Jose Graciano in his hospital bed, recovering from COVID
By Michael Haederle

Free to Breathe

How a UNM Critical Care Team Fought for a COVID Patient’s Double Lung Transplant

On March 12, 2022, Jose Graciano emerged from anesthesia following a five-hour lung transplant surgery at St. Joseph Medical Center in Phoenix. He looked down to see the newly sutured “clamshell” incision stretching across his upper chest.

And for the first time in nearly seven months, he could breathe freely.

“I felt normal,” he says. “It felt good.”

His medical ordeal had begun in a Colorado hospital with a COVID-19 diagnosis. Doctors there predicted he would die due to severe scarring in his lungs. But his fortunes dramatically improved when he was transferred to The University of New Mexico Hospital, where a critical care team got him strong enough to undergo the transplant.

“We were adamant that he was going to get this,” says Maria Kelly, the critical care nurse practitioner who refused to give up on Graciano and fought to get him admitted to UNMH.

“We just needed a win.”

Jose and Anita, his wife of 21 years, met while they were students at Santa Fe High School. They had five children together and settled in Farmington, N.M., where Anita managed a restaurant and Jose spent weeks at a time away from home working in the oil fields.

In August 2021 he was based in Greeley, Colo., with a crew that was plugging non-producing oil wells when he started having trouble breathing. (Diagnosed with Type II diabetes, he had been awaiting his endocrinologist’s advice about whether to get the COVID vaccine.)

When he was admitted to Northern Colorado Medical Center, his oxygen saturation level was 71% (normal is 95% or above) and he tested positive for SARS-CoV-2. “I remember them telling me if I got worse that they would have to intubate me,” he says. “I told them I don’t want to do that. And then that’s all I remember. I woke up five months later, and I was still there.”

While Jose lay in a medically induced coma on a ventilator, Anita and Jose’s father took turns maintaining a vigil at his bedside. Along with sedatives he had been administered a paralytic drug to prevent involuntary movements.

The doctors were not encouraging, Anita says. “They said, ‘He’s not going to recover from this. He’s been paralyzed too long.”

With the discouraging news, she was ready to let him go. “I just stood over his body and thanked God for the 21 years he gave me with him,” she says. “He gave us a good life. He worked so hard to provide for us.”

But the next morning she got a call from Jose’s doctor. “She said, ‘Don’t get excited, but something happened, we got him off the paralytic. He’s been off it since 7 o’clock this morning.’ I said, ‘It’s God – he’s making a miracle happen.”

It took two weeks to fully wean him from the paralytic, and then he developed pneumonia. Nearing the two-month mark, doctors had further bad news. “They told me that he was brain dead – that there’s no activity,” Anita says. “They said, ‘Really, there’s nothing else we can do.’ It was about the third time they said that.”

Mistaking a Sharpie for a dry-erase marker, she scrawled a pointed message on the window of his hospital room: “No negative talk in this room.”

Against all odds, Jose continued to rally as they withdrew the sedative medications and he was fully awake after three months in the hospital. “Every day he showed improvement,” she says.

For Jose it was as if three months of his life had disappeared. “My first memory was before I came back to New Mexico,” he says. “The doctor came in and told me, ‘You have two options. You can go home with this ventilator and wait until you die, or you can stay here and just die in the hospital. But we can’t help you. Your lungs are pretty damaged. They’re dried up, no good.’”

The doctor came in and told me, ‘You have two options. You can go home with this ventilator and wait until you die, or you can stay here and just die in the hospital.'
Jose Graciano

A lung transplant would be the only alternative, but an affiliated hospital in Tucson denied him admission to their transplant program because he hadn’t received a COVID vaccination.

In mid-January 2022, Jose was airlifted to an acute care facility in Albuquerque. The plan was for Anita to learn how to maintain a ventilator so he could be sent home to Farmington, where he would never breathe unaided and would likely succumb to his disease.

As it happened, UNMH nurse practitioner Maria Kelly also co-led the critical care team at the acute care center. Reviewing the new patient’s paperwork, “Something just seemed like, ‘Why is this 43-year-old not a transplant candidate? It didn’t make sense to me.”

Because the care center’s ventilators were not as powerful as the ones used in hospitals, Jose grew sicker and required a transfer to UNMH to stabilize his carbon dioxide levels. “That when I met Anita and we talked more about his story,” Kelly says. Learning that had been unable to visit his endocrinologist because he had been working out of state, “It made me much more passionate about getting him seen.”

Jose returned to the care center, while Kelly lobbied UNM doctors to admit him to the hospital, and before long, he was transferred to the Cardiothoracic Intensive Care Unit.

Critical care specialist Isaac Tawil, MD, professor in the Department of Emergency Medicine and medical director of New Mexico Donor Services, the state’s organ procurement organization, oversaw Jose’s care.

“It was obvious that this was someone who had some options perhaps prematurely closed to them and if we could get him fit from a rehabilitation perspective we could start having discussions about potential transplantation with various transplant centers,” he says.

UNM doctors had previously seen success in referring patients with COVID-scarred lungs to the St. Joseph transplant team, Tawil says. “We knew the things they are looking for. We needed to demonstrate he was awake, alert and able to have conversations. He needed to demonstrate that he had rehab potential.”

In the transplant equation one point in Jose’s favor was that only one organ system – his lungs – was affected. “Single system organ failure in a young, previously healthy guy – he needs to be given that shot,” Tawil says. He credits the hospital’s physical and occupational therapists who, over the course of six weeks, got Jose out of bed and walking around the ICU while tethered to his ventilator.

At the outset, even the slightest exertion was grueling after spending so many months confined to a hospital bed. “They had me getting up every morning walking around in the unit, trying to get me stronger for the transplant,” Jose says. “It was hard because every time I stood up it felt like my bones were going to break.”

But Jose was determined. “I knew my son was in his senior year in high school and I wanted to be there for his graduation to see him walk,” he says. “And I knew I had a grandbaby that was waiting for me. I figured, ‘You’ve got to stop feeling sorry for yourself and fight.’”

Kelly, who regularly checked in on him in the ICU, says he had to walk 100 feet a day. “The therapists would work their butts off with him every single day,” she says. “They would set weekly goals on paper until he met the transplant criteria.”

On Feb. 22, 2022, Jose was discharged and flown to Phoenix on an air ambulance. His UNMH caregivers, still mourning the loss of so many patients during the COVID pandemic, chalked it up as a triumph. “I told Anita, ‘We needed this as much as you did,’” Kelly says.

In Phoenix, a set of lungs became available 2 ½ weeks later, and Jose came through the operation with flying colors. He and Anita spent six months living in an apartment near the hospital before returning to New Mexico over the summer. He remains on 28 drugs to prevent organ rejection, but is regaining his strength and hopes to return to work.

The ordeal has given Jose a new perspective. “We need to slow down in life,” he says. “I was all about work, work, work. I’ve just learned to slow down and focus more time with the family. We should spend more time with the people we love and appreciate them and be grateful.”

His newfound gratitude extends to include the team at UNM Hospital.

“Thanks to all the people at UNM – all the people that pushed me,” he says. “You get a new perspective on life when you go through something like we did. You learn to appreciate life more.”

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