Months after being warned that her partner may never hold his daughter, Vanessa smiles as the girl works to cut two teeth on the device Freddy wears like a necklace, a blue ribbon tied around it. Freddy spent five months in the hospital, a four-hour drive from the couple’s home in the southwest Missouri town of Carthage on the most intensive life support available. The 41-year-old father of six has come close to death repeatedly and now – like so many who have survived a COVID-19 hospitalization – has returned home changed. While more than 1 million have died from COVID in the US, many more survived an ICU stay that left them with anxiety, PTSD and a host of health problems. Research has shown that intensive care starting in the ICU can help, but it has often been difficult to provide as hospitals fill up with patients. “There is a human cost that the patient pays for surviving in the ICU,” says Dr. Vinaya Sermadevi, who helped care for Freddy throughout his stay at Mercy Hospital St. “It’s almost like going to war and having the aftermath.” Freddy’s memories of those long months come in spades – moments where he regained consciousness, connected to machines to breathe for him, clinging to life. He sometimes asked for his mother, who died of COVID-19 in September 2020. He lost the birth of his daughter, Mariana, and the first four months of her life. He may never be able to return to his construction job. His other young daughter fears he will leave again. As the world moves on and mask mandates disappear, COVID-19 is not gone for them. “We’re left to deal with the remnants of what it caused,” says Vanessa.

Vanessa, 28, was still pregnant in Marianna last summer when the Delta strain hit poorly vaccinated southwest Missouri. She was skeptical about the vaccine, but her obstetrician assured her it was safe and she decided to go ahead and have it. And Freddy was receptive to the idea. The Mexico City native had come to the U.S. about 20 years ago to work in construction — mostly cement — and was now a permanent resident. Sometimes he worked from 5 in the morning until 8 at night, and often at least one day on the weekend. On the same day in late August that they planned to make an appointment to get vaccinated, his throat started to hurt. It was COVID. Days later, with Freddy coughing and struggling to breathe, Vanessa rushed him to the emergency room at the local community hospital. Freddy, though worried for his family, remembers thinking “it’s only a little bit.” But pneumonia was running through both his lungs. The next day, he was taken to a larger Springfield hospital that was full of patients and put on a ventilator. Even that wasn’t enough. He ended up in St. Louis, nearly 270 miles away from his two young daughters. Vanessa’s 10-year-old son Miguel, who considers Freddy his father. and three other children with his ex-wife — boys ages 10, 8 and 7. It was a dark time when many people hoped the pandemic would end, but the Delta variant flooded the healthcare system once again. Filling the shifts was a daily battle and death was everywhere, recalls Dr. Shermadevi. He said that at the beginning of the pandemic, everyone was “surprised and amazed that this was happening”. But grief, he says, has a “cumulative effect,” and by the time the Delta wave came, “there wasn’t even room for those feelings.” However, Freddy was lucky. For all the talk of ventilator capacity, what was less present during the Delta Wave was something called ECMO, or extracorporeal membrane oxygenation. It is used when a ventilator is not enough, drawing 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, Freddy became one of them. But there were risks to the long hospitalization that was beginning, says Dr. Anne Parker, a pulmonologist who directs the Post-Acute COVID-19 Team clinic at the Johns Hopkins University School of Medicine. Survival rates for ECMO patients dropped during the pandemic to around 50%, according to a 2021 report from the medical journal The Lancet. This meant that even when he was in the machine, his chances of survival were far from guaranteed.

Vanessa gave birth to Mariana on October 13th. Freddie was in the hospital for 48 days and didn’t even know he was the father of a healthy 6-pound, 11-ounce baby girl. Away from her fiance, Vanessa connected on video calls with Freddy’s doctors the same day she brought the newborn home. The news was not good – Freddy was suffering from infections and did not recover well. A lung transplant, Sermadevi said, seemed to be his best option, but it was a long shot, she warned them. “I don’t want to give you false hope,” Shermadevi recalled telling the family. “And there is a chance that Mariana will grow up without a father.” Vanessa, helping the hospital interpreter translate for Freddy’s family, glanced at the baby snuggled in an easy chair next to her. She wore the same yellow and white knitted sweater and boots that the couple’s eldest daughter, Melanii, now 4, had worn from the hospital. He wanted to keep fighting. So when the baby was just a week old, Vanessa began making the weekly commute from Carthage to St. Louis, where she stayed in a hotel Monday through Friday. Freddy’s sister came with her and her parents watched the kids. It meant giving up the first few months with the 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 that he would come home and then we could all be with her. So I had to take that risk.”

Some of the most important keys to recovery in critical care are non-medical. Visits from relatives, along with physical therapists, occupational therapists and speech therapists, have long been shown to make a difference for the sickest patients. COVID-19 upended these practices in many hospitals as families were kept away to prevent the spread of the virus. “When our health care system starts to get overwhelmed and our hospitals start to get overwhelmed, some of these things don’t get as much priority as we would like,” Parker says. “And that affects patient care and patient outcomes.” Fears of infection, as well as short staffing, often meant less physical therapy, which is proven to speed recovery. When Freddy’s family came, it made all the difference. His room was transformed, his family photos taped to the ceiling. Freddy’s family held his hand when he had trouble breathing, telling him about it. He needed less sedation and painkillers because, he says, “those were for him.” “We would listen to such love at the bedside,” she says. “And I feel like there’s only so much you can do in medicine, and then there’s the rest.” However, the money increased, with Freddy and Vanessa no longer working. People showed up on the family’s doorstep. “Here,” they told her, “we know you need it.” A devout Catholic, she prayed sometimes 10 times a day, begging God, “Please give them a miracle. heal him. He’s got all these kids to watch grow up.” As the weeks went by, staying on ECMO was becoming unsustainable. There was bleeding and infections. What followed was a careful dance that involved weaning off the ECMO settings and increasing the ventilator settings to get his lungs to do more work. December 2nd was the day she came off the machine and Vanessa was warned that there were no guarantees she 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 make it.” That first night was hectic. After he made it, his sister hugged the doctors. He had a chance.

With his lungs slowly improving, Freddy was soon up and trying to walk. Three people helped as he took his first steps on legs that were so numb just weeks earlier that he asked a cousin if he still had them. The staff were happy – a manager brought out pom poms and there were streamers. Eventually, a lung transplant speech was filed. By February 9, he was back home, 167 days after he first arrived at his hometown hospital. Outside 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 air for you”. All Vanessa could think was ‘finally’. Freddy had never met his baby. Nor had he seen any of his other children. Their interactions had been limited to Facetime and photos. Freddy arrives home. Melanii is shy, hugging him briefly along with her older brother Miguel, before clinging to her mother. “I told you dad was going home, right?” Vanessa tells a smiling Melanie before pulling the baby out of the car seat. “Can your dad hold your sister?” Vanessa kisses the baby and then lays it in Freddy’s arms. Now just a few days before he turns 4 months old, Mariana smiles at him. Melanie was his pre-pandemic shadow, “Daddy’s Princess,” following him around the house and out as he cleaned his truck. In the months she was away, she consoled herself by watching a video of her parents dancing to Latin country music. Her father is twirling her mother. both are smiling. Now is…