Ep. 24: I am Iron Man

0:06 Welcome to M4 Medicine, mystery, mayhem, and sometimes murder. I'm Andrea Marciano and RN with 35 years of experience across various fields. From direct patient care in hospitals to home health, geriatrics, and injury medicine, I face life, death, and everything in between. And I'm Crystal Miller and RN with 13 1/2 years of experience. My work spans home health, Hospice, emergency care, geriatrics, and occupational health. From the chaos of trauma based quiet moments with patients, I've seen stories that defy explanations. We've been friends for over 25 years and as nurses we've shared countless stories that have left us and our families speechless. Now we're bringing those stories and many more to you in medicine, mystery, mayhem, and sometimes murder.

0:53 Each week, we'll uncover cases that challenge the boundaries of medicine, sharing the human stories behind the science. From puzzling medical mysteries to shocking real life crimes, we'll bring you stories that'll leave you questioning everything you thought you knew while. We're both experiencing treats, nurses. We want to make it clear we're not here to give medical advice. This podcast is about storytelling, education and exploration, not diagnosing or treating medical conditions. This is medicine, mystery, mayhem and sometimes murder. Let's dive in. Hey Crystal, how are you doing? I'm doing great. How are you? I am very well, thank you. What's going on in your life? Anything exciting? Yeah, so my little sister and little, she's 45, I think maybe a younger sister and two of her daughters came out to visit, visit us from Utah last week and we had a blast.

1:43 One of her daughters just had a baby about six weeks ago and the other is pregnant with twins. And so we got to see my sister's new grandbaby. And just like, we just had a lot of fun. We went to we went to the Museum of Osteology, which is a bone museum here in Moore, where I live. We went to, Oh my gosh, why am I? Why am I forgetting all of a sudden? I don't know, but let me ask, why on earth do you have a bone museum? There's just a guy who was really interested in bones and I think he's from here, so he just made a bone museum. That reminds me of Oh my gosh. So I when I was dating, I was on an online thing and somebody had put that they were an orthopedic surgeon or no, a surgeon, and I said, really, what area of specialty are you? And he said I like bones.

2:31 So I was fairly certain a he was a surgeon and BA very smart person but it just reminded me that knowing that there was a bone museum, I wonder if it was the same guy. Maybe who knows, but we went to a thing called Pumpkinville, which you from being from Utah are, you know, having lived in Utah, it's very similar to like oh, Gardner Village, like Gardner Village. Not permanent structures though, just booths, but it was really cute. Just as they had like artwork that had been recreated with pumpkins in it for for example, one of the examples was they had Vincent Van Gogh's pumpkin the night. Right. So the starry night, they were really cute American. So instead of American Gothic, it was American pumpkin. So it.

3:11 Was 22 pumpkin heads standing with tools? No, actually the two. People with the pumpkin on the pitchfork. Oh my gosh, I don't know. Were these things for sale or was it just just for? Display just for the, for the thing, the just for the event. And then we went to the the what is it called? It's the Greek conservation greenhouse. And we went also, we Sunny Joe found, it's my sister. She found a, a, an alley that's all murals. It's called like murals at Plaza Street or something like that. So we went and looked at the murals, then did some shopping. It was a lot of fun. It was so much fun. And we got to catch up and yeah. That sounds awesome.

3:52 We went to an alley like that, but I I believe it was in Philadelphia. There's one like for sure in Boise, and I've been to that one. The one in Boise is bigger, but it was still really great. Really great artwork, very diverse, just lovely. Well, that's what I liked about this. It was just some odd alley and there were live businesses that worked into the alley. I mean, they would bring her step in through and that sort of thing. And we did see one door open, which was odd because it was an art covered door. And then right when it opens, I'm like, oh, hey, this because it's kind of easy. At least it was for me easy to forget it was a building that I was looking at cause some of the things were so amazing and other things were really cool. Not as as talented artists as far as the classical sense, but they use beautiful colors.

4:39 And there was one that had stained glass on it and that I've always been attracted to stained glass. And in fact, I picked up a Joshua, my son's property. I picked up a bunch of pieces of stained glass that somebody had with a big piece of property. People usually dump junk everywhere. Well, there was this whole pile of glass that that must have been where they dumped it. And so I sat out there for about 2 1/2 hours picking up all this glass that I do need to now decide what to do with. But I. How many acres does he have? 11 1/2 or 11, but we have 11 1/2. He has eleven. Yeah. Wow. Anyways, crazy. Yeah. He's like, what are you doing, mom? I'm like, well, anyway, but that's not so much fun. It's.

5:19 It was a lot of fun to let her see where you're living now too, right. Because. Yes, for sure, because she so far only my parents have been out here. So now they've been out here. I love my house and like I'm really proud of my house. And I don't mean proud like there's nothing special about it. It's not huge. It's, it's just, it's just perfect for me and my family. The way it looks now, you know, and I, I, I had a little bit of money from the sale of my Utah house to do some new furniture and like to do like to be a little more conscious, yeah conscious of what I was putting into the house because I, you know, I raised 7 little kids and, and I just was like, you guys can destroy everything I'm not going to replace it till you're older and. That day came and that day came, Yeah. And it's just.

6:07 Really cute and I really love it and it's just I really feel at home here. And until you've seen it, you know it's hard to understand. Yeah, I get that well. And where we live reflects a lot of who we are. Yeah. All of it. I mean, everything from the cobwebs in the corner to the plants on the other side, you know? Oh wait, that's my sorry, I was distracted anyway. Well, that's so awesome. I'm so happy for you. I love that. And also it sounds like it's really good connecting opportunity for all of you for. Sure. Yeah, it was great. And I cannot believe the babies are having babies. I know that there's they're way younger than anyway. No, it's not. It's not that I'm 60. It's that they're young. They're babies.

6:50 Yeah. Yeah. Anyway, well, the topic we have for today is something that is, it's really interesting to me. It's about the iron lung. Have you heard? You've heard about the iron lung, haven't you? I. Have heard about the iron lung. I obviously because it's not used in medicine anymore. I don't know a lot about it. I've never used one. I mean it, you know, it's kind of just a historical thing that I know about. I think. I think they treated polio and tuberculosis with it or something. I my knowledge and it's like your knowledge, right? That was me guessing or trying to. Hurt. Who knows? Yeah, the polio thing was correct. And we'll talk more about exactly how it came about. I actually thought that the iron lung was invented to deal with polio, but we'll talk about the history with it and, and it wasn't my sources today are, you know, I, I hate, I'm embarrassed to say that I looked things up on Wikipedia, but I did.

7:45 Here's the thing. If the Wikipedia entry has sources that are legitimate sources, go for it. That's my opinion. OK, so my sources are description of the iron lung from Wikipedia and an article called the Man in the iron Lung and this was in the bbc.com news publication and it's the title was how Paul Alexander lived Life to the full and the iron lung Science, Technology and society. A student LED exploration and this was from Clemson University. I used parts of all of this to get what I came up with. So here it is now since since we both are younger than having use of iron lung was common. Since we've both been vaccinated for polio. And we will talk about that as well. But yes, because those vaccines are huge and they had almost eradicated polio and there is a resurgence. We don't get political in the show, but there is a resurgence and it does seem to be linked to a lack of vaccinations. Yes, correct.

8:54 And that's what we'll say about that for now. An iron lung is a type of negative pressure ventilator, and it's a mechanical respirator. And what it does is it encloses most of the person's body and then varies the air pressure in the enclosed space to stimulate breathing. Now I sent you a picture of my great uncle who was actually in an iron lung, as far as I know, until his death, and I'm waiting. Oh, and my dad said it was from about 1949 or 1950 and it was about two to three years duration. And that was my great uncle. I have a picture that I put in her chat. We can probably later put in the show notes with him in it. So we'll talk a little bit more about how he could have been in for a short period of time versus a long time. And there's a reason for that.

9:41 But anyway, so this iron lung totally encapsulates a person except for their head. That's all that sticks out is their head. Wow, I don't even know if I could take it. But I don't either think about an MRI machine. I mean, granted your head is also in the machine, but I hate those things. And it's not because of the noises. I couldn't care less about the noises. It's the claustrophobia, I guess. I mean, I don't know that I am claustrophobic in all circumstances of enclosed spaces, but I know that I do start to get anxious when I'm having an MRI as opposed to ACT scan right? Which is open and no big deal. Sure, and the reason I feel like I don't have any anxiety in an MRI is because I know I can get out because I'm not very big and so I know I could actually turn if I needed to or just scuttle my way out. But I've seen people in there that they are totally touching the edges.

