By Tracie White

Surgeons describe the patient’s 24-year-old son as a hero for his persistent and dedicated advocacy on behalf of his father.

Each day, month after month, as his father, John, suffered some of the worst that COVID-19 can inflict, 24-year-old Patrick kept watch.

"He was always such a healthy guy," Patrick said of his 54-year-old dad, who was first hospitalized in late March of 2020. (The family asked that their last name not be used.) But the disease was devastating, eventually destroying John's lungs and kidneys. His doctors in Tacoma, Washington, said he was too weak to undergo the transplants he needed to stay alive.

"They said there was no point in continuing," Patrick said. "I said, 'Eh, no.' That’s when I started calling transplantation centers around the country." Many centers turned him down, but Stanford Health Care left a door open. If John could regain some strength, the hospital would fly him to Palo Alto to see if its doctors could help him.

"That was a glorious day," said Patrick of the time, last August, that John boarded a helicopter for Stanford. He packed his bags and drove south from Washington to California to be with his dad.

A mysterious illness

Patrick lives with his parents and 18-year-old brother in Auburn, a small town in Eastern Washington. He and his mom work in the family business, a building restoration company that his dad founded in 2012. It was his mom who first got sick with the coronavirus, in the early days of the pandemic when no one thought to wear masks and tests for the virus were hard to find. Shortly after their mother fell ill, Patrick and his brother developed mild symptoms. Then their dad became sick.

"My mom had it moderately bad for a week or two," Patrick said. "She tested positive. We have no idea how we got it. Back then, it was considered such a rarity that you had to be showing bad symptoms to even be considered for testing."

While the rest of the family recovered, Patrick's father grew worse. The day his fever shot up to 103 degrees and he could no longer talk without coughing, they took him to a nearby hospital.

"It was hard to find a hospital," Patrick said. "Urgent care wouldn't take him, and we got bounced around." Finally, a hospital in Covington admitted him, putting him directly into a COVID-19 isolation ward. The next day, he was put on oxygen to help him breathe.

"I was terribly scared," Patrick said. "I had this bad habit of researching online, trying to settle my nerves. I'd found out the mortality rates, and they were absolutely not in his favor. That was terrifying."

For the next 17 days, Patrick called the hospital day and night for updates on his father's condition. The family couldn't visit, and John couldn't talk on the phone, so Patrick kept up the online research. He learned how to ask about vital signs — body temperature, respiratory rates, blood pressure — and to understand what the numbers meant. There were good days and really bad days, he said. Eventually, John had to be put on a ventilator, a machine to keep him breathing. Still, his condition worsened.

On March 30, John was transferred to a hospital in Tacoma with a more technologically advanced intensive care unit. Then his immune system went into overdrive, something researchers were only beginning to recognize as a consequence of this new disease. The immune response destroyed his lungs, and by April his doctors were forced to put him on an ECMO machine, which helps the heart and lungs function. ECMO, or extracorporeal membrane oxygenation, was being used to keep other severely ill coronavirus patients alive for extended periods of time. Eventually, John's kidneys also failed, and he was put on dialysis.

The days crawled by, but the family got a break in May, when a COVID-19 test came back negative. Because John was no longer contagious, he was moved to a non-COVID ICU and the family could visit.

"The day we finally got to see him in May, he looked really bad," Patrick said. "If you had seen him attached to all these tubes, you would not have thought that he was alive."

From that point on, Patrick rarely left his bedside. When John's condition took a turn for the worse, his doctors suggested they take him off life support.

"He experienced an internal brain hemorrhage in mid-May, and that's when the doctors started really trying to push for taking him off ECMO," Patrick said.

The family refused, and Patrick, in desperation, started reaching out to major transplant centers around the country.

Stanford calls back

"We got an email out of the blue from Patrick," said John MacArthur, MD, assistant professor of cardiothoracic surgery, who returned Patrick's call and set up a video meeting with his dad in June. "When I saw his dad, he was so weak he couldn't do anything," MacArthur said. "I told Patrick, 'We would still consider him a transplant candidate, but he will have to get stronger before we could transfer him to Stanford.'"

Patrick pushed his father hard, making sure he got as much physical therapy as possible, and by August he was able to send a video of his dad sitting in a chair doing leg raises. MacArthur gave the thumbs-up, and John was flown by helicopter to Stanford on Aug. 23 for more testing.

"They got him to Stanford really fast," Patrick said. "But I was still worried. At any point, they could see how sick he was and change their mind."

John was approved for surgery and placed at the top of a waiting list for donor lungs and a kidney. A week and a half later, a donor for both became available, and on the afternoon of Sept. 10, he was rolled into surgery.

"My dad is doing great," Patrick said during a phone interview from San Jose in January. "He's walking with a walker, doing physical therapy here in the apartment and feeling remarkably well. He's in great spirits." He added how grateful he and his family are to Stanford and its surgeons for saving John's life. But the surgeons describe Patrick as the true hero of this story.

After spending months at a rehabilitation center in San Francisco, John finally grew strong enough to move into Patrick's San Jose apartment. It was the day before Thanksgiving, and all John wanted to do was cook a turkey dinner with his son, MacArthur said. John sent the surgeon a photo of them doing just that.

"I told our patient multiple times that his son Patrick is the reason he is alive," said Joseph Woo, MD, professor and chair of cardiothoracic surgery and the Norman E. Shumway Professor, who performed the lung transplant. "Patrick was so persistent, working with his father to help him gain enough strength to undergo the challenging operation.  I was just privileged to be the surgeon who performed the transplant that night."

Patrick laughed over the phone when he heard about the surgeon's comment, then he handed the receiver to his father who was beginning to speak again after so many months on breathing tubes and ventilators.

"I'm feeling good, just waiting to be able to go home," John whispered into the phone. "My son, he is my hero."