Something was wrong.
Cynthia Decker always liked to talk at the gym, and now, as she sluggishly pedaled atop stationary bike No. 88, she wasn’t talking at all.
Her personal trainer, Toni Badinger, asked why.
“I have to go on dialysis,” Decker told her. “I’m so scared.”
Decker began to cry.
She had arrived at Brambleton Sport&Health in Northern Virginia two months earlier after spotting an advertisement. For $99, the fitness center offered three sessions with a personal trainer — help Decker desperately needed as diabetes and two failing kidneys ravaged her health.
But one trainer called off their appointment, and then another. On the day Decker intended to ask for a refund, her phone rang.
“Hi,” the woman on the line said. “My name is Toni.”
Badinger, a new trainer at the Ashburn gym, secured her third client.
She took notes during Decker’s initial session.
Next to a question about high blood pressure, she circled: “YES.” Next to one about diabetes, she added: “type 1.” Next to a request for information about chronic illnesses, she wrote: “kidney disease — on transplant list.”
At that first meeting, Decker couldn’t do a single squat or curl more than three pounds, but Badinger understood how important their work together would be. For Decker to remain on the transplant list, she had to stay healthy enough.
It helped that the women liked each other from the start. Both were 53 and sarcastic, mothers to two kids and wives to men they’d loved for three decades. They also shared a firm belief that, at the worst times, nothing mattered more than faith.
Still, the pair remained little more than acquaintances who spent one or two hours a week together.
And that’s why a few days after the dialysis began and Decker was again pedaling atop bike No. 88, she didn’t register the meaning of a question her personal trainer posed.
“So,” Badinger asked, “what blood type are you?”
Toni Badinger, a personal trainer at Brambleton Sport&Health in Northern Virginia, works with her client Cynthia Decker on Nov. 28. (Linda Davidson/The Washington Post)
‘Are you nuts?’
Badinger was sitting on a bar stool in her Ashburn kitchen a week later when her husband, Barry, walked in. On the laptop screen in front of her was an 11-page questionnaire from MedStar Georgetown University Hospital.
“What are you working on?” he asked.
She was being tested, Badinger explained, to find out whether she could donate her kidney to a client.
“Are you nuts?” he demanded. “Who is this woman?”
Decker had been no less stunned when Badinger, after learning their blood types were both O positive, revealed her intentions.
“Who would do this?” Decker thought. “She’s not my sister. She’s not my aunt.”
A possible match with a relative had fallen through for reasons Decker never understood, but she suspected the woman had changed her mind. The experience was devastating, so she urged Badinger not to be hasty.
“It’s not like I’m asking for a pair of shoes,” she reminded her trainer. “I can’t give this back.”
“No,” Badinger eventually responded, “you’re just asking for my left shoe.”
Barry didn’t accept that.
His wife would be risking her own life, first with the surgery, then by gambling that nothing would go wrong with her remaining kidney. How could she consider doing that for someone she barely knew?
She didn’t know, for instance, that Decker had come to the United States from Bolivia at age 4. That after Decker’s kidneys began failing two years ago, the illness forced her to quit a job working with autistic students at a time when she and her husband, Mike, were deeply underwater on their mortgage. That she’d lost the ability to taste food and needed reading glasses to give herself insulin shots four times a day because her eyesight had rapidly degenerated. That after Decker collapsed into a cavernous depression, a psychologist told her she must stay active, even when her body was so devoid of energy she had to lie down after taking showers. That she had tried antidepressants but gave up when they made her feel worse. That if she hadn’t started dialysis in June, a doctor concluded, she would have been dead in a month.
But what Badinger didn’t know didn’t matter to her, nor did it matter that both her husband and mother adamantly opposed the idea of donating her organ.
A devout Christian, Badinger had prayed for guidance again and again, and she was certain God’s answer hadn’t changed: Keep going.
Barry knew his wife would be hard to dissuade. She had grown up in a tough North Dakota town where temperatures routinely dip to 15 below, she’d earned a black belt in karate at age 45, and she could still bench press her body weight of 125 pounds. She didn’t quit.
Still, he argued, what if something went wrong?
“I don’t want to lose you,” he told her over and over. “You’re my best friend.”
Barry, a thickset construction manager with a shaved head, refused to discuss it in the weeks that followed, even on the night of his birthday in early August, one day after she had driven to Georgetown to turn in a jug of urine and have blood drawn.