10:31 They're wedged, yeah. I know. And I'm like, I would be more concerned, I think at that point. And the iron lung is more of that sort of thing where they're stuck. They're really stuck in there. The point of an iron lung, as I said, is it's a mechanical respirator and it assists breathing when muscle control is lost. And there's a variety of reasons that can happen. We'll be talking more about the polio one this time. Also, they have the thing where they lose muscle control. So if you think of something like Lou Gehrig's or something like that, that the the lung ability to move the muscles around the lungs is lost. This would have been in history what they would use. Or also sometimes the work of breathing exceeds their ability. Like say they have in history if they had a really bad pneumonia or something and they just couldn't do it. Or maybe they were in an accident and they were unconscious and they couldn't do it for whatever reason they might have been.

11:20 Is this pre intubation or do they overlap? Do they? Overlap, well, they overlap some and then we'll talk a little bit about what how that occurs. So no, it's a good question because I was wondering the same thing. But the need for the treatment of an iron lung might result from polio. Like we talked about Botulism or block jaw can have it can be one of the things that come up and certain poisons, so barbiturates and turbo curing. And so that would be the paralytics of the respiratory muscles. The use of the iron lung is largely obsolete as we were talking about because there are more modern breathing therapies that have been developed due to the eradication of polio.

12:03 With our side note of used to be in most of the world polio was the biggest reason people use these iron lungs. But in 2020, the COVID pandemic revised some interest in them because they were cheap air quotes, because they had been paid off, I mean. Right years ago, 75 years. Ago yeah yeah some of them even that part they were readily produce reproducible for the positive pressure ventilators. Remember when so many yes, but in this positive pressure. Well, they the iron lung is a negative pressure. The substitutes now have positive pressure ventilators. So instead of having external pressure, we have internal pressure. So that's the that's the difference. Yeah, thanks for that.

12:50 So just in case I did say something super goofy, which I have done but when and so do you remember during COVID when people were worried that we'd run out of ventilators and in some places they we did they were considering using these especially third world countries that had fewer of everything anyway, I know that I had read that they had a few of these back, but they end up needing unfortunately and as we described a little bit the iron lung is a large horizontal cylinder designed to stimulate breathing in patients who have lost control of the respiratory muscles. As we've discussed this cylinder I saw a big picture that they had taken a bunch of these iron lungs and it was in some kind of movie. They didn't say what the movie was but they set up this whole room that was filled with iron lungs and I noticed that they were different sizes.

13:43 So apparently they had some for children, some for adults, and maybe they even had male, female because of size, because it has to be the appropriate ratio, the way I I read it to be correct for the person. So if there was too much pressure for a person, that wouldn't work. And if there wasn't enough pressure, it wouldn't work. And. I, I don't know that this is the case, but what that conjures up for me is the idea of like a blood pressure cuff, right? Where as you're adding air to it, it's, it's conforming to the shapes and and hills and valleys of your body. Is it like like that or is it like? I don't think quite like that because I don't think that, well, what it said here and everything I read is that so the body's sealed inside.

14:27 I'm like sealed inside because it has to be sealed. It has to be, I don't know. I don't know a lot about these things, but I envision a vacuum. It's got to have that pressure that can't be released except for with the machinery. So the only thing that's open is their head. I'm not exactly sure how they kept the air in. I'm thinking it must have been sort of a baffle or something. So not only were you in this device, but then also something really tight around the neck and that would drive me. I can't even wear it. I would die. I can't wear T-shirts. I can't wear T-shirts because the necklines are too tight. Right, Even the T-shirt I have on them right now, it's a loose neckline, but it's still too high. I have to cut them off. At any rate, Another another look into the minds of the Coast hosts on the show. But with their head exposed, they're sealed inside. So the air pressure is cycled to facilitate inhalation and exhalation.

15:22 And they had different different devices, but the main known ones were called developed by a person named Drinker and a person named Emerson. And those were just, I guess the brand names, if you will, of of these things. And one of the things they did not address very much, but they talked slightly about it was if a person was in this and the only thing exposed was their head, how were pressure sores and things like that avoided? That's I was waiting. I was going to say I have so many questions like how do you cleanliness? What about what hygiene? What about yeah pressure sore like? And what's that? We'll talk a little bit about it, but they didn't talk about it very much.

16:06 And I thought, well, that would be one of my primary concerns and going to the bathroom. And does this mean that a person is catheterized for their entire lives? I don't know, because it seems like they'd have to be. I didn't see anything about that, those particular things. And it could be too that because it was older time, they maybe just never talked about it. I just don't understand. But we're getting slightly off topic for right now because we'll talk. No, we'll talk more about it because these are the things that I was wondering as well. And there are smaller versions of the iron lung, which were a jacket ventilator, which only includes the torso, which perhaps I could have dealt with. These people really had a choice of using this or dying. I mean, it's not like there were a ton of options at that time. I just, every time I think about it, I get the heebie jeebies because I just don't know if I could deal with it. Even if I knew I was going to survive with it. It's just like, well, that's.

17:01 What I was going to say maybe I'd have to maybe I'd have to be sedated. I know because I do feel like with I know how I feel with something around my neck, you know, that's even slightly tight at all, like AT shirt collar like a regular T-shirt collar. I can foresee myself being unreasonable and saying I would rather die than be feeling this feeling. So like, you know, I and also, I mean it was the I've been thinking about all of the million minute, obviously, right, But also like if I, if my prognosis was poor, then I probably would also be like, Nah, no thanks, right, But maybe maybe if given a, a strong good prognosis and being sedated for the time that I'm in it, maybe that would work. But I just can't imagine being fully conscious and and living with that.

17:46 I just can't. I Oh, I can't imagine. Yeah. And there's some stories that I'll talk about that are just remarkable. So I want to back up just a minute. So to discuss how breathing occurs, Now, breathing in different kind of living beings can be slightly different, but there are some main things that mammals have in common anyway. But we'll speak specifically about humans because I don't know that any other animal has been put into an iron lung. I never saw anything about it. Hi, put this elephant in here, won't you? That'd be a thing. Breathing in humans occurs through negative pressure, and so the rib cage expands and the diaphragm contracts, which causes the air to flow in and out of the lungs.

18:28 Now most of the time we're completely unaware of this happening because our body just naturally does it. It's so it's not even anything we think about unless we have a problem like we have a cracked rib or something happens with our diaphragm or we have hiccup because that's the diaphragm being in spasm usually. That's usually the 'cause there are some other things, but that's the most common cause. But most of the time we don't even think about it. The concept of the external negative pressure ventilation was introduced by John Mayo in 1670. Which, you know, when I hear people who have thought of stuff like this that long ago I was like, wow, that's a smart person. Because I even now I don't know if I could figure out how to make a machine that could do that with all the technology and everything available to me, I said. No kidding.

19:16 So people I wouldn't, but I don't have an engineering, an engineering mind either. You know what I mean? Like I'm way more like artistic and figure it out not exactly right. And if you if you saw the chicken run I made in the back, I was figuring it out and it didn't work. But that's why we have other people in our lives like that. The first widely used device was of this nature was the iron lung. And they call it that based on what it looked like 'cause it was iron and it created a a lung experience. And they were £650 each. Yeah. So it's not like these are just tiny little things. And they first started. They were first developed by Phillip Drinker and Louis Shaw. And that's why one of them was named the Drinker. I don't know why it wasn't named the Drinker. No kidding.

20:09 And that was in 1928. And its initial use was for coal gas poisoning treatment because so many people were working in the coal mines. They had coal gas. Poisoning. No, wait, that's not coal gas. So I just learned at work actually about a new chemical. I mean, it's not new. It's it was used in World War 2. It's actually illegal to say its name in France, but I just, it's like highly caustic and it's a choking and all this stuff. But I don't think it comes from coal, so. Yeah, I'm not sure. But I don't know if I should say it on the podcast, because what if somebody's listening in France and then they'd get mad? I don't know. I don't know, we'll skip it for. Now, if you want to, yeah, that's right. But but then with this, they initially used it for that, like I say, because people, their lungs were damaged to the point that they weren't working properly. And so this assisted them.

