A dying poet. The doctor who saved him. And the night it all changed.

Part I of IV

IOWA CITY — William O'Neal II glances over his laptop screen every time the front door scrapes the sidewalk above, the extended whoooosh of escaping current like an airlock depressurizing. One of those rare moments when sound has a feel.

He watches the newest bargoers descend the carpeted stairs into the Dublin Underground, a subterranean Irish pub in the heart of town.

O'Neal picked this particular booth — a worn wooden pew of stark right angles, second on the left — to be his workspace a few weeks earlier. A poetry fellow at the world-renowned Iowa Writers' Workshop, he needed one of those public-private spots where he could be both amidst humanity while also tucked away and unbothered. Bell jar-like.

And he didn't want to be around his colleagues, didn't need to whip up worries about their perceptions when he was in the mire of working. So, coffee shops were out. Libraries, too.

His friend Eva Long suggested this bar, and he'd felt an uncanny spark in the Dublin right away. An otherworldliness almost, as though he'd rolled aside a rock and discovered a hidden city, bustling, full of history and lore.

True, the green eyeshade droplights only illuminate a dinner plate's worth of the table, but there's inspiration in the walls, lined by liquor boxes, all with Tolkienian names like Laphroaig and Oban. It's ritual for writers to tuck notes in these abandoned cartons like messages left in hollow trees.

Some are just records of a night or a relationship. But others are summonings, calls to creation.  

"I can be anywhere in the world in this place," he says. And cheap Guinness pours only lubricate the mystique.

O'Neal knows the regulars, patrons whose photo strips are taped behind the bar. Others pass in flashes, especially when he's focused. As he is tonight.

Which is why he didn't register the group of five men, each wearing their coats with the bulky newness of a crisp fall night — the sort that feel like winter is sending up a flare. 

He returns his gaze to his cursor, his keyboard a bifocal for the world on the page and the world without. He's drafting an essay about a new book from a favorite poet, one who used to write about sex and abandon. The poet's work now centers on illness and relearning how to live after a stroke stole his language and mobility.

Most don't know O'Neal followed a similar path. Sorta. Professionally, he writes about sex and abandon. A lot.

But, personally, he's also relearning how to live — post-exorcism, which is what he's come to call marking his own deathbed with a comma instead of a period.

A few years ago, doctors put a stopwatch on his life. Three months, like his own little Doomsday Clock.

The son of a preacher, his parents always said to pray, to take care of himself long enough for research to catch up with their belief in a different future. He wanted to believe, too.

But O'Neal grew up knowing an early death was coming for him. That was a medical fact. 

Until it wasn't. 

Turns out you don't have to suffer rotting flesh to be undead.

Usually, O'Neal composes as an escape into new worlds, a habit he picked up as a child trying to flee hospital sterility. But not including his own story of disease in this piece would be disingenuous: "Language," he types, "requires large doses of faith." 

"I am living a dream that has only ever existed inside my head; my body has become a memory of itself. Still, every day, I am fearful the body will suddenly fail me again."

His friend Eva calls out, breaking his concentration to beckon him to the bar, and to the five men he'd glimpsed earlier.

She turns to them. Will has cystic fibrosis , she says.

"My first thought was, 'Why are you telling a bunch of men that I have this disease?'" O'Neal says.

Only his closest friends know he used to be suffocated by cystic fibrosis, a progressive genetic disorder in which thick, sticky mucus slowly drowns the lungs while destroying other vital organs. As an illness, it's nothing if not holistic in its deadly campaign.    

Then Greg Peak — a friend and a regular so regular employees hang him a Christmas stocking behind the taps — introduces one of the men: Dr. Mike Welsh.

Welsh and Peak have worked together peripherally for years. And Peak begins to describe Welsh's research: How Welsh has been a pulmonologist and a physician-scientist at the University of Iowa for 45 years.

How he studies cystic fibrosis, a rare disease that had been a true medical mystery until … well , until Welsh and his team. They'd had a breakthrough, Peak says, the sort of big advance that comes around as often as Halley's comet. 

And how their work — plodding, iterative, incremental, consuming, as it is with research — culminated in paving the way for a revolutionary medication. A series of pills taken in the morning and at night.

The treatment metamorphosed patients' lives so drastically even cliches fail to capture the shift. Night and Day. Black and White. 180-degree turn. Phoenix rising from the ashes.

But the reality is undeniable: What once was a fatal diagnosis is now a manageable condition for the vast majority of those with cystic fibrosis.

