It was July 1994. I was a newly married third year medical student on my first rotation: cardiothoracic surgery. Nothing like diving in headfirst for your third year—you have the most energy in July, after all. Unfortunately, while you have energy, you lack both the temerity and the experience to stand up for yourself, even when all you need is a few minutes for a bathroom break. Well, to all the third year medical students out there, I say, “A bathroom break is a very reasonable request, and don’t let anyone tell you otherwise!”

 

Not having had anyone tell me this ahead of time, I ended up with refractory pyelonephritis. (If you are wondering whether or not I missed any days of work, of course I did not! I was a third year medical student!) In an attempt to understand why the multiple rounds of antibiotics were not clearing the infection, my doctor ordered an intravenous pyelogram (IVP). For those who entered medicine after 2000, this was a radiologic study with contrast dye, most commonly used to look for a kidney stone. Based on that IVP, I was diagnosed with polycystic kidney disease (PKD), an autosomal dominant disease causing progressively increasing cystic changes to the kidneys and usually resulting in kidney failure. I had no family history. Imagine being eight months married, two months into third year on a surgery rotation, and learning you have a genetic disease that will likely lead to dialysis or transplant in the future and all your future children have a 50 percent chance of inheriting it. It was a stressful moment. However, since the one thing I did not have at that moment was extra time, there was never really any processing or pondering of the diagnosis. I simply went on with my life.

 

Flash forward to fall 1998 when our first child was born. PKD had been pushed to the back of my mind as I progressed through residency back in the days prior to the Accreditation Council for Graduate Medical Education’s 2003 mandate of the 80-hour work week. However, as my blood pressure increased during the pregnancy, culminating in an early induction, PKD refused to be ignored.

 

It further forced itself into my thoughts when our infant son began having hematuria in his diapers. Unable to convince our pediatrician that I was certain I had not spilled red Kool-Aid in the diapers, I asked a pediatric nephrologist at the hospital if he would recommend an ultrasound. He ordered one, and it showed bilateral cysts. PKD was never far from my thoughts after that. Would my son’s case be significantly worse than mine since he had symptoms as an infant? When would either of us require additional treatment? How life-altering would the treatment be?

 

The next two pregnancies followed the same pattern as the first, and by the third pregnancy, I required anti-hypertensives during pregnancy, while my blood pressure remained elevated after delivery. From there, the disease marched forward to a slow but steady rhythm—blood pressure increasing and glomerular filtration rate (GFR) decreasing, but always in tiny increments.

 

Then came March 2020. (Sorry if I triggered any flashbacks by mentioning that date!) It began the terrible two years of sick patients, patients arguing their diagnoses, patients begging for treatment, patients angrily refusing vaccinations and, for those of you in the hospitals and ICUs, patients dying while you had to be the go-between in communicating with their families. I only work outpatient, so it was not as bad for me, but it was bad enough. Numerous patient encounters were difficult, and wearing masks (and initially eye shields and hazmat suits) was hot, was uncomfortable and made communication with patients more difficult. It was a strange time of pride in our hard work, excitement in our ability to be involved in fighting something huge, exhaustion from the hours we worked and anger at the people who minimized the risk of infection.

 

I managed to avoid COVID until summer 2021, and even then, I had a mild case. Unfortunately, even a mild case can cause microvascular complications. Prior to that illness, my GFR was 60. At my routine nephrology visit three months later, it was 21, and our initial hopes that it would recover over time proved unfounded. It just kept slowly dropping.

 

The next time you talk to a patient in renal failure and casually throw out the word “fatigue,” please know the word you are using does not even begin to encompass what your patient is experiencing. This is a fatigue so deep and so severe that you can’t imagine it if you have not felt it. It is a feeling of being buried and trying to move your limbs against the dirt packed around you. A feeling that you need to sleep, but when you awaken, you feel just as tired as you did when you laid down. A feeling that you might not be able to stand up when seated and walking to the next room just might require more energy than you can muster. And, more than anything else, it is a fatigue so severe you are certain you absolutely cannot go to work, stay awake and do anything meaningful. Unfortunately, in my case, with the renal failure coming at least 10 years earlier than I expected, we were not in a position for me to simply quit work and wait to see when I would need dialysis or when I would get a transplant.

 

This seems like the right time to introduce David, my husband. We married at 23 as wide-eyed, head-over-heels, naïve students, certain our love would never fail us. My mother pointed out that the reason the marriage ceremony includes vows to be faithful “for better, for worse; for richer, for poorer; in sickness and in health” is because all of those things are going to happen during your life together. Nevertheless, like every newlywed couple before us, we were certain we would only have better, richer and health. And, like every newlywed couple before us, we were wrong.

 

In our 27 years of marriage, we had experienced better, worse, richer, poorer and health. We had not yet experienced sickness—at least, not anything more severe than a week of flu symptoms. Neither of us had ever had surgery or been hospitalized for illness. Despite my diagnosis during our first year of marriage, I had not yet truly been sick. In 2020, as my health and energy began declining, I began making up for all those healthy years we had. As the fatigue increased, I continued to work full-time, because that’s just what we healthcare professionals do. My overall activity level decreased rapidly, though, until I wasn’t doing anything but going to work and returning home, far from the super-involved person and parent I had traditionally been. As I began to have nausea and itching all the time, I felt even less inclined toward any voluntary extra activities.

