San Antonio Express-News (Sunday)
JOHN’S NEW LUNGS
COVID-19 nearly killed him at age 34. Only a double lung transplant would save his life.
In his hospital room, he kept the blinds drawn and the television off. He rarely looked at his phone, not even to talk with his daughters. He was prickly with medical staff and his older sister, who was sleeping in his room on a pull-out couch.
It had been two months since John Vargas Jr. had fallen ill with COVID-19 and weeks since doctors in San Antonio had determined that the disease had destroyed his lungs. At age 34, he needed a double lung transplant. He had been flown halfway across the country to be evaluated at University of Florida Health Shands Hospital.
In preparation for the surgery, John was supposed to do intensive physical therapy to ensure he was strong enough to withstand it. But when the team of therapists stopped by his room, he would resist their efforts to get him out of bed.
“Leave me alone,” he would say.
A few months earlier, he had been upbeat and ablebodied, a veteran of the oil fields of West and South Texas. Now he was far from home, unable to eat, too weak to stand on his own. He was entirely dependent on machines for survival.
One evening, four doctors from the hospital’s transplant program visited John in his room. They had decided against putting him on the list for new lungs.
“You’re not showing me that you want it,” one doctor said.
The doctors knew John was struggling with nausea and the helplessness of being hooked to a maze of tubes and was unable to breathe on his own. Still, if his attitude didn’t change soon, they would have to send him back to San Antonio. He had one week.
The doctors left, and John was alone with his sister.
“I just want to go home,” he said.
Janette Armstrong began to cry, pleading with her brother as she laid out everything he had been through — the weeks-long coma, the months of intensive care, the separation from his family, the flight to Florida that almost killed him. It was a privilege to even be considered for a transplant.
They had friends and family members who had died of COVID-19. Somehow, he was still here. He was one of the lucky ones.
He needed these lungs. And his girls — Mariah, 7, and Leilani, 8 — needed him.
“You’re not supposed to be here, and you are,” Janette told him. “God kept you here for a reason. What the reason is, I have no idea. But you can’t give up.”
John considered her words and those of his doctors.
He had to do something, he thought, or he was going to die.
Chapter 1: The diagnosis
The first time John realized his life was in danger, he was
surrounded by strangers.
It was late June, and the coronavirus had been spreading rapidly across San Antonio, infecting people in their homes, at gatherings with friends and family, in restaurants and bars and stores — and at the call center where John had recently started working.
His temperature had spiked to 102 degrees, and he was gasping for breath between words. An ambulance rushed him to Baptist Medical Center downtown.
The emergency room was packed with coronavirus patients. There were no beds available there, nor at the next hospital paramedics checked, so he was transported to North Central Baptist Hospital.
John was receiving supplemental oxygen from a sleep apnea machine, but his blood oxygen levels were still dangerously low. Doctors wanted to intubate him.
He refused, vowing to fight on his own for as long as possible.
While the oil fields paid well, they had kept him away from San Antonio for long stretches. He knew his absence affected his daughters. At his new job, he could spend time with them almost every weekend.
Now he didn’t know when he would see them again.
BBB
When Dr. Jeff DellaVolpe heard about a 34-year-old San Antonio man who was quickly deteriorating from COVID-19, he thought it was the perfect case for his program.
For months, DellaVolpe had been treating some of the sickest coronavirus patients in the city. As medical director of Methodist Hospital’s extracorporeal membrane oxygenation program, he specialized in a type of life support that bypasses the lungs by pumping oxygen directly into the blood and filtering out carbon dioxide.
ECMO carries risks of lifethreatening complications, including infection, clotting and bleeding. It is also a limited resource — the hospital had only a dozen machines, each of which required the attention of a large team of specialists. The treatment had to be reserved for the patients with the greatest chance of survival.
So when DellaVolpe got a call from doctors at Baptist, asking if there was a bed for John, he was eager to help. Here was a young man, in relatively good health aside from his controlled diabetes, who was in danger of dying. The ideal ECMO candidate.
But getting him into the hospital would not be simple.
Over the course of that month, coronavirus hospitalizations in San Antonio had surged by more than 900 percent. Every bed in DellaVolpe’s unit was taken. Nurses and equipment were in short supply.
Finally, after three days, a bed opened up. Late in the night June 22, John was transferred to Methodist.
There, DellaVolpe inserted a pair of tubes called cannulas into John’s blood vessels — one for draining oxygen-deprived blood from his body, the other for returning it — so that a machine could do the work of his lungs.
It wasn’t enough. John needed to be placed on a ventilator to keep him alive. He would be sedated.
He was wheeled into a room with no windows. Doctors and nurses in full-body protective equipment crowded around him.
An air filtration machine roared like a jet engine. Hospital staff fumbled with his phone as they tried to unlock it.
“Is there somebody that we can call?” one finally asked in exasperation.
His daughters. He wanted to talk to his daughters.
John called Ashley Simmons, his ex-wife. As foster parents, they had adopted Leilani when she was 6 weeks old. When her sister, Mariah, was born a year later, they took her in, too.
“Get the girls on the phone,” he told her. “They’re going to intubate me, and I don’t know what’s going to happen.”
BBB
In his dreams, John was a fighter pilot. Then he was in a hospital in Japan, having traversed the globe to access the treatment he needed. Now he was lying down, paralyzed. He was trying to remove a blanket, but it was too heavy. No matter how hard he tried, his legs would not move.
He was in the grip of delirium, completely unaware of where he was. Any time staff tried to wean him off sedation, his oxygen levels would plummet. The disease was straining his heart and kidneys.
The blood oxygen saturation of a healthy person is between 95 and 100 percent. Even on full ventilator and ECMO support, John’s levels hovered in the 70s, sometimes dipping into the 60s. The machines were no substitute for healthy lungs.
As John slept, days turned to weeks, and DellaVolpe grew concerned.
Under the best circumstances, patients on ECMO have about a 50 percent chance of surviving. The flip of a coin.
To the hospital staff, the odds seemed against John. They worried that their efforts were futile and that they were doing more harm than good. Even if he survived, they wondered, what would his quality of life look like? His lungs might never recover. They began to discuss the possibility of withdrawing care.
Even so, DellaVolpe tried to remain positive. This was a devoted father, a young man with his whole life ahead of him. John, known as JR to his family, should be doing the things he loved: spending time with his daughters, rooting for the Spurs and the Dallas Cowboys, playing video games with his friends and watching movies. They had to do everything they could to get him through this.
One night, his sister, Janette, got a call from Methodist. If she wanted, she could come to the hospital to say goodbye.
In the intensive care unit, Jan