During one of the worst polio outbreaks in history, in a time that feels all to familiar to todays Corona-19 pandemic, the last known Iron Lung casualty of the Polio pandemic Paul Alexander, now has to contend with battling to survive through Covid, a second pandemic.
Just like what we are experiencing today, people back then were told to wear masks, isolate as movie theatres, swimming pools, bars, offices, schools and most of the world shut down.
Polio (poliomyelitis or infantile paralysis) is a viral infection that was common in the Western world until the early 1960s. In Australia, there were major polio epidemics in the late 1930s, early 1940s and 1950s. The last epidemic was in 1956.
Back then, very little was known about Polio, a virus most commonly affecting children, entering the body through the mouth via tiny particles of contaminated feces, or more rarely, droplets of saliva from a sneeze or cough. If you were one of the unlucky enough to catch Polio, you would first suffer flu-like symptoms, and if it were to escalate, it had the potential to invade a person’s spinal cord or brain, causing paralysis and potentially death.
For Paul Alexander, then 6 years old, that one rainy day in July 1952, would change the course of his life forever.
Alexander had been playing in a field behind his home in Dallas with his brother when the last day of freedom came with the sound of a screen door slamming behind him. When his mother called the boys in for dinner and out of the rain, he dragged his bare feet, covered in mud onto the kitchen floor, appearing hot and feverish. She ripped his wet clothes off and threw him onto her bed and called a doctor immediately.
His mother cried out “God, Please No” as she knew Polio had come for her son.
Alexander recalls, “She knew right away that I had polio. I don’t know how she knew, but she knew. I remember feeling hot and feverish, and for the next few days, I stayed in the bed and didn’t move”.
So why didn’t his mother take him immediately to the hospital?
Alexander, “Our family doctor said that all the kids with polio were at Parkland (Dallas’ big municipal hospital), and he didn’t want me there with the other kids because maybe I had a better chance to recover at home.”
Six days later, he lost his ability to walk, swallow and breathe. He had terrible pain in his legs, and breathing became laborious. So they finally took him to the hospital. It was here in the hospital, the most horrifying event occurred before Alexanders long battle with polio could even begin. He had become immobile, he couldn’t even talk, so the hospital staff put him on a gurney in a long hallway and left him there with all other polio kids. Most of them were deceased.
That would have been Alexanders fate also, if not for Dr Davis, a pediatric cardiologist who was examining the children in the hallway. He took one look and Alexander and scooped him up into his arms.
Dr Davis immediately performed a tracheotomy and placed his little body into an iron lung. Alexander blacked out after this. During the epidemic, hospital wards were lined with these types of respirators.
They stimulate breathing by varying air pressure to compress and depress the chest.
Typically a child would spend anywhere up to two weeks in one, lying on their backs unable to do much else, whilst they recovered from the disease. But for Alexander, he would never recover enough to leave his permanently.
After 18 months, doctors said to his parents to take him home thinking he wouldn’t live much longer. His body at that time was completely paralysed from the neck down, and he couldn’t breathe at all on his own outside his iron chamber. So arrangements were made to bring Alexander home and his iron lung for what they thought would be their last Christmas together.
Family members stayed with Alexander in shifts, feeding him, helping him with school work (he was still enrolled in elementary school) and his parents encouraged him to keep up his curiosity and enthusiasm for learning.
As a boy, Alexander learned how to breathe outside within the iron lung for extended periods of time, this skill opened doors for him. Then when he turned 8, a physical therapist taught him how to use his muscles in his mouth and throat to gulp air into his lungs, a method they call “frog breathe’.
Alexander eventually became very wary of the health care professionals treating him, as many times they would force him to try and breathe outside the Iron lung causing him to pass out. But one therapist with a more nurturing method of dealing with him convinced him to learn how to breathe outside the lung for three minutes, and if he achieved it, she would give him one of her boxer puppies.
It took just over a year to achieve, but the puppy was finally his. Breathing on his own meant he could spend hours outside of the Iron lung.
As time went on, television became boring, so he had to come up with other ways to entertain himself. His father came up with the idea of a stick/paintbrush/pencil that he could put into his mouth to play with his toys, write and paint.
