation, whatever had happened inside his lungs, they were very stuck to the chest wall,” Wall explains. “It took us ages to get them out.”
As Wall and Cox rib each other goodnaturedly about their choice of football code – the surgeon a definite rugby man – Julie speaks in superlatives about the health workers who cared for her son. “My husband gets quite teary when he talks about Doug ... because he feels he’s Elliott’s saviour,” she says. “Doug is just this amazing person. He has such a presence, everybody seems to jump away, like: ‘He’s coming, he’s going to help this person.’”
“We’re lucky to have you, Doug,” she tells the surgeon during one of Cox’s medical appointments earlier this year.
“I just did a bit of plumbing,” Wall replies. “The only reason we’re here is because James Winearls put him on ECMO. That’s the bit that actually saved his life.”
Cox was one of 27 patients who received a lung transplant at The Prince Charles Hospital in 2020 during the first year of the coronavirus pandemic. Queensland Lung Transplant Service director Professor Peter Hopkins says numbers for the previous five years varied between 31 and 46. “It’s no secret that most transplant programs in Australia had reduced activity in 2020,” Hopkins says. “Donor numbers were slightly down but the reason for some of the reduced numbers was the fact that some patients elected to come off the transplant list during Covid.”
For them, the risk of getting Covid and being immunocompromised from the drugs transplant patients must take to prevent organ rejection was deemed too high, Hopkins explains. Cox and his family had no such choice – it was either have the transplant or face imminent death.
The Queensland Lung Transplant Service
celebrated its 25th anniversary last year. It’s performed more than 530 lung transplants since the first in September 1996. The service is one of only four adult lung transplant units in Australia, with others in Sydney, Melbourne and Perth. About a third of the Queensland donor lung recipients have cystic fibrosis, dozens of others have been diagnosed with emphysema. A small number, such as Cox, have been cancer patients.
Cox emerged from his lung transplant surgery so weak “he couldn’t even hold his mobile phone”. “I kept dropping it on my face,” he says, with a laugh.
But gradually, with help from hospital physiotherapists, he began lifting “tiny weights” in bed to start regaining some strength. By August 13, almost two months after he was put on the ECMO machine, he was allowed home.
When he returned to the gym in 2020, he was only able to leg press about 10kg. A year later, he increased that to a whopping 300kg. He’s also bulked up. He was 56kg when he left ICU and now weighs 80kg.
The fitness fanatic was 18 and studying for a degree in law and international business when doctors first discovered an inoperable tumour 22cm long and 10cm wide that had wrapped around his heart in October 2015. Six years later, he’s just been accepted into a Griffith University course to study clinical exercise physiology, keen to work with hospital patients, like himself, in future. “My outlook on life has changed and my goals have changed,” Cox says. “I’d love to get into hospitals and work with people who’ve got cancer, who have got any sort of life-threatening illness, if they’ve had a transplant ... whatever it is, and help them get through it.
“The research shows that exercise is one of the best medicines for physical and mental health. I think if I can do something I love, which is sport and the gym, and exercise in general, and combine that with helping people, I don’t think I’ll ever have to work a day in my life.”
After spending a quarter of his life dealing with serious medical issues, Cox, 24, describes every day as “a gift”.
“It might sound a bit corny, but it feels like it’s Christmas every day since my lung transplant,” he says.
“It’s hard to put into words what it feels like to wake up and be able to do what I want to do. It’s a feeling that’s indescribable but at the same time it’s the greatest feeling I think I’ve ever had.”