Gabe Pastores is walking on a treadmill and cracking jokes. Given what he’s been through the past two years, he’d count those as giant steps.
“Next, I’m gonna sing…‘Cover of the Rolling Stone,’” he half-seriously tells his pulmonary rehab specialist. Pastores, 58, loves classic rock, and the intro to that ‘70s song by Dr. Hook & The Medicine Show could not be more appropriate:
“Hahaha, I don't believe it.”
The last time I saw Pastores in March of 2021, he was still in rough shape but grateful. He'd just left a five-week stint in rehab after nearly three months at Mayo Clinic, where he was treated for a severe case of COVID-19. That day, he was just happy to be alive.
In the hospital, he’d been intubated and on an ECMO — a machine that oxygenates blood when the lungs can't — in Mayo’s COVID-19 unit, a place where many patients never made it out. Pastores did, but months in the hospital left his body weak. The virus left his lungs permanently scarred.
On oxygen and through choppy breathing, Pastores looked out the window of his Cannon Falls, Minn., home at a fresh coating of snow, and told me it was precious.
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"I said I was sick for a season. But I didn't miss it. It snowed. I got to watch it fall, so I didn't miss any snow,” he said. “I feel lucky. It was awesome.”
I left that interview hopeful Pastores would improve fast. It turned out not to be the case.
Nearly three years after the first cases of COVID surfaced in the United States, Minnesota and the rest of the world have mostly moved on. Masking is down, vaccinations are at a trickle and the disease that killed nearly 14,000 Minnesotans and made thousands more ill is viewed now as more nuisance than crisis.
But for Pastores and thousands of others, the disease continues to take a toll. Their struggles are real yet fading out of the public consciousness.
In the two years I’ve come to know Pastores and his wife Cindi, I’ve learned he is ever optimistic, and determined. But his breathing and quality of life continued to decline. Exercising to rebuild muscle tone was an impossible task.
In the year following his homecoming, Pastores knew things weren’t going well.
“It was a lot of sitting, watching TV, making myself get up and go and do stuff. But that was hard too,” he said. “And it was getting pretty bad. I got a notebook to write stuff to my wife and my sister and my daughter, because it was really getting to that point."
In November, Pastores underwent a double lung transplant, a rare though increasingly necessary step for people who have survived the worst of COVID-19, but whose lungs are wrecked from the disease.
His story is a window into the long-lasting effects of the pandemic, effects that are increasingly invisible to the world at large as life gets back to normal.
Table of Contents
A patient rallies
When Gabe Pastores first got sick in November 2020, it was a different world. Vaccines were just about to hit the market, masking was mandatory and widespread, and most people were taking unprecedented precautions to avoid the virus.
It was a dark time in the hospital, too, and the deadliest phase of the pandemic in Minnesota. At the worst of that fall wave of COVID, an average of 270 were hospitalized daily across Minnesota and an average of 70 people were dying daily.
I witnessed this bleakness first hand in Mayo’s COVID ward on Dec. 31 of that year. Holding back tears, nurse Kari Giersdorf told me that recently six of the 12 people in the COVID ICU had died in a 24-hour period.
“That's like half the floor. It's just so difficult,” she said.
Death was all around her, but Giersdorf had hope, too. One of her patients — Pastores — was suddenly getting better. The ICU was buzzing about Pastores’ progress, lifting up a staff that sometimes felt like their relentless work was all for nothing.
Giersdorf said this was the good news she needed after a short break from work.
“I told him that I thought I was his black cloud because, when I left, he wasn't doing as well,” she said. “But when I came back, he was doing so much better. And he laughed at that."
‘Marrying us at the transplant center’
Fast forward two years, and the pandemic is starting to feel like a thing of the past.
Minnesota has seen other deadly and chaotic waves of COVID-19. Today, deaths and hospitalizations — particularly ICU hospitalizations — are a fraction of what they were in the late fall of 2020.
More than 20 percent of Minnesotans are up to date on their vaccines, hundreds of thousands more have had at least one shot, and an untold number have had at least one bout of COVID.
But medical professionals are just starting to understand the long-term effects some people experience from COVID. Just this month, a Centers for Disease Control and Prevention report found that 3,500 Americans died of long-COVID related illnesses.
It’s a stark reminder that some people continue to live with the after effects of the disease, said Minnesota Health Department Commissioner Jan Malcolm.
“We're not individuals on islands,” she said. “It can be easy to think of, sort of just moving on. But being aware that there are many, many people in our community for whom that is not true, is really important."
For Pastores, with his lung transplant, the virus has morphed from an illness to a lifetime of being immunocompromised, said Dr. Kelly Pennington, a Mayo Clinic lung transplant specialist who is overseeing Gabe's care.
The procedure is reserved for people whose lung function is severely diminished, but who are otherwise healthy, she said. The best candidates are people who have a strong support network, and who are determined to get better.