What bargoers didn't hear is that Welsh's discoveries have provenance in trauma. In watching patients die for so long. When they were too young. When they were mentally sharp and emotionally raw — aware, painfully so, of what was happening to them.

Nor how circuitous the work really was, how, like so much of nature, it bent and curved and turned back on itself. Or how many people contributed, hard-charging characters and headline-grabbing names. 

Welsh reaches out his palm. You have CF?

Yeah , O'Neal says.

What are you taking? Welsh asks. 

That's all he said. That's all he needed to say.

"I knew he was talking about the drug," O'Neal says.

The air shifts. Depressurizing again. Like a wormhole opening between the two men, a bridge ripping through spacetime to connect disparate realities. Science, meet impact.

Mental ley lines begin to illuminate the connection. Welsh's mind. His hands. The drugs. O'Neal's lungs, breath refreshed.

Nothing but exotic matter could have allowed for their meeting: the undead, and the man who O'Neal is slowly realizing is behind his reanimation.

Unbelievable , the doctors will say when they later tell the story of this night. In disbelief. A daze. Pinched ourselves.

"I was crying just because the way that this happened was so incredible," O'Neal says. Welsh is crying, too, as they shake hands.  

"I never thought I would be in Iowa City," O'Neal continues. "I never thought I would be at the workshop."

Never thought he'd be alive this long. Never thought he'd know how or why he had been spared.

Never. Never. Never. Never.  

But then the man who saved his life walked into this bar, held out a hand and asked the question O'Neal's wrestled with since a box of tablets arrived on his parents' stoop: Why are you here? 

The scientist: Wrangler jeans, sneakers and a fearless desire to know truth

Dr. Mike Welsh slices through the Iowa heartland, first on gravel roads then backcountry two lanes, as the pinks and oranges of a Midwestern morning spread like ink in water. A prairie alpenglow. Edenic, if you ask him.

The drive in from his farm near the Amish portion of Johnson County takes 20 minutes on a slow day. Enough time to listen to the audio version of a few New York Times articles. Today, it's a column on faith — losing it, gaining it back — by columnist David Brooks .

"All of life is a series of daring explorations from a secure base," Brooks writes.

A series of daring explorations . Maybe something along those lines gets at what Welsh, 77, has been trying to contextualize for a while now.

He's been reflecting a lot lately on stories, how best to tell them, how they can spur action.

Partly that's due to recently winning the Lasker Award , considered America's Nobel and one of the most prestigious honors in medical research, but also because there's just enough distance from the drugs his research helped produce to want to put words to the arc. 

Numbers tell a certain story: The University of Iowa hospital inpatient count used to be 10 to 15 CF patients daily. Now it's zero. Maybe one, but that's rare.

The labs at Iowa used to get 30 to 35 lungs a year for study from transplanted patients. Then it fell to less than 10. And now its possibly one. Possibly .  

And life expectancy, which a century ago was less than a year old, has slowly climbed into the teens and then young adulthood and now retirement age. Adults are canceling their clinic appointments because they feel fine, and Welsh's colleagues are wondering if there's a new field of study emerging: CF gerontology.

Welsh says he's got "graphs for days." But they're bare. Impersonal.

He wants excitement. He wants you to find connection, even if you don't care about CF. Heck, even if you don't care about science.

"We evolved not with data and spreadsheets and experiments," Welsh says. "We evolved sitting on our parents' laps with them telling us a story." So, he wants to tell a story.

Welsh arrives at the hulking, hyper-modern Pappajohn Biomedical Discovery Building early, around 6 a.m., a vestige from his pastoral childhood. His own "secure base," as Brooks said, which feels as divergent from this scientific life as the hands of prima ballerinas and petroleum engineers.

He grew up on a rolling hill acreage outside Haverhill, Iowa, a no-stoplight town so small its main roads weren't paved until the 1980s. His two-room schoolhouse split attendees into "early learners," grades 1-4; and "older learners," grades 5-8.

"I was in the biggest class. We had five kids," he says, deadpan.

Welsh's father, Leo, dropped out of school his sophomore year to join the war effort as a Marine and ship off to World War II's Pacific front. He came home wounded and worked two jobs to keep his family afloat: foundry during the day and a bakery at night.

They didn't want, but more than enough was a luxury, Welsh says. But that was true for most in his rural town after the war.

"One of the things I got from my parents was hard work," Welsh says. "Saying someone was a hard worker was high praise."

Just after sunrise, when the lab is quiet, Welsh can focus on his own experiments — including his current work in the complicated field of metabolism and on developing drugs to stop neurons' progressive deaths in Parkinson's disease.

