After Almost a Year on a Ventilator, a Washington Pastor Stricken by COVID Emerges

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EVERETT — Hector Garcia stood up from a wheelchair, pointed to the sky, and thanked God. The 61-year-old pastor's voice was raspy. Normally a beautiful singer and host of a Christian radio program, he had lost the ability to speak for almost a year — a year spent mostly on a ventilator, his body ravaged by COVID-19 and its aftereffects.

He had been so ill that his wife, Lizbeth, wrote out a funeral service. Now, here he was discharged from an Everett rehab center, about to go to his Federal Way home and a meal including pupusas, a tortilla-like dish from his home country, El Salvador.

In a black-and-white tracksuit, his white hair freshly cut by his wife, Hector was so excited that he hadn't slept much the night before. Neither had Lizbeth, who months ago had given up her front desk job at a health clinic to visit him as often as she could.

"It's a new chapter in our story," she said.

Last week, as members of his church and two of his four children cheered, he was helped into a silver Mercedes-Benz his brother-in-law brought so Hector could go home in style. Tucked in with him was a portable oxygen device, hinting at ongoing challenges. He is too weak to walk much, and needs physical and speech therapy.

Even so, Hector has emerged from an ordeal that most people can't imagine and which he, largely unable to remember, has learned of through others. "I myself cannot believe what I've been through," he said in Spanish, Lizbeth interpreting, during a long conversation last month.

When it comes to COVID-19, "a medical student could learn everything from this one patient," said Dr. Kamaljit Atwal, a pulmonary critical-care specialist at Adventist Health Portland, where Hector was treated for a time. "Everything that could go wrong, did go wrong."

To Atwal, Hector's story shows not only the multitude of ways COVID-19 can attack the body, but the body's ability to overcome tremendous stress. "Having said that," she added, "he is truly the exception. Most patients going through what he went through will not make it."

The twists and turns, not just for him but his family, have kept coming. Most recently, just as he was improving rapidly, COVID-19 struck his two daughters.

"I needed proof"

Flashes of memory have been coming back to Hector. A helicopter ride. Voices talking about passing Mount Rainier. Wondering: "Where's my family? Where's my family?" Waking up in a hospital room, alone.

"There were a few times I remember I was suffering a lot" — he felt like giving up. He remembers pain, thirst barely quenched by the little sponges soaked with water that nurses would give him, and an inability to communicate what he was feeling.

Lizbeth has filled him in on the rest. In photos, records and notes, she has documented the year. A co-pastor of their small Edgewood church, Iglesia Celebración de Vida, she said: "I had that picture in my mind that he was going to be a miracle from God and I needed proof."

A placard she made gives highlights: 304 days on a ventilator, five hospitals,130 days in ICU. He also spent 38 days undergoing extracorporeal membrane oxygenation, a sophisticated way of oxygenating blood outside the body.

An available ECMO machine led a Federal Way hospital to helicopter Hector to Oregon Health & Science University Hospital in Portland on Nov. 16.  He had been in the hospital for over two weeks by then, and on a ventilator for six days, but his blood oxygen level was still dropping.

In time, his body could handle stopping the oxygenation treatment. But he still relied on a ventilator and, like many COVID-19 patients, faced a new threat: "superinfections," which follow a previous illness.

"Ordinarily your body may be able to fight off these infections," Atwal explained. "Now your body's vulnerable, so these buggers say, 'let's take over."

"He had infections in his lungs, in his urine, even in his blood," she said. His kidneys gave out, requiring dialysis. He bled in the space around his brain. His heart was beating so slowly several times that he had to be resuscitated. Other times it beat too quickly.

Lizbeth said an OHSU doctor told her Hector might never come off the ventilator, and to prepare for the worst. Her heart pounding, she managed to calmly ask the doctor not to give up, then went back to her hotel room and cried. That's when she wrote out the  funeral service.

"There was definitely a point where he was not making progress, and it was very disheartening," said Dr. Ran Ran, who works in critical care and on the ECMO team at the Portland university hospital. A big concern was scarring in Hector's lungs, which makes the organs rigid, restricting their ability to move air in and out, Ran said. When lungs don't inflate with air, they shrivel.

