A hodgepodge of holiday decorations still adorned the Welch family’s Plano home in mid-February.
A Christmas tree covered in homemade ornaments sat in a corner just outside the living room. Valentine’s Day garland hung on the opposite wall, and pink and red hearts were placed throughout the home.
At first glance, it seemed like seasonal chores had been put off.
But Emily Welch, 48, had purposefully left the decorations up. She wanted to give her husband a chance to experience the milestones he had missed over the last six months. Josh Welch, her husband of 18 years, was diagnosed in July 2021 with COVID-19. He battled the worst effects of the disease over a 197-day hospital stay, most of which he doesn’t remember.
“I lost a year of my life dealing with this, a year of my kid’s lives,” the 47-year-old father of four said over the hum of his oxygen machine.
Josh spoke from a wheelchair in his living room on Feb. 24, less than three weeks after he had been released from the hospital. At 6-4 and about 225 pounds, he’s 65 pounds lighter than when he was first admitted to Baylor Scott & White Medical Center in Plano. Even now, he gets winded when he speaks.
He’s finally home, but has a long recovery ahead.
“When I see the videos, I’m like, ‘Why me? Why was I the one chosen to survive COVID?’” Josh said about images his wife took to document his treatment. “I’m still looking for those answers.”
Every symptom in the book
In July 2021, the pandemic outlook seemed to be taking a turn for the better.
It had been more than six months since federal regulators granted emergency use authorizations to COVID-19 vaccines, and most people who wanted them were able to get one.
Fewer than 5,000 daily cases were recorded statewide then, only a few hundred of which were in Dallas County.
And school districts across the state were gearing up to return to in-person learning, including the Welch children and Emily, who was starting a new job as a counselor at St. Patrick Catholic School in Dallas.
The Welch family had chosen to wait to get vaccinated against COVID-19 until a shot was granted full approval from the Food and Drug Administration, the first of which wouldn’t come until late August 2021.
Throughout the pandemic, they wore masks in public and followed health guidelines as cases ebbed and flowed. And Josh, who works at industrial moving company MEI Rigging & Crating, worked in person the entire time.
“We thought we had done a good job because it’d been a year and a half … and Josh never stopped working,” Emily said.
But the delta variant was about to cause alarming surges across the country. By early August, hospitalizations were climbing toward record-setting numbers in Texas and Dallas County.
On July 3, the family had just gotten back from a beach trip – an annual vacation they felt comfortable taking because cases were low – when Josh started feeling sick. He had a hard time breathing, was feverish and achy.
“He had every symptom that you could have possibly had,” his wife said. “In the end it was the oxygen dropping” that required his admission to the hospital.
He went to the emergency room twice and was sent home with medication.
On July 22, Josh drove himself to Baylor ER in Plano. He said he was “still feeling terrible,” but expected to be sent home again.
After signing his intake paperwork, he was admitted to the hospital. That’s the last full memory he has until December.
‘This is not my life right now’
For the first week of his hospital stay, Emily stayed in contact with her husband through texts and Facetime calls – conversations Josh no longer recalls. It was scary, but she stayed positive, hopeful it would be a quick stay.
But on July 30, the doctors called and told her that Josh’s blood oxygen level had dropped into the 60s and that they were sending him to the intensive care unit. A healthy person’s blood oxygen is between 95% and 100%.
“That was hard,” Emily said. “I was like, ‘Hey, this might not be just a few weeks. This might be more than what I was ready for.’”
On Josh’s seventh day in the ICU, Emily got a call from his cellphone. But it wasn’t Josh on the other line – it was his doctor. Josh wasn’t doing well, and they were going to try and intubate him.
Emily, who has multiple friends whose family members died of COVID-19 shortly after being intubated, said the moment was petrifying.
“I was completely terrified. … Just thinking, ‘What if he doesn’t pull through this?’” she said.
An hour later, the doctor called back. The intubation wasn’t working, and doctors had found an ECMO machine for Josh at Baylor’s heart hospital.
ECMO, which stands for extra corporeal membrane oxygenation, is a life support machine used on people with heart or lung failure.
Using a tube that is inserted into the patient’s neck and heart, the machine pumps blood from the body into an artificial lung. The artificial lung then adds oxygen and filters out carbon dioxide before sending the blood back to the body.
Getting a person on a machine is a relatively straightforward procedure, but its success varies, said Dr. Timothy George, who oversees the use of life support machines at Baylor heart hospital and was Josh’s heart surgeon.
Internationally, the survival rate for COVID-19 patients on the machine is just over 50%, George said. At Baylor, the rate is between 60% and 70%, he said.
“The longer that you’re on ECMO, the more [complications] might happen,” he said.
ECMO machines are also hard to come by because of the equipment and staffing required to support patients. At Baylor’s heart hospital, eight ECMO machines are available – double what the hospital had before the pandemic.
“It became clear very quickly that we would put people on ECMO and they would need ECMO support for a long time if they were going to get better,” George said of COVID-19 patients. “With the already limited supply, you are really going to be committed to that person.”
Some patients, like older individuals or people with multi-system organ failure, wouldn’t do well on the machine. But Josh, who has no underlying health conditions, was a good candidate because had been “holding his own” for some time, George said.
By noon on Aug. 6, Josh was hooked up to ECMO. He was paralyzed and sedated for the next five days, and on day three, doctors performed a tracheotomy and hooked him up to a ventilator.
“When he first came out of surgery with ECMO, it was like a Christmas tree of medications because there were so many,” his wife said. “Each time I’d go in, I would never know what I was walking into.”
