Chris Klug stepped out of the elevator onto Floor 7West at University Hospital. This was the transplant floor, the walls near the waiting room adorned with plaques from organ recipients and their families thanking the doctors and nurses for "the gift of life."
The staff greeted him immediately. Everybody seemed to want to help. As Chris was led to his room, one nurse asked how he was feeling. "A little sore...we water-skied our brains out yesterday. I'm excited but nervous," he replied. "I'm excited to get split open like a trout."
Chris's girlfriend, Missy, and his father, Warren, hovered nearby. Warren commented on everyone's efficiency. "Well, we've done 28 of these since last October," the nurse said.
When first-year resident and Aspen buddy Thos Evans showed up, he told Chris that after his plastic-surgery rotation was over, he would help repair the stomach scars Chris would have. "We'll get you fixed up for those underwear commercials," Evans joked.
Chris's loon laugh rang out. He'd been working extra hard on sit-ups during the two and a half months he'd spent waiting at the top of the transplant list -- to speed up his return to the professional snowboard racing tour and to continue his quest to medal in the 2002 Winter Olympics in Salt Lake City. He looked down, mourning, "Goodbye, abs. See ya next year."
Dr. Josh Goldberg arrived. Short and dark-haired with a goatee, the third-year resident already exuded a surgeon's confidence. He was going to be assisting Dr. Igal Kam, the chief of transplant surgery.
"Kam wants to roll," Goldberg announced. The procurement team -- "We don't say 'harvest' anymore" -- was at St. Anthony Central Hospital preparing the donor.
"Do we get our money back if this doesn't work?" Warren Klug quipped.
"Yeah, do I get a $2,000 rebate for my old liver?" Chris added.
Goldberg went right along with the humor. "If you're not happy, return the liver and we'll give you a full refund." Then it was back to business as he explained that the entire procedure would take five to six hours. Using his own body to demonstrate, he described how the incision would be made starting just below the sternum, running straight down, then off at an angle toward his right hip.
"If you added another cut to the left, it would look like a Mercedes symbol," Chris said of his impending scar.
"Or a peace sign," Goldberg offered. He then reviewed the steps of the surgery, rattling off the parts that would be getting sliced: the vena cava, the hepatic artery, the portal vein.
"I don't want to hear any more," Chris said, making a face. "I might leave. Let's just do it."
Goldberg ignored him. The patient needed to be told that there was a possibility of post-surgery pain, infection and bleeding. Complications could lead to another operation. Or death. Such problems were, however, very rare with Kam.
"That's why they're the best liver-transplant team in the country, if not the world," Evans said.
"The world," said Warren, who had been with his son months ago when Kam assured Chris that he didn't lose any in surgery. The Klugs had done their research, too. They asked around about liver-transplant programs elsewhere, and the word came back that there was no better team anywhere.
"That'd be my vote, too," Goldberg acknowledged, "but I haven't worked with them all."
"The infection risk is low, right?" Missy asked.
Goldberg nodded. "The whole trick post-surgery is finding a balance between enough immuno-suppression, to keep his body from rejecting the liver, and too much immuno-suppression, which invites infection."
Chris wanted off the subject and onto one that interested him: his comeback. He noted that pro basketball star Sean Elliot had told him that he'd returned to his sport after a kidney transplant without any setbacks.
"Well, he's the man," Goldberg agreed. "But you've got to take it easy for a while." Everybody in the room who knew Chris laughed at the suggestion.
"Six weeks before you do much activity," Goldberg cautioned.
"Hear that?" Missy asked her boyfriend.
"Enough of negatives," Chris replied, a little testy.
Chris wondered about the donor liver. He wanted to know if it was healthy or if he would be back again in a year or two, having to go through it all again. If another liver could be found in time.
Because there were confidentiality issues, the donor's identity was protected. But according to the hospital grapevine, the donor was a thirteen-year-old boy who'd been shot in the head; otherwise, Chris was assured, he'd been perfectly healthy. The news sobered Chris. "I hate to think that some poor kid died," he said. "His mom and dad are damn generous to do this for me."
Missy and Warren immediately thought of the newspaper article they'd read on their flight to Denver about the teenager killed by a friend. Warren wondered aloud if a thirteen-year-old's liver wasn't too small. But Goldberg assured them that a developing liver would adapt to a new body even better than an organ from an adult.
Goldberg left, then returned a few minutes later. There was a complication that might delay the surgery. Apparently, there was a problem finding a proper recipient for the donor's heart; they thought they had one, but the match was no good. And they couldn't take the liver until they were ready to take the heart.
Chris and Missy walked to a small hallway with a row of windows that faced the setting sun, which was painting a brilliant display over the mountains. Several stationary bikes were lined up, and Chris started pedaling one.
Now that the initial excitement had died down, he was feeling guilty about being so happy that his wait was over. He was going to be saved, but only because a boy had been killed. He thought about how his family would now be going on with their lives -- to the Olympics, if all went well -- but somewhere in the city a mother was grieving for her son. Her life would never be the same.
The pedals on the bike spun faster and faster as the sun dipped behind the silhouette of the mountains. Chris's face and eyes reflected the oranges and reds of the dying day. He wished he were in Hawaii, sitting on a surfboard as waves gently lifted him up and cradled him back down. Out there, he felt closer to God.
The thought evaporated when Goldberg rounded the corner. The surgery was postponed until morning, by which time they'd have a recipient for the heart, he said. Chris could check out of the hospital if he wanted, get some dinner and spend the night in a hotel.
In a perfect world, the paths of Chris and his donor would have never crossed. The shooting victim was born in 1987, the year fifteen-year-old Chris told a reporter he'd be in the Olympics, racing in an event that didn't yet exist. The boy's parents had split up, and by the time he was thirteen, he lived most of the year with his father in California. But fate brought him to Colorado in July 2000 to visit his mother.
His mother and grandmother lived in a north Denver trailer park, where a banner near the entrance hailed the benefits of owning a mobile home. "Stop Dreaming and Start Living," it read. It was an older park, shaded by large cottonwood trees. The vintage homes were single-wides, many in need of paint and repairs. Some tenants were retirees on fixed incomes who tended to keep their homes and the tiny lawns well maintained. Others were young working couples with toys in the yard and hopes for the future. But the park also had a reputation with county deputies as "transitional" housing for certain elements just out of jail -- or heading there.
The boy's mother was 33, tall and blond with tattoos, and she'd had her own run-ins with the law. Back in 1982, when she was arrested for driving under the influence of alcohol, she'd told police her nickname was "Beauty." She was arrested again for driving under the influence in January 1998; two months later, she was arrested for larceny and interfering with police officers. A year later, she was apprehended again, this time for carrying a concealed weapon, which she topped off with several "failure to appear" and "contempt of court" citations.
The boy was a pretty typical adolescent. He liked radio-controlled toy cars, riding his bicycle and playing video games. The neighbors in the trailer park considered him a good kid, a quiet follower who'd been tagging after a fourteen-year-old who lived nearby with his parents. Although neighbors sometimes called the sheriff's office complaining about the two boys trespassing and smoking on their property, the visiting thirteen-year-old seemed likable enough.
On the night of July 25, the mother went out, leaving her son playing video games. A short time later, there was a knock on the trailer door. It was the fourteen-year-old neighbor, a different kind of kid altogether. His parents had trouble controlling him. He came and went as he pleased and refused to go to school most days. He'd been smoking pot, drinking alcohol and running with an older crowd for years.
Then again, the fourteen-year-old's parents had experienced their own difficulties. The mother had been arrested on domestic-violence charges of disturbing the peace and assault back in 1992 and for "possession of dangerous drugs" in 1993 and 1995, as well as being cited in several "failure to appear" warrants. The father had a 1994 arrest for driving under the influence. The son had his own record: minor scrapes with the law, juvenile stuff such as trespassing and criminal mischief. That was about to change.