Meanwhile, each time she met with the medical staff — the doctors, a social worker, a donor liaison — they reminded her she could opt out at any moment and that Decker would be told Badinger couldn’t donate for medical reasons.
At Georgetown, more than four in every five people who initially express interest withdraw before surgery.
A few days after going to the hospital, her phone rang.
“You’re a match,” the voice said.
She hung up and patted her beating chest. “This is real,” she thought.
She texted Decker and told Barry later that day.
“This woman,” he said again, “is a stranger.”
At the fitness center the next morning, trainer and client returned to bike No. 88. This time both women cried, a combination of relief that Badinger was a match and angst that her husband still disapproved.
One of Toni Badinger's healthy kidneys is prepared to be transplanted into Cynthia Decker. (Linda Davidson/The Washington Post)
Hidden under Decker’s long sleeves was a left arm ravaged by the 12 hours of her weekly dialysis treatments. The longer people remain on the regimen, she knew, the less capable their bodies are of accepting an organ.
And now Decker was so close to a new life she feared could slip away at any moment.
“I don’t want to have to choose,” Badinger told her, “between my husband and you.”
That night, she and Barry shared a quiet, awkward dinner. They picked at their fish and said nothing about the test. Afterward, he started putting leftovers in the fridge. Then, suddenly, he turned around and clapped his hands.
“Okay,” he said. “If we’re going to do this thing, I’ve got some questions for the doctors.”
Three months later, and three days before the surgery, he finally met the woman taking a piece of his wife. At an Italian restaurant in Ashburn, Barry reached across the table to shake Decker’s hand. He stopped.
“I need a hug,” he said, and walked around to embrace her.
Decker’s husband still struggled to find the right words for Badinger’s gift.
“I’ve tried and tried, and I can’t,” Mike said. “It’s life-giving, literally.”
And Barry, at last, explained what had changed his mind.
“It became a lot easier to accept,” he said, pointing at Mike, “when I put myself in his shoes.”
Cynthia Decker, left, and Toni Badinger see each other for the first time since the transplant the day before. Wrapped around Decker's wrist was a pink 'Recipient' bracelet, and Badinger wore a green 'Donor' band. (Linda Davidson/The Washington Post)
‘You all right?’
It was just past 5:20 a.m. on December’s “Giving Tuesday” when Badinger approached a receptionist at Georgetown hospital.
“I’m here for surgery,” she said, and soon Barry and their 24-year-old daughter, Aly, joined her in a quiet second-floor waiting room.
It had been a long night. She’d woken up at 1 a.m. and posted a message to Facebook, thanking her friends for their support. She had worked through a quick series of exercises with a foam roller on the floor. She had knelt and asked God to be with her.
And now Badinger was thumbing a smooth black stone her pastor at Christian Fellowship Church had given out during a sermon about casting one’s cares on the Lord. Congregants were supposed to return the rocks in a symbolic gesture, but she’d kept hers.
Badinger wondered aloud if she was doing the right thing.
“You are,” Barry assured, and rubbed her shoulder.
Decker and her husband arrived moments later, and the women embraced.
Decker couldn’t speak.
“You all right?” Badinger asked.
“What’s going on?”
“I don’t know how to thank you.”
A day earlier, Decker had spent four hours hooked to a machine she hoped was cleaning her blood for the last time. The other patients — almost all gaunt and gray haired — offered congratulations, speaking to her as if she were a fellow prisoner who had just been pardoned.
Receiving organs from near-strangers is rare but not unheard of, said Matthew Cooper, Georgetown’s director of kidney and pancreas transplantation. Many people still believe matches are scarce and must usually come from a family member, but that’s not true.
Advances in immunosuppression drugs have vastly expanded the pool of potential kidneys. Recipients’ bodies seldom reject organs, even when they aren’t ideal matches.
But such progress hasn’t triggered a horde of new donors.
“For every person who gets a kidney transplant,” Cooper said, “another 20 die while on the waiting list.”
Only one in 10 people who stay on dialysis, he explained, live more than a decade beyond when they started the treatment. Nationwide, around 100,000 patients a year need kidney transplants, but only about 15,000 receive one. And fewer than half of those come from living donors, whose organs last an average of nearly 20 years — close to double those harvested from people who have died.
At the hospital, in a pre-operative holding area, Decker laid in bed No. 9. A nurse asked how she knew Badinger, who was in bed No. 10.
“She’s my personal trainer,” Decker said.
