The cinemas and swimming pools were the first buildings to shut down. Then, the bars. People were asked to social distance and to stay safe.
Preventive measures were imposed to arrest the outbreak of a virus without a cure as the cases swelled rapidly across the United States.
Without a vaccine, the overwhelmed healthcare machine struggled to keep up with the pace of the illness.
Patients got hoarded in the corridors of overcrowded hospitals, left to wait as more people - mainly children under five years of age - fell ill.
It was the summer of 1952, an annus horribilis of polio in Texas.
In the July of that year, Paul Alexander was six, and he had no idea at the time that he’d end up spending decades living inside an iron lung.
He lived in a quiet suburb of Dallas, Texas: a child like many others.
Taking advantage of the 'unusual' wet weather in Texas, Paul and his older brother were playing in the rain.
Covered in mud, the children only went back into the house when their mother called them for dinner. Paul closed the screen door behind him as he padded into the kitchen. Fever warmed up his face and flushed his cheeks, although he didn’t give it much thought.
That’s when he started to realize he’d been feeling ill: neck pains, fatigue, and an ache deep in his muscles.
That’s when his mother knew.
“When mum saw my face, she knew,” Paul says now. "I don't know how."
Polio hit during the summer, mostly.
It looked just like common flu, until it wasn’t anymore.
Despite his rapidly deteriorating health — to the point that he couldn’t talk or hold a pen — Paul was advised to stay out of the congested hospitals.
The outbreak had dragged the healthcare system to its knees, and finding proper care in the overcrowded polio ward seemed unthinkable.
He could best recover at home, where he spent the next few days bedridden.
However, after his condition worsened, Paul was finally taken to Parkland hospital. There, as he struggled to breathe and swallow, his parents were told that he would not survive.
"I had become immobile; I don't think I could even talk, so the hospital staff put me on a gurney in a long hallway with all the other hopeless polio kids. Most of them were dead,” Paul told HealthDay.
It was another doctor who, after visiting him, performed the emergency tracheotomy that saved his life.
Three days later, Paul finally awoke.
He thought he was dead, but he was not.
He woke up a survivor after pushing through the initial acute phase of the illness, his sore body enclosed in a machine.
It was the iron lungs ward, an overcrowded section of Parkland hospital cramped up with young polio survivors: little bodies trapped in big machines that kept them anchored to life.
Some of the kids were crying, Paul recalls. Due to the tracheotomy, he couldn’t emit a sound. Nobody could move.
The polio ward was loud with the cries of the patients and the whirring of the pumps. Nurses in white scurried between never-ending corridors of metallic cylinders.
“As far as you can see, rows and rows of iron lungs. Full of children.” – Paul Alexander for the Guardian
Now considered outdated, in 1952 the cylindric-shaped negative-pressure ventilators, commonly known as iron lungs, allowed patients to breathe even after their chests had fallen through.
Originally developed in the late ‘20s by the Australian physician James Carrel, iron lungs used to be the only hope for paralytic polio patients: after their lungs collapsed, the survivors were entirely reliant on the machine and their caretakers to survive.
Paul’s head stuck out of the circular sealed chamber through an air-tight gasket, while the pump inside the canister forced his chest to breathe by raising and lowering the air pressure inside. The fluctuations in the pressure expanded and contracted his lungs, allowing him to continue breathing.
Unable to move, Paul communicated with nurses and doctors using a mirror built into the structure of the iron lung, or a speakerphone.
Over the months that he spent in the hospital, many of his fellow patients died.
He remained confined to his iron lung until he was eventually deemed healthy enough to return home.
In 1954, March of Dimes, a US nonprofit organization founded in the ‘30s to eradicate polio, contacted Paul’s family.
With the aid of a physical therapist called Mrs Sullivan, he was able to master what he called “frog breathing” — an alternative breathing method also known by the technical name of “glossopharyngeal breathing”.
The technique consists in using the throat muscles to force air past the vocal cords. The patient swallows oxygen one mouthful at a time, pushing it down the throat and into the lungs.
A year passed before Paul mastered frog breathing.
This accomplishment allowed him to leave his iron lung for prolonged periods, to the point that he could return inside the canister only to sleep. Since frog-breathing relies on intention, with the patient actively swallowing air, he couldn’t use it while unconscious.
Paul was given a puppy as a reward for learning to breathe autonomously for at least three minutes: a life-changing accomplishment that, many years later, would name his memoir Three Minutes for a Dog.
Paul went on to finish high school with flying colours at the age of 21, becoming the first student to graduate without physically attending classes thanks to a homebound programme.
Although he still needed the iron lung, Paul could now pursue his studies away from home.
The college years presented an unprecedented challenge for Paul, who transferred to Austin after enrolling at the University of Texas.
At UT, Paul earned two law degrees, successfully passed the bar exam and spent his career practising family law and running his own legal practice. He represented his clients from a wheelchair.
In spite of that very first diagnosis at Parkland hospital in 1952, Paul clung to life with fierce stubbornness.
Part of his motivation comes from his late parents, who encouraged him to pursue his dreams despite the hardships of his condition.
“They just loved me,” Paul says in a 2018 interview with Star Tribune. “They said, ‘You can do anything.’ And I believed it.”
Today, at the age of 77, Paul Alexander is the longest iron lung patient ever.
Paul has been using his negative-pressure ventilator for 70 years, and currently spends most of his day inside the machine in his house.
Keeping himself busy, he continues to raise awareness regarding the risks of polio and its devastating consequences. Recently, Paul spoke up regarding the COVID-19 pandemic and the risks for vulnerable, high-risk patients like him.
He also chose to tell his story through his 2020, self-published memoir: Three Minutes for a Dog.
"It took him more than eight years to write it, using the plastic stick and a pen to tap out his story on the keyboard, or dictating the words to his friend,” the Guardian explains in an in-depth interview with Paul.
“But the title of the book was Kathy Gaines’s idea. Kathy, 62, has been Alexander’s caregiver since he graduated from law school and moved to the Dallas-Fort Worth area, although neither can remember precisely when she found his advert in the paper and became his 'arms and legs'.” - The Guardian
Paul's resilience remains a testament to willpower, and his experience — especially in the years of COVID-19 — is a reminder of the worldwide fight against endemic diseases.
1916 saw the first polio outbreak in the US (when “public health experts recorded 27,000 cases and 6,000 deaths — roughly a third in New York City alone,” reports History.com).
After that year, the illness continued to loom over the continent cyclically, prevalently appearing in the spring and summer months.
Only the introduction of the vaccine in the ‘50s contained the nationwide emergency, and a global vaccination plan permitted a dramatic decrease in the number of cases. As a result, the use of the iron lung also declined.
Even if the US has been deemed Polio-free, the illness itself is still a threat in some parts of the world.
“Cases due to wild poliovirus have decreased by over 99% since 1988, from an estimated 350,000 cases then, to six reported cases in 2021,” shares the World Health Organisation. “Endemic transmission of wild poliovirus is continuing in areas of Afghanistan and Pakistan.”
Paul’s iron lung, once a vital piece of medical technology, is more than a world record or an outdated machine: it’s a symbol of willpower.
“I’ve always been an inquisitive person,” says Paul to Gizmodo’s cameras. “My parents taught me to use my energy and my intelligence to be productive.
“I’ve experienced in life everything you have, and more. I’m Paul Alexander, human being.” - Paul Alexander
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