Daru Smith is in a hospital bed at the University of Chicago and his organs are failing. Specifically, three of his organs are failing—his heart, his liver, and his kidneys.
He’s fading, spiraling, winking in and out. Then he’s above his body, looking down at himself, looking down a dark hole. He’s back and sees doctors, white coats, hospital lights, and words, coming in like radio signals from the dark side of the men. Daru, we’re doing everything that we can to save you. Daru, you’re dying right before our eyes. Then he’s gone again, back into the void. He’s above his body, watching it spiral, watching it revolve like a piece of food as the dishwater drains out, and at the bottom of the drain he is standing tall. His body is up from the bed and he’s looking at nothing.
He is cradling something, protecting it against his chest. He’s carrying it down an impossible hallway that’s round with square edges. He’s walking towards the void, which is blindingly white as a wedding dress, a brilliant light waiting at the end. He hears a gentle, calming hum, a chord progression like a hymn. The needles and IV lines in his neck and arms have faded from feeling, the stiffness and pain has been lifted, his soul is soothed and calmer the closer he draws to the end of the hall.
Then he’s outside himself again and he’s behind himself as he walks down the hall. He has a thought. He knows this because he sees a light bulb, a literal light bulb in a cloud, and he thinks that sometimes horror has a sense of humor.
“Daru—excuse the language,” Daru tells me, snapping out of recounting his out-of-body experience. “Daru, this is the shit they say happens when you die! . . . I’m at peace, I’m walking towards the light, I’m gonna fucking die!”
He turns and runs. Scenes flash in his peripheral vision like ads on the el. He sees his three-year-old son, Daru Jr., at first only his son, until in front of him is a screen showing his son’s life: cutting his umbilical cord, changing diapers for the first time, holding him for the first time, feeding him for the first time, watching him crawl for the first time, holding his hand as he walked for the first time. Watching him saying dada for the first time.
Daru knows now why he will live. He can’t leave his son. He will never leave his son. Even as his organs fail him, he will not fail his son.
Five months before talking to me, 29-year-old Daru was open on an operating table, his chest cracked and ribs spread beneath an incision like a bloody Y, the signature of the triple transplant. You’d never know that by looking at him. He stands more than six feet tall with a medium build. When I meet him at the Starbucks at the corner of Drexel and 57th, on the first floor of the University of Chicago Medicine Center for Care and Discovery, his red Bulls track jacket really makes his mint green surgical mask pop.
Daru was recently the recipient of a triple organ transplant, joining Sarah McPharlin, also 29, in back-to-back triple organ transplant surgeries that began on December 19, 2018. This was the first time a hospital in the United States performed the complicated procedure twice in one year. These transplants happened in the span of only 27 hours.
The heart, liver, kidney triple crown is something of a specialty for UChicago medicine. The two procedures made the institution the most prolific in the world; seeing as how UChicago’s record number of these surgeries performed is now six, one understands the rarity of the procedure. Usually incorporating three organs from one donor—it’s easier for the body to accept new tissues from one source—the surgery requires balletic timing, steady hands, and mental preparedness for anything that could happen on the table.
Daru is congenial and talks to me as if I were an old friend. He leans in as he tells his story. He stays strikingly upbeat as he describes hardship and hard work, and only wavers when he tells the story of his out-of-body experience. Tears well up in his eyes when he gets to the part about his son.
The first hint that something was deeply wrong came on a staircase in 2014. “I’d try to walk up the stairs, and literally I couldn’t walk up the stairs,” he says.
A neck biopsy in 2015 led to the revelation that he had sarcoidosis in his liver. Sarcoidosis is a disease in which inflamed tissues build up on the body’s organs to form abnormal masses called granulomas. These granulomas can cause complications on the organs they encrust; shortness of breath, from granulomas in the lung, is among the most common symptoms. Often patients like Daru don’t know they have the disease until enough granulomas have built up and they have trouble breathing.
After the diagnosis, Daru felt fine for two years. He worked as a truck driver and would travel from the south side to as far as Pennsylvania and Tennessee, and soon resumed hitting the road—and breathing—like normal.
Daru had been diagnosed with diabetes a few years earlier. While shooting the medications into his arm he had an epiphany: he did not want to do this for the rest of his life. He began to eat in moderation and work out, and felt his health improve. So having already faced one chronic disease, he redoubled his efforts to change his lifestyle to fight the sarcoidosis. He used his mandatory half-hour breaks while his truck was being loaded or unloaded to walk around, jog, stretch, and do push-ups. He ditched the truck-stop burgers, chicken, and french fries and opted for vegetarian Subway sandwiches at rest stops, sometimes with herb and cheese bread when he wanted to splurge a bit.
“It wouldn’t bother me for a while, and then it would come back,” Daru says, snapping his fingers, “like a thunderstorm out of nowhere.”
On Christmas Eve day 2016, Daru had another coughing fit. “I remember, because my nephew was standing with me, and he had almost freaked out,” Daru says, laughing at the memory. His body racked with a violent cough, he knew a blackout was coming. He told his nephew to call an ambulance, then pounded his chest and slumped against the wall. As he slid down, his nephew tried to keep him calm. Daru laughed and told his nephew that he was the one who needed to calm down. As he began to come to, his cousin yelled that he was not breathing and paramedics put an oxygen mask to his face. The mask was like a quick charge to a battery, and his eyes shot back open.
