Daru Smith was talking to his doctor and sister one day in December 2018 when he began to die. He saw their forms grow dim, a dark curtain coming down on them and himself in his fluorescent-lit hospital room at University of Chicago Medicine. Then the 29-year-old was above it all, looking into a hole in the ground where a torrent of water was swirling like a giant draining sink.
And then he was in a hallway. At the end of it glowed a white light. He felt at peace. No more heart palpitations, no flutters, no aches. He saw pictures on a wall. Scenes from his life. His son being born. It felt good, the light. Until Daru realized: This is what happens when you die. He turned around and began to run. The light pulled him. I gotta fight, he said to himself.
Daru had been sick. A few weeks earlier, he’d gone to the emergency room with a cold he couldn’t shake. But tests showed it was much more than that. Daru was in cardiogenic shock, a condition in which the heart can’t pump enough blood to meet the body’s needs. He also had something called sarcoidosis, a rare autoimmune disease that can cause the body to overproduce certain cells that all but shut down organs—in Daru’s case, the heart, liver and kidneys.
That meant Daru needed all three vital organs replaced, a procedure so complex and risky that only 15 had been performed in the United States by that point. He would need the rarest of donors, one with three healthy organs compatible with Daru’s blood type and strong enough to support his nearly two-meter-tall body.
Daru fought the light long enough that his eyes fluttered and opened. “Hey, where’d you go?” said Daru’s cardiologist, Bryan Smith. “Thought we lost you for a second.”
SARAH McPHARLIN sat in a spare room at UChicago Medicine, waiting to plead for her life. She was there to meet with the centre’s transplant evaluation team.
As different as Sarah was from Daru— she’d grown up in a tree-lined suburb of Detroit, gone to graduate school, travelled the world; he was raised by a mother who managed a Harold’s Chicken Shack in Chicago, where he worked until he found a better-paying job as a truck driver—they were, in more important ways, alike.
Like Daru, Sarah was 29. A rare autoimmune disease—an inflammatory condition called giant cell myocarditis—had attacked her heart. At 12, Sarah had had a heart transplant, but over the years the replacement organ also began to fail. Surgeons had to open her chest five more times to repair ongoing problems. Complications from years of procedures and medications had all but destroyed her liver and kidneys. Her only hope, too, lay in a triple transplant.
But there were some ugly realities that needed to be addressed: The degree of difficulty of a heart transplant doubles with each previous cardiac operation. Sarah’s numerous procedures had left her heart buried in scar tissue. This “hostile” chest, as surgeons call it, makes it harder for them to locate the arteries and veins they will need to disconnect and reattach. What’s more, she was so physically weak that doctors weren’t sure she could survive such a gruelling surgery.
And then there’s the macabre math that goes into such decisions. A triple transplant means using three organs that could potentially save three other patients. Does it make sense to use them on a single long shot?
Dr. Nir Uriel, a heart specialist, was at first skeptical about Sarah’s case. She was as pale as the hospital sheets. She had almost no muscle mass. Her chest seemed to have collapsed in on itself, while fluid swelled her arms and abdomen. She could barely speak a sentence without gasping for breath. But when Uriel asked what she planned to do post-transplant, the words she could get out moved him.
She’d travel, she said, maybe to Europe, where she had visited as a student in high school. She’d restart her career as an occupational therapist. Beyond that? She loved spending time with her family. They were inseparable.
Before the day was out, Sarah had spoken with nearly 30 members of the transplant evaluation team. Afterward, they unanimously voted to move forward, each one seeing what Uriel had seen: someone who, though facing death, radiated life.
For both Sarah McPharlin and Daru Smith, it was now a waiting game. Waiting for organs to become available. Waiting, to put it in blunt terms, for the right person to die.
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