“When I woke up I was confused. I remembered the doctors in St George’s hospital deciding to intubate me. But when I woke up from the intubation, I’d been transferred to another hospital, St Thomas’, and was on a machine that was keeping me alive. I wondered how things had gotten so bad and how I’d gone from being just ill to being, you know, very close to dying.”
Cesar Franco is reliving how he fell gravely ill with Covid-19 late last year and ended up in the intensive care unit (ICU) of St Thomas’ hospital in central London, helpless, struggling to breathe and only still alive thanks to the quiet pumping of an extracorporeal membrane oxygenation (Ecmo) machine. It was the start of what became five arduous, precarious months in ICU on Ecmo. That is an unusually long time, even for a Covid patient, to receive what, for some but not all, proves to be life-saving care.
Those five months were tough for Franco, both physically and emotionally. The spectre of death was ever present. Covid had ravaged his lungs. Over time, his inability to breathe normally put his heart and other organs under intense strain. But his spell in ICU culminated in Franco becoming the first person in Britain to receive a double lung transplant as a direct result of Covid. A stranger’s lungs, and some of the finest care the NHS can provide, gave him a second shot at life.
“Cesar is a great advertisement for the wonders of medical science”, says Prof John Dunning, the surgeon who performed the operation at Harefield hospital, a provider of often life-saving specialist heart and lung treatment located on the fringes of the capital. “He’s also a great advertisement for the National Health Service and the care it can provide for acutely ill patients in incredibly complex situations. It delivers that 24 hours a day, seven days a week.”
When Franco fell ill, he was a fit, active 49-year-old building services engineer. “I was working in a five-star hotel. Every day there were about 120 of us, all working together. We had a problem with people getting infected. There were times when more than 10 of my co-workers a week were getting the virus. I was hoping it wouldn’t be me, but then I got infected.”
He isolated, but his health deteriorated quickly, so – on 23 December – he called an ambulance. After a few days in St George’s he was moved to St Thomas’, opposite the Houses of Parliament. St Thomas’ is one of the UK’s leading specialist centres in respiratory medicine and also where Boris Johnson was treated when he got Covid early in the pandemic. The drugs Franco received in the hospital’s ICU induced hallucinations. “I saw dead people, like they were coming to visit me. I saw 1970s rock stars like Jim Morrison and Roy Orbison, and some demonic faces.”
Franco hated being in hospital; because he was attached to the Ecmo machine, he was confined to bed and suddenly dependent on the nurses for all his basic functions. Ecmo is the highest form of life-saving care the NHS can provide to those who can no longer breathe for themselves. It uses two large pipes inserted into veins in the groin to first take out the patient’s de-oxygenated blood, then clean and reoxygenate it outside their body and finally put it back in. It aims to boost the patient’s lung function. Franco needed the Ecmo to work as his own lungs were working at just 40% capacity, but it didn’t.
“Even after five months my situation didn’t improve. The doctors at St Thomas’ told me: ‘Unfortunately we cannot help you.’ It got to the point where the only option was going to be a double lung transplant. It was the only thing that would help me survive,” Franco recalls. He hoped to recover naturally but had come to accept that that wasn’t going to happen. He factored in the risks involved – a stroke or serious bleeding during the surgery or his body rejecting the new organ – and went ahead. He had no choice.
In his tiny, shared office at Harefield hospital, Dunning recalls first meeting Franco. “His lungs had been destroyed by Covid. He had acute Covid-induced pneumonitis, which causes inflammation and ultimately fibrosis – scarring – of the lungs. Normal lungs are soft and springy, like a sponge, but Cesar’s lungs were solid and non-compressible, like liver tissue or nutmegs. His lungs had pretty much stopped working.
“If he hadn’t had a double lung transplant, he wouldn’t have been able to leave the hospital free from machinery. So, ultimately, he would have died, because if we had stopped the [Ecmo] machine he would have had no way of ventilating himself. His prospects were pretty bleak. Really he was a prisoner in the ICU and there was no exit strategy for him other than transplantation.”
The procedure at Harefield in August lasted 11 hours. Franco’s new lungs were from a healthy younger man. Patient confidentiality means he knows nothing about the tragedy that allowed for his salvation. “Cesar received the only life-saving and life-prolonging therapy that was available to treat the complications of Covid-induced lung disease,” says Dunning, a veteran of about 900 transplants. “From there he has flourished and gone on to make an excellent recovery and is once more independent and living life to the full.” While the procedure had already been performed on some Covid-ravaged patients in the US and Europe, this was new territory for the NHS.
Why was Franco the first Covid patient in the UK to need a double lung transplant? Dunning replies that his patient was “unlucky” because, while others with recoverable lung disease have been successfully taken off a ventilator or Ecmo, “Cesar couldn’t get to that point because his lungs were so badly destroyed that he needed something else”.
Franco was unvaccinated when he caught Covid. That might help explain why the gymgoer with no medical history suddenly found his life in great danger. At home in south London, the Mexican – his first name is pronounced “Caesar” – explains: “I waited to get the vaccine because I had my doubts about it, about the side-effects, and also how fast it came to be approved without more extensive testing. I was also reluctant because when my wife got vaccinated, she ended up being admitted to hospital after she had an allergic reaction to the vaccine.” He has now been immunised.
On that, Dunning says only: “We will always try to deliver first-class care to people in their time of need, regardless of personal circumstances and their decisions around vaccination.”
Relaxing in his living room four months after his surgery, Franco looks remarkably well. However, an eight-and-a-half-inch scar down the middle of his chest, from just below his throat to just above his bellybutton, tells its own story. On top of his bookshelves are photographs of him with his wife, Gosia, and their son, Gabriel, and cards celebrating his survival and his recent 50th birthday. One is from staff at St Thomas’ wishing him luck when he left there for his transplant. An exercise bike is helping his positive but slowgoing recovery. He can now walk 20 minutes a day. He is overjoyed to be back among his family and glad to be alive.
What kept him going through all this? “The support of my family really helped, as did all the nurses, doctors and other staff at the three hospitals I spent, in all, eight months in. I cannot describe in words how well they took care of me. They were special people. They gave me emotional as well as physical support. They always said to me: ‘Don’t give up. You are very strong and you are going to make it through.’ The care I had was awesome,” Franco says.
He would love to meet his donor’s family to convey his deep gratitude. His brush with death has taught him that “a transplant is a wonderful thing. It gave me the chance to be with my family, to be alive, to be in this world again. Transplants are wonderful gifts that come from another human being and help people who cannot be alive by any other means. Transplants are a gift of life.”
As Franco approaches the anniversary of succumbing to Covid, he still bears the scars – mental as well as physical – of his ordeal. Quiet tears flow at one point as he recalls how during his spell in St Thomas’ he became reconciled to what seemed an inevitable demise.
Life is good again. “Being able to breathe normally now is just amazing. When I was connected to the Ecmo machine and before the transplant, I had to really grasp for air. That was just horrible. Now I can walk, I can move around, I can breathe normally. It feels good. I mean, it’s just awesome, you know. It’s just awesome.”