A Machine, a Baby Girl and a 289-Day Miracle

A machine breathed for 4-month-old Aubrey, doing the work of her tiny lungs, pumping her blood with a soft hum that provided the steady soundtrack of a life in the balance.

Doctors who looked at the baby’s lungs in scans saw white blotches showing an infection ravaging her lungs.

Would she survive even a few days?

Aubrey’s parents, Heather Craig and Gary Green, prayed for her life.

Families have long come to University of Florida Health Shands Children’s Hospital when their children are at their sickest and other hospitals have run out of options. In their most trying moments, families place their faith in caregivers with advanced skills and years of experience.

Aubrey’s large team did extraordinary work, but the difference between life and death can sometimes come down to one stubborn doctor’s refusal to give up hope.

For Aubrey, that was UF Health cardiothoracic surgeon Giles J. Peek, MD.

“Nobody else,” Heather said, “would have done what Dr. Peek did for my daughter.”

Aubrey Ginette Green was born on June 10, 2023, weighing 5 pounds, 11 ounces. In one of her first hospital photos, she wore a pink ribbon on her forehead.

Heather, then an operating room nurse at a Fort Myers-area hospital, and Gary, an electrician, lived in Cape Coral near Fort Myers. Aubrey was the couple’s third child.

The virus came into their home unexpectedly. Killers don’t knock.

The couple’s second child, 4-year-old Madilyn, brought home the respiratory syncytial virus, or RSV, from preschool.

RSV is a common virus that infects the nose, throat and lungs. For most, it feels like a mild cold, with a runny nose, cough and sometimes a fever. But in infants, older adults and people with weakened immune systems, it can be dangerous.

Babies’ immune systems haven’t been exposed to many viruses. Their defenses are weak. At the time, Heather said, the RSV vaccine was not available to newborns.

Madilyn got the sniffles, and then Aubrey, too. No big deal, Heather thought. Kids catch colds. Madilyn recovered quickly.

In Aubrey, however, the bug was tenacious, and her condition worsened.

“She was nasal flaring,” Heather said, noting how the nostrils widened in the struggle for more air. “She couldn’t catch her breath. She was crying and wouldn’t sleep.”

Medical visits followed, first to a local doctor and eventually a Fort Myers-area emergency room. Tests confirmed RSV, which had triggered pediatric acute respiratory distress syndrome, or PARDS.

This wasn’t a baby struggling with a cold.

The girl’s white blood cell count nosedived. Antibiotics weren’t making a dent. Then, a CT scan showed septic emboli in her lungs.

Pulmonary septic emboli are infected clots or debris that travel through the bloodstream and lodge in the lungs, spreading infection and causing damage.

Aubrey eventually tested positive for Legionella pneumonia, better known as Legionnaires’ disease. She was also infected with methicillin-resistant Staphylococcus aureus, a dangerous bacterium resistant to many antibiotics.

A normal oxygen level is 95% or higher. Aubrey’s dropped to 65%.

“I never in my wildest dreams could ever imagine Aubrey ever getting that sick from RSV,” Heather said.

It was clear that Aubrey would die without a machine that could oxygenate her blood. It’s called an extracorporeal membrane oxygenation machine, or ECMO.

The small community hospital didn’t have one. Nor was ECMO available in the Fort Myers area.

Doctors called UF Health.

ECMO is a form of life support used when the lungs, the heart or both are too sick to do their job. Doctors place tubes into large blood vessels and route the blood from the body into the machine, which adds oxygen, removes carbon dioxide and then pumps the blood back into the body.

It gives the organs time to rest and heal or acts as a bridge to a transplant.

Andrew Jaudon, UF Health’s ECMO coordinator, flew down in a ShandsCair plane equipped with an ECMO machine to pick Aubrey up.

There wasn’t room on the flight for Aubrey’s parents. Before Heather left her baby to board a separate flight to Gainesville, she kissed her.

She whispered to her that she loved her and that she needed to keep fighting.