It’s not just the surgery patients are signing up for, Pennington said. They must take multiple medications to prevent organ rejection, everyday, forever. They’ll make monthly visits to the doctor and have to take extra precautions to avoid illness.
“I describe it to patients as they are marrying us at the transplant center. So they're going to be seeing us for the rest of their life, more than they ever wanted to,” she said.
‘Haven’t seen this in so long’
At first, Pennington said, Pastores wanted to get better on his own.
“From his perspective, that seemed like a lot. He was a healthy guy before COVID. Having a commitment with us for the rest of your life was a lot for Gabe to take on,” she said.
But on a Saturday in August, I got a text from Pastores’ wife, Cindi. After a flurry of hopeful updates and pictures from her over the last year, this one floored me.
“Just wanted to update you: Gabe is starting the process of a lung transplant evaluation,” she wrote. “We decided it’s time to ask God for miracle #3.”
After weeks of exhausting physical and psychological evaluation, Pastores was put on the transplant list in late October.
Twelve days later on Nov. 5, Pastores was called in for the transplant. A donor had been identified as the right fit for Gabe, in record time, too.
By 10:30 that night, the surgery was over. Cindi Pastores remembers watching Gabe's chest rise and fall.
"I was just like, 'OK, I just have to remember this moment of his breathing so calmly, and so relaxed.’ It was just like, ‘We haven’t seen this in so long,’” she said.
Pastores felt better immediately, too. Three days after surgery, he was walking the halls.
"I'm like, ‘I feel pretty good. I can breathe. I'm gonna do this,’” he said, taking deep breaths to demonstrate his once again robust lung capacity. “I walked to the door, walked out and probably at least 30 feet down and back. No problem.”
‘You get to look at a miracle’
For the next two months, Pastores will be living within minutes of Mayo Clinic for his weekly doctors’ appointments, his daily rehab visits or in case he gets an infection.
And more than a month out of his surgery, by all accounts, Pastores is doing really well. His big challenge now is gaining back the muscle mass he lost during and after his illness.
On a mid-December morning, he was able to show off just how well he's doing to the team who cared for him in the COVID ICU — and to thank them.
In a tiny conference room at Mayo Clinic, a dozen doctors and nurses filled the room to see their patient, the guy who lived in spite of all the challenges thrown at him and the statistics stacked against him.
For nurse Kaelen Dunn, seeing Pastores was an emotional reminder of why she does this work.
"I really don't get to hear the follow up stories very often, unless it's a card from a family member. I don't think I've ever spoken to someone who is here on ECMO, who left and came back,” she said.
Pastores said seeing the team who saved his life two years ago was a long awaited part of the healing process, because it brings him closure.
“I tell everybody, you get to look at a miracle. I'm one of those. I also get to look in the mirror and see one, too. Everyday."
Reporter’s notebook: Covering COVID brought stories of anguish, hope
Telling this latest installment of Gabe’s story is a bit of closure for me, too. I’ve covered the pandemic since Minnesota identified its first case of the virus. I remember how scared I was initially, and how I had to keep it together every day at work and for my kids, who were asking, regularly, if we were all going to die.
In those early days, I honestly didn’t know.
So to cope, I looked for people to help me — and the MPR News audience — understand what was happening, and Gabe Pastores has been one of them.
Through his story, I’ve seen the worst of this pandemic. One New Year’s Eve of 2020, while Gabe was rallying in his ICU bed, I know another patient down the hall from him was dead by the end of the day.
I’ve met countless health care workers who describe endless days and nights, filled with death that they sometimes felt powerless to stop. I’ve interviewed too many people who have lost loved ones during the pandemic — to death, or to the political fractures that the pandemic brought with it.
But through Gabe’s story, I’ve also seen how empowering hope can be in a time of crisis.
Gabe has always been hopeful about his recovery; I knew that the first time I saw him give his ICU nurse a thumbs-up when she tuned his radio station to classic rock. I saw that hope light up in his nurse Kari Geirsdorf’s eyes when she realized Gabe might just get better. Hope infused every text update and picture I’ve ever gotten from Gabe’s wife, Cindi.
I think we all know this: Having hope helps. But it’s so easy to lose, too, because it feels so flimsy in the face of epic tragedy. Finding it, and holding on to it, requires a lot of willpower.
Today, the pandemic doesn’t feel so scary to me, because I understand it better; meeting people like Gabe helped me hold on to hope, too. And I don’t write about it as much because it’s a far more manageable situation than it was this time two years ago.
Inevitably, we are learning to live with it.
But as winter sets in, I’ve been thinking a lot about that snowy day in 2021 at Gabe’s house when he told me how grateful he was to watch the snow fall. I looked outside, too, and man was it beautiful.
— Catharine Richert, Rochester