July 8, 2017
On her way back from a Weld County Airport Authority meeting, with the familiar weariness already digging in for the night, Sandi Elder called Layne Pachl in tears.
Ever since Layne came to Sandi’s house and announced that she would give Sandi a kidney, the two talked every night, after Sandi hooked herself up to her dialysis machine in her bedroom. This conversation couldn’t wait for the machine.
“The devil’s been talking to me,” Sandi said.
Sandi, 54, met Layne on a rainy May 17 afternoon, when Layne came to her house to introduce herself as her donor. Layne wanted the introduction to be special, so she hid her face with the umbrella and tried not to look at all the people peering out of the front window. Layne and Tamara, her mother, came through the door and shook off the storm, and Layne lowered her umbrella to reveal her cute and smiling face. Sandi looked at her and said, “You’re a nut.”
“I know what that pain feels like, and I don’t want her to feel that. I don’t want her to suffer.
— Sandi Elder, on her doubts about letting 20-year-old Layne Pachl donate a kidney to Elder
Layne, 20, knew Sandi only because she was a friendly face in the office when she attended St. Mary Catholic School at a kid, but she immediately reminded Sandi of her daughter-in-law, Niki, because both were young and sweet. It didn’t take Sandi long to love Layne just as much. Because of that, Sandi began to have serious reservations about the operation.
Layne was not yet old enough to buy a beer. She still lived at home with her parents in rural Greeley in between semesters at the University of Colorado-Colorado Springs. Her only surgery was a procedure to fix a torn ACL last year.
Now Sandi thought of her as a daughter, not a lifesaver. Sandi couldn’t let her do it.
And yet, Sandi needed Layne’s gift. Sandi was born with polycystic kidney disease. Healthy kidneys are the size of a fist. Sandi’s were 10 pounds each. The disease causes nausea, pain, vomiting, urinary tract infections and an evil, wearing fatigue.
The disease did all that to her, too, but it also stole so much of her life.
It tore a chunk out of her perky personality. That trait not only made her husband of 35 years, Willie, love her, it helped make her a beloved city councilwoman for almost eight years.
The disease changed her complexion into a faint, sickly yellow, which she tried to cover up with pounds of makeup.
The worst part of it all was she once had the kind of energy that made people wonder where she got it. She hated to sit still, and her constituents loved her for that, even if it sometimes frustrated Willie. She hated it even more that the disease made her want to sit still. She and Willie loved to go out, to Friday Fests and Stampede rodeos, but she had no strength for that anymore.
The disease even kept her from being a close friend: Her companions wouldn’t share their own problems because they believed they couldn’t measure up to Sandi’s ordeal. She hated that too.
Sandi didn’t want people to pity her, so she tried to keep her ordeal private, but in 2016, she started a Facebook Page, Sandi Needs A Hero, after her search for a donor dragged on for years. There were heartbreaking close calls, such as the time the Weld County Sheriff Steve Reams lost 20 pounds at the doctors’ request, only to be turned down on the last test.
She turned to Facebook because she was desperate: She hooked up to the dialysis machine every night since August. Dialysis was a crappy, uncomfortable solution, but it kept her alive. It also moved her down the crowded donor list.
Layne’s kidney was a godsend.
Layne, as she had every time Sandi expressed her doubts, told her the devil was whispering these bad thoughts. Layne felt a calling, she said, that even her father, Robert, struggled to understand. She wanted to do it. She already felt close to Sandi and her family as well. She even considered it a privilege to feel what she called a tingle.
“Let’s pray,” Layne told her.
That helped soothe Sandi’s fears, until a few days later, on Memorial Day, two days before the surgery, when Niki and Sandi’s son, Eric, held a party for their families and friends. There were many good speeches, and there was a cake and some masks of Layne’s face. Sandi called Layne her hero.
Later, surrounded by the celebration, as she signed a photo of the two of them, Sandi broke down again.
“I know what that pain feels like,” Sandi said and sobbed, “and I don’t want her to feel that. I don’t want her to suffer.”
Here’s the ironic thing about gifts: The more precious they are, the harder they are to accept.
Layne is a bit of a daredevil. Fearless, Tamara says about her. She’d been skydiving 30 times. She’s exactly the kind of person who would agree to give an organ because it’s a nice thing to do. Layne is a good kid, Tamara and Robert said, but fearless kids are hard to parent regardless of whether their hearts are in the right place.
They thought the complicated tests potential donors undergo would solve this issue for them. After all, those tests are there to ensure that the kidney is a good match, but they’re also there to ensure that daredevils don’t do anything on a whim.
With that in mind, Tamara and Robert stood by while Layne decided to get tested after hearing about Sandi’s story. The odds were so small that she would be a match anyway. Dozens of others had already tried.