It was Oct. 21, 2023. Most patients of Aubrey’s age who need ECMO recover in about a week or so. But by the end of her first week on ECMO, Aubrey was still desperately ill, with poor heart function and no lung function.

Dr. Peek quickly became a reassuring influence on the family.

Dr. Peek is an internationally renowned pediatric cardiothoracic surgeon specializing in ECMO, also known as an ECMOlogist. He works for the UF Health Congenital Heart Center and is a professor in the UF College of Medicine’s departments of surgery and pediatrics.

He specializes in treating critically ill infants and children with complex heart and lung conditions. He initiated the United Kingdom’s first and only pediatric mobile ECMO service. In 2012, London’s Sunday Times named him one of Britain’s top 100 children’s doctors. UF Health hired him in 2019.

One of the first things Dr. Peek asked Heather surprised her.

“Do you have pictures of Aubrey before she became sick?” he asked.

She did, of course. Dr. Peek told her to put one on the wall next to her baby’s bed. It allowed caregivers to judge the baby’s fluid status. It was also important in another way.

“It helps the staff and parents connect to a healthy baby,” Dr. Peek said.

Aubrey’s family knew, better than most, that she was struggling for her life.

Heather’s mother, Sandra, is a nurse practitioner, and her sister, Chantal Craig, worked as a nurse in the same Lee County operating room as Heather.

One doctor told Heather he had never seen an infant’s lungs in such bad shape. Some doctors thought Aubrey had poor odds for survival. Dr. Peek and others thought the girl might need a lung transplant, a dangerous procedure in an infant. On top of everything else, Aubrey’s heart began to struggle.

Heather lived in her baby’s room at UF Health Shands Children’s Hospital, sleeping when she could. Gary worked during the week, driving up to Gainesville on Fridays with the couple’s son, Collin, 14, and Madilyn. Heather would eventually quit her job, knowing she could not leave Gainesville while Aubrey was sick.

Aubrey’s tiny body seemed overwhelmed by the large plastic tubes of blood connecting her to the ECMO machine. The clear tubing, the diameter of an adult’s thumb, showed the deep red blood flowing back and forth between her and the machine.

With her family back home during the week, Heather might have become lost in the isolation. In truth, however, she was never alone.

“I had somebody in my room with Aubrey at every single second of the day,” she said.

An ECMO specialist continually monitored the machine. Nurses and other caregivers came and went at all hours.

These caregivers became a surrogate family.

“My ECMO people were who comforted me,” Heather said.

People like ECMO specialist Ryan Stahl, who worked regular shifts in Aubrey’s room.

“When these patients are really sick, some of us will call in the middle of the night or on days off to check and see how things are going,” Stahl said.

Aubrey, like any baby so ill, needed the best efforts of caregivers.

Jessica Cornman, a pediatric physical therapist, worked constantly with the baby, getting her moving. In a critically ill patient, movement is life.

“We had to creatively develop a plan to support her development while she was on ECMO,” she said. If she recovered enough in the months ahead, Aubrey would need to “learn to sit, do tummy time, roll, stand and walk all while on ECMO,” Cornman said.

Days and nights were filled with tension.

Getting away from the hospital, even for a few hours, could be mentally taxing. Once, Heather tried to get away for a few hours. Her mother stayed behind with Aubrey.

But Aubrey’s condition worsened, and Heather received a frantic call from her mom at 6 a.m. Heather rushed back to the hospital.

“I felt then like, ‘Oh my gosh, I left my daughter with my mom, and this happened, so maybe I shouldn't leave the hospital anymore because when I leave, something bad happens,’” Heather said. “That’s how your brain works.”

Although Aubrey’s heart had recovered by early November 2023 — doctors switched her to a type of ECMO supporting just the lungs — her lungs had not.

“The infection progressed to the extent that she had no underlying lung function at all, and then the infection also destroyed large parts of her lungs,” Dr. Peek said.

In one harrowing eight hours, an enormous amount of blood had to be suctioned from Aubrey’s tracheostomy. Heather said her daughter looked sickly pale. Her oxygen level was down to 81% even with ECMO. Her heart rate jumped to the 180s from blood loss as her body attempted to compensate for the lower oxygen level, she said.

