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Cash Lamar was a typical, healthy 8-year-old boy from Crested Butte, Colorado. But when he came down with the flu in late January 2012 that progressed into a rare staph-pneumonia infection (an infection that leads to severe respiratory failure and has a very low survival rate), everything changed.
"It was a really quick and crazy series of events," said Roxana Alvarez, Cash's mom. "I called Cash's school on a Monday morning to say he was staying home sick; I just thought he caught something from his sister. But by lunchtime his breathing was shallower, more labored, and within a few hours we were at our doctor's office in Crested Butte. I never thought we'd be spending the next 4 ½ months living at Children's."
When Cash arrived at his pediatrician's that afternoon, his heart rate was up, his oxygen levels were down, and the doctor told his parents he needed to be rushed to the nearest hospital in Gunnison by ambulance.
"When we got to our local hospital, they recognized right away that they didn't have the staff for something this serious - so they called in Flight for Life and we were flown to Children's Hospital Colorado," Roxana said. "In that helicopter was the first time I heard Cash's condition described as critical. We were petrified."
By the time Cash arrived at the Emergency Department at Children's Colorado at midnight, the staph-pneumonia infection had caused severe destruction of the lining in his airways, which meant there was no way of getting air in or out and little oxygen in his blood. Cash also had signs of triple organ failure in his heart, lungs and kidneys.
To help support his heart circulation and lung function, doctors recommended ECMO, a machine used to oxygenate Cash's blood and help his heart and lungs recover. Cash was connected to the ECMO machine (which circulates a portion of blood outside of the body to get oxygen) for 75 days - the longest ever at Children's Colorado. Learn more about how ECMO works.
"Cash has the 'honor' of being the patient longest maintained on ECMO at our hospital," said Vivek Balasubramaniam, MD, one of Cash's doctors from the Pediatric Heart Lung Center. "This is a big deal because every day a patient is on ECMO, we have to keep his blood from clotting in the machine. If blood clots form in the circuit, complications can lead to a high risk for stroke or even death."
Despite nearly two months of extreme ups and downs on ECMO, Cash continued to fight. He underwent multiple surgeries, gradually improving, and was eventually taken off ECMO - all without a single infection or neurological complication.
And that wasn't the only milestone Cash made.
"When a patient is on ECMO, they are often heavily sedated and comatose the entire time - which can be fine if it's only for a short period," said Shannon Buckvold, MD, Medical Director of the ECMO Program at Children's Colorado. "But in Cash's case, because he was on ECMO for 2 ½ months, we knew that if we didn't alter our strategy to wake him up, rehabilitate him and proactively contribute to his recovery, it was just a matter of time until something catastrophic happened. His body would waste away."
The multidisciplinary care team called a family meeting with Cash's parents, Craig and Roxana. The parents, along with specialists from critical care, pulmonology, cardiology, otolaryngology, rehabilitation and nursing agreed that continuing on ECMO in "critical care mode" would lead to certain death. Cash's parents and doctors agreed on a new strategy of caring for Cash in "rehabilitation mode," which everyone knew was unprecedented at our hospital and in any child younger than 10 years old.
So for the first time ever at Children's Colorado, a patient started rehabilitation and physical therapy while on ECMO.
"As our goals shifted toward rehabilitation and nutrition, we saw a boy returning to his old self," said Dr. Carleen Zebuhr, MD, pediatric critical care attending physician and Cash's primary intensivist. "It was a long road, but Cash slowly became interactive again, while gaining strength, getting his color back and being the bright, funny guy we all grew to know."
Cash's rehabilitation schedule wasn't easy. He did physical, speech and occupational therapy (plus schoolwork) twice daily - even on Sundays. While still connected to the ECMO circuit, he began sitting up in bed, started standing, then took a few steps and was able to walk down the hall. Eventually he was able to play the keyboard and ride his bike across the street.
"My trick to getting better was arm wrestling. I pretended like I was arm wrestling against Darth Vader," said Cash.
After 4 ½ turbulent months in the hospital, Cash was ready to go home.
On June 7, 2012, Cash was discharged from Children's Colorado - but not without a little celebrating first.
"We had all grown so close to Cash and his family that we threw an impromptu party in his room," Dr. Balasubramaniam said. "The medical staff brought in Cash's favorite: cheesecake with strawberries and blueberries."
Dr. Buckvold recalls going to visit Cash after the party: "He reached into the fridge and grabbed a piece of cake with his bare hands - like only an 8-year-old would do. He was a wonderful host, and it was very special moment," Dr. Buckvold said.
"I was so excited to go home that when I saw Crested Butte through the car window, I just screamed as loud as I could," Cash said.
The Crested Butte community rallied around the Lamar family throughout Cash's illness and hospital stay. His schoolmates raised money to help with medical bills, and an anonymous donor paid for the family's kitchen renovation that was underway when they unexpectedly left for Denver.
But the flagship celebration was the "Love for Cash" town parade held in Cash's honor. A crowd of family, friends and strangers moved by Cash's recovery lined the streets. All eyes were on the healthy boy riding down Elk Avenue in a red Mustang convertible.
"People often ask what we think of Children's Colorado now," said Craig Lamar, Cash's dad. "I love this place. We remind Cash that this is the hospital that saved his life. I'm so grateful that even though we live in practically the middle of nowhere, we have this hospital."
Cash, who just started third grade, has big plans for the future. After being granted a "wish" to go to the Monterey Bay Aquarium in California from the Make-A-Wish-Foundation, Cash wants to be a marine biologist when he grows up.
And when the 8-year-old reflected back on his time at Children's Colorado, he said, "I feel good. I don't really miss the hospital, except the nurses, the TV and the Cartoon Network."
And life today is good for Cash. He needs only oxygen at night, and he comes back to Children's Colorado every few months for routine follow-up care and to visit his "friends."
"This is a story about a kid with an incredible will to live, as much as it is about what we did medically to help him," Dr. Buckvold said. "Cash defied all expectations for survival. As caregivers, we joined his parents in their hope that Cash would continue to break records every day. And he did exactly what some doubted anyone could do."
And Dr. Zebuhr agrees: "Cash's recovery was in a league I'd never seen before. The fact that he recovered is nothing short of a miracle -- a miracle mixed with a lot of hard work."