If Jamie Calcasola had one do-over to choose, he’d have gotten the COVID-19 vaccine sooner.
“This has been the scariest and most miserable experience of my life,” said Calcasola, who caught the delta variant while vacationing in August.
After a week in bed thinking his symptoms would go away, Calcasola “couldn’t catch his breath.” Scared, the husband and father went to the emergency department at New Hanover Regional Medical Center (NHRMC), now part of Novant Health.
The 34-year-old who’d never had any health problems would be placed on a ventilator, and later, an extracorporeal membrane oxygenation (ECMO) machine – the most advanced form of life support. He didn’t know it at the time, but there was a strong chance he would not survive.
Most of his 77-day stay is “a blur.” Today, he’s out of the hospital with a “new lease on life” – and a cautionary tale for others to get vaccinated.
‘I couldn’t even talk to him’
The summer surge of COVID infections was fueled by the contagious delta variant, which doctors say can make even young, healthy people very sick.
“With delta, I began to see critically ill people in their 30’s and 40’s, even a couple of 20-year-olds,” said Dr. Peter Kane, a cardiovascular and thoracic surgeon at NHRMC.
Kane cares for some of the sickest COVID patients in the cardiovascular intensive care unit (CVICU). Calcasola became one of them on Aug. 25.
“By all accounts, Jamie was as an active, healthy guy with no history of medical problems. But when I met him, I couldn’t even talk to him. He was already very sick,” Kane said.
Days earlier, Calcasola had been sedated and placed on a ventilator. “I remember a doctor leaning in and saying, ‘We’re going to have to intubate you.’ And I teared up because I wondered if I was going to die,” the father of three daughters said.
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The connection between COVID and lung failure
COVID can damage a person’s lungs, Kane said, by causing necrosis (dead cells in an organ or tissue) and pulmonary fibrosis (scarring in the lungs).
“The fibrosis and necrosis we’re seeing in COVID patients is likely caused by the inflammatory response that follows the virus, more than the virus itself. We’ll know more about it in the coming years, but for one reason or another, certain people have an extremely aggressive course of COVID where the lungs are severely damaged and they become stiff and fibrotic,” he said.
Thickened, stiff tissue in a person’s lungs can make it difficult to breathe – the “very scary” feeling that led to Calcasola’s hospital visit.
Advantages of ECMO
While a ventilator helps people breathe to keep them alive, Kane said it also comes with risks. Here’s why: When someone inhales, their diaphragm goes down and it creates a negative pressure that pulls air into their lungs. A ventilator uses positive pressure to push air into the lungs, so it works in the opposite way.
“With people who are really sick, the pressure needed to do that goes up and up, because their lungs and airways get stiffer. As it gets increasingly difficult for a ventilator push air in, it causes damage to the lungs,” Kane said.
Instead, doctors can use an ECMO machine to do the work of someone’s lungs, heart or both.
“With ECMO, you can turn the ventilator almost all the way down, so the lungs can actually relax. It releases that pressure I mentioned,” Kane said. “And like many things with COVID, we’re learning more over time. So, I know younger patients have a better chance at recovery if they’re moved to ECMO sooner than later.”
With that in mind, Calcasola went on ECMO three days after being ventilated. His heart was working, so the machine was directed to support his lungs. This is known as venovenous (VV) ECMO.
How ECMO works
An ECMO device is a specialized version of what’s commonly called a heart-lung machine. It’s connected to a patient through cannula (plastic tubes). There are two connections – one leaving the patient and another going back to them – which function as a circuit outside of the body.
Kane surgically placed one tube in Calcasola’s femoral vein (located in the thigh) and another in his neck. With these connections in place, the machine pumps blood from the body to an artificial lung (or oxygenator), which adds oxygen to it and removes carbon dioxide. This is the same process that happens in the lungs.
The ECMO machine, essentially operating as the heart, then sends blood back to the patient at “about the same rate the heart pumps blood. So, it just takes the lungs out of the equation,” Kane said.
Think of ECMO as a support tool, he added, not a long-term treatment. It does not cure or treat the underlying problem, so the affected organ must heal.
‘I was a wreck’
Calcasola would remain on ECMO for nearly a month – an average length of time for COVID patients with lung failure, Kane said.
