The machine is what people see first. The submarine-like metal cylinder dominates the room, rhythmically humming and pulsating as it helps keep Paul Alexander alive.

It is simple but effective: A big tube, a motor, a moving arm. As the paralyzed Dallas lawyer lies inside, his head protrudes from a velvety, airtight closure at one end, propped on a pillow on a height-adjusted table.

Alexander has spent much of his life in a can, a childhood victim of a once-epidemic disease that menaced the nation and now leaves him at the mercy of a mechanical respirator. Though unable to move from the neck down, he refused to be limited by his metal prison, finding success in both the classroom and the courtroom.

Paul Alexander looks out from inside his iron lung at his home in Dallas. Now in his 70s, Alexander is one of the few people left who uses an iron lung to help facilitate breathing for those affected by polio. (Smiley N. Pool / Staff Photographer)

At the University of Texas at Austin, where he earned his bachelor's and law degrees, students crowded his open dorm door and gawked. Later, clients visiting his home waited awhile before they ultimately asked: What is that thing you're in? Is it a sauna?

No, he would say. It's an iron lung. I had polio as a kid.

Then, some would ask: What's polio?

'The horror of the day'

No one makes iron lungs anymore. Barely a handful of people still use the hulking respirators, which apply negative pressure to enable breathing for those unable to do so on their own.

Alexander, 72, is among the few. The semi-retired bankruptcy lawyer has been using one since he was 6, his lungs and muscles ravaged by paralytic polio. He's a living reminder of a time when fears of the crippling, infectious disease gripped the country and parents kept kids away from playmates, pools and birthday parties for so much as a sniffle.

"Polio was the horror of the day," Alexander says, his speech punctuated with clicks, wheezes and silent breaks as he pauses to gulp in air. "It was like the Black Plague."

The disease destroys nerve cells in the spinal cord. It spread silently, explained Steve Cochi, senior adviser at the global immunization division of the Centers for Disease Control and Prevention. For every one person who contracted paralytic polio, another 200 might display few or no symptoms.

"It was a disease that terrorized a community," Cochi said. Its most famous victim was President Franklin D. Roosevelt.

Until 1955, when Jonas Salk became a hero by developing the vaccine that would largely eradicate the disease globally, polio reached pandemic levels. The worst year was 1952, according to PolioToday.org, with nearly 58,000 reported cases causing 3,100 deaths and leaving more than 21,000 in varying stages of paralysis.

That summer, on a hot and rainy day, 6-year-old Paul Alexander was playing outside his Pleasant Grove home, when he suddenly felt like going back inside.

As he walked in, dripping and muddy, he said, he let the screen door slam — an act that would normally draw scolding from his mom, who was mopping the kitchen.

Instead, she saw him and her face froze. "Oh, my God," he remembers her saying.

She told Paul to run out and get his shoes. When he came back in, she cleaned him up and told him to go to bed.

"She knew instantly," he says. He still wonders how.

He was pampered. His parents brought him crayons and coloring books featuring his beloved cowboys. It was pretty great, though he had the sense something wasn't right. And so he colored, page after page, like there would be no tomorrow.

Life in a machine

Inside his canary-yellow machine in his Love Field-area home, Alexander's rigid body lies under a white sheet, fingernails long as talons and resting on his chest. He depends on a caregiver to help him eat, wash his face in the morning, brush his teeth and shave. He can be bathed, or his sheets adjusted, through portholes on the machine's sides.

On the table, his head is ringed by technology linking him to the outside world — a computer, a push-button telephone, an Amazon Echo. What's the Echo for? He grins. "Rock 'n' roll," he says.

Closer to Alexander's face, a straw pokes from a tall water cup; on his chin rests one end of a long, plastic T-square-like implement that he operates with his mouth, pecking out emails or answering and hanging up the phone.

It's been about 30 years since his longtime caretaker, Kathryn Gaines, answered Alexander's newspaper ad: "Disabled professional seeking part-time help."

When other caretakers flaked, she stepped up. Eventually, she moved in.

For 15 years they lived together, then Gaines moved next door, and now she lives down the block. "We just kind of get along," she says. "I haven't killed him yet."

One typical morning, she showed up at 7, Alexander's human alarm clock, and gathered the implements of his morning routine, starting with a toothbrush, a metal bowl and a glass of water.

Caregiver and friend Kathryn Gaines washes the face of Paul Alexander beside his iron lung at his home in Dallas. (Smiley N. Pool / Staff Photographer)

Gaines brushed his front teeth, then let Alexander take over as he worked the brush around his back teeth with practiced movements. She put the straw to his mouth; he took a swig from the glass and swirled before ejecting the wash back through the straw into the metal bowl.

Similar routines followed as she rubbed his face with a wet towel and lathered him up for a shave, the two reading each other's body language.

Like an old married couple, they've had their moments, but Gaines has proved reliable where others haven't.

"People need people," she says.

Breathing like a fish

As young Paul's polio set in, his back and neck stiffened and pain shot through his limbs; by the next day, he said, he was hallucinating, with a high fever. By week's end, he was too weak to sit on the toilet.

"My hands were gone," he says. "I couldn't color."

Paul Richard Alexander, 9, was struck with polio right before he began elementary school in 1952. He is shown in August 1955. "I like to paint, go on picnics and go to church," said the boy, who has no use of his limbs. (John Young / The Dallas Morning News)

The family had kept Paul home after their doctor suggested he'd be better off recovering there than at a hospital teeming with sick kids. But when the practically immobile boy had trouble breathing, it seemed he wouldn't be among the lucky ones whose symptoms eventually passed.