He had crawled out of bed about noon, rolled a joint and left his parents' mobile home to visit another kid, who also lived in the park. They spent the afternoon smoking pot and playing with a .38-caliber revolver called a Titan Tiger. It was a cheap, evil-looking thing with a short-barrel and the serial number filed off; it wasn't much good for anything except shooting people at close range. The two friends eventually left the trailer and walked to a nearby middle school, where they hoped to find some other kids selling pot. A little later they returned to the trailer park. The fourteen-year-old dropped his friend off, stuffing the gun into his pocket as he left.
At about 9 p.m., he returned and knocked on the thirteen-year-old's door. He went inside, and a few minutes later, a single, loud report issued from the trailer. The older boy burst out of the door, then stopped and went back in. He re-emerged moments later and fled into the night.
When the mother returned to the trailer not long afterward, she found her son slumped on a bloodstained couch. He'd been shot in the eye but was still breathing. She called 911, believing that there might be hope. But the bullet had entered the boy's brain, and he was already dead; his body just didn't know it yet.
An ambulance whisked the boy off to St. Anthony Central Hospital, where he was placed on life support. At the hospital, a detective interviewed his mother. It was obvious she'd had a rough life. Still, while she may not have been anyone's candidate for mother of the year, she had obviously loved her son and blamed herself. She said she had just stepped out that night to buy cigarettes; if only she'd been there, this never would have happened.
Back at the trailer park, it didn't take detectives long to identify the shooter. A neighbor reported that the fourteen-year-old had stopped by, shown him the gun and told him, "I shot that kid." The boy was found at a pay phone at a local billiard hall and arrested.
At the police station, the fourteen-year-old said he and the younger boy had smoked pot and played video games before playing with something more realistic: a gun with a single bullet in it.
"I said, 'Hey, take the bullet out of the gun.' And he said, 'All right'...I was smoking pot at the time," the suspect told the detectives. "And then I said, 'Well, let me see it.'"
He said he pointed the gun at his friend's head, thinking that the bullet had been taken out. And when the younger boy grabbed for the gun, "It just went off, you know," the older boy told them, crying a little. "And it, it just...it was all bright, and my ears were ringing."
He'd left his friend bleeding on the couch, but returned for his marijuana pipes and the gun, worried that his fingerprints would tie him to the shooting. He'd had to reach under the slumped body to dig the weapon out from between the cushions of the couch.
He'd run back to the house of the other kid he'd hung out with that day. It was this friend, he said, who'd loaned him the gun. The two discarded the spent shell, and then he hid the gun in a field behind the mobile home park. After that, he'd settled down by smoking more pot.
Only after he'd gotten high did he think to summon help -- but not an ambulance. He'd called his mom, who was at her job as a cocktail waitress.
After the confession, the detective talked to his superior, who asked, "Think he's telling the truth?" The detective shrugged. It was hard to say. The shooter wasn't as upset as might be expected for someone who had "accidentally" just shot his "best friend." Toward the end, he'd shed a little tear, but it seemed more like an act than a show of genuine remorse. Then there was the coverup -- returning to the scene to retrieve evidence, reaching under the body of a bleeding friend; that was pretty brazen and cool-headed.
The police found the gun in the field. But with the serial numbers gone, there was no way to trace it to its original owner. The boy whom the fourteen-year-old had identified as the owner denied knowing anything about the gun.
The thirteen-year-old lingered on life support through the night and into the next day. There was no chance he'd recover. The sole purpose of the machinery that kept his heart and lungs functioning was to prevent his organs from deteriorating.
After the neurosurgeons had declared the boy brain-dead, his mother was approached by a representative of the Denver-based Donor Alliance, a nonprofit agency that coordinates the recovery of organs and helps match organ and tissue donors with recipients. There was something her boy could still do. His heart, his lungs, his kidneys, pancreas and liver could save the lives of others. But only if the mother agreed.
In an imperfect world, she was asked to put aside her grief for a moment and act for the good of strangers. And in that moment, she made a heroic decision. She reached out and gave the only thing her child had left, a gift of life.
A little before 6 a.m. on July 28, Missy and the Klugs gathered in the waiting room on the transplant floor. Chris sat on the couch, absorbed in a surfing magazine. Missy leaned against him. Chris's sister, Hillary, sat nearby. She had recently returned from France, where she had watched Lance Armstrong take a second triumphant Tour de France spin through Paris.
Warren and Kathy, Chris's mother, stood and sat and stood again. False bravado hung in the air. Warren noted that the record number of laps around the transplant floor for a liver-transplant patient in the first 24 hours after surgery was thirteen. Kathy responded with a strained laugh. "Let's not turn this into another sporting event," she said.
Chris didn't even look up from his magazine. He was frightened but trying not to let his family or girlfriend know just how much. Missy shut her eyes. She couldn't imagine life without Chris and was realizing that nothing was guaranteed on this day.
No one had managed to get much sleep. After Chris's release from the hospital, they'd gone to dinner at the Cheesecake Factory, where Chris, who'd been told he couldn't eat after midnight, stuffed himself with chicken and dumplings. He was still loading up when Thos Evans showed up and advised him to stop eating; a liver transplant was better on an empty stomach, he said.
About midnight, they returned to a downtown hotel. They all said a prayer and hugged each other goodnight before heading off to their rooms.
Chris and Missy stayed up watching television and calling friends until about 2 a.m. They laid in bed and talked about the morning. Chris worried that after he'd gotten to this point, someone could still "come in Status 1 and snake my liver." He said it lightly, but Missy knew that his fear was real.
After Chris had been moved to Status 2B in April, he was introduced to the transplant-floor staff and then attended a two-hour class given by transplant coordinator Tracy Steinberg. Steinberg had gone over the myriad things Chris needed to know about, such as the anti-rejection drugs he would need to take for the rest of his life.
She'd also explained how the United Network of Organ Sharing worked, and stressed that nothing was guaranteed. He might get the call saying there was a potential donor and that he needed to report to the hospital. But then, after coming all that way, maybe even going through the pre-operation preparations, the organ might be rejected by the surgeons or assigned to a patient who was more suitable for reasons such as age or size.
Perhaps, as Chris feared, someone might "snake it." As a Status 2B, Chris could be just about on the operating table, then lose the liver at the last minute to someone with a higher status level at another transplant hospital within Region 8, which includes Colorado, Wyoming, Kansas, Nebraska, Iowa and Missouri. The object is to save lives, so UNOS rules require that organs be offered first to patients who have the most serious medical predicaments.
On the other hand, there were occasions when a Status 2A or Status 1 would be too sick for the operation. The anti-rejection drugs worked by suppressing the immune system; if a patient was already battling an infection, suppressing his immune system might kill him before liver failure did.
In spite of his worries, though, Chris was optimistic. He had his comeback all figured out. He'd get through the operation and then out of the hospital in record time; after that, physical therapist Bill Fabrocini would put him through an intense rehab program to get his body back in shape. Chris thought that he could do it and still make the October training camp with the U.S. snowboard team on Mt. Hood in Oregon.
Exhausted, Chris and Missy fell asleep sometime after three, only to be awakened at five to go back to University Hospital. On the ride over, Chris didn't say much. Instead, he just listened to his father talk about his being in God's hands and prayed that it was true.
Back on the transplant floor, Chris was readmitted and ushered to the waiting room. A short time later, nurses arrived with a gurney to transport him down to the pre-op room. His father quickly gathered the family in a circle; they held hands as he prayed, thanking God for "this miracle...while our hearts go out to the family of the young man who died." Then, like a quarterback breaking a huddle, he finished with a rousing "Yea, God! Amen."