Josh stayed on ECMO for 87 days – nearly three months. During that time, he missed Emily’s first day at her new job, his son’s first day of high school, Halloween and Thanksgiving.
“[The doctors] would say, ‘Each day is a marathon.’ I’m like, ‘I didn’t sign up for a marathon,’” Emily said. “Every day going in there I was like, ‘This is not my life right now.’”
The complications during that time were seemingly endless: Josh’s right lung collapsed, his kidneys failed and he was put on dialysis. He suffered gastrointestinal bleeding, was put on a feeding tube and had multiple atrial fibrillations, or irregular heart rhythms.
“We really brought every specialty to bear,” George said, listing the dozens of specialists who helped Josh during his stay. “This was a guy who was critically ill and required a tremendous amount of resources … but between the hospital and the staff’s perseverance, Josh’s perseverance, his family support – he made it.”
‘Did you bring me in here to die?’
For the first several months, Emily didn’t share many details about Josh’s condition with her four children, who range in age from 9 to 17.
By the fall, Josh was hooked up to several machines, all of which made various honking and beeping noises as they kept him alive.
His face was swollen from the medication, and while he was aware of what was going on, his eyes were often closed, and he didn’t do much more than squeeze his wife’s hand or motion for visitors to quiet down.
Nurses worked to stand Josh up while he was on ECMO every so often to ease the effects of the months-long bedrest. In videos of the lengthy process, he’s smiling and making small hand motions as nurses cheer him on, wafting an alcohol swab under his nose to help with his nausea. He coughs constantly, which sounded like a puff of air because of the tracheotomy.
In late October, Emily told her kids about his condition. After working with child therapists at Baylor, the kids saw their father for the first time in months.
“They showed us a doll and it had ECMO on it, and they were like, ‘This is what’s on your dad right now,” said their 15-year-old son, Andrew.
But he said nothing could have prepared him for what he saw in the room.
“It hit me hard,” Andrew said. “I was like, ‘Is this really happening?’ And then to walk up there and [Mom] saying, ‘He can hear you, you can talk to him,’ it was like talking to a brick wall because he was just laying there. It was terrible.”
His younger sister, 9-year-old Maggie, held her dad’s hand. She said he touched his fingers to his thumb as she talked to him.
It was one of the children’s only visits to the hospital during the most severe parts of their father’s illness.
Over the next several months, Emily and her family adjusted to a grueling routine without Josh.
Emily got up at 5:45 each morning, got the kids to school, went to work and then spent a few hours at the hospital – where staff became like family to her – before coming home to make dinner and help her kids with their homework. The next day, she’d do it all over again.
The family received immense support from their family, school and church communities, but uncertainty loomed.
Andrew described hearing his mom crying in the room next to him most nights throughout the fall.
“That was the hardest part, trying to explain to the kids he’s going to be OK even though I really didn’t know if he was,” Emily said. “Just watching them every day without their dad home.”
Multiple times, doctors advised Emily to visit the hospital because they were unsure if he was going to survive.
“Every time, he just somehow pulled it together,” she said.
In mid-November, after coming off ECMO and going through speech therapy, Josh was transferred to a rehabilitation hospital.
Waking up there is the first full memory Josh has after going to the ER five months earlier.
“I remember a lady rolling me into the room and … I remember asking her, ‘Did you bring me in here to die?’” Josh said. “And she looked back at me, turned around and closed the door and walked out. That was a long, long night because I remember laying there laboring to breathe thinking, ‘OK, this is it.’”
But Josh pulled through again. On Feb. 4, after five weeks there and another five at an inpatient Baylor rehabilitation center, he was headed home.
Josh uses a wheelchair almost full time and will be on oxygen for most of the year. Normal activities, like showering, brushing his teeth, and getting in and out of a car take twice as long as when he was healthy, if not longer.
Walking even 20 feet can send his oxygen level into the 70s, and requires a substantial amount of recovery.
Josh now goes to outpatient therapy at Baylor’s Frisco rehabilitation center a few times a week, which he’s expected to continue at least through the summer.
His days at the center are filled with exercises like pedaling on a recumbent bike, boxing or throwing darts from his wheelchair and practicing walking down hallways – all of which can leave him breathless after only a few minutes, if that.
On March 4, one month after he was released from the hospital, Josh walked his longest distance without a walker – about 50 feet.
“Strength-wise I could have kept going,” he noted, panting in his wheelchair.
Like his family, his health care team celebrates small victories. His physical therapist, Janel Nwoko, pumped her fist in celebration when Josh told her he stayed awake after coming home from the center the day before, and had walked across the living room and into bed by himself that night.
While his wife has had seven months to adjust to a mentality of taking one day at a time, the last few weeks have been “devastating” for Josh, who is only beginning to get used to his new normal.
“I’m the fixer,” Josh said. “I’m the guy that comes home and … I want to be involved. I see things and I’m like, ‘Do I need to fix that? I want to do that.’”
Josh said he plans to go back to work eventually, but it’s unclear when he’ll be strong enough to do so. The family has set up a GoFundMe to help with health and living expenses in the meantime.
When asked if he could go back and change anything, Josh says he would have gotten a vaccine sooner. But Emily says she’s come to terms with their decision.
“You can’t go back and say, ‘I should’ve done this differently,’” she said. “I really struggled with that because it was me really making the decision for my family.”
Emily and Josh both say the experience has taught them the value of life and how quickly things can change.
“You just have to take each day as it comes,” Emily said. “You don’t know what’s going to happen.”