As researchers start to arrive, his door is open and all talkers are welcome, whether to seek advice out of a scientific jam or to commiserate over disappointing results or, hopefully, celebrate a breakthrough — and plan out a course for more.

"Dr. Welsh is fearless in terms of discovery. It's what gets him up every morning. It's what he falls to sleep thinking about. It's what drives him day to day," says Dr. David Stoltz , chief of the division of pulmonary, critical care and occupational medicine at the university and one of Welsh's mentees.

Welsh reads every edition of the journals Science, Nature and Cell, among many others, Stoltz says, seeking articles that have nothing to do with his area of study and hunting for overlooked tools or techniques he can repurpose.

Taped-in charts and illustrations from his research form a sort of scientific vision board in the black hardbound notebook always tucked under his arm. Annotations and memos marking up the margins are a Lascaux -like history of his thoughts and plottings. 

On the cover of the one open on his desk, he's written #168, the latest in a 167 notebook lineage — and, yes, he still has them all — that started in the 1980s.

Back when he couldn't shake the sound of that little girl's cough.

Welsh isn't the sort to wear a rack of honors, literally or metaphorically. His work marks one of medicine's most revolutionary advancements of our time — some whisper the word "Nobel" to describe his experiments — but no one told his Wrangler jeans or his sneakers.

"There's lots of noise in research, and there's big figures, people that take all the oxygen out of the room. That's not Mike," says Paul McCray , chief scientific officer in Iowa's pediatrics department, another Welsh mentee. "Mike's an Iowan. He's not out there beating his chest, saying that 'I am the most amazing person.'"

Let the science speak for itself, Welsh preaches, while you keep investigating, following new lines of inquiry. He likes to say his favorite brand of research is "curiosity driven." A simple: How can this be?

Just the other day, he came up to the bench of Grace Fritz, a medical student new to the lab, and asked for her thoughts on an experiment he was designing to study oxidative stress. 

He wasn't partial to a particular procedure, she says. "He just wanted to use the best method to get at the answer, to better understand what's going on."

Or, as he said to her then: "I just want to know the truth. "

In cystic fibrosis, bodies hold medical mysteries and parents hold each other

Dorothy Andersen didn't mind being relegated to the basement of New York City's Babies Hospital — at least not at first. She was an oddity, and she knew it.

She rejected the popular caked-on eyebrows and exaggerated Cupid's bow lips of the late 1930s for a clean face and a simple bun, high and tight in the back.

She chain-smoked, often huddled over a microscope viewfinder with a lit cigarette hanging from her mouth. Another nearby to be ignited directly from this one's end.

And she was a female doctor at a time when there were hardly any women in the field. So few, in fact, she'd not been able to find steady work seeing patients.

So after graduating Johns Hopkins' medical school in 1926 and being denied surgical residency, she went back to Columbia University to get a doctorate in medical science and began working in a pathology lab.

"She was not interested in in fitting the mold," says Bijal Trivedi, a science journalist and Guggenheim fellow. Her book " Breath from Salt " traces the comprehensive saga of cystic fibrosis' treatments.

"She wasn't your prim and proper lady of the 1930s. She was sort of hard core."

Pathology was well-suited for Andersen. She was solitary, anyway. And serious and studious, all requirements when tasked with being the final hands to touch a young patient who, most of the time, had died of unexplainable causes — painful questions added to the heartache of already grieving parents. 

Make no mistake, these were bodies, yes. But they were patients to Andersen, Trivedi says.

And in the Babies Hospital basement, Andersen started to make connections among some of her patients. They were all quite young, around toddlerhood, and they seemed to be totally malnourished, some with distended bellies as if they were starving. But the children were being fed, Andersen knew.

They were thought to have died of celiac disease. But when Anderson performed the autopsies, she found a series of abnormalities: They had cysts in their pancreases, which would partly explain the issues with digestion. There were irregularities in the gastrointestinal tracts and bowels. And they had a thick, sticky mucus in their lungs.

Unlike the normal mucus that coats the lungs, which captures dust and bacteria and other foreign objects and moves them out of the airway, this mucus lacked fluidity. It seemed to entangle the little hairs meant to keep the airways clear. It built up and infections persisted, eventually destroying the lungs.

Andersen noted that while many of the patients were of European descent, it wasn't a wholly white disease, writing in her papers that one of her patients had been Black, Trivedi says. She also reported the disorder seemed to have no connection to poverty, targeting children of all social classes.

She became obsessed with finding the truth about this complex condition that seemed to vary in severity, sometimes killing babies within days and other times allowing a lucky few to live into early childhood.