20:57 And then the Ireland game fame by treating respiratory failure caused by polio as we were talking about, John Emerson introduced an improved and more affordable version in 1931. So when I read that, I'm like, oh, what's it? Everyone get one for the home? Just, you know, oh, it's affordable now. I'll get one. And if no one needs it for that, I'll just, yeah, it'll just now be my casket. So it would probably feel the same way. But apparently it was a cheaper and lighter alternative and that other one by the drinker model was invented in 1937 in Australia. Anyway, they had a couple of other versions that were created, but apparently the drinker one was the most common.

21:41 A philanthropist William Morris finance production of a respirator called it both Nuffield and he donated them hospitals through Britain and the British Empire during the polio outbreaks in 1940 and 1950s. So that was awfully nice that he, he saw a need obviously, and he donated a bunch of them. And these iron lungs, while I was talking about it being a prop during a movie, they actually filled the hospitals. They assisted people who had paralyzed diaphragms for the recovery. And sometimes, and we'll talk about this more, sometimes it was temporary and sometimes it was permanent. And when we talk about my great, great uncle, his was temporary. And so that's that's good news because and I asked if he just died after that and he did not. He just got that's good.

22:27 Like, oh, well, it was temporary because he didn't like I say because before my time, so I didn't know him. Now the use of modern ventilators which as we talked about are positive pressure and they blow air into the patient lung, bring using intubation, intubation for our listeners who are unfamiliar with it. So a ventilator is when they take a tube and they put it down your throat through your vocal cords, place it into your trachea, avoiding your esophagus because you don't want air in your tum, tum. And then once it's in place, they attach oxygen to it in a positive pressure. So it's a very light pressure because you don't want to blow out your lungs. You know, your lungs are very delicate little balloons.

23:10 So it's a very light pressure, but it is enough to inflate the lungs with oxygen. And then often you've probably seen it in movies right where you hear the machine go and that's that in and out of the that's the the in and out pressure from that machine basically pumping your lungs for you both to ingest oxygen. And it's not really ingest, but to get absorbed. Thank you. Absorb oxygen and release carbon dioxide. Very good. Yeah. And that's true. It literally saves lives. And sometimes, like we've talked about with this negative pressure, it would be something that could hold someone over while they recover. And what's interesting to me is that negative pressure ventilation is actually more similar to normal physiological breathing then the positive pressure, which I, I guess I didn't even think about it that way because the positive pressure is just replacing what our body does is not stimulating our body to do the thing that it's supposed to do. And in some cases the.

24:17 Did you say the positive pressure is not positive? Pressure is less like what we normally do. OK, just OK, sorry I I wasn't sure. OK, just digesting or? You know, yeah, no, no worries. And negative pressure, though, can actually be preferable in rare conditions such such as central hypoventilation syndrome, which I did not look up. And as of we'll talk about this person who was on an iron lung for a very long time. His name was Paula Alexander. But at this moment, only one person person in the United States is still using the iron lung. I can't. Believe there's one. I know, me too. We'll talk a little bit more about her later, but I like what someone's still in an iron lung somewhere. That's goodness.

25:00 What I was saying before about COVID is that some enterprises developed prototypes of new, easily producible version of the iron lung in case it was necessary for the response to COVID. Fitz. That's all fascinating because then it makes me wonder why did we move to positive pressure? Because it seemed there's got to be benefits. I mean, I trust science, you know, and obviously we're not using iron lungs in our IC, us in, in U.S. hospitals. But I'm very curious as to why we switched. I'm very curious what the added benefit is, I guess. And it might just be space, right? I don't know. But that's what I got, that's what I got from it is a space thing, because these iron lines are pretty huge and it's not that. As big as the human that's in them, right? Right.

25:49 And it's not that it's bigger than a bed, but also when you think of the body needs, the iron lung made that difficult at best. And there was a time where they tried larger room size iron lungs. That way they can have multiple patients in it and each one this. I didn't see a picture of it, but I'd really like to. But each person had their head hanging out. So I I just envisioned this box with heads hanging out of it. Yeah. And what was good about it, though, is several. Patients that you break in half there? You go and but what was good about it is that several patients could be in the same space. So that did save some space and also nurses and respiratory therapists could be inside the seal room taking care of the patients. So, OK, how does this compare to a negative pressure room in the hospital that we use for tuberculosis? Because I think the negative pressure in that situation remains negative the whole time.

26:47 And in this case the the pressure will vary. The negative pressure there keeps things from leaving the space. In an iron lung, there's a variation of pressure so that the lungs will expand and contract or the diaphragm will expand and contract, and that's where it went. Fascinating. And and so I think about the. Larger room size, iron lungs. So I would imagine the person working there would have to go in and stay in. It's not like you can pop in and out, right, Right. And then how does that feel to someone who is actually breathing? Does it make breathing difficult? Does it do do I would think that I would start breathing at the rate that whatever they decided was the rate and that feel, I think that would feel really unpleasant because what if I really want to breathe right now, but I can't because the pressure is such that I can't? I don't know there there are a lot of rabbit holes that could have gone down, but I don't think anyone wants to hear me talk for a week at a time.

27:41 So I decided not to do all of that. It's really interesting though. So if you're if you like learning more about this, there's a lot of a lot of information on the Internet, which also surprised me because I know I want such an old topic nobody who cares, but apparently AI found out I do care. Also knowing that my great great uncle was in one for a time, but I just the whole situation seems untenable to me. Agreed. But I mean that are dying I guess was the choice at the point again polio is it's either paralytic or non paralytic. And that I didn't realize I thought all polio was paralytic, which means paralyzed. And for those who are not familiar with that word. But apparently the symptoms of non paralytic polio would be easy to mix up with something else because their symptoms usually last about 10 days and the symptoms can include fever, sore throat, headache, vomiting, fatigue, back pain and more. OK, so that sounds like everything right? How would you I think that was discovered. And this is this is thoughts by Andrea. I don't know this for a fact, but I'm wondering if they knew about the paralytic polio and then they saw the non paralytic, which had similar, similar sorts of illness things going on, but it didn't have the paralysis or sometimes it was temporary paralysis.

29:08 But these symptoms could be almost anything. I mean, so who knows. But the part that this iron lung was for was the paralytic polio. And that is the most critical form of polio and that it has similar symptoms. But after a week or so, other effects take place. So this was news to me too, because I thought you get polio, you get paralyzed, you either die or you don't die. That's what I knew about polio, Which. Is Frank and Franklin Delaware Roosevelt had polio? I know that, right? And we'll talk about that in a little bit in a few minutes, too. I thought back back in the dark ages when I went into nursing school. I don't even really remember talking a lot about polio. Do you? We only talk about vaccines. Yeah, yeah, 'cause I mean, your, your nursing experience is much more recent than mine, but it's just, I had no idea. At any rate, surprise, surprise, the paralytic part of the polio is after the initial 10 days when people start developing other things in addition to the symptoms we talked about before. The body loses its reflex, the limbs go, this was in the article, loose and floppy, that's what it was called. And severe muscle aches occur.

30:23 So, dear listeners, viruses are insidious. I implore you, don't mess around with viruses. That's all I'm going to say. They I mean, you saw it in COVID. I said, that's all I'm going to say. And then I'm saying more, but saw it in COVID. Think about all the different symptoms that different people had. There were probably, you know, there's probably a list of 100 symptoms and most people got four or five or six of them, right? So I'm just just hearing all of these possibilities with this polio virus as well. It's like, Oh my goodness, viruses are just so insidious. Yeah, and it it brings back to me a memory of nursing school when they'd ask us what are the side effects of medication?

31:06 We can say nausea, vomiting and dizziness to almost all of them. And it got to the IT got to the point where our instructor said you cannot list those three things. We know that's probably a side effect of everything medication. Now you have to think outside the box and point about a virus. You know, a lot of times we say, well, it's just a virus and we're not saying rush to the hospital for every possible thing you have. If you know your body, know what's different. And if something lasts for any period of time. And I'm not going to put a day on it because this is outside of what I want to deal with in the scope of this podcast. But if you're concerned, get it checked out. Really, it's really important. So back to polio. After the limbs go loose and floppy air quotes and the severe muscle aches occur, the prowess impacts the patient's ability to breathe on their own.