Out in the hall, Chris looked uneasily at the gurney. "Can I walk?" he asked.
No, he was told, hospital rules wouldn't allow it. He reluctantly climbed aboard. Missy and his family escorted him down the elevator and into the pre-op room, which was large, dark, and chilly as a morgue. A row of empty beds were lined up against one wall. Across the room, Chris lay on the gurney in a halo cast by the only light in the room.
At 6:10 a.m., anesthesiologist Tom Henthorn arrived. "The liver's here," he said. "It looks good."
Chris perked up. "Really? Is it perfect?" he asked.
Well, Henthorn backtracked a little, the surgical team would have to inspect and approve the organ. Nevertheless, that was the report he'd heard from the recovery team that had procured the organs at St. Anthony.
A short, barrel-chested man with long, wavy silver-gray hair tucked back behind his ears and a thick gold chain around his neck strolled into the room. Even without the green surgical scrubs he wore, there was no mistaking him. Chief of transplant surgery Igal Kam appeared to be in no hurry as he looked about with brown eyes beneath arched brows, a king surveying his subjects. "God has entered the building," a nurse standing next to Kathy Klug said under her breath. Chris was lucky, she added. "He gets the boss."
"There's certainly an air about him," Chris's mom replied as Kam went to speak to her son.
Rather than being off-putting, the imperious bearing of the surgeon was reassuring to Kathy. Since the transplant program's reincarnation at University Hospital in 1988, more than 500 livers had been transplanted, and, Kam noted, he'd done "most of them." Now he was going to get her boy to the other side.
Kam announced that he had done a visual inspection of the donor liver, and the team was ready to proceed. Chris was getting sleepy, but he wanted more reassurances. "Does it look perfect?" he asked again. But Kam would say only that it looked fine, and then he was gone to scrub up for the operation.
More nurses arrived to wheel Chris off to the operating room. Up to this point, he'd appeared nonchalant. Now he struggled not to cry as he looked up at his mother. "Am I ready for this?" he asked her.
Kathy Klug smiled at her son. She thought about all the times she had looked down on him lying in a hospital bed. Her infant with his pneumonia. The ten-year-old with asthma whom she'd willed to breathe in, breathe out. The young man who was told he might never walk normally again. What do you love, Chris? I love the starting gate, Mom. I love the possibilities. She thought about the people who'd gotten him through the bad times: his family, who made sure he knew he was loved, and the doctors who had cared for him and, as he'd once told his pediatrician, "took away the fear." He'd always shown such determination in the face of adversity, whether it was his health, injuries or disappointments and, with the help of those people, he'd always come back stronger than ever. The Bounce-Back Kid. It was as if he'd been in training for this greatest test of his will and courage.
Yes, she'd thought about his question a lot and knew how to answer him. "Chris," she said, "your whole life has prepared you for this."
Chris's eyes were shiny with tears, but he managed a smile. "I'm ready," he said quietly as the nurses wheeled him away.
"We love you, Chris," his family and girlfriend called after him as his gurney was pushed through the doors.
Missy stifled a sob as she and the family got on the elevator. Kathy, her voice wavering, cautioned, "The floodgates, Missy. The floodgates."
When the thirteen-year-old victim's mother gave her consent to Donor Alliance, the care of his body was taken over by one of the agency's coordinators, all of whom are registered nurses. The boy's vital statistics, such as age and blood type, were fed into the UNOS computer, and a regional list was run. There were no Status Level 2A or Status 1 patients who qualified for the liver, so the computer began ranking the patients on Status Level 2B. Chris's name had popped up at the top of the roster, thanks to the three years he'd spent on the waiting list.
Once a heart recipient was located, the other organs could be removed, and the procurement teams moved in. There were two main teams: One would enter the chest cavity for the heart and lungs; the other -- the solid-organ team -- would open the abdomen for the liver, kidneys and pancreas. After the major organs were removed, others would come for the corneas and skin.
The two main teams worked in stages. The first opened the donor's chest but left everything in place -- the heart beating, the lungs rising and falling with the whooshing aid of a ventilator. The abdominal team then moved in, opened the abdominal cavity and got their three organs ready to remove but left them hooked up to the blood supply. The victim was beyond help, but the teams were as precise in their surgery as the transplant surgeons would be. They had to leave large enough segments of arteries and veins for other surgeons to attach to reciprocal places in their new bodies.
When the abdominal team finished its preparatory work, the first team returned to remove the lungs, and, finally, the heart. With that organ no longer supplying blood, the second team quickly removed the kidneys, pancreas and liver. The entire procedure took about two hours.
Once removed, the organs were immediately flushed with a preservative solution and placed on ice. Each of them was then rushed off to a recipient -- the liver to University Hospital and down to the operating room where Chris had been brought.
Chris lay naked on a steel table. His head and shoulders were shrouded beneath a blue half-tent, his face visible only to the anesthesiologist. Electrodes had been placed on his chest to monitor his heart rate; other electrodes were attached to his head to measure his brain waves, which would let Henthorn assess his level of consciousness. Under his careful ministrations, Chris slept.
On the other side of the blue tent was the rest of Chris's body. He was covered from his hips to his feet with another blue sheet, but his torso, from his rib cage to his hips, had been wrapped in a thin, yellow plastic covering called Ioband, which was impregnated with iodine to cut down on the risk of infection. The blue sheets represented areas that were not to be touched by anyone or anything that was not sterile; the yellow was where the surgeons would operate.
Kam stood at Chris's right side wearing an odd pair of glasses called "loupes" that had what looked like microscope lenses attached. To Kam's right was a large tray bearing a wide assortment of instruments -- forceps, scalpels and curved needles already threaded. Surgical nurse Anthony Adams hovered over the tray, counting and recounting the supplies, making sure that all was in order, while other nurses bustled about assisting him. Goldberg, also wearing loupes, stood across the operating table from Kam. Ignored for the moment in a corner of the room was a small plastic basin covered with a sterile blue towel.
There was a momentary pause, like a symphony orchestra between tuneup and that first note of Beethoven's Ninth, then Kam spoke a single word: "scalpel." Adams handed over the instrument and noted the time of the first incision: 7:47 a.m.
Kam started at the middle of the abdomen and made a diagonal cut through the skin toward Chris's right hip. From his original starting point, he then cut up toward the sternum.
Instead of continuing through the next layers with the blade, he handed it over and called for a "bouvie." The penlike instrument, which cuts by using electricity to quickly burn through flesh, has the effect of also cauterizing severed blood vessels. With it, Kam proceeded through the fatty layer beneath the skin -- a very small layer on Chris -- and then through several layers of muscle to reach the abdominal cavity.
With Chris split open, Kam placed retractors along the sides of the cut to spread his abdomen, creating a gap that revealed the internal organs: pink-gray intestines and stomach and a large, dark-purple liver.
With some surprise, Kam immediately noted an abnormality in the liver. Laid on a surface, a liver resembles a partially deflated football. A closer inspection of a normal liver would reveal that it has two lobes of fairly equal size, attached in the middle. However, as Kam pointed out, the left lobe of Chris's liver had atrophied and was hardly bigger than a child's hand, while the right lobe was much larger than normal.
Kam didn't know if the defect was genetic and unrelated to the current problem, or a result of the disease. Perhaps, he speculated, the left lobe was the area most affected by the PSC, and the right lobe had increased in size to compensate. There was no other outward sign of the PSC. If the liver had been destroyed by hepatitis or cirrhosis caused by alcohol, there would have been scar tissue throughout the organ with nodules of liver tissue in between the scarring where the organ tried to rebuild itself. Such a liver would have a lumpy appearance, as opposed to the smooth look of Chris's liver, which a disease was destroying from the inside.