As they waited to see how he’d respond, Calcasola’s wife, Brittany Chitty, made daily trips to the seventh floor at NHRMC.
“Going to the hospital became like an obsession. I asked 50 questions every visit to make sure I knew what was doing on. And Jamie is a big goofball, so I decorated his room to show his personality. Pictures of us skydiving, working out, birthdays, holidays – everything,” Chitty said.
She credits their daughters (ages 2, 11 and 13) with keeping her sane. “Emotionally, I was a wreck, but at the end of the day, I’m a mom. I put on a happy face, and they forced me to be a normal human being,” Chitty said.
A lifesaving, but resource-intensive machine
There’s no question ECMO saves lives. And it’s being used to give younger COVID patients a chance at survival. It’s also “very, very resource intensive,” Kane said.
Typically, there’s both a nurse and either a certified, advanced ECMO specialist known as a perfusionist or a respiratory therapist at the patient’s bedside 24/7. They adjust the settings to provide the right amount of heart or lung support.
“Those providers are solely dedicated to that patient. So, it can be tough for the hospital to manage when all four ECMO machines are being used at once,” Kane said.
As health care workers cared for an influx of COVID patients in 2019, national guidelines were set to best utilize the resource. Age, weight and underlying medical conditions are all factored in.
“When we consider who is a good candidate for ECMO, they have an organ that isn’t functioning properly, but the rest of their organ systems are working well. So, if you look at Jamie, he fit all the criteria. He was young, in fairly good shape and had no other known medical problems,” Kane said.
Pre-pandemic, ECMO was primarily used for:
- “Very sick” flu patients.
- People with pneumonia.
- Someone who’s had a heart attack or massive lung failure.
- Trauma victims.
- A person with organ failure.
- Someone waiting on an organ transplant.
A chance to heal
About half the time, Kane said a COVID patient on ECMO will “deteriorate even further and they, unfortunately, don’t get better. But for the fortunate half, like Jamie,” the fibrosis breaks up and the lungs become more compliant and functional again.
(It’s worth noting, Kane said, that patients who go on ECMO for causes unrelated to COVID, “the survival rate is a bit higher – about 70 percent.”)
On Sept. 23, after nearly a month on ECMO, Calcasola was removed from life support. His memory picks up about a week later.
“I woke up and a nurse asked me if I knew what month it was. I shrugged my shoulders and heard them say, ‘It’s October.’ I went to the hospital in August, so I was really confused. It took a couple of days for that to really sink in,” he said.
He’d spend another month in the hospital recovering. Touched by the care he received, Calcasola arranged to thank the health care workers who saved his life before he left on Oct. 28.
“It was really powerful. It was everything to be able to see them and say, ‘I’m alive, because of you guys.’ I’m tearing up right now, just thinking about it,” he said.
Miracles can happen
The return to his parent’s house in Carolina Beach, North Carolina, was nothing short of a celebration.
“The entire neighborhood was lined up down the street like a parade. Everyone was cheering and hollering; they had poppers and signs. It was pretty memorable,” Calcasola said.
And as they pulled in the driveway, a banner over the door read, “Love is stronger than COVID. We believe in miracles!” Considering how dire his condition was, “miracle” may not be much of a stretch.
“I got the title of sickest patient in the CVICU. A nurse told me later I had about a 15% chance of survival. That still gives me chills,” Calcasola said.
Vaccine ‘poster child’
Told he wouldn’t survive another bout with COVID, he plans to get the vaccine once doctors give him the all-clear.
“I’m the perfect poster child for not believing that COVID is serious. I thought, ‘Oh, I don’t want that vaccine in my body. Blah, blah blah.’ Now that I look at it, I really wish I had,” Calcasola said.
Despite lingering complications like weakness, swelling and neuropathy (nerve damage that causes numbness or tingling) in his feet, the 34-year-old is “feeling really good.”
The truck driver is eager to get back on the road, but thankful to be back home in Henrietta, Texas. (When he got COVID in August, the family was vacationing at Disney World in Florida. So, they drove to his parents in North Carolina where they stayed through early November.)
“I’m grateful to my family, and that my employer is giving me the time I need to recover.” Calcasola said. “But more than anything, I have a new lease on life. I’ve called it ‘my new life.’ I just want to be the best dad, the best husband I can be.”