Deep Breaths

Using the tools that we have

When I was eight years old, my parents threw a summer cocktail party. I remember watching four not-so-burly men shakily hoist one of their friends up the stairs to the deck of the house. Full of energy and warmth, if also a little imperious, Judy sat in her wheelchair at the centre of the swarm of adults. I knew she had had polio, but I didn’t give much thought to the virus. After all, it had been almost completely eradicated before I was born.

Over time, however, I did grow interested in medicine and became an intensive care physician responsible for critically ill patients. I have seen many kinds of ailment in the ICU (though never polio), and I have a “favourite” diagnosis: urosepsis. When a UTI gets out of hand and starts to overwhelm the body, bacteria escape into the bloodstream and the body goes into shock. By the time the person (usually elderly) gets to the emergency room, they may be unresponsive, not breathing, and close to death. But if the infection is caught in time, I can resuscitate the patient with the help of antibiotics, blood pressure medications, and mechanical ventilation. Often within just twenty-four hours, the individual is sitting up in bed and asking for food. It feels miraculous, and I find it hard to imagine what it was like to practise medicine before this kind of care was available and ventilators were ubiquitous. Of course, such a time did exist.

In 1952, Copenhagen was overwhelmed by polio. Hospitals were inundated, and with only one iron lung available, many were dying. Something had to be done. When the anesthesiologist Bjørn Ibsen was invited to visit the Blegdam, the Danish capital’s fever hospital, he noted that patient deaths were frequently caused by respiratory complications rather than the “primary disease process.” He proposed a radical solution: perform a tracheotomy — that is, cut a hole in a patient’s neck — and then push air into the lungs. Ibsen had used this intervention during operations and believed it might work for those with polio. Although some doctors were dubious, he was allowed to try his new approach. When the demonstration proved successful, he cried with relief. Over a thousand medical and dental students were then recruited to act as “human ventilators.” They sat at the patients’ bedsides for hours at a time, keeping them alive with persistent vigilance and their repeated steady squeezing of a rubber bag filled with oxygen and air.

The City Archives in Copenhagen contain a handwritten list of everyone who assisted, detailing the number of hours they worked over each month of the epidemic. I met Anne Holten Jensen, one of these former students, who recounted her time living in the hospital, working shift after shift tending to those paralyzed by the disease. The experience inspired her to specialize in anesthesiology, like Ibsen. But the events also left deep scars. With cramped hands and wrists, Flemming Balstrup spent a full night looking after his first patient, a two-year-old boy. The next evening, he learned the child had died. Months after leaving the Blegdam, Balstrup remained numb and struggled with his grief.

Polio survivors and their families described their own traumas and journeys. Lise Ølgaard, just a baby at the time, wailed when her family left after one of the short, twice-weekly visits — the only kind allowed. Niels Frandsen’s first memories were of living in a rehabilitation centre. And as a child, Dan Foldager was determined to get strong enough to jettison his corset, leg braces, and crutches. Even now, these individuals live with the shadow of illness. It haunts their memories, or it resurfaces in the form of post-polio syndrome. Everybody I interviewed for my book expressed a sense of relief that no one else would have to suffer the way they did; modern medicine had prevailed in the form of a vaccine.

And then, in July 2022, the virus caused a case of paralysis in Rockland County, New York. Two months later, the governor, Kathy Hochul, declared a state of emergency: polio had been found in the wastewater of several counties. With vaccination rates in decline, the disease is making headlines again. We can banish polio from newspapers — and ICUs — forever. The tool is there. Whether we wield it effectively is another matter.