Freddy Fernandez almost wasn’t here, on his couch in his Missouri home, his baby in his arms, crunching on the pulse oximeter he uses to check his oxygen levels after a month-long battle with COVID-19.
Months after her partner warned her daughter never to keep one, Vanessa smiles as the girl works on two teeth that Freddie wears like a necklace.
Freddie spent five months on the most intensive life support in a hospital four hours from the couple’s home in the southwestern Missouri city of Carthage. The 41-year-old father of six almost died repeatedly and now he – having survived most of the COVID-19 hospitalizations – is back home.
While more than 1 million people have died from COVID in the US, many more survivors have ended up in ICUs that have left them with anxiety, PTSD and many other health problems. Research has shown that intensive therapy starting in the ICU can help, but it was often difficult to provide because hospitals were overwhelmed with patients.
During his stay at Mercy Hospital in St. Louis, Dr. Freddie helped take care of him. “There is a human cost to the patient to avoid the ICU,” says Vinaya Sermadevi. “It’s almost like going to war and suffering the consequences.”
Freddie’s memories of those long months come flooding back—the moments where he regained consciousness, was hooked to machines to breathe for him, clinging to life. Sometimes he asked his mother, who died of COVID-19 in September 2020.
He remembered the birth of his daughter Mariana and the first four months of her life. He will never be able to return to his construction work. Her other young daughter fears that she will go away again.
As the world moves on and mask mandates are lifted, COVID-19 has not gone for them.
“Because of that, we’re left to deal with what’s left,” says Vanessa.
Vanessa, 28, was still pregnant with Mariana when the Delta variant failed to vaccinate in southwest Missouri last summer. She was skeptical about the vaccine, but her obstetrician assured her it was safe and she decided to go ahead.
Even Freddie was warming to the thought. A native of Mexico City, he came to the U.S. about 20 years ago to work in construction — a cement job — and is now a permanent resident. Sometimes he worked from 5 a.m. to 8 p.m., and often at least one day on the weekend.
On the day they planned to schedule an appointment for the vaccination in late August, her throat started to hurt. It was COVID.
Days later, with Freddie coughing and struggling to breathe, Vanessa rushed him to the emergency room at a local community hospital. Freddie, though worried about his family, remembers thinking, “It’s just a little bit.”
But pneumonia was going on from both his lungs. The next day, he was taken to a large Springfield hospital that was full of patients and put on a ventilator. Even that was not enough.
He wound up in St. Louis, about 270 miles from his two young daughters; Vanessa’s 10-year-old son, Miguel, who considers Freddy his father; and three other children — 10-, 8- and 7-year-old boys — with his ex-wife.
It was a dark period when many people hoped that the epidemic was ending, but the delta version again flooded the health care system. Filling shifts was a daily battle, and death was everywhere, Dr. Sermadevi remembers. She said that at the beginning of the pandemic, everyone was “surprised and shocked that this was even happening.” But grief, she says, has a “cumulative effect” and “there wasn’t even room for those emotions” when the Delta increase came.
Freddy was lucky, though. For all ventilator capacity, the shortest supply during a delta surge is called ECMO, or extracorporeal membrane oxygenation. It is used when the ventilator is not enough, pumping blood from the body, oxygenating it, and then returning it.
Mercy Hospital St. Louis only had the equipment and staff to care for three ECMO patients at a time. And on September 3, Freddie became one of them.
Dr. Ann Parker, a pulmonologist who co-directs the Post-Acute COVID-19 Team Clinic at Johns Hopkins University School of Medicine, says, however, that there are risks to long hospital stays.
According to a 2021 report in the medical journal The Lancet, the survival rate of ECMO patients has dropped to around 50% during the pandemic.
This meant that even with the machine, his chances of survival were far from guaranteed.
Vanessa gave birth to Mariana on October 13. Freddy had been in the hospital for 48 days, and he didn’t know he was the father of a healthy, 6-pound, 11-ounce baby girl.
Away from her fiancé, Vanessa logged video calls with Freddie’s doctors the day she brought the newborn home. The news wasn’t good – Freddie was suffering from an infection and wasn’t recovering well.
A lung transplant, Sermadevi said, seemed her best option, but was a long shot, she warned them.
“I don’t want to give you false hope,” Sermadevi told the family. “And there is a chance that Mariana could grow up without a father.”
Vanessa, helping the hospital interpreter translate for Freddie’s family, looked at the baby sitting in the bouncy chair next to her. She wore the same hand-knit yellow and white sweater and booties that the couple’s older daughter, Melanie, now 4, also wore home from the hospital.
She wanted to keep fighting.
