Correction: An earlier version of this story incorrectly identified the staff members Dr. Madhu Pendurthi texted during a recent visit with Janie Pendergraft. The story has been updated to note texted the ECMO team in Springfield.
Janie Pendergraft wears a smile that is apparent even behind her face mask. Her eyes brighten as she tells her story of recovery and her hopes for her future.
A year ago, Pendergraft was desperately trying to get a COVID-19 vaccination when she started to feel ill. On Sunday, Feb. 28, after suffering from a sore throat, coughing and a high fever, she headed to urgent care where she was diagnosed with COVID-19. They sent her home with the advice that she go to the emergency room if she started to have trouble breathing.
Eight days later, on March 8, she went to the ER. While there, she was given dexamethasone and remdesivir. Three days later, she was given convalescent plasma. Nothing helped as she kept getting worse. She developed pneumonia and was put on a vent.
That was when she was advised to “say goodbye” to her family. Calling her sons was one of the hardest things she had to do.
“I was so scared,” she admits. “I couldn’t have visitors. I didn’t have anyone to hold my hand and comfort me.”
So she told her sons that they were her greatest joy and that she tried to do her best as a mother. “They said I was the best mother.”
Son Jeff Pendergraft, who lives in Neosho, admitted that the call was “kind of nerve-wracking,” but he always believed she would pull through. “She’s a pretty tough woman.”
Son Mike Pendergraft was all the way in Canon City, Colo.
“Being in Colorado, it was really hard,” he said. “I had to call every day and depend on what other people were telling me.”
He was ultimately able to see her for himself after she had been transferred to a rehab hospital, but at one point he was making plans for the last time he would see his mother.
On March 23, Janie Pendergraft was put on life support.
The next time she saw her home was June 24. Her 108-day odyssey included double pneumonia (twice), collapsed lungs (four times), a bleeding ulcer, septic shock, hemorrhagic shock, an induced coma and 34 days on an ECMO life support machine.
“My sister-in-law now calls me Lazarus,” she quips.
For Pendergraft, the disappointments and struggles are simply foils to her natural optimism. Today, she is quick with her praise of her medical care, her family’s support, the cards and prayers of friends.
“I don’t know why I was spared,” she says in a moment of retrospect. “There’s always hope.”
Hope and prayers kept Pendergraft’s spirits up, but she points to the medical teams at Mercy Hospital Springfield and Select Specialty Hospital and an amazing machine that kept her alive for a record number of days while her body fought the virus and its aftermath.
“I owe my recovery to God and a lot of doctors,” she says. “They made good decisions. They know more about COVID treatments.”
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Pendergraft is talking about the use of ECMO — extracorporeal membrane oxygenation. The ECMO machine pumps the patient’s blood outside of the body to a heart-lung machine that removes carbon dioxide and sends oxygen-filled blood back to tissues in the body, according to the Mayo Clinic website. Blood flows from the right side of the heart to the membrane oxygenator in the heart-lung machine, and then is rewarmed and sent back to the body.
Until COVID-19 hit, ECMO was primarily used for infants and heart transplant patients. Mercy Hospital Springfield is the only ECMO center in the area using ECMO as part of its cardiovascular medicine program. In fact, there are only 11 ECMO centers in Missouri. In addition to the five in St. Louis and three in Kansas City, only Mercy Springfield, Freeman Health System in Joplin and the University of Missouri in Columbia have ECMO teams.
Dr. Madhu Pendurthi, a pulmonologist and critical care specialist, is on that team in Springfield. He loves talking about Pendergraft and her amazing recovery.
When she recently walked into Pendurthi’s office, he pulled out his phone to text the ECMO team in Springfield to tell them about her recovery. “You don’t know what a miracle you are,” he told her.
Pendergraft’s extraordinary recovery has also provided a great deal of information for doctors working with ECMO. Use of the treatment for COVID-19 patients was immediately considered when the pandemic began but it wasn’t until about August of 2020 that a standardized treatment was established. With each variant of the disease, there are subtle differences in how it manifests and how it should be treated.
The Mercy ECMO team is part of the Extracorporeal Life Support Organization — ELSO, an international nonprofit consortium of health care institutions and researchers. Data is gathered on the ELSO website, which also publishes studies and results of ECMO use on COVID-19 patients. Those studies have shown that many people don’t survive — but more and more do.
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Pendergraft is one of them, but the decision to put her on ECMO was not a simple one. When she went into acute respiratory failure, conventional medical intervention had already been exhausted. At 65, she was at the top of the age range, but because she was otherwise healthy the team hoped for a good outcome.
She stayed on ECMO for the next 34 days, a record for Mercy Springfield. During that time, she had to be put into a drug-induced coma. She was also at high risk for infections, blood clots, muscle weakness — all of which she experienced.
“She’s a miracle because she went through all this and came into my office walking,” says Pendurthi, adding that making it through rehab was daunting even after surviving treatment.
At the time, Pendergraft was the fifth COVID-19 patient put on ECMO at Mercy Springfield and only the third one to survive the ordeal. Larry Krauck previously held the record, with 32 days on ECMO.
Krauck called Pendergraft to congratulate her for breaking his record. Although he did not experience as many medical problems, Krauck says he had a lot of issues with rehab because of immobility. He had neuropathy, frozen shoulders and more after lying in bed for so long.
“Through all of this I became a case study,” he says, explaining that because of his experience, Pendergraft was given physical therapy during her time on ECMO.
The physical therapy team and ECMO team have since developed a protocol to actually walk the person on ECMO, Pendurthi says. Other techniques are also being developed.
Although it was ultimately successful, Pendergraft’s time on ECMO was also fraught.
“If anything could go wrong, it went wrong,” she recalls. But things also went surprisingly right.
Her ECMO machine began having trouble after about a week. But a spare machine was available, so she was switched to it. Her sons were warned that she might not survive the switch. But she did.
She experienced fascinating hallucinations, including a room full of cats and a 19th century scene including a little lady who was quilting.
“None of it was scary,” she adds quickly. “I wondered if I had crossed between the living and the dead.”
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When Pendergraft woke up, she couldn’t talk or walk. The doctors warned her that she might never do either one again. She was able to use a white board, but even holding the marker was difficult. Later, a tracheotomy was performed and a voice box put in for a few weeks.
“For a while I was depressed and wondered why my family let me wake up,” she admits. “But it didn’t last long.”
Living through her ECMO experience, Pendergraft recalls fear, anxiety and confusion, but determination and her own positivity were quick to return once she began the next harrowing leg of her journey to recovery — rehab.
She was moved to Select Speciality Hospital in May, unable to walk. While there, she developed pneumonia, gastrointestinal bleeding, blood clots and collapsed lungs, not an unusual thing for a COVID-19 patient who has been on ECMO, according to Dr. Brent Bergen, medical director and pulmonologist at Select.
“Attitude is so much of it,” says Bergen. “The recovery is really on the patient.”
Bergen has seen several ECMO patients since the COVID-19 pandemic began, several from St. Louis. Most, however, have been much younger than Pendergraft, so he saw challenges for her full recovery, he admits.
Pendergraft did not let him down. When she left Select a month later, she continued her recovery with home health, walking to a neighbor’s house and back again, then graduated to Mercy’s rehab center, where she walks two miles on the track. She just recently moved to the next phase of rehab and is still hopeful to be able to ditch her oxygen machine someday. Dr. Pendurthi believes she will.
“I’ve always been an upbeat person,” Pendergraft says. But she is also realistic. She recognizes that she may always need oxygen assistance. “But it’s not a game changer.”
