On a Sunday afternoon in early January, Edwin Ng drove to a vaccination clinic for health-care workers near his home in Barrie, pulled up the sleeve of his blue scrubs and got his first dose of protection against COVID-19. Then he went straight to work. The 48-year-old rarely missed a shift at Roberta Place, the nursing home where he’d been a personal support worker for nearly 20 years. He didn’t get sick often.
That night at home, Edwin started to feel strange. He was tired. His breathing was heavy. He slept in a room away from his family, to be safe.
It’s probably just side effects from the vaccine, he thought. But his wife, Samantha Ng, was uneasy.
Within weeks, Edwin would be among the sickest COVID patients in the province. He needed new lungs, and a miracle.
Days before Edwin’s vaccine, health officials declared an outbreak at Roberta Place that would become one of the most devastating in the country. The B.1.1.7 variant tore through the home, infecting nearly every resident in the 140-bed facility over six weeks. Seventy would die — the highest proportion of resident deaths during the pandemic.
The virus also spread to more than 100 staff, most of whom, like Edwin, did not yet have the vaccine’s full protection.
Edwin was a healthy father of three who worked overtime to send money to his sister in the Philippines and happily shovelled snow for an elderly neighbour all winter. He believed in doing one good deed every day. He brought clothes to work for residents who didn’t have family. He sometimes made residents laugh by draping lingerie over his scrubs and walking around as though nothing were amiss.
His coworkers adored him. “He has really good energy,” said Sonja Goldie, a former Roberta Place nurse. “When he was on the unit, it was like, oh, thank goodness he’s here.”
On Monday, the day after his vaccine, Edwin developed a fever. On Wednesday, his test came back positive. By Friday, he was in rough shape. The fever wouldn’t break. His cough sounded bad. He struggled to breathe.
“You need to go to the hospital,” his wife said.
Edwin refused. He told Samantha he was scared. “If I go, I don’t think I’ll be coming back for a long time,” he said.
The next morning, Jan. 16, Edwin could barely speak.
“I’m calling the ambulance,” Samantha said.
She watched from the window as paramedics took him away. She had tested positive and couldn’t go with him. Edwin would soon be on life support and sedated. Samantha wouldn’t see him for weeks. And Edwin was right: he wasn’t going home anytime soon.
Dr. Jonathan Yeung, a thoracic surgeon at Toronto General Hospital, has seen how COVID-19 can ravage the lungs of young and healthy patients, turning the spongy organs into shrivelled husks.
Some of the worst COVID cases end up at Yeung’s hospital, where patients can receive the extraordinary life-saving support of an ECMO machine, a measure of last resort for those failing on mechanical ventilation.
The ECMO, or extracorporeal membrane oxygenation machine, is an artificial lung that siphons blood from the body, removes the carbon dioxide and pumps it with oxygen. The machine keeps patients alive while giving their body — especially the lungs — time to heal.
Toronto General, part of the University Health Network, has the largest ECMO program in the country, with capacity for 30 patients. The survival rate for COVID patients on ECMO is 50 to 55 per cent.
It’s a “heroic machine,” Yeung said. But it can create a dilemma when a patient’s lungs don’t recover. If doctors take them off ECMO, they’ll die. But they can’t remain on life support forever. “So where do you go from there?”
The case of Edwin Ng, who became Yeung’s patient in late January, highlights the fraught decisions around life-saving measures, which have become even more challenging to navigate as COVID-19 sickens younger patients.
Edwin was admitted to Toronto General on Jan. 31, after weeks in intensive care on a mechanical ventilator at a Barrie hospital. Standard ICU treatments were no longer working. Doctors believed he would die without ECMO.
“What really struck me was how young he was and that he was a PSW,” said Yeung. “Someone who was in our field, working hard.
“He was one of us.”
Weeks passed and Edwin’s condition didn’t improve, even on ECMO.
“His lungs were completely destroyed,” Yeung said. They were scarred and shrunken, unable to expand for him to breathe.
There is only one option for a patient whose lungs have failed beyond recovery: a transplant. But few are candidates.
“Lungs are a scarce resource,” Yeung said. “We can’t just use them like antibiotics, where you say, oh, we’ll try it. If we use them in someone, someone else doesn’t get them.”