So when the baby was just a week old, Vanessa began driving weekly from Carthage to St. Louis, where she stayed in a hotel Monday through Friday. Freddy’s sister joined him, and his parents watched the children. This means skipping the early months with a newborn.
“I have to split myself in two,” Vanessa remembers deciding. “I knew he needed me, but he needed me too. And so I knew that if I was there with him, there was a chance for him to come home and then we would all be able to be home with him. So I took that risk. Had to pay.”
The most important keys to recovery in critical care are not medical. Visits from relatives, along with physical, occupational and speech therapists, have long been shown to be difference makers for patients.
COVID-19 upended those practices in many hospitals, as families were kept apart to prevent the virus from spreading.
“As our health care system begins to become overwhelmed and our hospitals begin to become overwhelmed, some of those things are not prioritized as much as we would like them to be,” Parker says. “And that affects patient care and patient outcomes.”
Fear of infection, as well as short staffing, also often means less physical therapy, proven for faster recovery.
When Freddie’s family came, it made all the difference.
His room was changed, his family photos thumbtacked on the ceiling. Freddie’s family held his hand as he struggled to breathe, talking him through it. She needs less sedation and pain medication because, she says, “they were there for her.”
“We can only hear such love in bed,” she says. “And I think there’s only so much you can do with medicine, and then there’s the rest.”
However, as both Freddie and Vanessa were not working, money was running low. People showed up at the family’s door. “Here,” they told him, “we know you need it.” A devout Catholic, she sometimes prayed 10 times a day, pleading with God, “Please, give them a miracle; heal her. She has all these children she has to watch grow up.
As the weeks passed, the stay on ECMO became unsustainable. There was bleeding and infection.
What followed was a careful dance that involved lowering the ECMO settings and increasing the ventilator settings to get his lungs to work more.
December 2nd was the day he came out of the machine, and Vanessa was warned that there was no guarantee it would be successful.
“But in my mind and in my heart, I guess spiritually, I didn’t have that mindset,” Vanessa says. “I had the mindset that he was going to do it.”
That first night was perfect. After she made it through, her sister hugged the doctors. He had a chance.
As his lungs slowly recovered, Freddie was soon up and trying to walk. The three helped as he took his first steps on a leg that had been so numb a few weeks earlier that he asked his cousin if he still had it. The staff was happy – a manager brought out pom-poms, and there were streamers.
Finally, lung transplant negotiations were tabled.
By February 9, he was on his way home, 167 days after first arriving at his hometown hospital.
Outside, on the glass door of Freddy’s room, the nurses had drawn two lungs, painting them blue and red. Next to the lungs, they wrote “We will be the wind for you.”
All Vanessa could think was “Finally.” Freddie had never met his child. Nor did he see his other children. Their interactions were limited to FaceTime and pictures.
Freddy arrives home. Melanie is shy, hugging him briefly, along with older brother Miguel, before clinging to her mother.
“I told you to come home daddy, didn’t I?” Vanessa tells Melanie with a smile before pulling the baby out of the car seat.
“Can your daddy hold your sister?”
Vanessa kisses the baby and then places her in Freddy’s arms. Now a few days after turning 4 months old, Mariana smiles at him.
Melanie had been his shadow before the epidemic, “Daddy’s princess,” following him around the house and out as he cleaned his truck. In the months she was gone, she consoled herself by watching videos of her parents dancing to Latin country music. Her father drives her mother around; Both of them smile.
Now, she’s still scared, Vanessa says, “because every time she meets with him, he’ll say, ‘Don’t go.’ She doesn’t cry. She just says, ‘Don’t go.’
Freddie initially relied on a walker and wheelchair. She cannot sit or eat alone.
But now the wheelchair is left on the back steps of the house. He walks around the whole block, dragging a portable oxygen canister behind him on a dolly. He is about to be able to carry his oxygen in a backpack, which will give him more freedom.
The family spends hours outside in the afternoons and evenings, with Freddy watching the children jump on the trampoline. Her German Shepard clings to her side.
“He’ll be nervous at first,” says Vanessa. “Now I think with him seeing his own transformation progress, I see he’s doing so well. I think he’s more excited than anybody right now. He’s going to have his moments where he’s like, ‘Oh, I feel good.’
As Vanessa returns to work, life “goes back to normal a bit”.
They want to wait until Freddie is well to get married.
Although they don’t know how well he’ll get — or how soon.
Such is the story of many who remain alive but change forever, says Sermadevi, who has followed his progress from afar. Some nurses have even become Facebook friends with Vanessa.
“It’s sad and happy at the same time,” she admits. “And it’s very difficult to reconcile.”
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