As he grew older, his dreams of becoming successful as a lawyer were all but a mere dream. He knew he had to go to school, there was simply no other way to achieve this. His mother lobbied the school district for home-school learning, something very rare in the 1950s. Through their efforts and his own fierce determination, Alexander graduated high school as the class salutatorian.
As one of the first students to attend the homebound program, Alexander shocked everyone even himself, graduating top of his class.
The SBCSC provides instruction to children unable to attend school because of physical disabilities or special health problems. It is important to note that although it is called “homebound services”, rarely are the services actually provided in the home.
He then attended Southern Methodist University before transferring to UT to study economics and finance. Scholarships to Southern Methodist University in Dallas and the University of Texas in Austin allowed Alexander, with the help of a paid health aide, to get an undergraduate degree and then a law degree.
When he got to Austin, he refused to contact his parents when his hired caretaker did a no-show fearing they would take him home. Before he would be accepted to study law, he was given two conditions. One he had to have the polio vaccine and he had to get the fraternity to agree to be responsible for his caretaking. Students in his residence all came to the rescue and devised a caretaking roster to take care of him.
It took him 7 years, but in 1978, he graduated. But Alexander wasn’t quite done with school yet. He then went on to attend UT Law, but this time he felt rejection from the professors. They weren’t as encouraging. Alexander recalls one particular professor who called him into his office only to tell him that he didn’t look like a lawyer, and he wasn’t going to pass his class. But pass it he did.
He graduated from law school in 1984 and passed the bar two years later.
Alexander spent decades as a reputable lawyer in Dallas, practising family law, whilst representing his clients from a wheelchair. Clients attending his office for the first time, would become transfixed on the Iron Lung asking “What is that?”
At the start of Alexanders career, he placed an advertisement for a caretaker. Kathy Gaines passed the interview and has been with Alexander for over 30 years now. She started with tasks such as preparing meals, doing his shaving, brushing his hair and teeth, and many other daily tasks he cannot perform himself due to his limitations. For most of their relationship, Gaines has either lived with Paul or nearly next door. They’ve moved a lot: his legal career was not lucrative, and he has struggled financially. Today, Kathy lives upstairs in their communal apartment building. She sees him every day, whether she’s working or not.
As with time, Alexander found it more difficult to breathe on his own. It was time for him to retire from practising law as he was now confined to his Iron Lung permanently.
Alexander has now outlived both his parents and his older brother, Nick. He has outlived his old friends. He has even outlived his original iron lung.
Alexander has always craved independence. But his life depends on his caregivers showing up for work, his iron lung and the electricity staying on. “He’s been 100% dependant on the kindness of others since he was six years old. Various district Rotary clubs have volunteered to make improvements to his house — an old ramp leading to the front door was replaced — and to be available to take him to his appointments. His iron lung is no longer supported by any company on an ongoing basis. The last company to service his machine, Philips Respironics, no longer does so. “So now, they have to source and strip spare parts from other discarded iron lungs to keep him going.
In 2015, the seals were failing and it was leaking air. So a friend posted a video of Paul on YouTube asking for help, a local Dallas engineer kindly fixed him up with a refurbished one.
Alexander may no longer be able to practice, but that hasn’t stopped him from setting out more goals to achieve, so he set about writing his self-published memoir, “Three minutes for a Dog”. It took eight years to complete as he wrote the whole thing himself using a pen attached to a plastic stick, with a mirror above his head to reflect his notes back to him. The main reason Alexander wanted to write his memoir was to highlight the severity of polio and to ensure that people continue to do all they can to prevent it.
At 75 years of age, Alexander is currently the only living person to be housed in an Iron Lung, a confinement he will endure for the remainder of his life.
Here in Australia, Polio vaccines were available in 1956 and were followed by mass immunisation programs. With continuing immunisation of children to date, the disease will be eradicated in Australia and other parts of the Western world one day.
Whilst polio no longer threatens Australian society today, it is not forgotten. Covid 19 is a clear reminder of that. And just as before, we now have a vaccine to prevent the spread of the disease, even though it is only available to specific ages and industries within the community at the moment.