31:57 Now a lot of the polio paralysis is other parts of the body, and that's not great, but breathing, of course, is. Is great. I know it's not not overrated. And that's one of the things that is the big worry is that people will stop breathing. They will typically, from what I read, they would struggle to breathe on their own. So it wasn't, again, it wasn't one of those things that I got polio one day and the next day I was paralyzed, couldn't breathe. It was a progressive sort of thing. And I imagine that must be based on the viral load or, or whatever is going on because of the struggle. You know, they had to get into the iron lung or, or something else that could assist them. If it wasn't too bad, they could just have oxygen. But the worst of them did have to go into this iron lung. And what's interesting too is it didn't have impact only on the people that were in the iron lung because there was a whole societal change because of it.

32:59 One of the things that it did do, and we'll talk, I keep saying we'll talk more about this because we will talk more about this. But some of the more well known people who have polio, like FDR, yes, brought it to the forefront. So with that and some of the other more famous cases, the awareness of disability rights was brought to the forefront and it helped even the the field for people who are disabled. And we know right now, many, many years later, it's still not anywhere close to even. But it's when some of the, some of the people who had disabilities were actually able to come out and be seen where prior to this, a lot of times people with disabilities were just hidden away and and not right and not address.

33:46 And what's shocking about that to me thing is the people with disabilities, it's not like they did it in most cases anyway. I mean, it's like they were born that way. And how can they be treated poorly, as if somehow it was contagious or something. I that just, that just doesn't make sense to me. But anyway, so it did help get this idea of people with disabilities having value. One of the things when it says I just have to read this because it was funny to me, ironically funny. 1 downside the iron lung was how inaccessible it was to the patients body like we talked about, right, right. So it that pushed innovation for other things again because of that.

34:26 And that's when the use and development of mechanical ventilators and things like that started. These ventilators were not very popular. The other kinds that weren't iron lungs, they weren't very popular. Nobody really was totally sure. But before polio, it just hadn't become a thing. And maybe, well, I can't even say why, but it was practically an overlook. And guess if you want to. I think, sure, I'm good at guessing and making up wild facts, why not? But the treatment of the ventilators was, it was really an overlooked medical breakthrough for some reason. But once polio and the iron lung started being used, they were looking at options. And these ventilators were useful.

35:07 And one predecessor to the ventilators that we use now was called the Thunberg barrowsbarator brassbarator. I'm probably saying that very wrong. It sounds wrong. Anyway, something along that line and it fully encased the head and body. See, this would be a problem for me. That's just. Being buried alive, right? And there was limited clinical success as well. So that didn't stick, which I, Oh my gosh, I just think of that going, how could, how could that even, I don't understand even how that could happen. But there was, there were a lot of things that move towards the full controlled ventilation and partial ventilation support. And we're not going to go into that particularly today because there's a lot about it.

36:01 But just know that the iron lung and the ventilator were both available. Iron lung hung out for a while and then people developed ventilators that were the predecessors to what we use now. And back to your comment about why was 1 better than the other. And, and a lot of it, like I say, was because in the iron lung, the people were isolated from their surroundings because they're totally encased in a machine. And they also. Rolling down the rolling down the street on a walk, right. Actually, what's funny is the guy who lived in the longest, We'll talk about that. Yeah, but one of the things that was a problem is because it wasn't only difficult to breathe or people weren't only and some people were completely incapable of breathing, they also had the inability to eat, swallow and talk. So imagine being in a ventilator, I mean a iron lung, you can't eat, swallow or talk and you're stuck in there and people are trying to feed.

37:01 And there's a lot of like my, my great uncle, his name was Daddy Guy. He had a nasogastric tube, which I would rather have that than risk eating and choking to death because that obviously having a choking incident would be a huge problem. One of the things is they mentioned is that patients had to relearn the basic abilities to eat, talk, swallow after they've been in the iron lung for a while. One patient here said that she she was talking about her experience in the iron lung and she said, quote, I used to sit up perhaps to have a cup of tea, but then would have to keep an eye. They'd have to be keep an eye on me because my fingers would go blue and in about 15 minutes, I would have to go back in.

37:42 Wow. Yeah. So she, I don't see her name. They didn't put it in here anywhere that I could see. But it said that she had to practically live in the iron lung for a while. As we mentioned, it made them feel trapped, which, of course. And she said that most people were just waiting until the escape the iron lung. One story that was published in The Washington Post talks about a person who was 19 years old, bold and paralyzed. After she was in the in the iron lung for about 13 hours a day for months. She was allowed to come out for about 12 hours and then started having a air quote, normal life. That's the difficulty with these things, especially polio. Go ahead where you can say something. I just you, you're in the iron lung for months and then you're you're let out for 12 hours and then you go back in. That seems like a really long time to be unsupported. Well, and people would build up to that. We'll talk a little bit about that when we talk about the individual people.

38:43 And they, and so they would build up their tolerance for breathing and some could build it up to the point that they could be out of their iron lung altogether. A lot of people like these two people could build it up to a degree. And then the problem is, is that because of their paralysis, the breathing effort was so huge that they would just become exhausted. So they could no longer continue to breathe because they had to create the breathing that it wasn't just their body doing it. They had to do things. And we'll talk about this person Paul here in a minute and how he learned to breathe himself. Like we said about polio, it's such a huge problem related to the breathing. And because of being in these iron lungs or even being, not having one of those chest ones or, or even a ventilator, it would just take a toll on the person psychologically. And there was nothing, nothing about an iron lung that was pleasant that I could see they also. Then why is daddy guy smiling and is that? Right, that's right.

39:42 Good question. And also the with this feeling of isolation, they often felt hopeless and and very scared. And the people outside the iron lung couldn't really do anything about it either. They could talk to them, they could support them. The iron lung device came with a head support, which as I looked at it, looked intensely uncomfortable. I mean, have you ever been? In the same place for a while and not been able to move. Yes, it sucks. Well no actually because my body moves me anyway, right? Like I'm because I'm not paralyzed, I autonomically move so. But yes, I have felt uncomfortable enough even to move right. Well, so I can't imagine.

40:25 No, it would be awful. And one of the things they had us doing in nursing school is they gave us assignment for a homework and they said go home and for two hours find find a really comfortable position, a place you really like, somewhere you're super comfortable and lie there for two hours without moving. Just don't move at all. You can't move no matter what. You can't move. Obviously we could, but just don't. And so I thought, OK, I'm going to get a really comfortable place. I got into the love Sack Big Bean pillow and I thought this is going to be great. And besides, I thought the the whole pillow and stuff would just move around a little and I wouldn't be moving, but it'd be moving me. So that would be good. And I was in there for probably 15 minutes and I'm going, Oh my gosh, I want to move. And do you know why they chose the two hours? Probably because that's when the skin starts to break down well. That historically was the amount of time we could let someone lay in the same position without moving them. Because back in the day we had no, we had no air baffles in the beds.

41:28 We didn't have any rotation of the beds. It was just a bed. So we, we move them every two hours at minimum. We could move them more, but two hours was mandatory because as you say, it would start to break down and plus just felt terrible. So I was lying there for two hours in what I felt was a super comfortable position and it became awful. And that was a good position. It wasn't a hard hospital bed, plastic under me and sheets that were 12 thread count instead of, you know, 500. That was that was interesting to me too, because. Potentially laying in your own urine. Just had to throw that out there. Sure. And whatever else was going on, wounds and all of that. Yeah, exactly. So just I just imagine the psychological aspects of this is just.

42:13 I just can't. One of the other things too is with the iron lung, the body isn't able to be dependent on its own. The body will would start depending on the machine to actually create the breathing. And that's another reason why they started to let people out for a period of time so they could maintain the ability to breathe. But even still, like we talked about before, if I could partially breathe and get put back in the iron lung and it made me breathe when I didn't want to, that seems like that would be difficult as well. So there's just not. It was a great scenario because it saved lives, but just seems so horrid. And one of the things, one of the things about polio that is important to remember is that it didn't affect just adults, right? It affected just all people who got it it. It was non discriminatory.