Doctors have to be selective in who they list for a transplant. Typically, the patient must have severe, irreversible lung damage; their other organs should be in good shape; they should be awake and able to participate in decision-making; and they should be in good physical shape, to have the best chance of surviving the operation and getting through rehabilitation.
“How sick is too sick to try to transplant?” Yeung said. The decisions come with high stakes.
Samantha went five weeks without seeing her husband. She was finally able to visit Edwin at Toronto General in late February, when he no longer had COVID.
“It was bittersweet, lots of emotions but really happy to be able to hold him and take care of him even for just a couple hours,” she wrote in a social media update for friends and family.
From then on, Samantha, on leave from her job with an aircraft manufacturer, made daily trips to Toronto to see him. “Edwin is strong and keeps on fighting,” she wrote March 17. “Even on bad days when he wakes up and sees me he gives me a smile.”
Samantha would sometimes count the tubes keeping her husband alive. There was a large ECMO tube on the right side of his neck, connected to his jugular vein, and another connected to the femoral vein in his groin, doing the work for his lungs; a breathing tube in his throat, attached to a ventilator; a feeding tube in his nose; an IV in his arm, delivering antibiotics; tubes performing bodily functions; an arterial line monitoring his blood pressure. Her highest count was 11.
One morning in March, a vessel in Edwin’s right lung spontaneously ruptured.
Yeung had never seen anything like it. “He bled litres into his chest in a matter of moments,” he said. “I thought that was it for him.”
Samantha was at home making breakfast when she got a call. Doctors told her the family should come. Edwin was not expected to survive.
Edwin and Samantha had been together for nearly 30 years. They met in university in Manila, then immigrated to Canada in the mid-1990s. They have three children — a 10-year-old son and 20-year-old daughter at home, and a 25-year-old son who is married with two small children.
Edwin was in no shape for surgery. Instead, the medical staff tried a Hail Mary: a team of interventional radiologists, doctors who perform minimally invasive procedures guided by medical imaging, attempted to plug his pulmonary artery with a coil.
The coil stopped the bleed and saved his life. “That was a miracle, in my mind,” Yeung said.
The move bought Edwin time, but his condition remained precarious. He developed one infection after another. His lungs were full of blood clots, but he was too weak for an operation to remove them. His kidneys were failing. When conscious, he was often delirious and had to be sedated. His muscles were atrophied after months in bed. The medical team didn’t know if he would stand or walk again, and they weren’t sure about his mental state.
“I wish I had some good news, but doctors think his lungs are too damaged and won’t recover,” Samantha wrote on March 31. “His only chance for survival is a double lung transplant or a miracle.”
Samantha stopped writing updates for a while. There was nothing good to report.
Doctors had differing opinions on the path forward, Samantha said. “Some really didn’t want to do the transplant. They weren’t sure how his body would take it, how his recovery would be and what his quality of life would be.”
Edwin needed to be alert and physically stronger before he could even be considered for new lungs. His mental state was a big concern. It is critical for doctors to have first-person consent, or at least feel confident the patient understands the risks and benefits.
In mid-April, Edwin’s condition began to improve. He regained consciousness. He was able to participate in physiotherapy exercises from bed. His kidneys got better. The delirium subsided. He could write and mouth words, in English and Filipino. “We are blessed,” he wrote one day.
Yeung and other surgeons pushed for the transplant. He had a gut feeling Edwin would do well.
“What really struck me was his optimism,” Yeung said. “Imagine waking up after three months of being extremely sick, and still kind of having a smile.
“Even to this day I don’t really know, but looking at the bedside, I kind of felt that we should take a chance on him.”
Yeung told Samantha that he believed Edwin would make it through the surgery, but he also warned that Edwin “could suffer a fate worse than death … where his lungs are fine, but everything else around them is not.”
ECMO patients, because they are critically ill for a long time, are sometimes left with severe physical and mental disabilities. The last thing a surgeon wants is for a patient to wake up with new lungs but a body that will never recover, and ask: Why did you do this to me?