“I felt like she was drowning because every time we suctioned her trach, it just filled right back up with blood,” Heather said.

The mother was frantic, especially since Dr. Peek was in Poland attending an ECMO conference. He reached her by phone.

Dr. Peek reassured Heather that he thought Aubrey still had a good chance at recovery “with good quality of life.” He told her he would be back in Gainesville in a few days.

Aubrey’s healthcare team got the bleeding under control.

Such reassurance came routinely from Dr. Peek.

Heather said the surgeon remained positive throughout Aubrey’s illness.

“Dr. Peek was huge in our lives,” Heather said. “He kept telling me, ‘She will get better. We just have to be patient.’”

Some on the team questioned whether his optimism was justified. Weeks and then months passed, and the girl would improve slightly, only for some challenge to complicate her health.

As time dragged on, family members began to wonder if keeping her on ECMO was the right thing to do. They considered hospice care and spoke with UF Health pediatric palliative care specialist Celine Cattier, MD.

“The parents felt like she was experiencing too much pain,” Dr. Cattier said.

She said Aubrey’s parents strongly advocated for her comfort.

“Part of what we did from a palliative care standpoint was to adjust medications to ensure that her symptoms were controlled,” Dr. Cattier said.

Even Stahl, the ECMO specialist, had doubts.

“What we were seeing was that she just wasn’t getting better, particularly the lungs weren’t improving,” he said. “We had some bad days when I thought we were at the point of doing futile care.

“We had imaging of chest CT scans and X-rays that were just the worst I've ever seen,” he added. “And I’ve seen the way COVID would destroy the lungs, and this was like COVID on steroids. Her overall appearance was just terrible — very dusky, gray, mottled. She looked like she was dying.”

He called Dr. Peek and said, “I think we’re done.”

“Nope,” Stahl recalled him responding. “Keep pushing. Keep pushing until I’m back.”

For Dr. Peek, offering reassurance in a grave situation was familiar territory.

“I started working with ECMO in the UK in 1994,” he said. “And every single patient you treated, you’d hear the doubts. ‘Why are we doing this? It’s a complete waste of time.’ Then, after our first 50 patients, 66% survived.

“And then the H1N1 (influenza A “swine flu”) arrived, and 80% of those patients survived … You just have to keep at it,” he said.

“The lungs have extraordinary power to heal if we let them. I was very confident that they could recover if we just waited.”

A patient’s recovery, Stahl said, is like the stock market, with highs and lows. It’s a market whose direction, at times, can seem utterly random.

About three days after Stahl’s talk with Dr. Peek, Aubrey began to make tiny improvements. The stock began to turn.

“I’m a pretty firm believer that the main reason that Aubrey is here today is because of Giles Peek,” Stahl said. “I think if she had been anywhere else in the country with any other physician, they would’ve withdrawn care because the writing on the wall was quite clear.”

Aubrey gradually became a baby again.

Staff took her and the ECMO machine outside so she could enjoy sunshine. For most of her life, she had been indoors. She wore tiny sunglasses.

Aubrey became more playful. She began to smile. A personality emerged from the sickness.

On June 10, 2024, eight months after being placed on ECMO, Aubrey celebrated her first birthday with a cake that had “Happy 1st Birthday Aubrey!” spelled in red frosted letters.

Then, Dr. Peek arrived. He gave her the best birthday gift of all.

“Oh, let’s just try this out,” Dr. Peek told Heather, turning off the ECMO’s fresh gas supply. Her blood kept circulating in the machine, but now the membrane lung stopped oxygenating. Everyone waited to see if Aubrey’s own lungs could take over.

Heather hadn’t expected Dr. Peek to turn off the gas. This miraculous machine had saved her daughter’s life. It had been Aubrey’s guardian, a lifeline in a turbulent sea.

“I’m looking at the clock, and I’m like, ‘Oh man, five minutes have passed,’” Heather said. “And I’m like, ‘Oh, she’s going to be put back on soon.’