43:02 Every age was affected. And so children would get polio and they had to get into these iron lungs. But children are supposed to be developing in their brains, in their bodies, and everything else. Right, and exploring. Sure, so polio made them not be able to move, but their bodies still had needs and things like that for growing, and their minds did too. So it took quite a while for people to figure out how to educate children in iron lung because it's not like they could write down homework assignments. They can't go to school, they can't do of those things. So there were a lot of teachers that got together to try and help teach children and give them the appropriate mental development and stimulation so that they weren't stunted when or if they got out of this iron lung. Some of the techniques that they developed involved. I saw one child who's in the iron lung. He looked like he was probably probably about 8 or 9. Hard to tell just by his head but. That looked about.

44:00 That age to me. And he had a paintbrush in his mouth and he was painting a picture. Oh, wow. I know. What they found is with the different strategies for teaching these children and trying to assist them to thrive as much as humanly possible, they had to do easy projects that didn't involve moving the arms or legs. Can you imagine how difficult it was to engage a student when they're just lying there? No, I cannot. And then you've got people who couldn't talk also don't even know what they're learning. But they worked real hard to do that and they tried to get the kids to participate in activities, but there's not a whole lot of person can do from an iron tongue. They just the best solution they felt like they came up with was teaching the children how to form a task. So they teach them and potentially just in verbal instruction and then have that student teach someone else. They could see if they learned it by teaching it by the chain, right?

44:59 Right. To me, it just says that they knew how to memorize things. But I don't know if it helped, but they tried really hard. And they also, they also were surprisingly talking about emotions that children have because, you know, a kid isn't going to understand as well as an adult why the heck they have to be in this tube. How scary it must have been. They did address some of that as much as they could, but they said one of the issues is that these kids could be OK and then their emotions would be all over the map during the whole day. And that was for the teachers too, because at 1 moment they could be super engaged and other other moments they could be sad, crying, yelling, all of that sort of thing. And through no fault of their own. I mean, they were just frustrated. And as a child, they had fewer tools to deal with the difficulties than an adult did.

45:53 And. I have two similar scenarios to that, and they're not, obviously they're not an iron lung, but first one is when Odyssey was 20 months old, 20, she had her tonsils out because she was having chronic strep throat. And she was so young that I couldn't get her to drink any anything. I couldn't get her to drink anything because her throat hurt, right? And she was so young that I, I couldn't reason with her. There was no way to say to a 20 month old, if you don't drink something right now, you're going to have to go to the hospital and get a needle put into you and you know, get IV fluids. Yeah, that would make a difference, would it? Yeah, exactly. And so I mean, obviously those obviously, but we did not end up having to go to the hospital. She finally, on the last day, she finally drank something last day before she would have had to go. And then the other scenario is when Kira was about, I want to say six months old.

46:40 I got to be honest, my memory about these kinds of things isn't good. So if this is medically not right, shush when. She was about 6. Months old she had, she had a crooked head. I can't think of what it's called, but she needed a helmet. I always want to say hydrocephaly, which is not, it's hydrocephaly is way worse, but it is something. Seth played geocephaly. There we go. She had played geocephaly, which basically means that your face, in her case, it meant that her twin was sitting on top of her and smooshed her skull and made it misshapen, right. So she had to get a helmet about six months old. Well, she fought the whole plastering process and fought getting the helmet on every time for the nine months that she had it. And I couldn't explain to her why she had to have it, right. Like it just, it is what it is.

47:26 And so, you know, you think about these are non verbal kids or pre verbal kids, I should say. But still, even when they're verbal, they may not necessarily know what they're feeling or they may not necessarily understand the explanation that you're giving them. And so it's it, it's very like, it's heartbreaking, frankly. Yeah. And, and it, it makes it such a challenge and like you say, with even these kids, the ones that they talked about were a little bit older at the at the school, but they're, I wonder if they don't talk about younger children because maybe they didn't survive it. True. Maybe not. And I'm, that's what I was thinking when I, when I saw the evidence they were talking about with the way people responded to it. So I'm not really sure, but it is very difficult. One of the things that they talked about is as the new medical technology accelerated, there was a term that was called the iron, iron lung, which was not, it was sort of referring to the iron lung itself, but it was more describing a, the entrapment and claustrophobic nature of the machine. And it had the effect it had on people for the rest of their lives, even after they were out of the iron lung. And I wouldn't be surprised if people had what we would call now PTSD from it because the whole experience must have been most unpleasant.

48:53 As you mentioned, Franklin Delano Roosevelt was a victim of polio initially. There is some evidence that most people believe that his diagnosis was kept hidden because they didn't want everyone to know that the president was in trouble and there was some reporter. Did he contract it as president? I. Didn't know that. There was a reporter apparently in the White House and the secret surface that would take pictures that made him look like he was OK and but they didn't want him and to be in a date and disabled or weakened state, which obviously was easier than would it be now.

49:34 And it talked about how the disabled were not always respected, as we discussed. And FDR was part of a air quote group that was often looked down upon. His ability to change how people saw the disabled was impeccable, they say, because he became a single signal of strength and perseverance and his problem and his disabilities. So I. Don't know, sorry, I don't know anything about his politics, but he he has a warm part in my heart like because specifically because he was in a wheelchair and I had a great uncle who was in a wheelchair who would take us. He was the fun uncle right for wheelchair rides and like put us on his lap and spin around, do do tricks and and so whatever I think of FDRII have like I said, I have no idea what his politics.

50:23 I mean, I know about the New Deal and stuff, but I don't know, you know, I don't know his character per SE, but I was, to me, he's also like the fun grandpa. He's the fun Grandpa president. The fun Grandpa president. I like that. That's good. Well, then one of the things that was fun to learn to me was that his connection to the handicap pushed him to do the fundraiser for. You'll recognize part of this, the Franklin Roosevelt found Roosevelt Foundation of March of Dimes. Nice. Yeah. And and I thought that was awesome that the Roosevelt family started that as the epidemic of polio increased. FDR. Really turn to the public to fundraise, to learn what to do about it, how to do vaccines and rehabilitation for the survivor.

51:09 And as I mentioned, that was called the March of Dimes. And most of us have probably heard about that one way or another. Jerry Lewis, I think, was the one who did the March, wasn't he? March of Dimes. Yeah, That might be that might be too far before your time. No, no, no, I know what Jerry Lewis is. I'm trying to remember if it was March of Dimes. I was thinking it was I could be incorrect on that. And listeners, if I am, please just put a note, a comment in our yeah comment section. I I can't think. Of I can't think of another option, so I'm just going to agree with you for now. Yeah, that's how I remember it, but I could be totally wrong anyway. You know, I know about the March of Dimes free address. Labels, baby.

51:50 That's Yep, you know, everything has a hook. That's right. The hook was the labels. But the March of Dimes was developed in 1938. I don't know of any other large fundraiser prior to that. That doesn't mean it wasn't there, but I just don't know know about it. So it actually the foundation contributed to innovation and the advancements in the iron lung. So without FDR's participation, the iron lung. Jerry Lewis's muscular dystrophy. Thank you. Correction made. And so that was something that I remember as a child watching the Jerry Lewis telethons and that was the only time we got to spend stay up overnight for some reason because our parents supported it. I guess I don't really remember. I just.

52:31 I forgot that it went overnight, went 24 hours or however. Yeah, I remember at the end of it, he was so tired every time. So, yeah. But this FD Rs contribution to the advocacy of disabled people was huge. There was a person who had a big influence on disability rights as well during the during the polio disease part. And his name was Mark O'Brien. And he was 6 when he was diagnosed with polio, and it was so severe that he needed this assistive respiration operators for the rest of his life. And as we talked about, he lived in an iron lung and his tank had a movable mattress that gave it the more enduring nickname of the cookie tray. So I don't understand that completely, but apparently they called it that maybe because they could pull him out on the mattress.