One year later, Daru opened a window in the bathroom and was struck by a coughing attack again. He blacked out. He says the cold breeze probably woke him up. He was stuck between the toilet and vanity on the floor, breathing slowly and deliberately for 20 minutes until he could muster the strength to get back up. While he had a brief hospital stay, he resumed life as normal after being discharged. “Everything was cool,” he says.
At the University of Chicago, they told him that his heart inflammation, caused by the sarcoidosis, was progressing. “I’m doing everything,” Daru says, “and this shit is still killing me.” Before he was fully resigned to death, the birth of his son snapped him out of it. A flight of stairs had beaten him in January; after riding the exercise bike and walking the treadmill in cardiac rehab, by March he was skipping steps on his way up.
“All I could do is leave [my son] some sort of financial stability,” Daru says. He began working as hard as he could again that spring. The driving itself was fairly straightforward, but the manual labor—opening and closing the heavy trailer doors, strapping down his cargo, hopping in and out of the high cab, sliding the tandem axles, refueling in the cold—that worried him. He would tell loved ones that if he did not get in touch with them by a certain point on his route, they needed to call 911.
On one of Daru’s routine trips to UChicago to check on his kidneys, Jay Koyner, his pretransplant nephrologist, gave him bad news: the sarcoidosis had spread to his liver.
Every piece of bad news cut deep. “It fucked me up,” Daru says. “It hurt me bad. Every time I would go home and break down and scream and holler and punch the wall and ask myself, Why me?” Diabetes, a horseshoe kidney (a congenital condition causing his kidneys to be fused together), then sarcoidosis in his lungs, his heart, now his liver. “I got a death sentence.”
When Daru returned to the hospital in November 2018, unable to shake a cold, he figured it would be like his previous visits. As he lay in the bed in his room, he heard the raucous response to someone’s vitals crashing. Someone’s having a bad time, he thought. The doctors rushed in and placed him on a stretcher. He began to fade in and out.
The sarcoidosis of his heart was the primary culprit. Incapable of pumping enough blood through his body and getting enough oxygen to his other organs, Daru’s body had initiated a potentially fatal cascade. His heart, his liver, and his kidneys were shutting down.
But what had changed things was pneumonia. Daru had been hospitalized November 8 when an upper respiratory infection had taken a turn for the worse. “You imagine somebody who already has really bad heart failure and is super sick, and you add pneumonia on top of that?” Bryan Smith, one of Daru’s intensive care cardiologists, says. “You’re body doesn’t have much reserve.” He was admitted to the intensive care unit. “When I first met him, he wasn’t really responding much. He was a little delirious.”
Seeing this young patient, soft-spoken and sitting in the room, with his heart and lungs and liver and kidneys failing, Smith knew they would be in for a fight. It was crucial to keep Daru’s spirits up and keep his mind and emotions in a good place while doctors could keep him healthy long enough to receive the transplant. “I remember us having a number of conversations early on,” Smith says of their pep talks. “And I did see a different person emerge after that.”
After his out-of-body experience, Daru woke up in his hospital bed. His condition soon improved. The hospital became his primary residence as he walked around the halls. He needed to show he had the will to live to be put on the list for the heart, liver, and kidney transplant that he now desperately needed. Daru promised himself he would be out of the hospital soon.
“You could see that he took ownership and was more invested in the process” once he knew just how severe his sickness was, says Koyner, who remains active in his posttransplant nephrologist care. “He worked as hard as he could to comply with the instructions that he got.” Between the bad news and Smith’s pep talks, Daru took his treatment to heart. The doctors tell me he was buoyant, insightful with his questions, charismatic, and easy to care for.
“The person he became when he was waiting for transplant—he was such a model patient,” Smith says.
On Sunday, December 16, Daru had another spiritual experience. He told God that he felt he could no longer stand to be in the hospital because his son needed him. Three times, Daru told himself he would have a donor by the end of the week, getting stronger with each repetition. After the third time, he says he felt butterflies in his stomach and a sense that everything would be all right.
Two days later, Bryan Smith came into his room. Daru had a donor. The transplant began at 3:07 PM on Wednesday, December 19.
Daru was under the knife for a total of 17 hours and 11 minutes, according to the university. First came the heart, placed into Daru’s chest by Valluvan Jeevanandam, who has played this role in all six of the triple organ transplants performed at UChicago Medicine so far. Next, Talia Baker transplanted the liver; after that, Yolanda Becker transplanted the kidneys.
Sarah McPharlin’s triple transplant was of a similar order and duration. McPharlin, an occupational therapist from Michigan, had already received a heart transplant earlier in her life for a rare disorder. After that heart failed, a series of setbacks led to fluid accumulating in her abdomen and legs, eventually damaging her kidneys and liver. Daru says he and McPharlin met in physical therapy and bonded.
Daru left the hospital on January 17. He credits surviving his ordeal and his recovery to his mind-set and the medical team uniquely suited to saving his life. “He’s truly just a fighter,” Smith says.
“The post-op can be quite trying,” says John Fung, a transplant surgeon and codirector of the UChicago Medicine Transplantation Institute, who has been involved closely with Daru’s care. Beyond the possible medical complications associated with major surgery—luckily, liver transplantation protects the other new organs from rejection, Fung says—a patient’s muscle mass and endurance have decreased from being bedridden. Just getting back to normal requires a level of perseverance.
Beyond a heart, liver, and kidneys, Daru has emerged from his moment in medical history with a powerful new outlook. “I really think you’ve got to believe in yourself,” he says. “That’s what it’s gonna take. You have to believe in yourself.” v