Kam didn't spend more than a moment considering the abnormality. It didn't matter, the liver had to come out. Reaching deep into the cavity to move the organ aside, he began what would be hours of work to free the liver by first cutting the bile duct where it exited the liver. Inside the liver, the bile ducts branch out like vines before joining the right and left hepatic ducts, which then merge into the "common" duct that carries bile from the liver into the intestines; it was this common duct that Kam severed. The duct was then tied off near the intestines.
The team began working quickly, but methodically, to cut off the liver from its complicated blood-supply system. Almost all organs have arteries that bring oxygenated blood from the heart and veins that return "used" blood to the heart to be pumped into the lungs for oxygen. But the liver also has a third "portal" system that brings nutrient-rich blood from the digestive tract -- intestines, stomach and spleen -- into the body's "chemical factory," the liver, where the nutrients are altered and packaged for use by the body.
Using forceps, Kam first clamped and then cut the hepatic artery. (About the size of a drinking straw, the artery brings oxygenated blood from the heart to the liver via the aorta, the biggest artery in the body.) He then repeated the procedure with the portal vein, a white tube about the size of a pinkie. Cut off from the hepatic artery and portal vein, Chris's liver began turning a blotchy gray-brown. Next in line was the hepatic vein, which carries blood back to the heart.
Finished with these, Kam lifted the liver to get at the connective tissue that attached the organ to the abdominal wall. Doing so revealed the purple-pink muscle of the diaphragm that separated the organs in Chris's abdominal cavity from his heart and lungs, which could still be detected by their regular movements. Goldberg followed along with a bouvie to cauterize blood leaks with a blue arc of electricity and a buzzing sound, then tiny white wisps of smoke.
The next step was the diciest part of the operation: separating the inferior vena cava from the liver. Vena cava translates rather undramatically from the Latin as "hollow vein," but it is responsible for returning the blood from the lower part of the body to the right atrium of the heart. It carries a lot of blood, and puncturing the vein could result in death within fifteen seconds.
In the pioneering days of liver transplants, surgeons used to clamp off the vein at either end of the liver and remove the portion that was inside the liver along with the organ. Then, like connecting garden hoses, they would attach the vena cava ends from the donor liver to the recipient's counterparts. The problem with that was that the heart was cut off from more than half of its blood supply, and its response was to increase the rate at which it beat, while blood pressure dropped. The longer the vena cava was cut off from the blood in the lower half of the body, the greater the danger of a heart attack or stroke.
Although surrounded by the liver, the vena cava is not actually an integrated part of the organ. It's like an interstate highway that passes through a city: There are a few "on ramps" -- small veins that drain from the liver into it -- but otherwise, one doesn't have much to do with the other. Kam was going to attempt to separate the vena cava from the liver while leaving the vein intact, a relatively new procedure he'd helped develop.
The team worked with few words, but a radio in the operating room was tuned to KBCO. The chief surgeon began freeing the vena cava just as Jimi Hendrix launched into "All Along the Watchtower." There must be some kind of way out of here/Said the joker to the thief...
Goldberg's head bobbed to the beat as Kam began working from the bottom of the liver up. As he lifted the organ away from the large vein, he and Goldberg found the "on ramps," which he cut and passed a suture through that his assistant promptly tied off. If all went well, Kam wouldn't have to clamp the vena cava and cut off the blood supply to the heart, except for a brief time when he would have to tie the ends from the donor's vena cava into Chris's system. There are many here among us/Who feel that life is but a joke...
After about a half-hour, the vena cava was freed from Chris's liver. Paul Simon's "Graceland" was playing when Kam, his scrubs smeared with traces of blood and the band of his surgical cap dark with sweat, asked nurse Adams to make sure there was enough ice on the donor liver. I may be obliged to defend/Every love, every ending/Or maybe there's no obligation now..., sang Simon as Adams hopped down from his perch, walked over to the plastic basin and looked under the blue towel. He added more ice and returned to his post. Maybe I've reason to believe/We all will be received/In Graceland...
Thos Evans entered the operating room but hung in the back where he could not see his friend's face or much of what the surgeons were doing. He'd have preferred not to be there -- this was just too personal -- but he knew that Chris's family was in the waiting room, anxious for any news. Kam assured him that everything was fine, and he risked a peek.
"Would you look at those abdominal muscles?" Evans said with admiration.
Kam deadpanned, "This is a liver, not a muscle."
"Thank you, Doctor Kam, for pointing that out to me," Evans said with a laugh as he turned to walk back out the door.
"Sure, you're welcome," Kam replied. The surgeon glanced up at Goldberg. His mouth was hidden by a surgical mask, but his eyes were smiling.
For several hours, the surgical team of Kam, Goldberg and Adams worked as one organism with six hands. Goldberg, who had assisted with ten liver transplants, anticipated Kam's next moves with only the occasional correction or guidance. Adams was even more automatic.
While the surgeons operated, Henthorn came around from his end of the table to check the plastic canisters that collected the blood suctioned off from the abdominal cavity. "He's doing great," he said.
At 10:02, Kam announced that the liver was out. He handed it to a nurse, who placed it in another plastic basin. In the meantime, the new liver had been flushed with a saline solution to remove as much of the dead boy's blood and the preservative as possible -- just that much less foreign material for Chris's immune system to react with.
The boy's liver was smaller than the organ removed from Chris. Devoid of blood, it was tan in color as the surgeon slipped it into its new home. With hardly a pause, Kam began to reverse the steps he'd been taking for the past two and a half hours by attaching the vena cava ends from the donor liver to Chris's vena cava, which he now clamped.
With the donor liver off the ice and still lacking a blood supply and Chris's heart under stress, it was important at this point to work as quickly as possible. "You can have the vena cava back in four minutes," Kam told Henthorn. At 10:25, he released the clamps on the vein, and the anesthesiologist immediately reported that Chris's blood pressure was climbing back to normal while his heart rate slowed. "The heart's happy to see all that blood," Henthorn said.
Next, Kam began to attach Chris's portal vein to its counterpart on the new liver. Using thread so fine it was hard to see with the unaided eye, he began to sew the two severed ends together using one continuous suture. It was like sewing the mouth ends of two balloons together into a single passage, only balloons are made of stronger stuff.
No one remarked on the irony when the band Dada came on the radio singing Shot my gun into the night/I'm going to dizz knee land/I just saw a good man die...
Kam made pass after pass with his needle, each perhaps a thread's width apart, around the circumference of the vein ends.
How many passes? No one had ever counted.
After the portal vein was sewn together at 10:40, Kam asked how long the donor liver had been out of the ice. "Thirty-five minutes," Adams replied. Kam released the clamp on the portal vein, and almost immediately, Chris's new liver regained a dark-purple color as blood rushed in.
Kam didn't wait to admire his handiwork. He started right in on the hepatic artery. Fifteen minutes later he released the clamps, and the artery turned a bluish purple and began to pulsate to the rhythm of Chris's heartbeat.
Almost as an afterthought, Kam took the bouvie and burned a white bubble the size of a fish bobber off the liver. It was the gallbladder, which, other than as a storage place for bile, serves no purpose and is a potential source of problems in the form of gallstones.
Throughout the operation, Kam's cell phone had rung and was answered by one of the nurses, who relayed the messages. One call was from Donor Alliance, concerned because their calendar didn't indicate who would be on call at University Hospital or Porter Adventist Hospital, which has a smaller liver-transplant program, for an upcoming weekend. Kam didn't even look up as he told the nurse to assure the agency that "one of us will cover." Donor organs were too hard to come by for any to be wasted because of a scheduling snafu.
