Brenda Voglewede could see the tears welling in her husband’s eyes as he crossed the finish line of the 2013 Rock ‘n’ Roll Denver Marathon.
“I think he was holding back those tears of joy because a lot of people he knew were there,” said Brenda, smiling at Victor Carlos, her husband of more than 20 years.
That day’s finish line didn’t just mark the end of a 26.2-mile race for Victor. It signified the start of a full return — as a person, a husband and a father — after a grueling battle against an everyday illness that nearly took his life: the flu.
Flu season and acute respiratory distress syndrome
It was 2012, and the 41-year old Victor had already completed three marathons over the past two years. He was healthy, as was Brenda. In fact, Victor didn’t recall ever having had the flu before. So, the couple felt they didn’t need an annual flu shot, even though they made their two daughters, then ages 7 and 11, get that year’s immunization.
The flu hit Brenda first, then a few days later, it struck Victor. For Brenda, it worked its typical course: after about a week, she started to feel better. Victor figured he was just a few days behind his wife and would soon start to recover too.
“It was different than a cold,” Victor explained. “I coughed a lot, and it was the first time ever I couldn’t sleep because I’d stop breathing. I thought I might lie down and not wake up again.”
By day nine, Brenda was starting to get concerned about Victor. She began looking for signs of something more serious than the flu. He was drinking lots of fluids and keeping soup down. But by day 10, she noticed he was urinating less, and when he did, it was an amber color. His stomach was hard and bloated to the point he couldn’t get comfortable sitting up. His fingernails began to turn a shade of purple, and her computer-programmer-by-day husband started to not make sense, rambling on about having to take a spelling bee.
Brenda decided it was time to get Victor to the emergency room. She drove him because he’d refused to take an ambulance, not wanting to scare the girls.
“I thought I’d take him and drive him there and everything would be fine,” Brenda said.
But when Victor shuffled his way to the car, Brenda noticed he’d put on a nice pair of dress pants and his coat on backwards.
What is acute respiratory distress syndrome?
Victor slumped over the emergency room security desk at UCHealth University of Colorado Hospital on the Anschutz Medical Campus, exhausted from the walk through the parking lot. He plopped down in a wheelchair as a nurse placed a pulse oximeter on his fingertip.
It read 58%. The nurse adjusted it. Still 58%. She moved it to a different finger. The same reading.
“She abruptly got up and went around the corner,” Brenda recalled. “Then she rushed into the room with a whole team — eight to 10 people. … I didn’t realize how bad 58% was.”
A normal pulse oximeter reading usually ranges between 95 and 100 percent. Victor’s body wasn’t getting nearly enough oxygen. An oxygen mask tried to push air into his body, but it had nowhere to go. A rushed X-ray showed he had pneumonia in the lungs and was suffering from acute respiratory distress syndrome (ARDS), a condition where fluid collects in the lungs, depriving organs of oxygen.
After about 30 minutes, pulmonologists intubated Victor, hoping to help him breathe better. Brenda headed home quickly to make arrangements for someone to watch the girls and get necessary items for a stay at the hospital.
ECMO use as last effort
Brenda was familiar with medical verbiage. Her youngest daughter had had two heart surgeries as an infant. So, when doctors told Brenda that she needed to return to the hospital immediately to sign important paperwork regarding her husband’s care, she was a bit confused.
“They said they needed to do surgery for what I heard was an echo,” Brenda explained. An echo, or echocardiogram, is a sonogram of the heart. “I was thinking, ‘Why would they do surgery for an echo?’”
Brenda’s friend, who also was a physician next door at Children’s Hospital Colorado, was going to drive Brenda back to University of Colorado Hospital, where she’d dropped Victor off only a few hours before. While she waited for her friend, Brenda called Victor’s brother, who happened to be attending medical school, in Cleveland.
“Do you mean ECMO?” Victor’s brother asked her.
“He sounded very worried,” Brenda said.
But she didn’t know what he was talking about. He told her he’d be on the next flight to Denver.
Brenda conveyed these phone conversations to her physician friend in the car.
“She didn’t look at me when I asked her how serious this is. She just patted me on my knee,” Brenda said. “I still was not sure of the gravity of the situation, even as they asked me if I wanted a prayer when we were at the hospital. Then the doctor said there was a 40% chance of Victor making it — maybe 50% because of his health and age. I remember thinking, ‘What? That’s still not that good.’”
Brenda was in a daze, but it wasn’t just because of the news that her husband was critically ill. Having been battling the flu alongside Victor for the past week, she now had a 104-degree temperature. Nurses whisked her away to the emergency room as a separate team wheeled Victor into surgery. He was about to be hooked up to a device that would act as his lungs and heart. Victor was experiencing multiple organ failure and nearing death. Connecting him to the device called ECMO was a last-ditch effort to save his life.
Why ECMO for acute respiratory distress syndrome?
Extracorporeal Membrane Oxygenation, or ECMO, is a lifesaving technology that provides support when a patient’s heart and lungs are not working well enough to sustain them.
“The idea is that by putting (a patient) on ECMO, you let their heart and lungs take a break and therefore let them recover, which is hard for them to do if (the lungs and heart) are having to take care of the rest of the body,” said Dr. Jay Pal, surgical director of the Mechanical Circulatory Support Program at the University of Colorado School of Medicine’s Division of Cardiothoracic Surgery.
