At age 6, he woke up trapped inside a giant metal tube and spent the next 70 years in it. Meet Paul Alexander, who lived inside a 600-pound iron lung

For most people, waking up inside a giant metal tube sounds like something out of a nightmare. For Paul Alexander, it became reality when he was just six years old. After surviving polio in 1952, the Texas boy was left unable to breathe on his own and spent more than 70 years relying on a 600-pound iron lung, making him the longest-living person to use the machine. His story, however, became about much more than the illness. It became a story of determination, independence and hope.

Alexander contracted polio during one of the worst outbreaks of the disease in the United States. The virus left him paralysed from the neck down and affected the muscles needed for breathing. After doctors performed an emergency tracheostomy, he was placed inside an iron lung, a large metal machine that used negative air pressure to help his lungs expand and contract.

At one point, doctors believed he would not survive. His parents instead chose to bring him and the machine home, where they cared for him around the clock. Their decision gave Alexander a chance to build a life few thought was possible.

Learning to breathe beyond the machine

Over time, Alexander mastered a difficult breathing method known as "frog breathing," or glossopharyngeal breathing. By using his throat muscles to gulp air into his lungs, he gradually managed to spend time outside the iron lung.

His brother Philip recalled how a simple promise motivated him. "He was scared of course of choking to death," Philip told the BBC. "They told him if you last three minutes, you'll get the dog that you want." He did, and those few minutes eventually turned into hours outside the machine.

That independence allowed Alexander to attend school, move around in a wheelchair, and experience life beyond the walls of his home.

Building a career against all odds

Alexander completed his education, earned a law degree from the University of Texas and went on to practise law in Dallas. He also wrote a memoir by typing with a pencil attached to a stick held in his mouth.

Speaking about his outlook on life in a 2017 interview with Gizmodo, Alexander said, "My parents taught me to use my intelligence and my energy to be productive." He added, "I've never thought of myself as a cripple. That's the word I choose to use because I think it covers the ground in most people's perceptions."

He continued, "I'm crippled in most people's minds, except mine," before saying, "I'm Paul Alexander, human being."

His friend Christopher Ulmer, who helped raise funds for his care, told NPR, "Paul took a lot of pride in being a positive role model for others. More than anything I believe he would want others to know they are capable of great things."

The machine that kept him alive

The iron lung, invented in 1928, worked by creating negative pressure around the body, allowing the lungs to inhale and exhale naturally. Unlike modern ventilators, it enclosed nearly the entire body, leaving only the patient's head outside.

As these machines became obsolete, keeping Alexander's iron lung working became increasingly difficult. In 2015, when it began leaking, Dallas engineer Brady Richards restored another iron lung using salvaged parts and handmade components.

Recalling one tense repair, Richards told the BBC, "Paul was saying 'I'm fine, I'm OK' as we worked to correct the problem. The truth was, he was turning blue."

A life remembered for courage

Alexander lived independently for much of his adult life with the support of caregivers and friends. In 2023, Guinness World Records recognised him as the longest-surviving iron lung patient. He died in 2024 at the age of 78.

His brother Philip believed their parents would never have been surprised by how far he came. "They believed in him. They gave him so much strength and love. They wouldn't have been shocked," he told the BBC.

Beyond the world record, Paul Alexander left behind a reminder of what determination can achieve. Despite spending most of his life inside a machine built simply to keep him breathing, he found ways to study, work, write, advocate for polio vaccination and inspire millions around the world.