Freddy Fernandez almost wasn't here, on his couch in his Missouri home, his baby on his lap, gnawing on the pulse oximeter that he uses to check his oxygen levels after a months-long bout with COVID-19.
The 41-year-old father of six spent five months hospitalized a four-hour drive away from the couple's home in the southwest Missouri town of Carthage on the most intense life support available. He nearly died repeatedly and now he -- like so many that survived COVID-19 hospitalizations -- has returned home changed.
While more than 1 million died of COVID across the U.S., many more survived ICU stays that have left them with anxiety, PTSD and a host of health issues. Research has shown that intensive therapy starting in the ICU can help, but it was often hard to provide as hospitals teemed with patients.
"There is a human cost that the patient pays for ICU survivorship," says Dr. Vinaya Sermadevi, who helped care for Freddy throughout his stay at Mercy Hospital St. Louis. "It is almost like going to war and having the aftermath."
Freddy's memories from those long months come in snatches -- moments where he regained consciousness, hooked up to machines to breathe for him, clinging to life. Sometimes he asked for his mother, who died of COVID-19 in September 2020.
He missed the birth of his daughter and the first four months of her life. He may never be able to return to his construction job. His other young daughter is terrified he'll go away again.
His partner Vanessa, 28, was still pregnant with Mariana last summer when the delta variant struck. She got vaccinated at her obstetricians urging. Freddy too was warming up to the idea of the vaccine in late August, but it was too late. He had come down with COVID.
The native of Mexico City, who came come to the U.S. around 20 years ago to work construction, was so sick he ended up at a St. Louis, nearly 270 miles away from his two young daughters; Vanessa's 10-year-old son, Miguel, who considers Freddy his father; and three other children with his ex-wife -- 10-, 8- and 7-year-old boys.
It was a dark period when many people hoped the pandemic was ending, but the delta variant once again flooded the healthcare system. Filling shifts was a daily battle, and death was everywhere, recalled Dr. Sermadevi.
In some ways Freddy was lucky. For all the talk of ventilator capacity, what was in shortest supply during the delta surge was something called ECMO, or extracorporeal membrane oxygenation. It is used when a ventilator isn't enough, pumping blood out of the body, oxygenating it, and then returning it.
Mercy Hospital St. Louis only had the equipment and staff to care for three ECMO patients at a time. And on Sept. 3, Freddy became one of them.
Vanessa delivered Mariana on Oct 13.
Far away from her fiancé, Vanessa logged into video calls with Freddy's doctors on the very day she brought the newborn home. The news wasn't good - Freddy was suffering from infections and wasn't recovering well.
A lung transplant, Sermadevi said, appeared to be his best option, but was a long shot.
"And there is a chance that Mariana might grow up without a father," Sermadevi recalls telling the family.
Some of the most important keys to recovery in critical care aren't medical. Visits from relatives, along with physical, occupational and speech therapists, have long been shown to be a difference maker for the sickest of patients.
COVID-19 upended those practices at many hospitals, as families were kept away to keep the virus from spreading.
Fears of infection, plus short staffing, also often meant less physical therapy, proven to speed recovery.
When Freddy's family came, it made all the difference.
His room was transformed, photos of his family thumbtacked to the ceiling. Freddy's family held his hand when he had respiratory distress, talking him through it. He needed less sedation and pain medication because, Sermadevi said, "they were that for him."
"We would just hear such love at the bedside," she said.
Once he came off the ECMO machine, Freddy started to recover. With his lungs slowly improving, soon he was up and trying to walk. Ultimately, lung transplant talk was tabled.
By Feb. 9, he was heading home, 167 days after he first arrived at the hospital in his hometown.
All Vanessa could think was "finally." Freddy had never met his baby. Nor had he seen any of his other children. Their interactions had been limited to Facetime and pictures.
Melanii was shy, hugging him briefly along with older brother Miguel, before clinging to her mother.
Vanessa kissed the baby and then laid him in Freddy's arms. Now just days away from turning 4 months old, Mariana smiled at him.