Brenda had driven Victor to the right place. At the time, University of Colorado was the only hospital in Colorado equipped to use ECMO for severe pulmonary injury and disease, as it takes a specialized team that includes surgeons, pulmonologists, respiratory therapists, perfusionists and skilled critical-care nurses to care for an ECMO patient. And since then, the hospital has been recognized as an ECMO Center of Excellence at the gold level by the Extracorporeal Live Support Organization.
What is ECMO?
ECMO draws blood from a large vein in the body. The blood pumps through the device, where oxygen is added and carbon dioxide removed. It then pumps the blood back into the body’s circulatory system.
“Recognizing early that a patient could benefit from ECMO and getting them on that support so they can start rehabilitation is the biggest determinant for success,” Pal said.
EMCO is a short-term treatment for those with cardiac and respiratory failure for such things as heart attacks, infections, trauma, smoke inhalation and pneumonia. But this was 2012, and ECMO had not often been used at University of Colorado hospital yet for great number of patients like Victor.
“Everyone there was just top-notch — super professional but very kind,” said Brenda, who after 24 hours of recovering from her own illness was back at Victor’s side.
Daddy is very sick
At home, Brenda tried to be honest with their girls.
“I explained that dad was very, very sick and his lungs were not working anymore; that doctors were trying really hard to get the bad stuff out of his lungs, and until that cleared up, he wasn’t going to get better,” she said.
It was a more than a week before the children visited Victor, but Brenda encouraged them to talk to their father even though he was “asleep.” They would tell him about their day, hold his hand and brush his hair, she said.
Staying on life support
While the children stayed with family, Brenda stayed with Victor.
“The first two weeks, he wasn’t showing any signs of progress — just status quo,” Brenda said. “Then came the third week, and that’s when (the doctors) said we may have to do something different.”
One of the controversial opinions at that time was whether or not a patient should be awakened while still attached to ECMO. Risks and long-term repercussions increase the longer a person remains intubated. The ECMO team consulted with other experts throughout the country about how best to handle Victor’s case, and one Michigan doctor recommended that they wake Victor.
By rousing him, the team would allow him to breathe on his own, rather than using the ventilator. Behind the scenes, the ECMO would still do the work of his lungs and heart. The Michigan expert predicted that Victor would recover more quickly and be stronger down the road.
“Once he started to wake up, he became much more aware of his predicament,” Brenda said.
Victor had tubes coming out of him everywhere, which was scary to see, especially when they needed to move him. A trip down the hall to get an X-ray took about eight nurses, she said.
By the fourth week, Victor was pointing to things he wanted. He was trying to write, and his oxygen levels were up. He still struggled to breathe but was doing more of it on his own. He was growing stronger each day.
Finally, the time came to remove him from the breathing device and ECMO. It was then that Brenda finally stopped holding her breath as well.
“Once they took him off that, we felt secure that he was going to make it,” she said.
Victor spent another week in the cardiac intensive care unit. And by week seven, he’d been transferred to the cardiac rehabilitation floor.
“It was only a matter of a day or two before they had him walking down the rehab center with equipment to build up strength,” Brenda said. “He was using the walker at the time, but by the end (of the week) he was doing it on his own. He quickly started generating muscle and endurance.”
Finally, nearly two months after he dragged himself into the hospital, Victor was able to go home.
“We got into the car and he took a deep breath — I remember that,” Brenda said. “We were so happy the whole way home.”
Still, the couple knew the battle wasn’t over.
“During the whole ordeal, the nurses warned me that it was possible he wouldn’t be the same person, not to put expectations too high, but to take it day by day.”
Victor did take it day by day, but he also set high goals. He planned to run three more marathons “to match the three pre-ARDS (acute respiratory distress syndrome) marathons, proving to myself a complete recovery.”
Beating the odds
Victor returned to his home, pulling an oxygen tank behind him, and every day he took a walk outside.
“He’d take his oxygen tank, and every day he went one block further,” Brenda said. “Within a week, he was walking around the park.”
Victor didn’t know how much damage his lungs had sustained from his infection. Doctors told him it could be up to year before he got full lung function back.
He told Brenda he was going to start running and eventually work up to a marathon.
Each day Victor blew into a device that tested his lung function, and within four weeks of being home, he said (with a competitive grin), his lungs were outperforming Brenda’s.
“I thought a marathon was a big goal for someone running a half-mile at that point,” Brenda said, but she supported Victor nonetheless.
By March 2013, Victor was able to walk and jog three miles in 55 minutes. By May, he was running a nonstop three miles in 35 minutes — his goal time before his illness. And then by September, he was running 20-plus miles.
It’s been five years since Victor celebrated his full recovery by finishing his third marathon since his precipitous bout with the flu. After that race, he decided he didn’t need to “race” to prove to himself that he was back. He continues to run for fun — as well as shoot hoops or lift weights with his wife — but these days, Victor’s “marathons” involve raising two teenage daughters.
Sonoma will graduate from high school this year, and Vivian just became a teenager. The family has been wrapping college visits into family vacations, and time at home is spent around the table with homework.
“That’s one thing I’ve learned during this whole thing is that life is like a marathon,” Victor said, and with a chuckle he continued. “No matter how well you are training — conditioning yourself for the race — after mile 16, anything can happen.”
One thing is for sure though; the Carlos family always gets their annual flu shots.
“There are a thousand things that could have gone a different direction and I wouldn’t be here talking to you,” Victor said. “Here it is six years later, and every day something happens that gives me goosebumps and makes me think how lucky I am.”