Layne gave almost a dozen tubes of blood, and she took a 24-hour pee test, when she had to potty into a jug that she kept in the fridge. Initially, she was a match. She gave more blood to bring her count to 40 tubes, and she underwent a CT scan to make sure the kidney wasn’t in a place that was hard to reach. She passed all the hurdles. All systems go. It’s rare to have someone so young give an organ, and even less so for someone who isn’t a family member. And yet, Layne told her parents their only child between them would be donating a kidney.
Now, as parents, they had to decide how they felt about their child allowing doctors to cut her open and take an organ.
Tamara had what she called a “what the hell Mom moment” — she basically wanted to lock Layne in her room — but she also wondered if she would have the courage and selflessness to give an organ when she was 20, and she felt proud of her daughter.
As soon as he heard the news, Robert tried to talk her out of it.
“Of course I did,” he said.
He asked her about health insurance and whether it would be more expensive for her, and whether she wanted to volunteer for that much pain, and why someone so young would want to give up something so precious with so much life ahead of them. Doctors struggle with that too: Many prefer middle-aged donors because the odds are lower, simply because of the years they’ve lived, that they will develop a debilitating condition.
Layne was sweet but stubborn. She went skydiving the first time because Robert told her she shouldn’t do it. As always, she had good answers to his questions.
Why are you giving up one kidney? Well, Layne replied, that’s why you have two.
How come God gave you two? Well, Layne replied, to give up one to someone who really needed it.
What about your health? Well, Layne replied, many donors live a healthier lifestyle than those with two. There’s more motivation for them to watch their diet, curb their vices and exercise. She had a reason not to party now. What father wouldn’t want to hear that?
And if she was healthier than the average person, health insurance shouldn’t be more expensive. Sandi’s insurance would cover the costs of her own operation. Health insurance companies prefer to pay for an operation: Dialysis, after all, is much more expensive.
Then Robert knew he had a choice. He could try to forbid his daughter from doing it. He could stomp and yell and put his foot down. Or he could be supportive.
“He never tries to talk me out of things,” Layne said, even as Robert admitted he did. “He just questions me hard. He’s a great dad. I mean, I’d be worried and scared if I had parents who were, like, ‘Oh, cool.'”
When he was supportive, Robert, like Tamara, then felt proud. He allowed himself to be comforted by the stringent process. She had to pass so many tests, and even more than that, he went with her to a required session with a psychologist, who grilled her pretty hard about her motivations. Layne called it a God thing because everything had gone so smooth, but she was also excited to give Sandi a new chance. Yes, she was sure she wanted to do it. She grew to enjoy the questions from everyone: She needed to hear herself say it, over and over. Yes, she was sure she wanted to do it.
She was sure, that is, until the night before, when the devil began to whisper to her.
The night before the surgery, on May 31, Sandi and Willie took their 1940 Chevy Truck out for a spin. Willie rebuilt it from a shell. The truck is the couple’s porch swing, a way to relax over good memories. Sandi’s Facebook cover photo is a picture of the two of them in it. They decided to go to Fuzzy’s Tacos for dinner. Willie had a margarita.
Tamara and Robert tried to stay busy to take their minds off the next morning’s surgery and hoped they would eventually just collapse from exhaustion. That’s how Robert found himself on his lawn mower tractor at 10 p.m., cutting the grass in his rural Greeley neighborhood, where the lot is big enough for a few horses for Layne to ride. They then went to bed and, against all odds, actually slept a bit, before Tamara awoke with a start at 2 a.m., a couple hours before they had to leave. They were blissfully unaware of the struggle Layne was facing.
At midnight, in a hotel room near the University of Colorado Hospital in Aurora, with her boyfriend, Corbin, after a dinner of crackers, Layne was exhausted by all the concern, even if she was also touched by it. She had been asked three questions approximately 10 billion times: Are you ready? How do you feel? Are you nervous? She began to cry.
“What if I wake up in a coma?” Layne said to Corbin.
Six hours before she was supposed to arrive at the hospital, Layne wondered if she wanted to go through with it.
The sad truth is, two people wake up from a kidney transplant. Both of them are in pain, to be sure, but one almost always feels better than she has in years, and the other may very well wake up in more pain than she’s ever felt in her life. That would almost certainly be true for Layne. Layne was tough. She played volleyball at Valley High School, a storied, state-winning program with high demands, and flourished there. She once played through a strained back until doctors informed that it was, in fact, fractured. But she had little experience with surgery. She cried at the unknown of what removing a kidney would bring.
That night, over his margarita and the customers wolfing down shrimp tacos, Willie told Sandi in Fuzzy’s her guilt was understandable. He had it, too. He worried, in fact, she would regret the operation in a decade. But Sandi now had to be OK with Layne’s choice. She couldn’t let Layne’s pain prevent her from celebrating her own recovery.
They would worry, a lot, about as much as her parents, but they would accept Layne’s gift. They didn’t know that Layne was wondering if she wanted to give it.