Freddy relied on a walker and a wheelchair at first. He couldn't sit or eat on his own.
But now the wheelchair is abandoned on the home's back steps. He can walk around the entire block, pulling a portable oxygen canister behind him on a dolly. He's on the cusp of being able to carry his oxygen around in a backpack, which would give him more freedom.
Vanessa is returning to work, life returning "back to normal a little bit."
They want to wait until Freddy gets better to get married.
Yet they don't know how much better he will get -- or how quickly.
Such is the story of so many, who are alive yet forever changed, says Sermadevi, who has followed his progress from afar. Some of the nurses even became Facebook friends with Vanessa.
"It's sad and happy at the same time," she acknowledges. "And that's very hard to reconcile."
Freddy Fernandez sits with his fiancé, Vanessa Cruz, and their 8-month-old daughter, Mariana Fernandez in their home Friday, June 10, 2022, in Carthage, Mo. After contracting COVID-19 in August 2021, Fernandez spent months hooked up to a respirator and an ECMO machine before coming home in February 2022 to begin his long recovery from the disease. (AP Photo/Charlie Riedel)
Freddy Fernandez is tethered to an oxygen concentrator as he stands in the living room of his home Friday, June 10, 2022, in Carthage, Mo. After contracting COVID-19 in August 2021, Fernandez spent months hooked up to a respirator and an ECMO machine before coming home in February 2022 to begin his long recovery from the disease. (AP Photo/Charlie Riedel)
Freddy Fernandez looks out from the porch of his home after taking a short walk Friday, June 10, 2022, in Carthage, Mo. After contracting COVID-19 in August 2021, Fernandez spent months hooked up to a respirator and an ECMO machine before coming home in February 2022 to begin his long recovery from the disease. (AP Photo/Charlie Riedel)
Freddy Fernandez uses a device to monitor his blood oxygen level Friday, June 10, 2022, in Carthage, Mo. After contracting COVID-19 in August 2021, Fernandez spent months hooked up to a respirator and an ECMO machine before coming home in February 2022 to begin his long recovery from the disease. (AP Photo/Charlie Riedel)
Melanii Fernandez, 4, puts a portable oxygen tank away after going for a walk with her father, Freddy Fernandez Friday, June 10, 2022, in Carthage, Mo. After contracting COVID-19 in August 2021, Fernandez spent months hooked up to a respirator and an ECMO machine before coming home in February 2022 to begin his long recovery from the disease. (AP Photo/Charlie Riedel)
Freddy Fernandez walks with his daughter, Melanii, 4, and an oxygen tank, outside their home in Carthage, Mo., on Friday, June 10, 2022. After contracting COVID-19 in August 2021, Fernandez spent months hooked up to a respirator and an ECMO machine before coming home in February 2022 to begin his long recovery from the disease. (AP Photo/Charlie Riedel)
Freddy Fernandez holds his 8-month-old daughter, Mariana, as he sits with his fiancé, Vanessa Cruz, and their other daughter, Melanii, 4, in the living room of their home Friday, June 10, 2022, in Carthage, Mo. After contracting COVID-19 in August 2021, Fernandez spent months hooked up to a respirator and an ECMO machine before coming home in February 2022 to begin his long recovery from the disease. (AP Photo/Charlie Riedel)
Freddy Fernandez uses a machine to exercise while his daughter, Melanii, 4, watches Friday, June 10, 2022, at their home in Carthage, Mo. After contracting COVID-19 in August 2021, Fernandez spent months hooked up to a respirator and an ECMO machine before coming home in February 2022 to begin his long recovery from the disease. (AP Photo/Charlie Riedel)
Freddy Fernandez buckles the shoes of his four-year-old daughter, Melanii, while his fiancé, Vanessa Cruz, holds their 8-month-old daughter Mariana Friday, June 10, 2022, at their home in Carthage, Mo. After contracting COVID-19 in August 2021, Fernandez spent months hooked up to a respirator and an ECMO machine before coming home in February 2022 to begin his long recovery from the disease. (AP Photo/Charlie Riedel)