“And then, two hours passed, and I’m like, ‘Oh my God, she’s actually not on ECMO.’ “And then a whole day passed, and I’m like, ‘So are we leaving her off?’”

Aubrey’s lungs were working on their own after about 233 days on ECMO.

Not long after, Heather held her baby for an extended time. The nurses promised this would become routine.

Heather was overjoyed. But she missed her constant companions — the ECMO specialists who were always in the room, tending the machine.

“They were my emotional support system. And they were gone.”

The big day finally arrived.

Aug. 5, 2024. Discharge day.

As Heather walked out of the unit with her family, she held her baby. More than 30 people, including Aubrey’s caregivers, other families with children in the unit and friends, lined the corridor.

On the unit’s public address system, someone said, “Against all Aubs, after 289 days … Aubrey is leaving!”

Everyone clapped and cheered.

Aubrey looked at her applauding fans with bemusement. Now, she was just another 1-year-old, working to understand the strange adults around her, as if to say, “What’s the fuss?”

Near the end of the corridor, a surgeon stood in scrubs. Balancing Aubrey in one arm, Heather hugged Giles Peek.

Later, it felt odd for Heather to be out of the hospital bustle. All she wanted to do was collapse in bed. She was bone-tired from the accumulated weight of those 289 days.

“To lie down in my bed with Aubrey was the most satisfying feeling ever.”

Aubrey is a normal little girl today.

She loves dressing up as Cinderella and going shopping. She is a social butterfly and, her mother said, has never met a stranger. She loves babies, pizza and spaghetti. Her favorite shows are the animated children’s series “Baby Shark’s Big Show!” and “Danny Go!”

She is energetic and curious.

“Aubrey’s a normal, beautiful child, and she’s developing well, and her mother and father have done a fantastic job supporting her,” Dr. Peek said. “Aubrey is a fantastic success, and I’m so happy for her and for her family.”

Aubrey’s health is still closely monitored, and she occasionally visits UF Health with her parents for checkups.

“She is definitely my angel and definitely Daddy’s girl,” Gary said. “She goes around singing, ‘I love my Dad. No, I love Mama. No, I love my Dada.’ She’s a very, very funny girl, man, and I’m very blessed that she’s still with us.”

Dr. Peek was Heather’s medical lodestar.

“I remember him telling me, ‘Out of 10 doctors, I’m going to be that one who will tell you your daughter is going to make it,’” Heather said. “I’ll never forget what Dr. Peek did for us. Everybody at UF Health did so much. We’re forever grateful.”

“Aubrey,” she added, “is a miracle.”

On June 5, Dr. Peek and other care team members published a case report in the ASAIO Journal, a publication of the American Society for Artificial Internal Organs, about Aubrey’s treatment and recovery.

“To date,” it reads, “this is the longest reported duration of ECMO support for PARDS due to lower respiratory tract infection reported in the literature.”

In mid-November 2024, Heather gave birth to a healthy baby girl. Aubrey’s little sister.

Heather named the girl Genevieve after former UF Health nurse Genevieve Peltot, a compassionate and strong advocate for the family.

If it had been a boy, Heather had another first name in mind.

Giles.

A large team of healthcare professionals treated Aubrey. Some of those not named in the article are respiratory therapists Julie L. Powell, Jeff Gillette and Bradley Lapoint; nurses Emily E. McConville, R.N.; Jordi Sallent, R.N.; Morgan Fouts, R.N.; LeeAnn Hewitt, R.N.; and Katie Lowell, R.N., and former UF Health employee Marissa Molloy, R.N.; ECMO specialists Amanda Schwieterman, Nick Riley, Lindsey Fouts, Cristobal Velazquez-Lopez and Michael McGuire; occupational therapist Julia Lutz; and Tavenner Dibert, M.D., Marc Schecter, M.D., Sukamar Suguna Narasimhulu, M.D., Joseph Phillips, M.D., Kevin Sullivan, M.D., and Yuriy Stukov, M.D.

All photos courtesy of Heather Craig and Gary Green.