Another call suggested that Chris's fear of someone "snaking" his liver had almost been realized. A higher-status-level patient had been brought in during the night, but the patient was running a high fever and therefore not eligible for the operation. After he dealt with that call, Kam began lifting Chris's intestines out of the abdominal cavity and piling them on top of his groin area. The surgeon deftly handled these slippery ropelike parts, cutting here, stapling there, and burning a small hole at one spot just as the funky bass lead to Stevie Wonder's "Superstition" got the heads of Goldberg and the nurses moving in unison. The mood in the room was lightening; they all knew the operation was almost at an end.
When you believe in things that you don't understand... Kam connected the donor liver's common bile duct to the hole he had burned in the small intestine rather than to Chris's tied-off bile duct. The duct could not be attached to the new liver for fear that whatever caused PSC might find its way in from the old duct. Even with that precaution, there is a chance that the PSC could return someday, but such cases are rare. With that step completed, the surgeon plopped the intestines back into place.
At 12:20, Kam removed the retractor that had been holding Chris's belly apart. The yellow Ioband was stripped off, after which Kam used the bouvie to burn a hole through the skin and muscle near Chris's navel. A tube was inserted in the hole that would serve to drain any fluid, including blood, from Chris's belly while he recovered. Kam began closing the enormous wound by stitching a suture through the muscle layers as Goldberg followed behind, tying the sutures into knots. Finally, there was nothing left for Kam to do but staple the outside of Chris's skin together while Goldberg stitched in the drain tube.
At 12:50 p.m., five hours after the first cut, Kam threw up his hands like a concert pianist finishing a recital. "Thank you," he said to those he worked with, then walked away, removing his gloves, gown and mask. He placed the loupes carefully in a felt-lined wooden box.
As Kam spoke into a tape recorder, making notes about the operation, Henthorn began waking Chris with different drugs. A nurse bent down near his head and called his name. His eyes flew open, uncomprehending, then closed again. He began to shift restlessly and attempted to pull the intubation tube out of his nose.
"Chris, you're doing okay," a nurse assured him. "Can you try to move your leg?"
The request was perhaps a mistake. Chris began moving too much and struggled to get up as the nurses tried to hold him down. "Chris, you've had your operation," the same nurse said. "You've got yourself a new liver."
Chris said something indistinguishable but calmed down. He seemed satisfied to slowly flex and straighten his legs. Kam left the room to go talk to the family as Chris was moved onto a gurney for transport to the recovery room.
In the waiting room, Missy and the Klugs were getting antsy. Evans's report had been hours ago. To pass the time, Missy had started a journal of sorts on the pages of Chris's surf magazine. "It hurt me to see him so frightened," she wrote of the moments before he was wheeled off to surgery. "I told him to dream of waves and our next surf vacation. I hope he can."
As they waited and prayed, they had all been reminded again of the price that had been paid for the new opportunity. An older man sitting in a wheelchair near them had been listening in on their conversation while he read the newspaper. He finally asked if they had a family member who was getting a liver transplant. When they told him, the man nodded and held up the newspaper he'd been reading and showed them a headline and story.
"Boy Wounded by Gunshot Dies: Police Investigating to Determine if Handgun Shooting Was Accidental," read the headline.
"A thirteen-year-old boy, allegedly shot by a fourteen-year-old friend, died Thursday at St. Anthony Central Hospital," the story began.
"'This is all a nightmare,'" the boy's grandmother was quoted. "'I'm just hoping it was an accident.'"
"The fourteen-year-old could face charges ranging from first-degree murder to criminally negligent homicide," the story went on.
"'I think people should be more aware of what's going on in their household, and if they have guns, lock them up where children can't get hold of them,'" the grandmother said. "'Nobody's been exposed to guns in our family. I don't allow them.'"
She was quoted as saying that her grandson was "'a typical teenager...He was just a lovable kid. Everybody loved him.'"
"The family was left to find solace Thursday in those memories and the knowledge that he might help others to live because his organs were donated," the article concluded.
As parents, Warren and Kathy Klug wondered at the compassion the boy's mother had demonstrated in the midst of her grief. They were all signed up to be organ donors in the event of a tragedy, but they knew how devastated they would be to lose one of their children and couldn't imagine having to make such a decision. It was hard to fathom the courage that had moved this woman to reach out to strangers. They would have to try to find a way to thank her someday, but they had no idea of what words would be adequate.
At last, Kam walked into the room and came over to them. "It went as smooth as could be," he said, as if he'd done nothing more than change the oil in their car. "Everything is fine. He's awake."
Still, he warned, there could be bleeding; the sutures might not hold. They would have to wait and see. "The first 24 to 48 hours are critical," Kam added.
When Kam was done talking, the Klugs and Missy burst into applause. Kam, caught off guard, turned red. "Thank you," he said with a little bow. "That was new for me."
Two hours later, Warren and Missy poked their heads into Chris's room on the transplant floor. His mother had had to take Hillary to the airport as soon as they got the word. Chris had his eyes closed but opened them at the sound of their voices. He smiled weakly, raised a fist and announced, "I rule!" His father and girlfriend each moved to a different side of the bed and took his hands in theirs. "Thank you, God," his father began to pray. "Thank you for this miracle."
When his father finished, Chris joined in to say "Amen." But a moment later, his smile evaporated and his eyes watered as he added, "I just wish that kid didn't have to die."
The admitted killer said he, too, was sorry that his buddy got shot. But not everyone believed he was truly remorseful.
The Monday following Chris's surgery, the district attorney filed charges of reckless manslaughter and weapons violations. It was a close call, but in the end, the DA also decided to charge the offender as a juvenile instead of as an adult, which meant that he would serve two years in a juvenile detention facility at the most.
Some believed the charge should have been murder, with the possibility of a lengthy prison term, especially when it became evident that the young man had not shown a lot of remorse while locked up. But the accused and his lawyer knew a good deal when they saw it and quickly pleaded guilty on July 31, whereupon sentencing was set for September.
On the day of sentencing, the thin, pale fourteen-year-old in a jail jumpsuit was brought into the courtroom and seated with his parents at the defense table. The victim's mother was absent. The killer's parents told the attorneys that they were supposed to give her a ride, but when they went by the trailer that morning, she wasn't there.
"She's pretty tore up," the killer's mother added.
The victim's father was also a no-show. The victims' assistance office was going to need to come up with "emergency funding" to fly him in from California, the prosecutor told the judge when he came into court. Perhaps, the prosecutor suggested, the sentencing should be postponed.
As the judge considered the request, a juvenile social services investigator reported that the teen killer was "not doing well" at the juvenile facility. He'd spit at guards and other inmates and was "engaging in conflicts."
At this, the public defender rose to note that the fourteen-year-old's father had been trying to exert "some influence over his behavior." But, the attorney admitted, there had been problems in the past trying to control the boy. The attorney also noted that the teen's parents wanted the sentencing closed to the media. "There's already been a significant amount of coverage of this event," he said. But the judge replied that given the nature of what had happened, "the public has a right to know what we do here." The killer's mother shook her head.
Finally, the judge decided that because of "the enormity of what's at stake," he would wait until the murdered youth's mother and father could come to court and speak. He rescheduled the sentencing for October. In the meantime, he cautioned the boy, who had been sitting glumly at the defense table, to straighten up before the next hearing. If the errant behavior continued at the juvenile facility, it might not go well for him at sentencing. "Do you understand?"
"Yes," the boy answered.
Two weeks later at the sentencing, the victim's mother was still missing. The prosecutor told the judge that although the teen killer had toned down his act after the lecture, his attitude remained the same.
"The most troubling thing about this entire case was that about two days after he pled guilty, I got a call from the juvenile facility," the prosecutor said. "I have never gotten a call from them. They said something was wrong. 'He's going around bragging about what he did'...At that point in time, I kind of chalked it up to, 'Well, maybe he's having a tough time dealing with it, or maybe they're misinterpreting things.'
