The Best American Sports Writing 2011 (45 page)

Eighteen people die each day in the United States waiting for a transplant. In the case of the five people who received organs from Paco, each of their histories is tied together by a common thread: they had endured untold suffering in the grip of their various illnesses. Only days away from death in some cases, they looked upon themselves as fighters in the same very real sense that Paco had been. With the exception of his uncle, Ramon Tejeda, who received a kidney in a "directed donation," none of them had ever heard of the young boxer from Chicago. Given what they have received from him—a heart, a liver, two lungs, two kidneys, and a pancreas—none of them will ever forget him. While the recipients have not yet met, they share a bond that now unites them with someone they have come to cherish: Paco.

The five are:

•
Ashley Owens, 23, of Spring City, Chester County: Both Lungs

As a 10-month-old baby, she weighed less than seven pounds. Initially, doctors suspected she had a tumor. But tests revealed that she had cystic fibrosis, which compromised her breathing and to some extent her digestion. Simple childhood pleasures such as running and swimming were beyond her ability. In and out of the hospital during her school years, she became an excellent student with the help of a tutor. Physically, she began "going downhill" at age 20 or so, a period during which her lung capacity dropped to as low as 20 percent. Without the help of oxygen her lips would turn blue. Concerned by the statistics that foretold an uncertain outcome for lung-transplant recipients, she held off going onto the waiting list until just hours before she suffered a collapsed lung on November 13, 2009. Of the pain her daughter endured, Charlotte Owens says, "Some days she would push through it. Other days it would be more than she could bear."

Ashley says: "Until the last two or three years, I had an okay handle on it. But when I was 20, I had stopped responding to the medication I was taking. My body had become so full of it that I had become immune. They told me I had two years to live. When I was 21, they told me I had one year to live. I was scared."

•
Meghan Kingsley, 26, of Gaithersburg Maryland: Liver

At 16, she was diagnosed with neurofibromatosis type 2, characterized by the growth of noncancerous tumors along the nerve that transmits information from the inner ear to the brain. An exceptional competitive swimmer who had dreamed one day of going to the Olympic Games, she underwent surgery in June 2001 for the removal of a tumor and was left deaf in one ear. In October 2007, she had decompression surgery on another tumor that doctors chose not to remove. In an effort to preserve what remained of her hearing, they instead carved away some bone that would allow the tumor room to grow. However, she began experiencing significant hearing loss and in September 2009 enrolled in a study for the experimental drug PCT299. By November, she was in the throes of liver failure.

Meghan says: "I became very, very ill and ended up in Johns Hopkins. I remember I was constantly burping; I had so much fluid in my stomach. I became jaundiced. [The whites of] my eyes were green and yellow. Mom said I looked like 'The Grinch.' I no longer had any bodily function. They later told me I was within 48 hours of dying."

•
Alexis Sloan, 27, of Norristown: Heart

At 22, she was diagnosed with congestive heart failure, prior to which she had experienced symptoms that included a dry cough, fatigue, and shortness of breath. "A lot of big words were thrown at me," she says. "Scary." Within a year of her diagnosis, she received a biventricular pacemaker and defibrillator implant. Efforts to manage her condition with medication failed and in March 2007 she says she "coded," which is hospital slang for going into cardiopulmonary arrest. Doctors then equipped her with a left ventricular assist device (LVAD), which she found to be an unwieldy contraption. Battery-operated, it had internal and external components that left her feeling on some days as if she was a robot. To get on the waiting list for a heart, she had to fulfill a standard set of requirements that proved that she would submit to postoperative care. In May 2008, she had done that and was given a pager, with which she would be contacted when a heart was available.

Alexis says: "When they gave me the initial diagnosis, it was devastating. It seemed like a death sentence. There was a lot of confusion. When I got the LVAD, I was not happy with it. No young person should have to live that way. With the protocols I had to go through, it seemed like it was taking forever to get on the list. I became depressed and at one point even suicidal. I just thought: 'I am going to die anyway...'"

