Valley Streamer goes home after 111 days with Covid-19

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Tito Velasquez’s skin had turned blue when he stumbled into LIJ Valley Stream on April 28, his doctors said.

He was suffering from Covid-19, and his blood oxygenation was 11 percent, which Dr. Jason Yan, an LIJ emergency physician, said was so low that it was consistent with a machine error, but further tests confirmed it. Within minutes of intake, Velasquez, 33, was intubated and placed on a ventilator. At that point, Yan said, he expected his patient to die in moments.

But 111 days later, Velasquez had survived, and walked, albeit unsteadily, with a cane, out the doors of the Stern Family Rehabilitation Center in Manhasset, the Northwell Health facility where he had spent the last phase of his recovery. After more than three months, two strokes, a collapsed lung and a coma, Velasquez, speaking in Spanish through a translator on Aug. 17, joked that he looked forward to finally eating a good meal.

He said he never doubted his survival, but the doctors who cared for him said they were far less certain. 

When Velasquez entered LIJ’s Emergency Room, he immediately lost consciousness. Covid-19 had thickened his blood, and he had already suffered his first stroke. After the ventilator, the next step was to inject him with “clot buster” blood thinners, Dr. Kyriaki Poumpouridis, an LIJ interventional cardiologist, said.

“What struck all of us was that he was so young,” she noted. “He was a combination of being one of our youngest, and I think one of our sickest, at the same time.”

The next challenge was addressing the astonishingly low concentration of oxygen in Velasquez’s blood. “I had never seen an O2 stat that low,” Poumpouridis said. Yan agreed. Already on a ventilator, he needed more invasive procedures, his doctors said.

“Normally we code at around 60 percent” oxygenation, Poumpouridis said, hospital-speak for when a patient has a medical emergency so severe that a team of doctors and nurses is called to intervene.

“There was not a single thing about him that said he was going to live,” she said.

The disease had stopped his lung function, so Poumpouridis said Northwell staff resorted to a technique known as extracorporeal membrane oxygenation, or ECMO, in which a patient’s blood is removed from the body, oxygenated externally through a machine and then placed back, bypassing the lungs. The process takes about two to three minutes, Yan said, but requires him to be fitted with two tubes the size of garden hoses.

After that, the doctors said all they could do was wait, give his body a chance to recover and address any problems that arose.

“Everything he threw back at us we had to treat,” Poumpouridis said. “Every day was touch and go.”

The invasiveness of their procedures meant Velasquez was at a heightened risk for infection, and between the stroke and the state of his lungs, his survival depended on how much and how quickly he would heal.

“He had to recover from so many insults to his body,” Yan recounted.

Early on, his doctors called in his family to say goodbye. Velasquez’s wife, Juana, said that was the only time she was allowed to see her husband, which she said was the most heartbreaking aspect of the ordeal.

But roughly a month later, her husband had still not died, and she began to gain hope.

Transferred to LIJ Medical Center in New Hyde Park, Velasquez remained on the ECMO machine for roughly 30 days, according Poumpouridis. It was likely a record, Yan said — normally it is needed for only three or four days — and one for the medical journals. After that, Northwell doctors began rehabilitating his lungs, moving him to Northern Westchester Hospital, where he was first on a ventilator, and then he began breathing and eating on his own.

Finally, Velasquez started to regain his motor skills at the Stern center. He requested that staff play a bachata, a popular latino song genre originating from the Dominican Republic, over the lobby speakers upon his departure.

Enrique Carmana, information systems manager at the Stern center, said he was happy to oblige. “We have a playlist,” he said of songs patients can request upon their discharge. Carmana chose “La Bilirrubina,” which describes a man hospitalized with jealousy, and whose only cure is kisses from a loved one.

Juana, who greeted her husband in the lobby with balloons and a sign, said she would cook her husband’s favorite meal that night: barbecued hen.