53:25 I don't understand. But that made me wonder, if he had a movable mattress, what the heck did other people have? I texted it to you. Oh, a list of what? OK, hold on. Things of the creative, creative ways they got around things like AD LS. Oh, wow. OK, so there's there. Do you want to read a few of those things? Crystal found something online that is interesting. Yeah, sorry, I can't help but research while we're talking. Unless I'm. If I'm talking, then I won't be researching because I've already done it. But it's your turn. I just, you know, I just can't. But I can't myself. It's like it's in my blood. I do the same thing. So some of the things they would do is they would have a like a trap door where there would be a bedpan and they would, they were able to take the bedpan out from the bottom of the iron lung, they replace it with a new one and quickly close the trap door. Some of the other things they had tilt tables or rotating frames so that you can, this is probably the same as the cookie tray so that you wouldn't, you would get repositioned without having to come out of the iron lungs. You know, the table itself would reposition you a little bit. So you might be a little lean to the left or a little lean to the back or a little whatever, right. Another thing they would do is that sometimes they would feed them really long utensils that would go down into the tank to get to wherever their mouth was in comparison to their, you know, to their seal, I guess.

54:53 Yeah, because it was very close to the edge of the the tank, because it was part of it. Yeah, yeah, exactly. They would a lot of times it's, it's a very normal thing. All of all of us nurses and Cnas are taught how to change a a bed when a person is in it, right. So they would do that same sort of change where you take off half of the half of the linens, put on the clean linens, half of and then roll the person over onto the clean side, pull off the very side, but and you know, pull on the cleans on the other side. And they would just do that through the parts of the iron lung that couldn't be unsealed. Like like consider, OK, I'm probably what I'm envisioning. I, what I'm envisioning from the description is like if you were in scuba gear, and that's not a scuba gear, but a wet suit, and that wet suit is the pressure part of the eye and lung, then you'd be then on linens.

55:43 And so they would just kind of do it around, Sorry, I'm saying it backwards. It would be like if you were wrapped in linens and then had a wet suit over it, and then you'd have to manipulate it using the wet suit, but you were actually manipulating the linens. Yeah. And, and I just, that had to have taken a lot of time and coordination. And also I can't imagine it was done all that often because it was such such a big deal. And I think. About most specifically what they said is it took a lot of creativity and it took a lot of people. So this wasn't a one nurse job 1, you know, CNA or whatever they were called back in the day job. This was like you have to you had to recruit family members and friends to help with these sorts of things. So.

56:27 Well, I'm also remembering the fact that many of these people could not breathe at all while their machine was off Exactly, so it had to be fast too. And then I think about the. It's scary, right? Oh man, The idea, it's unpleasant, just being at the mercy of everybody around you as they, you know, remake your bed or whatever, and you do not get to have your next breath until they're done. Right. And the Paula Alexander will be talking about in a minute some of the things that happened through his life. But I'm back to the bedpan. I think about the times that I've removed bedpans and they've tipped a little. I don't, I mean it's difficult under the best of circumstances to remove a full bedpan and to try and do it in an iron lung and trying even, I mean, I always tried very hard not to spill anything, but if I did, I could clean it up right quick and change things or whatever.

57:18 Pretty easy. Independent person, it was still fairly easy, but they were open air. I could just move around and think to try and do that with an iron lung all around. And also again, the person not breathing. I just can't even imagine the pressure that would be for the 15 bottle too. Yeah. No kidding. Yeah. And so thanks for that. But back to our Mike Mark O'Brien and. I say sorry so much. Please don't send us messages that tell me to stop saying sorry. That's OK. It's just who we are, right? Like I said, Mark was diagnosed when he was six with polio and he always had to have that assistive device and he was using his cookie tray, which got us off the track that we were talking about. But I wanted to revisit it so everyone remembered what we were talking about.

58:09 Just note to listeners that only reason I remember is because I have notes in front of me. But when he he went to the University of California, he went to college and he had to use a motorized Gurney to get through the campus and then he'd go home to use the iron lung. So this is when we were talking about he would be off for a period of time, but he couldn't walk and he didn't motorized Gurney and then use the iron lung. And so I'm not sure exactly how how he could get by. Maybe he'd go for an hour or two, I'm not really sure. It didn't go into details in this article about how he actually got through at the moment, but he's considered his iron lung kind of his his second home because he had to live into it for four decades.

58:59 Oh, my gosh, yeah. As he grew up, though, he noticed that polio survivors, including himself, were extremely excluded from the world around them. You know, the iron lung added to this feeling of seclusion because even when he was out, he still knew he had to go back to it. And he looked for ways to bring this second home of his iron lung to just stop having to need it. And also if he didn't, he couldn't stop that, at least to start feeling less secluded. And so he started to really work on ending discrimination against disabled people. And it also inspired him to compound the lemonade factory. And I hadn't heard anything about this before, but it was a small press that like a printing press where they published various things.

59:47 And they published, It was in Berkeley, and they published poetry by people with disabilities. So it gave. Yeah. And it gave the people with disabilities a voice to the public. It was the first time that it ever happened. Wow. Yeah. And so that was good. And if anywhere in the world would or the United States would do it, Berkeley is definitely one of those. Places. Was it clear at Berkeley? It was in Berkeley, the town. Like I said, it gave them a voice and. I love that. I do too. And there was a film directed by a woman named Jessica Yu and it was called Breathing Lessons, The Life and Work of Mark O'Brien. So it talked about his life and how he and how he did things and it connects the audience to his struggle to live his life independently. And then it talks a lot.

1:00:33 So if you want to learn more about Mark O'Brien, if you watch that The Life and Work of Mark O'Brien, it talks about his life from his perspective. And the quote about it is it's an intimate window into the reality of the life of severe disability, as well as an illuminating portrait of a remarkable artist. And I really liked that. And, you know, noted here as we talked briefly, this didn't stop discrimination of people with disease because there's still issues now, even accessibility issues, which are shocking because it shouldn't be that way. But there were some steps that were taken for the first time that anyone's really recorded. This one is a woman named in in board. Cully was 35 and she was a mother of three children, but she passed passed away in 1961.

1:01:23 It was described that she took air quotes, a sudden turn for the worse, and her battle against polio. A few years prior to that, 1956, just after having contracted polio, she had a normal childbirth with her second child. So she was paralyzed, but she was able to birth this child. And this is interesting. It says that for this magnificent feat, she was awarded the Queen's Polio Mother of the Year Award 1958. Didn't know that. I know. I didn't even know it was the thing. But she did become paralyzed from the waist up. So I imagine that's how she was able to have the baby.

1:02:04 And then remarkably, she got pregnant again. And it was said to be more difficult than the the last birth, which is interesting to me because she was just first paralyzed in the beginning at the 1st, at the the childbirth she had with her second child. And then the third she had more difficulty and she was in the iron lung. So I don't know how pregnancy occurred, but I don't either. But she came out of the iron lung for 90 minutes during the complicated and difficult birth, and she had to have air pumped into her lungs through a tube in her throat. Tracheotomy and the delivery was successful.

1:02:46 But she passed away within the year. So there may be some argument about why did she get pregnant. I don't really know how that all worked. I'm sure there's more detail, but again, another rabbit hole that I did not go down. So one of the things that they talked about as with this Mark O'Brien person, a few people that were in the iron lungs did make educational advances and getting higher higher education. And Paula Alexander is someone we'll talk about. But he, he was as far as I read anywhere, he was the person who was in an iron lung for the longest period of time, which was 70 years, I believe. And he was confined to his iron lung.

1:03:30 He contracted the disease in 1952 at six. He was very amazing, for sure. We'll talk at length about his story in a minute, but he's one that is referred to in almost every every documentation of people being in iron lungs and being there for any period of time. Also, there were people called Mona Randolph and Jim Costello, and they became prominent figures for the disabled with their organizations for disability awareness. And Mona spent the majority of her life in iron lung. She performed what was called the Whole Person. It was an organization that still exists as an advocate for individuals with disabilities in Kansas, Kansas City.

1:04:13 It's just to me, the fact that they kept doing anything is shocking because they had, if anybody has a reason to say Nope, I'm just going. To thank you. Yeah, then these people are the ones. And Mona passed away in 2019. And Jim Costello was previously an iron lung patient, so she had been in an iron lung. And he was from Ireland. He contracted polio when he was 15. He was heavily paralyzed. And he went with six others and set up a charity called Post Polio Syndrome. And he was awarded the Louis Pasteur Polio Hero Medal in Paris in 2016.

1:04:54 They were people who were able to escape the adversity of the iron lung and the psychological issues that come with it by looking outside themselves in a way that I can't see that most people would have done. Some people are just built a certain way, you know. It's. Crazy. It's it's impressive. Yeah, it it really is. And there's story as several stories about people who have done things like that. The one I want to go into further, as I've talked about a few times, is Paula Alexander. The way it was reported, this was a description that he later gave, is that he was six years old. And he woke terrified to find himself inside a large metal tube with only his head sticking out and he couldn't move and he couldn't feel what was trapping him. And he tried to call for help.

