Gary came into the hospital in September. No history of illness except a mild touch of asthma. A roly-poly twelve year old who excelled at school, was the stand-in older brother to his 4 year old niece, and a comfort to his mother, whose other son was paying his juvenile dues to society at a work camp. Gary had been transferred to our unit for respiratory failure. After spending time in two other hospitals, where his breathing became steadily worse, he came to us intubated, breathing with the help of a ventilator, and sedated. I was surprised to receive the call at home to see if I could come in to do ECMO (a therapy involving an artificial lung), since I knew that the attending that week was not a fan. But Gary was so sick that there was no question that he needed it.
By the time I got to the hospital, Gary was all set up. The bed was raised as high as it could be, and he was resting on a special air mattress. There was a cannula from his neck draining dark colored blood into the ECMO tubing. It flowed through the machine until it got to the raceway, where it was forcibly pumped through the oxygenator. Then it was warmed and the crimson blood, bright because the carbon dioxide had been replaced with life giving oxygen, flowed back through a cannula in his groin. He was sedated, but lightly. As his sisters or mother stood at the head of his bed, he would nod or shake his head, a very little, to answer if he was uncomfortable.