Extracorporeal Life Support Organization. Most are still on the machines, and data is incomplete, so survival rates are unclear.
“ECMO doesn’t fix anything,” Dr. Raz said. “It keeps you alive while other things, hopefully, take place.”
Mr. Bello’s lungs were so stiff that his “lung compliance” — a measure of elasticity that is usually over 100 in healthy people and about 30 in people with severe respiratory failure — was in the single digits.
His lungs could handle breaths only the size of a tablespoon, a tiny fraction of a normal-size breath. Blood began oozing from around the tubes, so blood thinners were stopped, Dr. Raz said.
Chest X-rays documented the decline. His first on March 13 showed significant fluid and inflammation, but “you could still see the lungs,” Dr. Raz said. On March 18, the X-ray was worse, but lung space was still visible. By March 20, “he had essentially what we call a whiteout.”
Daily, doctors and nurses updated Ms. Bello, 48, who took a leave from her part-time marketing job to help their children — Hadley, 13, and twins Riley and Taylor, 11 — cope with their father’s illness. Ms. Bello also raised thousands of dollars to provide the I.C.U. with meals from local restaurants, along with other needs.
She and Hadley developed mild symptoms like chest tightness, but doctors had considered it unnecessary to test them for the coronavirus.
Because visitors are largely prohibited in order to limit the virus’s spread, a nurse, Kerri Voelkel, put the family on speaker phone in Mr. Bello’s room several times daily.
“Hadley would have baked a cake, and she would joke ‘It didn’t come out so good, Dad, I’m going to try again,’” Ms. Voelkel recalled. “Taylor said, ‘I did my soccer drills out in the backyard.’ It’s heartbreaking to be the caregiver standing there and listen to these children talking to their father.”
As of March 27, Mr. Bello’s ninth day on ECMO, there was no improvement. When nurses tucked pillows under him or subtly shifted him to prevent bedsores, his oxygen levels would crater.
Dr. Rubin called Ms. Bello to explain the gravity of the situation. If Mr. Bello went into cardiac arrest, she said, doctors didn’t believe they could revive him. Ms. Bello agreed to a do-not-resuscitate order.
“Be honest,” she implored Dr. Rubin.
Dr. Rubin assured her they were not giving up and Mr. Bello could still survive. But, she said, “Honestly, I think all of our assessment at that point was that he’s probably more likely to die.”
Devastated, Ms. Bello rolled into a ball on the grass.
The following morning, March 28, the medical team dialed down Mr. Bello’s paralytic medication to see if he could manage with less, Ms. Voelkel said.
The effect was striking. “Jim woke up,” she said. He raised his eyebrows, and “you could tell he was trying to open his eyes.”
When prompted, he squeezed both of Ms. Voelkel’s hands. He nodded yes or no to simple questions. And when the nurses said they were going to adjust his position, he gave a thumbs up.
“We were like, ‘Oh my gosh, he’s in there!’” Ms. Voelkel said.
Ms. Voelkel described the scene to Ms. Bello over the phone. That afternoon, the family’s golden retriever, Bruno, grabbed Mr. Bello’s Boston Celtics cap, holding it in his mouth. Ms. Bello texted Dr. Rubin a photo of the dog with the cap and wrote, “Please do everything you can.”
Dr. Rubin’s eyes welled up. “I give you my word that we are doing everything we can,” she texted back.
But later, several hours after the paralytic medication was stopped, Mr. Bello, alone in the room while nurses monitored from outside, shifted his body slightly, movement that increased pressure on his blood vessels. This happens normally when we breathe, but he was too unstable to withstand it, Dr. Raz said. His oxygen levels nose-dived.
Both Ms. Voelkel and Tyler Texeira, a respiratory therapist, threw on their protective gear and rushed in. “We rescued him, we got him back,” Ms. Voelkel said.
“This is a man who, his lungs are so bad that we can’t have him awake,” she said they realized. “So we had to re-paralyze him in order to essentially keep him alive.”