He was rushed to the hospital, where he underwent a tracheotomy and woke up in a plastic, steam-filled tent. By then, he was already in an iron lung, with no idea what was happening. "I figured I'd gone to hell," he says.

Doctors tried to get him to breathe on his own, but their sink-or-swim methods were terrifying to him and unsuccessful. It would be 18 months before he went home, paralyzed from the neck down.

With the help of a physical therapist, Paul gradually overcame fears of breathing on his own and learned to gulp for air — "kind of like a fish," he says. "I was using my throat muscles and my tongue to gulp in breath and swallow it into my lungs."

Motivated by the prospect of a puppy, he learned to breathe for three minutes at a time, and eventually for much of his waking day. "It's exhausting," he says. "People think I'm chewing gum. I've developed it into an art."

But for a boy who wanted nothing more than to go to school, it was a turning point.

"I knew that was the road to a future," he says. "To become something."

'Basic and bulletproof'

Iron lungs haven't been mass-produced for half a century, and insurance stopped covering Alexander's repairs long ago. His chest muscles too damaged to use the portable ventilators that have become common for others with breathing issues, he's dependent on a nearly obsolete machine.

When his iron lung began to leak air several years ago and he found it hard to breathe, he didn't know whom to call.

Around the same time, Brady Richard, whose boyhood how-does-this-work curiosity led him to launch Environmental Testing Laboratory in northwest Dallas, was trying to cobble together a working iron lung from the shells of others abandoned in a nearby workshop.

"I like old stuff, so I read up on it," he says, not knowing who might need it.

1 / 5A mechanical wheel used to adjust the respiration rate on the iron lung of Paul Alexander at his home in Dallas.(Smiley N. Pool / Staff Photographer) 2 / 5Paul Alexander chats with caregiver and friend Kathryn Gaines as he drinks coffee and she eats breakfast beside his iron lung.(Smiley N. Pool / Staff Photographer) 3 / 5Control equipment on the iron lung of Paul Alexander at his home in Dallas.(Smiley N. Pool / Staff Photographer) 4 / 5Caregiver and friend Kathryn Gaines feeds toast to Paul Alexander inside his iron lung.(Smiley N. Pool / Staff Photographer) 5 / 5Instructions on the side of the iron lung of Paul Alexander at his home in Dallas.(Smiley N. Pool / Staff Photographer)

About a month later, a woman came into Richard's business, which tests machinery and technology under simulated weather and seismic conditions, and asked if he had any iron lungs. A guy she knew named Paul Alexander really needed one.

Alexander's existing machine was "flat worn out," Richard says.

Using existing parts and a few he crafted himself, Richard eventually replaced it with another. The key was figuring out how the machine worked, its bellows moving back and forth to create a vacuum that makes the user's chest expand.

He's tried it himself. "It's a weird feeling," he says.

He's fascinated by the machine's beautiful simplicity.

"It's basic and bulletproof," he says. "There's no chips, no electronics. It's built to run forever."

But for Alexander, its purpose is singularly crucial. Without it, he'd eventually run out of breath.

In 2008, a Tennessee woman who'd used an iron lung for 60 years died after a power failure deactivated her machine. Earlier this year, Alexander's own electricity went out temporarily.

"That's how close I walk the line between life and death," he says.

Looking to the future

One of Dallas ISD's first homeschooled students, Alexander learned to memorize instead of taking notes. He graduated second in his class from W.W. Samuell High in 1967 — "The only reason I didn't get first," he said, "is because I couldn't do the biology lab."

Next came Southern Methodist University, where he got around with the help of volunteers from Alpha Phi Omega fraternity before transferring to UT, along with his iron lung. There, he earned his bachelor's degree in 1978, then his law degree in 1984.

He spent his career practicing family law and helping people filing for bankruptcy fight off creditors.

He was more flexible then. His 125-pound body has since stiffened, and he's unable to use a wheelchair as he once did, a situation he hopes to correct with surgery so he can return to lawyering.

He admits to one great love, an SMU classmate whom he says he couldn't allow himself to commit to because it didn't feel fair. "You like to dance," he says he told her. "But I can't dance with you, and that makes me feel bad for you."

To this day, the words he recalls her saying make him emotional: "When I'm dancing with others," she said, "in my head I'm dancing with you."

That's among the tales he wants to share in a book he hopes to self-publish — an autobiography, but also a plea to Americans to make sure polio never returns.

In the two years before Salk's vaccine was widely available, the average number of U.S. polio cases topped 45,000. By 1962, it had fallen to 910. Today, the CDC's Cochi says, polio is nearly gone: Only eight cases, all thought to be connected, have been reported in 2018, in Afghanistan and neighboring Pakistan.

But until it's fully wiped out, he says, "this disease can come back with a vengeance. As long as there's polio virus circulating in the world, everyone is at risk."

That's a prospect that horrifies Alexander as growing numbers of U.S. parents refrain from vaccinating their kids. What if just one affected person were to make it into the country?

Paul Alexander is reflected in a mirror as he chats with caregiver and friend Kathryn Gaines from his iron lung at his home in Dallas. (Smiley N. Pool / Staff Photographer)

'Why did God let this happen?'

When he was younger, some tried to discourage Alexander from imagining he could accomplish what he's done, and occasionally, he's faced those demons himself.

"Why did God let this happen to me?" he's wondered. "I would get so angry with him. I won't accept for a single moment that Paul Alexander is not good enough to stand before God and ask, `Why? What'd you do this for?' "

Faith powers him onward, and he credits his motivation to succeed to a spirit of defiance and, most of all, to his late parents, whom he describes as "extraordinary souls. Magical."

"They just loved me," he says. "They said, 'You can do anything.' And I believed it."