“Oh, wow,” the nurse responded, eyebrows raised.
“Everyone has the same reaction.”
An anesthesiologist asked Badinger to confirm which kidney was to be removed.
“Left side,” she said, then smiled. “Left shoe.”
Around 9 a.m., she was wheeled into operating room 8, and her body was layered in sterile sheets of blue paper, leaving only her stomach exposed. Surgeon Jennifer Verbesey made the first incision, then Badinger’s abdomen was filled with carbon dioxide, providing her two doctors enough room to cut out the organ laparoscopically.
The operation progressed without flaw, but as Verbesey readied to remove the kidney, she had to stop. There was a problem.
Earlier that morning, Decker’s blood sugar was tested at 390 — a reading so dangerously high that one nurse thought the meter had malfunctioned.
It took more than four hours for the medical staff to stabilize her, but at last, by noon, she was ready for her surgery, allowing Verbesey to finish Badinger’s operation.
“Okay,” the doctor said at 12:39 p.m. “I’m taking the kidney out.”
She removed her gloved hand from an air-sealed port mounted to Badinger’s abdomen and there, in her fingers, was a shiny, beige organ about the size of an avocado.
She gently carried it to a metal bowl filled with crushed ice.
“It’s a beauty,” said Cooper, who flushed out the remaining blood and trimmed off bits of tissue. He then placed a blue towel over the sweating bowl, cradled it against his chest and took a half -dozen steps across a dim hallway into operating room 6, where Decker’s operation had already begun.
“Kidney!” he announced, as Alison Krauss’s “Stay” flowed through the speakers.
“Where have you been,” the song played, “my long lost friend?”
Two other surgeons were prepping the organ’s new home, just above Decker’s waistline.
Their plan was, in principle, simple: Attach Decker’s bladder along with a vein and an artery to the kidney’s corresponding ports, bypassing her ineffective kidneys entirely.
Badinger’s graying organ was soon placed into Decker, but clamps on her vein and artery — preventing blood flow — remained on as the surgeons worked.
Ten, then 20 minutes passed. Verbesey came in to say that Badinger was recovering well.
Another 15 minutes ticked by.
“Every operation has a critical point,” Verbesey whispered as she watched. “The critical point here is when they take the clamps off.”
Then, at 2:19 p.m., they did.
The organ pulsed with blood, turning as pink as an azalea. In seconds, drops of urine appeared.
Decker’s new kidney was already working.
Toni Badinger shows her scars to Cynthia Decker about a week after the operation. (Linda Davidson/The Washington Post)
‘I just wanted it to work’
The doorbell rang on a mid-December afternoon.
Decker leaned forward and slowly pushed herself up from the dining room table. She grinned. Her guest had arrived.
It had been more than a week since the women last saw each other at the hospital. The day after their operations, a nurse had wheeled Badinger to Decker’s room.
In matching white medical gowns, they gripped each other’s hands, the green “Donor” and pink “Recipient” bracelets on their respective wrists nearly touching.
Decker announced she would no longer need dialysis, drawing a gentle high five from Badinger. Their voices quavered.
“We shouldn’t cry,” Decker said. “It’s a happy thing.”
“I just wanted it to work,” Badinger said. “That was my greatest fear.”
Badinger’s Christmas gift to Decker, a 'Wizard of Oz' tree ornament with 'Cynthia' written on the right slipper and 'Toni' on the left. (Linda Davidson/The Washington Post)
“That it wouldn’t work?” Decker asked.
“That it wouldn’t work,” Badinger acknowledged.
Decker’s tone quieted: “It did.”
And now Badinger sat at the dining room table in Decker’s townhouse, and she no longer needed to take anyone’s word that the transplant worked. She could see it.
When they hugged, Decker’s hair was still damp from a shower that hadn’t forced her to lie down afterward. When she smiled, her eyes no longer hid behind swollen skin caused by her previously high blood pressure. When she mentioned returning to the gym after the holidays, she talked of riding faster on bike No. 88. When she bit into a treat Badinger’s daughter had baked, she gasped.
“I can taste the brownie,” she said.
“What does it taste like?” Aly asked.
“Like a brownie,” Decker said. “Like it used to.”
And when Decker opened the Christmas gift Badinger had brought — a tree ornament of ruby-red “Wizard of Oz” slippers — she didn’t need glasses to read “Cynthia” written on the right shoe, and “Toni,” of course, written on the left.