•
Vicky Davis, 58, of Clifford Township, Susquehanna County: Pancreas, Kidney

At 37, she was diagnosed with diabetes, which through the years became progressively worse. In December 2005, she was told that her kidneys were failing. She went on dialysis in April 2006 and within a year was placed on the waiting list for a new kidney and pancreas. Initially, she says, she was told the wait would be just a few months. But whenever she received a call that there was a potential donor for her—and she says she received nine of them—the kidney and pancreas would end up going to someone else or there would be some other issue that would come up. For three and a half years, she spent three days a week on dialysis, a process by which the blood is cleansed of toxins.

Vicky says: "Going to dialysis was like having a job. I would have to be there by 5:30
A.M.
and I would not get back until 10:00
A.M.
And it was so draining. People would ask me, 'Do you work?' And I would say, 'No, I am on dialysis.' It takes a lot out of you."

•
Ramon Tejeda, 58, of Chicago: Kidney

At 40, Tejeda had his left kidney removed because of kidney stones. In December 2003, his right kidney began to fail. It was full of cysts and functioning at only 10 percent. He began dialysis and was placed on the waiting list for a kidney. Increasingly, the three-day-a-week, four-hour-a-day dialysis treatments began to wear on him. Depression set in. Though he says they were keeping him alive, they were not eradicating the underlying problem he had. Unable to continue in his factory job, he went on disability. On dialysis for six years, he had inched to the top of the waiting list when he received word last November that Paco had died and that his kidney was being offered to him in a "directed donation." Paco was the son of his cousin, Maria.

Ramon says: "I was not doing too well. I had been on dialysis for so long. When I heard what happened to Paco, I was so very sad, very depressed. I remember him as a boy. Knowing that the kidney would come from him was hard, but it was something I knew that Paco would have wanted me to accept."

Ramon pauses and says, "He was giving me a gift."

 

Jesse had told Ashley that evening when he proposed: "We have been through a lot of stuff, and we will have more stuff to go through. This is not the end. But whatever happens between now and whenever, I just want you to know that I will be here for you. Whatever happens, you can count on me."

And with that he slipped the ring on her finger, which had become so bony from her weight loss that it had to be reinforced with tape to keep it from slipping off. Ashley gazed at it as her eyes pooled with tears.

Immediately, the hopelessness that had engulfed her seemed to lift. From the hallway, the nurses came into the room to admire it, one after another. Suddenly, she says she found "the courage" to go over to HUP, where she was transported later that evening. There, she and Jesse had an impromptu engagement party. He ordered in pizza and wings. What they were unaware of as they sat there eating was that Paco was slugging it out with Kennedy at the Blue Horizon, the outcome of which he had hoped would propel his boxing career into a place where he could command larger purses and better support his wife, Sonia, and their baby daughter, Ginette. Uncertain of when she would get the transplant she so desperately needed, Ashley said good night to Jesse and went to sleep.

Whatever else the process of organ recovery and the ensuing transplant surgeries is, it is a synchronization of many moving parts. In the case of Paco, it began when he was declared brain dead on Sunday, November 22, at 7:42
P.M.
, at which point Janet Andrews, the transplant coordinator for the Gift of Life Donor Program, introduced herself to the Rodriguez family, offered her condolences, and arranged for a priest to come by at their request. At 10:30, Andrews sat down with them and offered them the option of organ and/or tissue donation. Sonia signed the consent form an hour later. Only when that occurred could Andrews move forward. She alerted the Illinois Organ Procurement Organization of the availability of a kidney for Ramon and arranged for Paco to undergo a series of tests to evaluate his suitability to be a donor, including an echocardiogram to test his heart. Until his organs were recovered, he would remain on a ventilator with his heart beating.

On Monday at 9:00
A.M.
, GOL began the organ allocation procedure: multiple potential recipients are identified and the organs are offered to the transplant surgeons, who assess them and reply via mobile device if they are interested or not. If they are, GOL contacts them by telephone and advises them of where they are on the list. By 1:00
P.M.
, the allocation procedure had been completed, the operating room space had been reserved, and the recipients had been contacted. Upbeat, Ashley says she prepared as if she was going to get better by taking a shower and braiding her hair. Told by her surgeons that they had found "a great liver," Meghan sat up in her hospital bed and said, "Let's go for it." Alexis was contacted not by her pager but by cell phone and told, "Come and get it. It's yours." At her dialysis appointment, Vicky was informed in a call and replied: "Are you sure?" Ramon could not help but think of Paco and how hard it had to be for Maria to lose a son.

