When Michael Roberts felt under the weather last fall, he didn’t think anything of it at first. A healthy, physically active young man, he figured he would bounce back within a few days.

The next night, he started coughing up blood. Although he felt so weak he could hardly get into his truck, he drove himself to the emergency room at Grady Hospital, where he was initially diagnosed with a bad case of the flu. 

“I made it to Grady and told them I didn’t know the protocol, but that I couldn’t breathe,” Roberts remembers. “They took my information and vitals and then took me to the back. I remember having a phone call with my mom, but right after that, the lights went out.” 

Dave and his team looked at Roberts’ case and identified that he might be going into complete respiratory failure driven by the flu or viral pneumonia. While most patients will recover relatively quickly from a bout of flu or pneumonia, both can cause additional problems such as organ inflammation, sepsis, or multiple organ failure, among other issues.

Due to the amount of medication Roberts was on at Grady, Dave requested that the team perform a cardiac ultrasound to get a clearer picture of what was happening. His instinct was correct — the ultrasound showed that Roberts’ heart was weak.  

A few hours later, his lungs seemed to be improving and he was stable enough to be transferred to EUH. But by the time Roberts arrived, his lungs were no longer the primary problem — his heart was. Within the first 24 hours, the team at EUH placed Roberts on a temporary left ventricular assist device (Impella), which is inserted through the axillary artery (which runs from the clavicle to the heart) by the shoulder and placed in the left chamber of the heart to improve blood flow and stabilize blood pressure.  

After the impella was placed, they moved Roberts to the cardiovascular ICU, where his lungs intermittently declined and caused the right side of his heart to struggle to pump enough blood to the left side. 

Creel-Bulos also initiated conversations with Roberts’ family, explaining the different medical teams they might meet depending on how he responded to treatment. “Being early and assertive about involving multiple teams is key to making sure that our patients don’t have those long-term stays and complications,” she explains. 

While Roberts’ family was thankful for the open communication, his critical illness came as a surprise. When Roberts was at Grady that very first day, his brother Tyrone visited, and was focused on getting the immediate issues taken care of (like moving Roberts’ truck) while anticipating that Roberts would be released within 24 hours. 

“It was surprising because this was a young guy, a former college football player, who goes to the gym once or twice a day and he was fighting for his life with no clear reason why,” Tyrone says. “It was shocking that it turned so fast and that his heart was giving out on him for no real reason.” 

Reflecting on how he was training before falling ill, Roberts explains that he feels like he was preparing for the fight of his life without even realizing it. But he’s no stranger to high-adrenaline situations. An all-around athlete and former running back for Oklahoma State University, Roberts also served as a military medic. 

While ECMO doesn’t treat or cure a disease, it offers time to heal and time for other interventions to work. Although there’s been an increase in treatment use since 2001, its usage radically jumped up during the COVID-19 pandemic, out of necessity for critically ill patients.

There are two types of ECMO: VA-ECMO, or veno-arterial ECMO, is used to support both the lungs and the heart. VV-ECMO, or veno-venous ECMO, is used to support only the lungs.  

On Nov. 3, 2022, one day after the impella was placed, Roberts was transferred to the cardiovascular surgery ICU and placed emergently on VV-ECMO by Dave and his team for additional pulmonary support. 

That whole time, the cause of his original infection was never definitively identified. The team suspects Roberts may have had viral myocarditis secondary to viral pneumonia. On top of that, he developed a superimposed bacterial infection. Developing a viral pneumonia followed by a bacterial pneumonia is also seen with flu and other viral diseases, with incidence ranging from 26-43%. Viral myocarditis due to a viral infection, however, has an incidence of less than 1%, so the confluence of all three issues is relatively rare, according to Sagar Dave.

Austin DeBeaux, MD, served as the intensivist during two weeks of Roberts’ stay in the ICU and was responsible for day-to-day intensive care management, managing the ECMO circuit and coordinating with other consultants on this case. 

“To not be able to have sure answers or know why this young man who was in great health was taken down by something he should’ve easily recovered from, it’s hard to not have those answers,” he says. When talking to a patient’s family in those situations, DeBeaux explains that he breaks things down into “what we know, what we hope for and what we’re doing today.”

The team closely monitored how Roberts responded to treatment and deployed best practices to give his body the time and support it needed to recover.

Helen Zackery, Roberts’ mom, was also impressed by how thorough and comprehensive her son’s care was. It was the first time she’d ever seen an ECMO machine at work. She remembers how carefully the doctors explained how this device would help save her son’s life.

They were right: VV-ECMO is a major reason why Roberts was able to walk out of the hospital after 36 days without long-term complications following his discharge from the hospital in early December 2022.  

In fact, Roberts didn’t have to attend rehab of any type — including acute care rehab — something that Creel-Bulos explains is thanks to the large, multidisciplinary team at Emory, as well as how strong Roberts was before being admitted. During his stay, the nurses worked to keep Roberts off sedation whenever possible and he attended physical therapy even when on ECMO, something that Roberts remembers as very helpful toward his recovery. 

“He gave me motivation,” Roberts says. “As we watched football a little bit, he gave me little goals, like to try to do 8 hours off of the ventilator, then to stretch to 12 off of the air. So, in my head, I became competitive.” 

Thanks to reaching for those goals, Roberts was able to move off of ECMO on Nov. 20. Eight days later, he showed enough improvement that he was moved out of the cardiac surgery ICU and into a general care room.

“I ran track and played football my whole life, so the way I’m wired is that if I’m here, I’m going to get through it,” Roberts says, explaining that bringing a competitive framework to his physical recovery at Emory made all the difference when the healing process felt like an all-out battle.

Dave said he was impressed by the positive attitude he witnessed in Roberts, who “always had a big smile and was interactive. It’s very hard to deal with critical illness, especially for a prolonged amount of time. Michael approached it as a challenge to conquer,” Dave says.

In fact, on Thanksgiving weekend, “the biggest issue he had was getting enough football games on the TV to watch,” Dave says.

Now, Roberts has reached his recovery goals and even started running again over the summer. Both Tyrone and Zackery are amazed at how far he’s come and say it’s great to see him back to being so physically active.

But it’s not just a physical recovery process. The healing happens mentally, too.

Roberts has been slowly but surely working through the trauma of what happened and relearning to trust his body. That process has been a bit slower, but Roberts added that the check-in texts he’s gotten from “Dr. Dave let me know I’m living, I’m alive, and it was well worth it to go through that.”

In fact, he says he wouldn’t change a thing about the past. “I realized if I can go through the hardest, darkest part of my life, I can definitely get through anything,” Roberts says. “Man, I was almost defeated. But I defeated it instead.”