241

DAYS ON ECMO LIFE SUPPORT

5

SURGEONS

90

UNPLANNED EXTRA

MINUTES

100%

OXYGEN DURING

THE CRISIS

The prep had been done in the 48 hours leading up to surgery. Every test imaginable. Cancer screening. Every form of hepatitis. My first colonoscopy, which was brutal. A lot of blood work. By the time they wheeled me in, there was nothing left to do.

The morning of, they placed a mask over my nose and mouth and told me to breathe normally. I can tell you with certainty that I inhaled as hard as I possibly could.

The next thing I remember is waking up to the sound of my wife, Maureen, and my oldest daughter, Sydney, talking. My eyes were still closed. I had no idea where I was or what had happened. But hearing their voices was everything.

To actually answer the question people are asking, I am going to share notes from the surgery itself. My hope is that it gives pre-transplant patients something to hold onto. My surgeons and their team at Northwestern Memorial are the best. I am grateful every single day they were in that operating room.

Full disclosure. What follows is an accurate account of transplant day. I am sharing it because pre-transplant patients deserve to know what actually happens, not a sanitized version. If you are squeamish, read with caution.

And to put it in perspective: this was minor compared to what came before it. 241 days on ECMO. Eleven months across three hospitals. Nine months relearning how to walk and use a knife and fork. By the time January 31, 2022, arrived, I had already survived the hardest part.

Since May 2021, a machine has been breathing for me. Not helping me breathe. Doing it entirely. Every breath, in and out, was controlled by a device called ECMO that removed my blood from my body, added oxygen, removed waste, and pumped it back in. My lungs, destroyed by COVID, could no longer move air on their own.

I had been connected to that machine for 241 days.

By January 2022, the medical team had reached one conclusion. My lungs were not recovering. The damage was permanent. The only way I would leave the hospital was with new lungs in my chest. Then on January 30th, the phone rang. A donor had been found. Somewhere, a family was living through the worst day of their lives. In the midst of that grief, they decided to donate. That decision was the reason I had a chance. One window. One shot.

BEFORE SURGERY BEGINS.

A cooler arrived.

Inside, packed in ice, were the donor lungs. The moment they left the donor's body, a clock started. Donor lungs can only survive outside a body for a limited number of hours before they become unusable. Every minute mattered.

While I was being put under general anesthesia, a surgeon at a separate table in the same room was already working on those lungs. Verifying the donor ID. Confirming blood type match. Separating the two lungs from the block they arrived in. Trimming the blood vessels. Cutting each airway to the precise length needed. Then, wrapping each lung in ice-cold towels to wait.

THE FIRST PROBLEM

What they found when they opened his chest.

The incision went horizontally across my chest from side to side and straight down through the breastbone, opening both sides of my chest simultaneously like a book.

What the surgeons found inside was not what they had hoped for.

My diseased lungs had fused to the inside of my chest wall with thick bands of scar tissue. To remove them, the team had to cut through every one of those fused connections first.

This took 90 extra minutes. Unplanned. The donor lungs were on ice the entire time.

My diaphragm had risen abnormally high from months of disease. My entire chest cavity had compressed and stiffened. The surgeons also removed enlarged lymph nodes from nine mapped locations in the center of my chest before the old lungs could come out.

THE CRISIS

The machine keeping me alive began to fail.

The right lung went in first. Three connections, all hand-sewn with suture thinner than a human hair. The airway. The artery. The veins. Each one was flushed of air before the final stitch was tied. The right lung was warmed and reinflated.

It was working.

Then the team moved to the left side. During the next step, a small tear opened in a blood vessel wall. Air was pulled through that tear into the bypass circuit, the machine keeping my blood circulating. When air fills a pump circuit, the pump can no longer move fluid through it. The machine began to fail.

What happened next

In that moment, five surgeons had seconds to act. They converted the circuit to a different bypass machine, reconnected the tubing, and administered six times the original blood thinner dose to prevent clotting during the transition.

Throughout the entire emergency, my oxygen level held at 100%.

Because the right lung, connected minutes earlier by hand with sutures thinner than a human hair, was already functioning. A stranger's organ was breathing for me while the team solved the crisis that threatened to end the surgery.

They stabilized. They proceeded.

THE FINISH

Both lungs in. Both working.

The left lung came out. The donor's left lung went in—three more connections, hand-sewn. The bypass machine was removed. The blood thinner was reversed. The chest was closed in layers: ribs pulled back together, breastbone wired shut with steel, muscle, skin, staples, dressing.

A camera was passed down into my new airway, and every connection was examined from the inside. Both lungs. All six connections.

Everything was intact.

I was transferred to the cardiac thoracic intensive care unit in stable condition.

Two days later, on February 2, 2022, the ventilator was removed.

I breathed on my own for the first time since May 2021.

A Life Returned

The full story is in the book.

241 days on ECMO. A double lung transplant. Nearly a year in three hospitals. And the long road back.

Contact:

nick@alifereturned.com

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