Doctors’ last option involved trying to drain more fluid by adding another tube to the heart-lung machine, a maneuver that would require a brief stoppage of oxygen flow from the machine.
“He was so tenuous that we felt honestly 30 seconds off the ECMO circuit, he wouldn’t survive that,” said Dr. Rubin, a pulmonary and critical care physician.
After her shift ended, Ms. Voelkel said, “I cried the whole way home.” She thought of the phone calls from Mr. Bello’s children, similar in age to hers. “The despair I felt that we couldn’t save this man was beyond anything I could comprehend.”
Dr. Rubin called Ms. Bello and suggested that she visit her husband that night, something she’d been allowed to do only once before. The hospital hallways felt eerie. She donned protective gear and entered his room.
“I felt like, ‘Oh my God, if I keep talking to him, if I talk to him for hours, maybe he’ll stabilize, and maybe he’ll be OK,’” she said. “I was just telling him how much we need him, he has to fight this, he cannot leave us.”
She was told she’d have 15 minutes, but was given more than three hours.
“I’m squeezing your hand right now, I’m holding your arm, I’m laying on your arm, I’m touching your head,” she told her husband.
Within three days, an X-ray showed hope — some clearing in his left lung.
“Then, it just started improving, slowly,” Dr. Currier said. “And then it just got dramatically better.”
On April 4, Mr. Bello’s 17th day on ECMO, Todd Mover, a respiratory therapist, suggested he might be ready to come off the machine. The next day, Mr. Bello was disconnected from ECMO. He remained on a ventilator, but began handling reduced oxygen levels supplied by the ventilator, so doctors started easing paralytic medication and sedation.
Days later, in a milestone, physical therapists sat Mr. Bello on the edge of the bed. Ms. Voelkel FaceTimed Ms. Bello. She saw her husband kick his leg.
“I love you, blow me a kiss,” she cried. Mr. Bello, groggy from sedation, breathing tube in his mouth, moved his hand to blow his wife a kiss.
On April 11, nearly a month after her husband’s hospitalization, Ms. Bello sat at their dining room table for another FaceTime session. She had her daughters sit across the table, to spare them the sight of their father on the ventilator. They held an iPad so their brother, Riley, who was in New Hampshire, could also listen and talk.
“Hi Daddy, it’s Hadley and Taylor. We miss you so much. Riley’s also on FaceTime with us. We just want to say keep fighting, and you’re going to be OK. We love you so much.”
Mr. Bello, unable to speak because of the breathing tube, lifted his head, opened his eyes briefly and waved his hand slightly. “Love, love, love,” his wife said.
Doctors said they did not know why Mr. Bello survived. Their best guess is time. Although in some cases, people’s odds worsen the longer they’re on a ventilator, other patients recover after long intubations. The doctors don’t know if any of the medications worked.
Dr. Currier said he wouldn’t be surprised if Ms. Bello’s visit helped.
“She was in there for three hours by the bedside,” he said. “It was at its darkest at that point in time. You just can’t underestimate how much a difference something like that makes.”
On April 14, Mr. Bello was disconnected from the ventilator and began breathing on his own for the first time in 32 days.
This time, when she received a FaceTime call from the hospital, his wife gathered the children around. On the screen, he whispered the first words he’d been able to say to his family in a month: “I love you.”
As he was wheeled out of the I.C.U. to a regular floor, the medical staff, previously despondent about his case, lined the hospital hallway, erupting in applause. He waved.
Video
“It’s phenomenal,” Dr. Rubin said. Noting Mr. Bello’s previous health and fitness, she added, “everyone is very optimistic that he’ll have a full recovery.”
In brief comments from a rehabilitation hospital where he was transferred three days after coming off the ventilator, Mr. Bello said he was looking forward to getting back to working as a lawyer representing medical providers. “I’m alive today because of those very same people,” he said.
Already able to eat and to walk, he said he was proud of his wife and was eager to be back with his family.
Not long after that, on Friday afternoon, Mr. Bello came home.