All winter, it was clear Maryland House Speaker Michael E. Busch's health was deteriorating. His stride was slower; his face was becoming gaunt.
He'd lost almost 50 pounds in six months, and by the end of the legislative session in mid-April, lawmakers were quietly wondering whether the state's longest-serving leader of the House of Delegates would be forced to pass his gavel to a successor.
Busch, 70, eventually learned the medications he'd been prescribed for a liver disease he was fighting were not working.
If he did not get a transplant, doctors warned, his liver would fail and he could die.
His three sisters readily offered to be tested. By early June, Kathleen "Laurie" Bernhardt was at the University of Maryland Medical Center donating about 60 percent of her healthy liver to her older brother.
"I'm eternally grateful," Busch said this week, slightly emotional. "None of them hesitated. They were all willing to be donors."
Busch, who has served 14 years as speaker, returned to his office in Annapolis last month, and is focusing much of his time on raising awareness about the living donor program.
He is also telling anyone who will listen he is ready, willing and able to continue his reign as speaker in January, and will be running for a ninth term in the legislature come November.
House Democrats, who elect the speaker on the first day of each legislative session, say they will stand loyally by Busch, who has led the House since 2003.
Possible successors like Dels. Maggie McIntosh (Baltimore) and Dereck E. Davis (Prince George's) made the rounds in recent months to gauge how much support they would have if the speaker's job became open.
Both have made clear they would seek the post only if Busch voluntarily gave it up.
"There's always people who want to succeed the speaker, that's the nature of the institutions," Busch said. "They have every right to position themselves … I'm not going to be here forever."
Even the younger, more progressive flank of the Democratic caucus, which has pushed back over the last couple of years against what it calls a lack of vision and energy from the leaders of the state's majority party, is not lobbying — openly or behind the scenes — for Busch to step aside.
"There really isn't strong enough support for anybody to challenge him," said a progressive delegate who spoke on the condition of anonymity to talk openly about House leadership.
Busch says he is ready to lead the legislature in its fight against Gov. Larry Hogan (R) and President Trump in a crucial election year, when the governorship and every seat in the General Assembly is at stake.
Republicans are hoping to build on their success from 2014, when Hogan defeated then-Lt. Gov. Anthony G. Brown (D). Democrats are hoping to regain ground and to capitalize on anti-Trump sentiment in the state.
"I fully intend to preside over the House next year," Busch said. "If the doctors are correct, and right now I'm ahead of schedule, next year I should be close to 100 percent, come January."
Still, Busch said he recognizes "numerous" people aspire to become speaker and, after 30 years in the legislature, his tenure eventually will come to an end.
"If I … decide my health isn't good enough to come back, there has to be an orderly transition," he said. "Respect for the institution is the No. 1 thing."
The liver disease affecting Busch, who said he has never smoked and only drinks an occasional beer, was nonalcoholic steatohepatitis. It results from a buildup of fat in the liver and causes the organ to swell and become damaged.
Even as his weight dropped precipitously, Busch was retaining considerable fluid on his abdomen. He wore jackets to hide the size of his belly and couldn't reach down to tie his own shoes.
"If he had not received [the transplant] when he had, he would have faced a period of increasing medical care, hospitalization and significant disability," said Rolf Barth, the head of the University of Maryland Medical Center's transplant program.
About 14,100 adults and children in the United States are waiting for a liver transplant, according to the United Network for Organ Sharing.
More than 1,500 die each year without having the surgery, according to the American Liver Foundation. Bernhardt, whose liver will regrow, remained hospitalized for three days after the transplant. Busch stayed for 21 days, including a week in the intensive care unit.
To put weight back on, his doctors have instructed him to eat ice cream and drink milkshakes and eat plenty of protein. "I think I've cleaned out every jar of JIF peanut butter," in the local grocery store, Busch laughed. "That's what feeds the liver and brings it back."
He returned to work about five weeks ago and is back in the gym, he said, doing curls, leg lifts and bench presses. He's gearing up for fall hearings on the budget, health care, and other issues, and attending fundraisers for fellow lawmakers and other events.
"Right now I have a little more fluid on my stomach, and that's the only thing slowing me down a little bit," said the former college football player who was doing 100 push-ups a day before his diagnosis. "But that will go away as my liver gets healthier."
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