1:05:47 He discovered he couldn't make a sound. That's how it was described. Can you imagine? No, me either. Paul had survived this bout of polio, but he had been left a quadriplegic at six years old, and he had an emergency tracheostomy, and he was unable to breathe without the iron lung that was encasing his entire body. We'll talk a little bit more here about how he did. And he was in Texas in 1952. There were a lot of other children in the same situation. And according to the World Health Organization, one in 200 polio infections leads to irreversible, irreversible paralysis. One in 200 that's huge to irreversible paralysis and along those that are paralyzed, 5 to 10% die with their breathing when their breathing muscles become immobilized. So many, many, many the five to 10% will die before they even get assistance is the way I read that. And they just because as we said, polio has these precursor, what I mean, polio itself has those kind of random almost every kind of illness sort of symptoms. But it's when it goes past that 10 day mark and it starts becoming more significant.

1:07:11 But I can imagine being a parent of a child with polio, especially like now when it's coming back and people are less aware of it than they were in the whole epidemic, big epidemic years. They wouldn't necessarily think of polio. I wouldn't. I mean, if my kids when they were little had gotten polio symptoms, I would have thought, oh, they're just sick. They have a flu. And if they didn't get particularly I'll, I probably would have gone to work and talked to my doctor, hospital friends about it and that maybe, maybe not. Maybe it wouldn't be notified or identified. And then they could just stop breathing, which, yeah. It's horrifying.

1:07:51 Yeah, it is. It is. So Paul was in the hospital for two years in this iron lung, and the doctors kept saying, you know, he has a future that is looking pretty sketchy. So they just didn't really worry about him. They didn't want to deal with it. Basically, it sounds like and. So sad. I know it's just like, well he's useless, whatever. And so he would have been 8 by then, and his parents decided to take him home in his iron lung. And I can't even imagine how scary that thought was. They weren't medically trained. I mean, they may have learned over the two years he was in the hospital.

1:08:32 I'm sure they learned stuff. But for heaven's sakes, I don't know if I want to bring someone home in an iron lung. And but they decided to do it because they just wanted him to live out his days in peace. So it sounds like with that idea that they probably thought it was kind of over for him too. And they were they were in the home. And he said instead of dying, he went from strength to strength once he was home in his parents care. So I guess the care that they were able to provide him assisted him to develop more than he ever would have been in the hospital. Crazy. OK, so here he is in his home and as we know in home sometimes power goes out. Bummer dude, that's bad.

1:09:18 And these bellows that made this iron lung do its negative pressure and in and out and in and out had to be pumped by hand. And it says that when that happened, the neighbors would come to help and his father. So they would do the pumping of these bellows for as long as it took for the power to come back on. And in the 50s, I don't know what ratio of time that would be, but it any amount of time would be bad. And to be standing there being responsible for someone's breathing. We've got all of the Ambu bags and things like that now, but this was a bigger system there where they had to probably put a fair amount of energy into it.

1:10:02 And Paul's father designed an alarm bell that Paul could ring using his mouth if he needed urgent attention. He because remember, he still couldn't really speak yet. If he needed something, he had no way of getting you an attention. He couldn't lift his arms to bang on the iron lung. He couldn't do anything. And I just think of how scary and especially he's still a young child to be relate to that is wow. I just over time, Paul learned to consciously breathe by gulping down air. He was able to use his throat muscles and somehow he figured out that if he gulped, he could breathe. And he called it frog breathing. I don't know why frogs do that. I don't know.

1:10:44 But his younger brother, Phillip. This was this this topic of of Paul was in the BBC article I talked about before. And so he Phillip explained to the BBC that the promise of a puppy gave Paul the incentive to be brave and attempt to spend time out of his iron lung to learn the complicated breathing technique that was of the day. And that was the medical term for frog breathing was what Paul called because it was difficult to say glossopharyngeal breathing is what it's called. So frog breathing is better. So Phillips says that Paul would was afraid of choking to death and which I can understand because if no, you can't breathe outside this machine, what the heck do you want to go outside this machine for? They told him if you last three minutes, you'll get the dog that you want.

1:11:36 So he did. And I mean a boy and his dog, right? But Paul, Paul realized that he could get out and his strength and confidence grew for breathing and he was able to spend increasingly longer period that of the iron lung. And as I said, the people who were able to get out of it were in situations like that were either their their paralysis receded. And so they weren't either as paralyzed or not paralyzed at all, or they developed ways to breathe outside the iron lung for a period of time. And so Paul was able to experience a little bit more of life. He was able to go out into the neighborhood with his wheelchair with his friends. And yeah. And then when he was tired, as I mentioned before, that was the problem as they get so tired because it's such a big effort.

1:12:19 I mean, think about it, if you had to actually consciously be breathing, I guess the person would know when to do it by whether they feel like they have to or not. Anyway, he said they'd return him to the Iron Man when he was tired so it could take over for him, Phillip said. This is a quote from Phillip. I thought it was cute. He said he was just a normal brother to me. We fought, we played, we loved, we partied, we went to concerts together. He was just a normal brother. And that's awesome because Phillip, I mean, I don't know you. You fought with a kid in an iron lung. What are you finding? But so Paul finished the school at home. So he did homeschooling up until high school, and then he went on to earn a college degree from home, which was new for that time. Because remember, that would have been, let's see, 12 June, I guess the mid 70s probably.

1:13:09 And then Paul decided to set his sights on law school. And I mean, this spirit of this can't, can't put you down. And Phillip in this interview continued to say that Paul's time at the University of Texas in Austin was incredible. And his Paul's parents helped him move in with his iron lung. Then he was on his own at college. Just bye. Good luck. Now, I don't know. And he did have limited help at first. Then the carer they had hired didn't show up and so he didn't really have any caregivers. He was in the dorm and different people just take care of him accidentally. That's like some nice people.

1:13:52 I know they they pushed him around the campus in his wheelchair because again, he had built up some time that he could be out. But I imagine, I mean, he was still paralyzed. It's not like that stopped, but he could breathe. So that was something. Then he just went on to practice law in downtown Dallas. He he had it says here that he had to deal with the surprise of clients on entering his office and seeing him in his iron lung. Can you imagine walking into your attorney? I'm like, hey, what, what what are you doing in there? When I guess it wasn't the first topic, but he said his brother said it wasn't an easy thing to see just a head sticking out. And they, the people kind of went into shock and then they were OK, you know, well, obviously they, his brain worked just fine. Just the rest of them didn't.

1:14:37 Which to bring up is a good point because many people who are in wheelchairs, their brains are perfectly fine. It's their bodies that aren't working. And that's that's something that I think a lot of people forget is that if someone's has any form of disability that their brain isn't working and there are disabilities that do have different cognitive levels. But to automatically assume that people, to me, it's important that we give everyone that we're around the benefit of the doubt, if you will. And don't assume that there's a problem, but find out what their capacities are. But Paul lived, Paul lived alone for much of his adult life, which I can't even again, he lived alone and he had minimal caretakers and he really couldn't take care of his basic human needs like using the toilet or getting a drink. So people did have to help him with that. He was able to express what he needed to people so that they could help him and he could even help them. Phillip said that he needed a unique type of care. And because he was a quadriplegic in an iron lung, Phillip did a lot of the assistance for his brother because, you know, he was his brother. And, and Phillip said that most care was basic shaving and feeding, for example.

1:15:55 But to move him, you need to be careful not to jam his finger and so on. So like he was saying that it was difficult with the iron lung to move him and not hurt him on the iron lung. And he said he said there was no instruction manual for those who answered Paul's advertisements for caregivers. There was just they just had to learn as they went. Phillip said many of them left after a couple of days because it was a lot. And Phillip tried to to go to care facilities and see if if they would help Paul, they can take him. And they said no, they just, they just couldn't. He did have one, one person that had cared for him for decades. And her name was Kathy Gaines. And she's to me surprisingly died before Paul did. And Paul was just devastated that she had gone partially because I imagine if he she worked for him for decades, she knew what he needed.