That Monday at 6:30
P.M.
, four recovery teams entered the operating room at Hahnemann, where Paco was prepped and draped. Each organ has to be implanted within a certain span of time once it has been recovered. Says Howard Nathan, the president and CEO of GOL: "You have 3 hours for the heart, 6 for the lungs, 6 to 12 for the liver, 12 for the pancreas, and up to 48 for the kidney." In the course of the three-and-a-half-hour surgery, the heart and other organs were cooled by separate cold profusion lines and were removed one by one. At 9:07, the heart was recovered, triple bagged, and transported to the adjoining operating room for Alexis. At 9:15, both lungs were recovered and rushed to HUP for Ashley. At 9:50
P.M.
, the liver was recovered and flown by helicopter to Johns Hopkins Hospital in Baltimore for Meghan. And at 10:00
P.M.
, both kidneys and the pancreas were recovered. A kidney and the pancreas were hurried to Geisinger Medical Center in Danville, Pennsylvania, for Vicky, and the other kidney was flown the following morning to the Rush University Medical Center in Chicago for Ramon.

Given that Paco had been a highly trained athlete, his organs were exceptional. In fact, Charlotte Owens said that the surgeon told her that he had never worked with better lungs, which Ashley discovered worked wonderfully. Suddenly, she discovered that she could breathe deeply, and that she had stopped coughing. Within weeks of their operation, the other recipients reported excellent progress. Alexis says she could hear "the profusion of blood" running through her, "that ocean sound," and that each of her senses became amplified. "I could think better," she says. "I was even answering questions off of
Jeopardy!
" While Meghan has been hospitalized seven times since her transplant for periods ranging from four to 23 days and still has "dozens of tumors" in her body from her neurofibromatosis, she says she is "no longer dying but living." And Vicky and Ramon both say they have regained strength.

But curiosity set in. With the exception of Ramon, none of the others knew who the donor was. Confidentiality guidelines are such that the identities of the donor and the recipients are guarded and cannot be set aside unless either party agrees to share information. Consequently, there was always only speculation on the part of the recipients on the identity of the donor. While she was in her initial recovery, Meghan says that some friends tried to piece it together: the liver had come from Philadelphia from a 25-year-old male. When the friend told Meghan that a boxer of that age had just died in Philadelphia, she remembers thinking: "How bizarre! In this moment, I could not be fighting more."

Meghan says, "I just knew it was him. I could feel his presence."

 

Outside, a November rain was slanting from the gray sky in heavy sheets. But inside the third-grade classroom at Limerick Elementary School, it was dry and warm and filled with the enthusiasm of children, who were seated on the floor at the front of the room with their student-teacher, Ms. Owens. In preparation for a book the class would be beginning soon,
The One in the Middle Is the Green Kangaroo
by Judy Blume, Ashley asked them to predict what certain items she placed before them would have to do with the story: a jar of peanut butter; a doll with a broken leg; a kangaroo; and a green marker. Working individually and then in groups, Ashley recorded some of the suggestions on an easel.

She stepped back to look at them and said, "These are all good predictions, but guess what? None of them are right."

The children moaned: "Awwwwww!"

"So," she continued, "we are going to have to find out what happened compared to the predictions. Okay? It should be a lot of fun."

Scarcely taller than some of her students, Ashley had always hoped to become a teacher, specifically third to sixth grade. She enjoys the enthusiasm that the children bring with them to class each day. When she graduates this month from West Chester University, she plans to start looking for a teaching job in Pennsylvania or New Jersey, somewhere she and Jesse can settle down. Doctors have advised her not to teach children any younger than third grade because it would place her at an elevated risk for infections. Such warnings are heeded by her but not just because of her own health. She says she has a responsibility not just to herself but to "the gift" that she has received. To show her appreciation to Sonia, she has crocheted a pink blanket for Ginette.