"But when I talked to them a couple days ago, Your Honor, they said, 'No, that behavior continued throughout the entire thing.' And I kept asking them question after question, trying to rephrase it in any way that would help me understand what it was that he was actually doing and why the people at the facility thought he was bragging about it. No matter how I asked it, their analysis always came up the same, 'He's going around saying, hey, he just killed someone; hey, he's only going to get two years.'
"But the worst part was when I asked them, 'Have you noticed any signs, anything at all, of any sort of remorse?' And I quote the supervisor when she said -- and she sort of laughed when she said this -- she said, 'You know what? He has shown the remorse of someone who stole a candy bar.'
"Yes, he cries at times," the prosecutor went on, "but it's interesting he only seems to show that when he thinks people are watching."
When it was his turn, the defense attorney insisted that his client had shown him "nothing but remorse" and was "a very sad child who was having a very difficult time dealing with the fact that his actions led to the death of one of his best friends."
"Your honor, [he] did take some actions to try and cover this up, but these were the actions of a terrified child who made a most horrible mistake, not the actions of somebody with the intent to do harm to anybody."
The defense attorney said he didn't want to go into much detail in open court about his client's past, but said that he "would just like to tell the Court that he has had quite a rough start in life." Looking over at the boy's parents, he quickly added, "He does have two loving parents, but his family situation has not always been the most stable."
The attorney ended by saying that his client wanted to make "a very brief statement." The admitted killer then stood up and mumbled, "I would like to say I'm sorry to his father and to his mother for what happened." He then sobbed and sat down with his parents.
The killer's father asked to speak. "Well, I'd just like to say that, you know, I know that he is very sorry, and I'm sorry," he said. "If there's anything I could do to help them, I will.
"And I'm worried about my son because, you know, I know what he did was wrong and stuff like that. Me and my wife were just hoping he can get help. He needs help -- he has for some time -- and I couldn't find any help for him. And it's led to this.
"And I apologize, because it's probably as much my fault as it was anybody else's."
He sat down, and then it was his wife's turn. "I apologize immensely for what has happened. It really is a tragedy, and I'm sorry that child is gone. Like his father said, I know [our son] needs a little help. He's had a tough time with, you know, in his life...I feel real guilty for that...I'm very sorry to [his] family for the loss of their son, because I don't know what I would do if I lost mine."
After the fourteen-year-old's parents spoke, the victim's father addressed the court. He didn't believe the accused's claim that the shooting was an accident. The boy might not have meant to pull the trigger, he said, but he'd pointed a loaded gun at his son's head. His ex-wife was still too upset to attend the sentencing, he added, so he and the boy's maternal grandmother were going to have to do the talking.
"Me and my family have been going through a pretty hard time, too," he said. "And my son will never come back. And there's not a day that goes by that, you know, any little thing can trigger memories and really upset me and stuff.
"And my daughter's having a real hard time. His mother is having a very hard time...He'll be missed forever. And when [this older boy] gets to go on with his life, it will still be in my heart every day that my son is not there forever."
The man tried to continue but choked on his words and had to pause before he could go on. "He looked just like me. He sounded just like me, same sense of humor, and I can never get him back."
The victim's grandmother was next. She was haunted by the image of her grandson lying on the bloodstained couch. The families of the two boys had spoken briefly about a week after the shooting, but there'd been no contact since. She felt that someone needed to speak on behalf of her daughter who, she told the court, "is having a real, real hard time accepting all of this."
"She would like to have justice done, but in the process, no harm to the [killer], you know, just some help through the community. It's a great loss. I can't even handle the situation...My daughter and my grandkids are hurting."
The judge ordered the youth to stand at the lectern. "Your irresponsible behavior, your criminal behavior, has destroyed the lives of two families...Frankly, I don't think that you're remorseful at all. And that's consistent with what your behavior has been like throughout your early life."
The judge turned to the youth's parents. "I don't mean to be disrespectful, but I have to say that while I believe that you folks bear some of the responsibility because he didn't have the life that a lot of kids in the community have had and deserve...I also am aware that there are other children who come from broken homes, or the support system isn't there, and their conduct isn't as irresponsible or as criminal as was your son's conduct in this case."
Turning back to the youth, the judge said his case "screams for the maximum sentence. If I could give you a longer sentence, I would." But all he could hand out was two years in a Division of Youth corrections facility, and one more unusual requirement based on a request from the victim's father, who wanted the slayer to be reminded once a year of what he'd done and whom he'd hurt.
"I will make it a condition of this sentence that you do write a letter of apology," the judge said and, nodding toward the slain boy's father, added, "and that on every Father's Day, you send him a Father's Day card."
On the September morning when the teen shooter was being lectured by the judge to act as if he had a conscience or face his wrath at sentencing two weeks later, Chris Klug stood at the top of a snowfield on Mt. Hood, Oregon, basking in the sun. His view of the Cascade Mountains was uninterrupted for hundreds of miles. Looking south, he could see the jutting volcanic peaks that guarded his old hometown of Bend: Three Sisters, Mt. Bachelor, Mt. Jefferson, and even the brooding presence of Black Butte, which as a teen he'd run up and down to get in shape for football.
So far, the comeback trail had been smooth, if arduous. Much as his mother had predicted, Chris had turned getting out of the hospital into a sporting event. He quickly set the record for laps around the transplant-floor hallways, often parading around with an IV pole in the company of family and friends who'd driven or flown in.
With the surgery over, Chris had finally talked about his disease with the media. There was no more need for secrecy, and, in fact, he wanted to use his status to publicize the need for organ donors. He'd had to wait nearly two and a half months after reaching the top of the list for his status level; he knew there were people on waiting lists who were dying every day because there weren't enough donors. His e-mail address was soon flooded with responses, many from people who were either suffering from PSC or had a loved one who was. He answered every e-mail and letter, moved in particular by those who said they had found hope for themselves in his story.
Still, he knew that the higher the podium, the more people he'd be able to reach. His hero, Lance Armstrong, who'd battled back from testicular cancer to win the Tour de France twice, had used his fame to raise money and awareness for cancer programs. Chris realized that the best way to do the same for organ-donor programs was at the 2002 Winter Olympics in Salt Lake City, on a slope at the Park City ski resort.
With that in mind, he knew he had no time to waste getting back on the slopes. Points earned at World Cup and Grand Prix races during the 2000-01 season wouldn't specifically determine who would be on the team, but they would determine seeding at the first few races the following year in the quest to make the Olympic team. That would be a huge boost in terms of the conditions under which he raced. There would also be a psychological advantage to being the best American rider going into the season.
That mental edge was important. He knew it wasn't just his body he was going to have to rehabilitate. After the fear and worry of the months preceding his transplant, he was going to have to switch from survival mode to the focus needed to become a champion again. If there were going to be physical and mental issues, he wanted a full season to get them out of the way before the push for the Olympics, and he wasn't going to do that walking around the corridors of a hospital.
According to the docs at University Hospital, the average stay for a liver-transplant patient after surgery was twelve days. He made it out in four, moving into the downtown hotel where he had stayed before the operation. As a recovering patient, he had to have bloodwork done every few days for the next three weeks to make sure his new liver was working properly and to gauge his reaction to the anti-rejection drugs.
Still, he did what he could at the hotel -- climbing on a stationary bike just two days after the operation and doing light repetitions using weights on isolated arm and leg muscles, always conscious of not putting a strain on his abdomen.
For all he'd been through, Chris hadn't lost his sense of humor. One day he was riding the stationary bike with his shirt pulled up to avoid irritating his scar when an airline pilot came into the weight room to work out. The pilot took a look at the huge scar with its parallel rows of dots where the staples had been and asked what happened.