"She sort of rose up from the basement, if you will," Trivedi says. "She gradually came up into the areas where physicians saw patients, and she began to see patients, and get to know the mothers and get to know the families." 

Her hard exterior softened in the exam room "because she knew that this was a grim disease," Trivedi says. "Her goal was to make these children comfortable, help their nutrition, and give them the best life possible, even if it was a really short life."

Doctors from around the country began referring patients to Babies Hospital, which allowed Andersen to expand her research and parents, whose children had been medical rarities in their hometowns, to connect and commiserate.

In her waiting room, caregivers traded advice and offered support as their children faced an immediately life-threatening disease. Some of their kids wouldn't do well. Some would. Relatively.

Heartbreak is built into the diagnosis of a fatal disease, and that bonded parents even then, says Dr. JP Clancy , senior vice president of clinical research for the Cystic Fibrosis Foundation and a former Welsh colleague.

"There's been this long-standing, deep sense of one community, together," he says, "And that was, by and large, driven by the parents and the families."

As study progressed, one of Anderson's colleagues noted another unique symptom in their patients: salty sweat. Pungent, like dumping the bottom of a pretzel bag straight into your mouth.

This discovery would become the CF diagnostic test: Take a sample of sweat. Measure salt. Too much and the child may have CF. 

In this, science reflected superstition. Mothers had long known that peril followed a salty kiss. The curse became folklore, immortalized in a medieval European proverb: Woe to the child who tastes salty from a kiss on the brow, for he is cursed and soon will die.

The disease had existed for millennia, as had the fear around its fatality, but Andersen, curious and steadfast, brought together the symptoms in 1938 under a name: cystic fibrosis of the pancreas. 

And over the next few decades, scientists would continue to home in on salt and water balance as the problem in CF patients. In bronchi, as Welsh would discover, chloride wasn't flowing freely through the cells lining the airway. Instead, chloride seemed to get stuck inside the cells, which was drawing water out of the airways and out of the natural mucus. Hence the dehydrated, sticky variety in CF lungs. 

Even as a unifying hypothesis was forming, the disease remained an enigma. A confusing mix of odd sweat, stuffed up lungs, cysts in the pancreas, gastrointestinal distress, intense fatigue, and a tendency to spread in family lines.

The symptoms seemed so disparate: like distinct mugshots neatly pinned to an evidence board, no sign of their connection.

But as knowledge around DNA and genetics grew and parents mobilized for answers, a group of passionate physicians tackled the problem, hoping they were carrying the right red strings that would finally crack the case.

Mike Welsh, then a medical student on his pediatric rotation, is about to join the fight.

Not a blue blood, not on the coasts, not at an Ivy League school. Just a cerebral farm kid, from a no-stoplight town whose curiosity is propelling him down a long hallway toward a strange coughing.

The first in a series of daring explorations.

Part II: An Iowa scientist chases a medical mystery as patients cling to breath

Courtney Crowder is the Register's Iowa Columnist and a senior writer. Please share stories and tips at  ccrowder@dmreg.com  or 515-284-8360.

The Miracle of Breath series continues

This is Part 1 of a four-part series. Future parts will detail the pivotal patient exam that propelled Dr. Mike Welsh into pulmonary medicine and cystic fibrosis research as well a turning point in the life of William O'Neal II, the quiet poet whose childhood with CF is one of struggle and escape — and hope.   

The Miracle of Breath series and "Giving Back Breath," its companion documentary, trace the story of how Dr. Mike Welsh's meticulous experimentation led to a breakthrough that transformed cystic fibrosis from a lethal diagnosis into a manageable condition.

Told through the intimate, unbelievable night Welsh met one of the people his work saved in an Iowa City bar, the 20-minute documentary is a co-production of the science-focused production company HHMI Tangled Bank Studios , USA TODAY Co. and the Des Moines Register.

Watch the film online and then dive deeper into the series.

Watch the 'Giving Back Breath' documentary free on YouTube

Influential Iowans

This is the last of the Des Moines Register's series on Influential Iowans. Through the end of 2025 and the start of 2026, the Register has publish profiles of people who have shaped our state and the country beyond. These people influence our politics, food, sports, communities, music, city development and arts, and health. They were chosen by Register staff ― and each is fascinating on their own. Together, they show the rich fabric of Iowa's influence.

— Rachel E. Stassen-Berger, Des Moines Register executive editor

This article originally appeared on Des Moines Register: Cystic fibrosis patient meets scientist who saved his life at Iowa bar