1:16:45 She knew how to do it. And, And things must have gone pretty, pretty well. Philip said he always saw himself as backup caregiver for his brother. He said, though, that his brother developed his own support system. And he had a lot of wonderful friends and some really beautiful people in his life. One of the people, yeah, one of the people that came into his life happened around in, well, it was in 2015, and his iron lung began to leak. And the problem was these machines were extremely rare because people weren't using them anymore. And 2015 he was still in an iron lung. This is amazing. And so they had to hurry and find someone that could to could fix it because it wasn't airtight.

1:17:28 So it wasn't helping him breathe the way it was supposed to. And so apparently they posted a plea on social media. Responses came from all over the world is it's so amazing to me. Luckily, the solution that they were able to use was someone who was 10 miles down the road, this company that was a mechanical durability business and they did environmental testing. This lab was owned by this guy named Brady. He had come into possession of 2 iron lungs at a building clearance sale. What? That's crazy. You know, I'm like, Oh yeah, sure, I'll take those iron lungs. Why not? And he said he, he had a paramedic walk in one day and said, is this the place I can find iron lungs? I mean, the whole thing is well, yes, actually. And this this medic had been transporting Paul to and from hospital.

1:18:21 He. Knew that he was Paul was in this failing iron lung. And as it became more desperate, the situation got known and word of mouth brought this paramedic to Mr. Richards. That was wild. They they were able to take care of it. And it's just to me, it's so funny. Hey, is this where I can buy an iron lung? Well, yes, here's 2. Which do you prefer? And so it was, it was able to be taken care of. And, and this Mr. Richards had, was kind of one of those tinkerer kind of people. And he had built parts from scratch and salvage others and scavenge things. And he had learned the how to do it as he went along.

1:19:03 And Mr. Richard said iron lungs are very robust machines. They're built to last, which is good because the people in them had been in them for lives their whole lives. And so Mr. Richard said it's simple machine, though, and he managed to work it out. And so that was, that was good. And he just happened to have this reefer service machine ready to go. He swapped it for Paul's damaged one. And he wouldn't even accept any money for the work. He just said OK. And so then I guess he probably tinkered the other. But they were saying, they were saying in the article that wasn't the end of the story. The swap wasn't the end. Later that night that that they did the swap, Mr. Richards got a call from from Paul's caregiver saying the machine wasn't working. And so he came to Paul's apartment and realized neck collar wasn't on properly and I'd come loose. So he fixed it and and that was good. And Mr. Richardson said Paul was saying the whole time, I'm fine, I'm OK.

1:20:03 Even though he was turning blue and he really couldn't breathe very well. But Paul was yeah, everything's cool. All, all things are good. Paul did, though, have a portable breathing device and that was useful to him. And that's what we talked about with the port positive pressure respirators. The thing that is difficult about that, Paul explained, was that it made him feel like he had his head sticking out the the car window. Where is this, you know, a big a big breeze blowing at them. And that was something that made him feel uncomfortable. So he never don't move full time to those masks or anything like that because he did not care for it. They do talk here and Paul died just I believe it was last year at 78, still in the iron lung.

1:20:45 Another person that they talked about is a person who was in New York and excuse me, in York and northern England. He did make the switch from the iron lung to the portable devices. He was also infected the same year as Paul was, which is an interesting fact to me too. Yeah. It's like, wow. The two and they were very close to the same age. He recovered to a point where he could live his life without significant breathing support. But as he aged, he needed more help. So then he started using the respirator really can help for him. James had said that he used the respirator mask for 17 hours a day and he doesn't remember much about being in the iron lung, he said. He said he's also placed in head to toe plaster cast initially because because they thought that would prevent the limbs from becoming deformed.

1:21:34 So he's in an iron lung, in a plaster cast, in a plastic full body plaster cast. Yes, yes. Most, most awful. Mr. Porteous James was had a long career, too. He was a stockbroker and he was in various senior roles for a business called Rowan Tree, which later became part of Nestle. He was married, had four daughters. He traveled the world and it's just, yeah, it's, it's just amazing. And one of the things like we talked about is that he chose this path, that he, he decided I'm not just going to do that. And he said, he was quoted saying I could have sat all my life with a rug over my knees, but I decided just get on with it.

1:22:15 I'm tired these days and I don't get out much anymore, but life is good. I'm a nice family and good friends. One thing I'd still like to see achieved in my lifetime is the complete eradication of polio around the world, man. Yeah. With Paul. It ending polio also was his. Ambition. And Paul wrote about it in his 2020 memoir, which he typed himself using a pencil attached to a stick gripped in his mouth to reach the computer keyboard. Yeah. Phillip, his Paul's brother, said that after his Paul's book was published, he fully realized what an inspiration his brother was to people around the world because his personality had a lot to do with how much he was admired. And he was always had a great big smile. He was welcoming one person, and he used to make people comfortable.

1:23:00 That was very huge. When a person named Brady Richards, who I referenced before who had been involved in his his care, said that it was always a pleasure to be around Paul. He had a very upbeat and positive attitude, attitude. The fact that his parents took their son home and a machine that was at at the time really high end technology they had, they had no, I mean there was very little training on it for anyone. But Paul also had a tracheostomy which called for special care. And so they basically had to be their own engineers, nurses and doctors. They had to do it all. And that is just the dedication was amazing.

1:23:43 And Paul was recognized by the Guinness World Records as the person who lived in the longest in iron lung. He died, like I said, last year at 78. He was in the iron lung for over 70 years. I know I just, I just don't even. And to have done so much as the other man had said, James, I could have just sat with a blanket over my knees and just done that and I it would have been fine. Nobody would have blamed him. But they they fought to have as normal a life as they possibly could. And that story about Paul and his family's dedication and even other people who have been in similar situations is just, it just kind of rocks my world. And I wonder if I was really in such a situation. You know, we talked earlier about just saying no peace out. I'm not, I'm not going to do it.

1:24:37 But there are people who have the fortitude to go through these challenges in ways that it's, I think a lot of us just can't, can't relate to. And, and granted, we haven't been in the situation. I mean, we've all been through hard times and we've, we've come out the other side one way or another. But when we look for me, when I look at people that go through stuff like this and then I look at my challenges and I'm like, yeah, that stuff, my stuff wasn't that big a deal. But then other people. Look at our challenges and go, how did they do it? It's. So I think, I think my point in this rambling that I'm doing here is just a people are fighting their own wars. They.

1:25:19 We all have something that we're dealing with, and how we deal with it is also something that we decide on our own based on our families or training and things like that. When we look at other people and whatever status or state they're in, that I just implore us all to give each other the benefit of the doubt, to give each other the grace to do the things that we need to do and to help as much as we can. Because that's to me, connecting our communities, connecting our world is, is what is so vital, especially as we say, a lot of times in in, in these times where people feel so separated. And I think if we can do that just one person at a time, it's going to make a difference. So what do you think?

1:26:04 What do you think about all this? My heavens, it's a big deal. Yeah, it's great. It's a crazy story. It's I. Mean I just yeah, it's I'm very impressed with I'm always very impressed with people who get dealt a bad hand and and play it with grace, you know mm hmm mm hmm. Well, so here's to not. Letting polio get rampant again. And yeah, here's to let's maybe think twice before. We expose people to polio. No, that's right. Please don't expose people Polio. Anyway, well, thanks. This was this was a a really interesting topic. I was going to use a fun topic.

1:26:46 No, it wasn't very fun, but it was really interesting to delve deep into it because it was something I knew of peripherally, but not really in any deep kind of way. So cool. Well, thank you. It was it was very interesting topic. I enjoyed it A. Lot All right, if you've made it this far, clearly you like a little mayhem with your. Medicine. Or you just enjoy hearing us ramble about weird medical mysteries. Either way. We'd love you for it. So hit that follow or subscribe button wherever you're listening and toss us. A rating or review while you're at it helps other curious weirdos. Find the show and we know there are a lot of you out there. Oh, so many. Come join the chaos.

1:27:26 Thanks for listening to. Medicine, mystery, mayhem and sometimes. Murder. Do you have an idea for an episode of this podcast? Just want to say. Hi, you can get in touch with us at our M4 pod that's OURM thenumberfourpod@gmail.com. We read every e-mail and sometimes we even respond just like real professionals because we are old friends with new twists and lots of body bags.