"I was attacked by a shark," Chris said with a straight face.
"My God, you're lucky to be alive!" the pilot exclaimed.
The conversation was so funny to Chris that he didn't have the heart to tell the truth. Besides, he did feel lucky to be alive.
As soon as he got the doctors' okay, Chris took off for Aspen to hook up with his friend Fabrocini. As a physical therapist in a ski town, Fabrocini was used to assisting people recovering from knee injuries or broken bones. This was the first time the prescription read "liver transplant."
A year earlier, basketball player Sean Elliott was the first professional athlete to return to his sport after a transplant, in his case a kidney. But a liver was a much more complicated organ, and as far as Fabrocini knew, there'd never been a world-class athlete who'd returned to the elite levels of his sport following such a surgery. And certainly not one in the history of the Olympic Games.
Although Chris was anxious to get back in shape all at once, he knew enough to stick with the schedule Fabrocini had devised after consulting with the experts. For the first few weeks, the regimen stayed light. Fabrocini massaged the scar, sometimes using ultrasound, to break up the scar tissue and keep his patient limber for the gut-wrenching, twisting maneuvers involved in snowboard racing. They also worked on regaining his balance by walking forward and backward on a narrow beam -- with eyes open, then closed -- as well as trying to stay upright while standing on a board with a wooden roller underneath.
Chris began hiking in the mountains around Aspen with Missy and other friends to regain his aerobic capacity. Within a couple of weeks he was on his mountain bike, charging up and down trails, something he'd always found to be good training for his legs and for getting used to riding in a narrow space at high speeds. He still avoided stress on his abdomen, though. No sit-ups, and no weightlifting moves, like squats, that might cause injury. His appetite had returned, and he was gaining back the twenty pounds he'd lost.
In those moments when he reflected back on what he'd been through in the past couple of years, Chris felt as if he'd been clinging to a pendulum: on top of the world at the 1998 Winter Olympics in Nagano, fearing he would die in July, and now riding back to the top. The support he got helped. He was still getting e-mails and letters from fans.
In August, he had signed a new two-year deal with Burton snowboards. He was grateful for the vote of confidence. Burton had said it would stick by him, and it had -- as had Bolle sunglasses and the Aspen Skiing Company. Another sponsor, the Aspen Club, where he worked out with Fabrocini, had helped him with the use of its facilities and therapist. When he thought about how Lance Armstrong's French racing-team sponsor had cut its support even as the bicyclist was fighting through chemotherapy, he was humbled by the unwavering loyalty he'd been shown.
The world and all its possibilities were his to explore again. The only downside was thinking about the boy who'd been killed by a gun...the reason he was still alive. He'd heard that the donor had not always had the benefit of parental guidance. He thought about his "brother" Jason, a friend whom his parents had taken into their home, and how he'd done so well as a result of their love and expectations for him, especially compared to Jason's brother, Josh, who'd wound up in jail. Chris's mom might drive him crazy sometimes with her exuberance, but she knew what to say at the right moments, and he loved her. And then there was his dad, who'd been there at all his races as a youth, helping him achieve his dreams -- and when things looked darkest regarding his liver, made him believe that God would not abandon him. They both had taught him to be a participant in his own destiny.
The other boy had not had the same opportunities. Still, when it mattered, the boy's family, strangers to him, had given him the most important gift anyone ever had. But he couldn't find the words that seemed adequate to express his gratitude. In September, his father had penned his own two-page letter:
There are times in our lives when paths cross, totally unplanned and unexpectedly. Sudden events change things forever, or something happens that brings a drawn-out story to conclusion.
I believe firmly that God does not cause bad things to happen to us, but of course, we all go through bad things at times, and it seems that God allows it. We do not know why...I also believe that God does step into our lives at times.
I am the father of a boy who received a liver transplant in late July. The transplant saved his life...
Even as we traveled to Denver from our home in the mountains, we were well aware that the gift our son was about to receive had come through great loss to another family...In your grief and sorrow, please know that the other side of your tragedy is that there are parents like me who are grateful for your gift...Thank you so much. You helped save our son's life.
A Grateful -- Very Grateful -- Dad
Chris had searched a thousand times for the right words, finally realizing he would just have to wait until they came to him.
In early September, Fabrocini and his doctors had pronounced him fit and ready for the early U.S. team snowboard camp on Mt. Hood. He was already behind; normally, by the end of summer, he would have had the opportunity to get used to his new equipment, making sure everything was ready for the start of the season. But he had been unable to do that.
He'd showed up at Mt. Hood a day earlier than the rest of the team was scheduled to report. The U.S. ski team members were there, but he knew only a few of them peripherally. He wanted to take his first few runs without anyone watching him.
Driving up to the ski area, he'd experienced a mixture of eagerness and fear. He was excited to get back on snow and take that next step on his comeback trail. But he was also afraid. What if I fall? Would he literally burst open at the purple seam that stretched across his abdomen? Might some organ tear loose or twist inside his gut? There'd been a scary moment earlier in his rehabilitation, when he'd slipped reaching for something in the shower and crashed to the floor. He'd lain there until he was convinced that everything was okay, but that fall was nothing compared to the wrenching he might endure crashing at high speed.
So he took it easy on that first day, free-riding to get a feel for the snow and staying out of the racing gates. He was certainly a little rusty, but he completed ten runs and felt strong. The old joy of setting an edge and allowing the board to carry him through an arcing turn was there from the first moment. He ended the day showing off his "shark bite" for the U.S. ski team. He was, after all, a snowboarder.
The snowboard team showed up the next day, and Chris jealously watched as his teammates ran the gates while he free-rode. This went on for about a week until he couldn't stand it any longer; when the way was clear, he dropped in on the course from outside. He was feeling the rhythm of the gates again, getting a little cocky, perhaps, when he approached a fourth gate for a toe-side turn and felt the back of the board sketch out on him. The movement suddenly stretched his abdominal area, and he panicked, fearing injury. He overreacted and fell backward -- though "ejected" might be a more apt description -- hitting his head and flipping over, twisting and turning as he struck the snow.
Because he'd been free-riding, he hadn't worn his racing helmet, and the blow to his head caused him to see stars. He hadn't worn a one-piece suit, either, and he ended up with a few yards of snow down his baggy rider pants.
Chris lay on the snow, afraid to get up. He mentally searched his body, waiting for some pain or strange sensation to tell him that his comeback was going to be short-lived. But there was nothing worse than a similar fall would have caused before the operation. I'm okay, he thought. I'm really okay!
At last he stood and made his way off to the side of the slope, where he dropped his pants to get the snow out. His coach, Jan Wegelin, who'd seen the crash, thought maybe Chris had really frightened himself in the fall. "What'd you do?" Wegelin yelled, laughing. "Shit your pants?"
Chris realized the image he must have presented -- bent over with his pants down while he dumped the snow out. His peculiar laugh pealed across the slope, partly at his coach's joke, but more in relief at having taken a hard fall and survived. It would have happened sooner or later, and until it did, it would have weighed on him mentally. Now, he concluded, he had nothing to fear on the slopes. The next morning, he joined his teammates at the running gates and quickly established himself as the top American rider going into the season.
On November 18, Christopher Jefferies Klug, the boy whose mother was told he might not survive his first few days of life, reached his 28th birthday. He celebrated by placing third at Breckenridge in "tune-up" races for the upcoming World Cup season in Europe, and later at home in Aspen with his family and girlfriend.
It was fitting that the Colorado Donor Registry went into effect the next day. Until that day, Colorado citizens had agreed to be organ donors by signifying their intentions on their driver's licenses. There were several problems with this. One was that potential donors rarely arrived at the hospital with their driver's licenses: In the case of a fatal accident, police or medical personnel often took licenses for identification. Another was that people from out of state might not have the same sort of identification. And a third was that families were often not told of their loved one's intentions.