Doctors feared much of the damage was permanent, but to what extent they didn't know, Ran said. "Medicine is really humbling."

To wit: Doctors also don't know why Hector, with only minor prior health issues, would get such a severe case of COVID. "It's the million dollar question," Atwal said.

"Keep breathing ... use your stomach"

Hector got better in fits and starts, punctuated by crises.

Last December, doctors lowered his sedation, and he became alert for the first time in months. While intubation kept him from speaking, he wrote on a board, though he still couldn't communicate when there weren't Spanish-speakers around.

In February, he stabilized enough to be transferred to a hospital in Oregon specializing in extended care, then suddenly began needing more oxygen. When moved to OHSU-affiliated Adventist, doctors there had to figure out why, and discovered another superinfection, according to Atwal.

He recovered from that and in June was brought to the Everett facility. "I can finally stay home with my kids," Lizbeth texted at the time.  The couple's two sons, 15 and 22, share their townhome and two daughters, 25 and 28, live nearby. She had been travelling back and forth between Federal Way and Portland, so stressed that she passed out one day on the street.

On Sept. 1, medical staff took Hector off the ventilator. "I felt a little fear," he said, adding he tried to keep calm.

"Don't think about it. Keep breathing ... use your stomach," a nurse told him.

"I was like jumping inside," Lizbeth said. "You're breathing on your own!" she exclaimed. "We cried together."

They were talking about that day just over two weeks later, Hector in a virtual whisper. He still had a small tube in his neck in case he needed to be put back on the ventilator, and a speaking valve allowed air into his vocal cords. He had spoken his first words in more than 10 months just three days before.

From then on, everything moved quickly. Staff took the tube out of his neck, deeming he needed  only a little supplemental oxygen through tubes into his nose, and  removed the speaking valve. He was weaned off a feeding tube and started eating, mushy food at first, then solid. His voice grew stronger and he cracked jokes.

Amid this good news came their daughters' brush with COVID. Melody, the youngest, said she thinks they got it while having a birthday and baby shower brunch at a restaurant for sister Katherine, eight months' pregnant.

Neither is vaccinated. Despite seeing what COVID-19 did to her father, Melody said she has wanted to wait to ensure the vaccines are safe, worried about side effects. Katherine said she wasn't comfortable getting the vaccine while pregnant. (Clinical trials show serious side effects to be extremely rare and scientists consider the risk, including for those pregnant, far outweighed by the danger COVID-19 presents to the unvaccinated.)

Melody got the sickest in a week that was its own mini-saga. She went to two hospitals because of what she said was a bad experience at the first. She said she was so frightened by her dad's experience that she told medical staff: "I do not want the ventilator, whatever happens." She got her wish, and both she and her sister recovered.

Hector got sick before vaccines were available. He's aware of them now, and when asked about being vaccinated said, "I have no problem." But he said he wants to consult a doctor first about whether his body is ready. Lizbeth, worried that her body is also not ready given the stress of the last year, has also waited.

Doctors generally advise that people who have had COVID-19 get vaccinated once they're out of the severe phase of their illness, said Dr. Mark Wurfel, a pulmonary and critical-care physician at Harborview Medical Center. For most people, he explained, their natural immunity isn't enough to protect them and, weakened by COVID already, another bout could kill them.

Last month, the Centers for Disease Control and Prevention announced that in tracking more than 600,000 COVID-19 cases in April through July, those who were unvaccinated were more than 10 times more likely to be hospitalized than those who had been vaccinated, and 11 times more likely to die.

Another infection of any sort is likely to be one of Hector's biggest risks, doctors said. Still, Atwal said, "I don't see anything in his way unless there's a huge crisis," even if effects linger. He might have trouble sleeping, or remembering, or "just say 'my brain doesn't work as well.'"

He likely won't be running a marathon given damage to his lungs, Ran said. "But can we get him to a place where he can just live a normal life?" Can he transfer from the bed to a chair and walk around? "Those are the questions you can't predict."

When Hector got home Wednesday, he enjoyed as much normalcy as he could. He sat at a desk with the consoles he used for his radio program, and reunited with his daughters and grandchildren, the youngest born by emergency C-section after Katherine became ill with COVID-19.

A photo shows baby Avianna sleeping on his chest, Hector patting her head and smiling.

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