Layne sobbed on Corbin’s shoulder until he reminded her about that Christmas in the New Life Church in Colorado Springs.
Layne didn’t have any relationship with God a couple years ago. Robert was raised Catholic, and Tamara converted for him. It didn’t bother her parents that she wasn’t Catholic — Tamara said she loves experimenting with religion — but they wanted her to have some connection. Layne peeked into Hinduism until Corbin’s father, a pastor, brought them both to New Life, and they cried through the service. Since then, she said, she’s been “chasing, chasing, chasing God.”
Corbin told Layne that they didn’t know what God’s plan was, but it seemed like they’d followed it pretty closely so far. Everything had gone so smooth. It would be a shame to not trust Him now. Layne cried a few more minutes, dried her tears and fell asleep. She would sleep soundly until 4 a.m., when she awoke with the same start that jolted her mother a couple hours earlier. It was time to go.
Layne told herself that she’d made it through her doubts. She really just needed to cry them out. She was due for a freak-out moment.
She thought about her parents, and Corbin, who was hours into his promise to quit smoking because she was giving something up as well, and Sandi and her family. Everyone was probably having their own freak-out now.
She would have to be in good spirits for them.
Willie shoves the curtain separating the two hospital beds to the right.
“Hiiiiiii,” Layne says.
It is 7 a.m. on May 31, just minutes before surgery at the University of Colorado Hospital in Aurora. Sandi and Layne pray together.
Then the anesthesiologist walks in to go over the procedure. A nurse sets a box of Kleenex by Tamara’s feet.
The doctor looks at Layne, not her parents, and after a talk, she asks Layne a question. Do you want us to use live-saving measures to bring you back if something goes wrong?
“My heart just started pounding,” Tamara says, gripping Robert’s arm. Corbin fidgets in a chair.
Layne eyes get big, and she goes quiet.
“Um, yes,” Layne says.
As they prepare to wheel Layne away, Willie stares at her with disbelief and concern but doesn’t say anything. Layne glances over at Sandi, and Sandi mouths two words.
Her parents say goodbye, but they do not cry. Layne seems relaxed again.
“She makes it so easy,” Robert says.
Then they wish Sandi luck and go for a walk.
Layne feels calm in the operating room, though she hears beeping, and when she realizes that beeping is her heartbeat, it starts beeping faster. She looks at all the instruments they’re going to use on her with curiosity. Her anesthesiologist tells her to stop looking at those and encourages her to think about a cruise and relaxing on the beach with Corbin. Layne smiles because last time, during her ACL surgery, she was supposed to think about Ryan Gosling, and she woke up crying.
She goes to sleep, and Dr. Tom Bach goes to work on her.
Sandi hears the same speech and wipes away a tear. Surgery is scary regardless of whether it will save your life or not. Willie gives her a kiss, Eric a hug, and Niki weeps into Sandi’s nightgown. Sandi’s oldest sister, Dolores Garcia, walks down the hallway with her. The moment Sandi’s been praying for, dreaming about and crying over is here.
Dr. Trevor Nydam sits at a table and works on Layne’s kidney. He strips away fatty tissue while it waits on ice for its new home. Guns ‘N’ Roses plays, and at different times, both Nydam and Bach do a rough but passable imitation of Axl Rose. Bach prefers Rush, but this will do.
“The kidney looks great, Tom,” Nydam said.
The mood is serious but light, partly because they’ve done this many times, and partly because a kidney transplant is one of the best moves doctors can make in all of medicine, Nydam said later in an interview.
He took the Hippocratic oath, and part of that oath says “first, do no harm,” and that can weigh on his mind occasionally because a donation is, technically, breaking that oath. They’re putting a healthy person such as Layne through surgery for someone else. It’s a difficult equation, Nydam said. But the benefits to the recipient are so huge they outweigh that equation. They even render it moot.
At 9:40 a.m., they take the kidney into Sandi’s room. It’s silent. It feels like a moment of reverence. It is a big moment. There’s some pressure there, Nydam said, because the donor has just given up an incredible gift, at some significant cost, and the worst thing would be for them to do something to screw that up.
There’s a long apprenticeship for transplant surgeries, Nydam said.
“It takes some guts to do the first few cases,” he said. “You won’t let your average surgeon do it. You have to be able to handle the gravity of it.”
An assistant announces that the kidney is going in. Nydam flashes his wrists around a bit.
Less than a minute later, with Layne’s kidney safely tucked away in its new home, the music starts playing. “Keep Moving On” by the Nelson Brothers kicks things off. In a few minutes, the kidney starts peeing, as doctors put it, even before he hooks it up to Sandi’s bladder.
A kidney from a cadaver can take up to a week to start working, but because this is Layne’s kidney, and Layne is a healthy, young lady, it starts working in less than 15 minutes.
Less than an hour later, in her recovery bin, Layne opens her eyes.
“Where have you been?” she says to Corbin and her parents.