To Edwin, a young man with children, grandchildren, a large supportive family and a deep faith in God, the risks were worth it. “I’m scared, but I have no choice,” he told doctors, writing from his hospital bed because the machines keeping him alive prevented him from speaking. It was the only way to be with his family.
Edwin was listed for a lung transplant in late April. Samantha signed the consent forms. Then they had to wait.
It can take months to find lungs that are a match. Edwin was prioritized because of his dire condition, but doctors believed it would be weeks, at least, before they heard anything.
Two days later, Samantha got a call.
“We have lungs.”
Doctors warned Samantha the surgery could take up to 14 hours, but the phone rang after seven.
Oh my God, she thought. It’s too early.
It was 10 p.m. Samantha and her family were home. They had been saying the rosary every three hours since Edwin went into surgery.
The call came from Dr. Yeung, who performed the surgery with Dr. Shaf Keshavjee, surgeon-in-chief at UHN. The transplant was a success.
“I have never seen a guy so lucky,” Yeung told Samantha. “He has dodged so many bullets.”
Physicians at UHN believe Edwin is the third person in Canada to receive a double-lung transplant after becoming ill with COVID-19, operations that all took place at Toronto General, while about 50 coronavirus patients around the world had undergone the procedure as of early April. Edwin’s case was especially difficult because he was the sickest of the three.
The timing was a gift. If the lungs had come a week or two later, Edwin may have deteriorated to the point where he could no longer have the surgery.
“After that, everything just started to fall into place,” Samantha said.
With his new lungs, Edwin was untethered from the ECMO machine that had kept him alive for 84 days. Within a week, he was breathing without a ventilator. He could speak. He learned to eat again. He was moved to the step-down unit, then a regular hospital room, then a Toronto Rehab centre. He started walking, with assistance. He learned to get into and out of bed. Doctors expected him to remain at the centre four to six weeks, but within two he was ready to go home. It was a remarkable recovery.
A few days before his discharge, Edwin, who turned 49 in hospital, remarked on how strange it was to be a patient. “I’m on the other side of the fence,” he said. “Before, I’m the one doing caring. Now I’m the one who is needing it.”
Edwin remembers nothing from his time in hospital, until he woke up from the operation. He believed his family had been on a trip — to Australia and Ireland, to visit close friends. He remembered scenes from a movie they’d watched the night before he got sick. He remembered leaving home in an ambulance four months earlier. But that was it.
He has months and maybe years of rehabilitation ahead, as an outpatient. He will be on immunosuppressants all his life, to prevent his body from rejecting the lungs. Currently on workers’ compensation, he may never be able to work as a PSW again, a devastating prospect because he loves helping people.
“I want to go back,” he said, but lifting patients and being exposed to illness may be too much. “If it’s going to be a risk for my life again, then I have to choose.”
Of the 22 residents on Edwin’s floor at Roberta Place, only seven survived the outbreak, he said. He hasn’t even processed that yet.
Edwin is overwhelmed with gratitude for his wife, who he calls “Super Sam,” and everyone who has supported him: the friends and coworkers who offered prayers and donations through an online fundraiser; the nurses who managed his daily care; the physiotherapists who got him in shape for surgery; the speech therapist who helped him find his voice; the surgeons, including Yeung, who fought for Edwin to have the transplant.
Yeung wants to be clear that Edwin’s story of survival is rare. He got better in the 11th hour and the timing worked out. It could have gone the other way.
“It’s a remarkable case,” Yeung said. “The stars aligned for him, but for many they don’t.”
On Wednesday, Edwin returned home. Supporters lined the sidewalks in his suburban neighbourhood — distanced and wearing masks — for a surprise welcome. There were neighbours, coworkers, members of his church, families from his son’s middle school, friends of his older children. A piper led the Ng family van down the street from their local Catholic school to their home. Edwin waved from the passenger seat, grinning, while Samantha, in the driver’s seat, wiped tears from her eyes. “I don’t deserve all this,” Edwin said.
At home, Edwin slid out of the van and into a wheelchair as the crowd cheered from a distance. He waved to everyone from the driveway, looking a bit dazed but thrilled. Then his son wheeled him inside to rest. After 137 days in hospital, Edwin was finally home.