The donor registry automatically took over a million names from those who'd indicated that preference on their driver's licenses and placed them in a computer file. Citizens could now also register by going to ColoradoDonorRegistry.org on their computers. In the case of a donor's death, Donor Alliance could look at the list and know his intention; a donor's family would no longer face that decision. The belief was that the donor registry might save an additional forty to fifty lives a year in Colorado and Wyoming alone.
Whenever he was asked, Chris participated in television and newspaper interviews, including a moving spot for NBC that covered both himself and his boyhood hero, Walter Payton, and their battle against PSC. With each media representative, he insisted that they devote some part of what they were doing to organ-donor programs. He hoped that by doing so, he could save lives as his life had been saved. Despite this, he still struggled with how to personally thank the family of the boy whose liver he carried.
Chris knew his comeback was not going to start at the top. During his first few races in Europe, he had problems with falls and a lack of focus. He returned to North America for the Whistler, Canada, World Cup giant slalom. He'd placed third in the race in 1999 and hoped that a repeat performance would get him back to his winning ways. But a mistake on the first run cost him, and it was little consolation that a fast second run moved him from 22nd to eleventh and back into the money and points that counted toward his seeding in future races. He did better the next day on the same slope when he placed second in a parallel giant slalom Continental Cup -- a step below a World Cup event, but still against the top racers and with half the points. He'd followed the Whistler races with a third place in the World Cup at Mt. St. Anne in Quebec, Canada, an event won by his archrival, Canadian Jasey Jay Anderson. Two days later, he followed that by winning the Grand Prix event in Okemo, Vermont, this time edging Anderson.
Back home for Christmas, Chris looked forward to the next Grand Prix race in Breckenridge, an event he'd also won in 1999. He'd drawn bib number 7 -- a lucky omen, he figured, as it was John Elway's Denver Broncos number. He was poised to have a great day after finishing the qualifying round with the second-fastest time to get him into the head-to-head competition. But then he fell on his first run, much to his disappointment and that of Missy and his family: Jason was there, as well as Hillary, who had raced the day before with an eye to following in her brother's footsteps.
Chris left for Europe, where he struggled again, falling in the first two World Cup races. He was riding fast, but small mistakes knocked him down. His problem was mostly one of staying focused. He was beginning to get discouraged. However, there was going to be one last World Cup parallel grand slalom, in Olang, Italy, on January 17, before the world championships in Madonna Di Campiglio, and he wanted to do well.
The U.S. team arrived in Olang a week early to train. Chris felt strong and ready, even though that hadn't yet translated into a win. As was his custom, the day before the race he took two runs through the gates, which went well. He was enjoying being on his board so much that he decided to do a little free-riding in the afternoon.
Taking the chairlift up, he got out his camera. Northern Italy had always been one of his favorite racing regions. It was so beautiful, especially on a cloudless day like this, with the Dolomite Mountains sparkling in the sun. He snapped off a few photos before getting off the lift and cruising down the hill. The snow was perfect, and he couldn't keep from smiling as he arced long graceful turns, aware of how powerful and in sync his body felt.
He got back on the chair and took another run. And then another and another. It was more than he would have normally done on the day before a race. But he was just so happy to be alive and doing what he loved. Arriving at the top of the chair for a final run, he knew at last what he would write to the donor family. He'd tell them what their gift had meant to him.
Dear Donor Family,
I am over in Europe doing my favorite thing in the world, snowboarding. I thank God every day I'm back on the mountain, and I thank you every day for your gift of life. You have given me a second chance to pursue my dreams and to enjoy life to its fullest.
I love my family and I love my girlfriend very much. They are as thankful and as grateful for your gift as I...I am forever grateful and humbled by your decision. And I am truly sorry for your loss.
It is impossible to express with words my gratitude. I hope through my efforts, I can spread the good news on my successful transplant and someday save someone else's life.
He sent the letter to University Hospital to pass on for him. The next day, a weight removed from his shoulders, he beat the top riders in the world to take his first World Cup win of the season.
In March 2001, there were 75,000 Americans on organ-transplant waiting lists, 1,214 of them in Colorado and Wyoming. Most of those people will wait in vain, however: The previous year, there were only 5,967 donors nationwide, a mere 86 in Colorado and Wyoming.
Meanwhile, a new person is added to the national list every fourteen minutes, and an average of sixteen Americans die every day waiting. The number of organ donors in Colorado and Wyoming has been static for the past five years, while the waiting-list number has multiplied by five. There are no mortality figures yet for Colorado in the year 2000, but in 1999 and 1998, 63 Coloradans died each year, hoping to the bitter end that someone would make the same decision that the thirteen-year-old's mother had. One donor could renew as many as a half-dozen other lives.
Chris heard those figures and wondered why, rededicating himself each day to an Olympic podium from which to champion his cause. The week after winning at Olang, he felt confident of his chances at the World Championships in Madonna Di Campiglio a week later. Although he had lost a contact lens four gates into the qualifying run, he still had the fastest time of the morning -- nearly a second better than that of his closest rival. But a race-course judge deemed that he had ever so slightly allowed the edge of his board to cross over a gate pole, and he'd been disqualified. Canadian Anderson later won, while Chris could only imagine what might have been.
After the European tour was finished, the racers went on to Japan for two World Cup events. Chris got back on the podium with a third-place finish at Sapporo, and a week later, in Asahikawa, he moved up to second.
With a first-place finish in Olang and a second at Asahikawa, Chris was almost guaranteed entry into the next season with seeding as the top American rider and one of a handful of the world's best. He'd definitely proved that as a liver-transplant recipient, he could return to the life he'd left behind. But he'd returned as a changed man. Just as every other ordeal in his life had seemed to toughen him, make him work that much harder, his latest, and worst, ordeal had made him stronger mentally and physically. He had a way to go to get where he wanted to be, but he looked ahead to having a full off-season to get himself ready for the Olympic push.
Given a new lease on life, he was more appreciative of what he had: a lifestyle that allowed him to travel the world, getting paid to do what he loved most. When he thought of the reason, he was humbled by the act of the strangers who had saved him and disturbed by what he was hearing on the organ-donor front.
He arrived at Park City aware that the race would be an Olympic preview. Same hill. Same type of race. Same competitors. His qualifying run was not the best, tying him only for twelfth, but still good enough to get him into the head-to-head competition. By afternoon, he was racing strong, easily blowing past his first challenge, Dieter Krassnig of Austria. He'd done the same in his first matchup with Austrian Alexander Maier, the younger brother of ski great Herman "The Herminator" Maier, beating him by almost a second (a large amount in the racing world).
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Chris thought he had the hill figured out. A steep pitch at the beginning, followed by a short transition to the flats, where, with his size and strength, he was difficult to beat. Maier was riding well, but Chris had beaten him regularly throughout the season and figured he would have no problem doing the same now.
They both burst through the starting gates, their turns around the gates nearly synchronized, picking up speed on the steep. They were almost to the flats when Chris made a small mistake and felt his edge slip on him, carrying him wide of the next gate. Too wide -- and Maier, who would go on to win the competition when the other racers fell, eliminated him.
Chris was disappointed in his finish; he felt the day had been his to win. Still, looking back up the hill as Missy and his family gathered around in their protective cocoon, he smiled. Sometimes it was good to be knocked down a bit to make him remember that nothing in life was ever guaranteed -- not trips to the podium, not the Olympics, not life itself. He'd bounce back from this setback, as he always had, and he promised himself that he'd return in a year to get his medal, hopefully with "The Star-Spangled Banner" playing in the background.
He was alive -- that was what really mattered -- looking ahead to all the possibilities a starting gate represented.