 

This strange, in-between time of marching toward end-stage kidney disease while still keeping up with the basics of life, from work to activities with our kids to keeping the house livable, was difficult. When I look back on it now, I wonder how I did it. How was I not in bed all the time? It was a gradual process, like the proverbial frog in the pot of water, not realizing the water is heating until it boils to death. Looking back, I might have “fatigued” myself to death had this stage gone on long enough. When you feel horrible, it’s hard to realize just how much worse you feel than you did last week, so you just keep trudging along, doing the next thing in front of you. As I was trudging, my nephrologist referred me for a transplant evaluation.

 

Upon arriving for my first visit, I was surprised to learn the Methodist Hospital system here in San Antonio, Texas is the highest volume living donor kidney transplant center in the United States. As David and I read the brochures and posters on the wall during that visit, it was clear I was in experienced hands. I was planning a living donor transplant, but I had not yet begun the process of identifying a donor or even discussing that with my family. So when the nephrologist said to David, “Are you the donor? Why don’t you go ahead and get your preliminary labs done today since you’re here?” it felt a bit premature. As the process of my workup to qualify as a candidate moved forward, the clinic simply moved David forward in the donor workup as well. And at the end, he was the best candidate. None of my four siblings nor our 22-year-old daughter Eleanor was an appropriate donor, but every step of the way, David cleared the hurdles. Unrelated donors have a less than 10 percent chance of matching the intended recipient, but David was an excellent match for me—matching my blood type as well as a number of my human leukocyte antigens, which are immune markers used to find the best match possible for transplants. Plus, his excellent health meant there was no reason not to go ahead.

 

The period of testing both of us was long and felt somewhat slow; yet, the day we received the final results of the screening tests, everything shifted into overdrive. Suddenly, instead of waiting for the next available appointments for mammograms and colonoscopies, we were facing a surgery date a mere two weeks later. Suddenly, there was a lot to do! We had to get time off from work. We had to make arrangements for Norah, our youngest child who was in ninth grade and not yet driving. We needed someone to be in our home to help during our recovery.

 

As things so often do when God is arranging them, all the details came together seamlessly. Eleanor was allowed by all her professors to leave school three weeks early. She and her fiancée arrived prior to the surgery and took things in hand. They cleaned the house much better than I could at the time. They drove Norah to the hospital each day so she could see us, and they also ensured she was doing her schoolwork. They brought David home from the hospital when he thought he was ready, and then they took him back when it became obvious he was not. And they ultimately brought both of us home, where they ensured we had food, drink and medications and were following all the rules the doctors gave us. My parents came to town for the surgery to make sure we were well and in good hands. David’s mother, who lives near us, brought food, shopped for anything we were craving and worried over us when we needed it. Our friends made a meal train and brought food, news and well-wishes. Our son called frequently from his home in the United Kingdom, ensuring we were well and expressing his frustration at not being with us. We were surrounded by love and support while all our needs were met.

 

The surgery and recovery were smooth. When I asked David about his time as a patient, he said, “I was amazed at the power of modern medicine and what God has given medical personnel and scientists the intellect to discover and accomplish. It was an intense experience to have surgery and to donate an organ, but the team’s skill and compassion made the process seem almost easy.” The surgeon did warn us ahead of time that the recovery is much harder on the donor, who was healthy when entering the hospital, than on the recipient, who was not. In fact, immediately upon awakening from anesthesia, I already felt better. David, on the other hand, chafed a bit at the post-operative restrictions. However, the six weeks of post-operative recovery went quickly overall, and then we were both back to full activity.

 

Several weeks after the surgery, a friend asked how I grew spiritually during the ordeal. It surprised me how hard it was to answer that question. I realized how easy it had been as a physician to view the entire process through a medical lens. As I read back through my posts on the CaringBridge site, it’s clear I was focused on the surgery, my lab results and the immunosuppressant dosages much more than I was on the spiritual aspects of being ill. My friend’s question sparked a change of mindset as I began thinking about how God was using this episode in my life to mold and change me, as He is always faithful to do.

 

I learned several important things, all of which I continue to ponder regularly.

 

First, I keep thinking about how incredible the human body is, how intricate and detailed in its design. It’s hard to contemplate the complexity of creation without seeing the divine hand in its creation. As Romans 1 says, people can clearly see God’s invisible qualities through everything He made, and I think the human body conveys the pinnacle of God’s invisible qualities.

 

Take the lowly kidney, for example. It is an organ you would never normally see, and its function is rarely lauded. After all, the kidney is responsible for wet beds, all-too-frequent stops on road trips, incontinence and the general nuisance of having to urinate regularly. Even when it is in top form and doing its job well, we find the result of its work irritating. When it is not doing its job well, it’s even worse. The poor kidney can’t win in the frenzy of human activities—it is always interrupting us doing what we want to be doing. Yet, if you look at it, it’s quite beautiful. It’s fascinating for something we would never see under normal circumstances to be so intricate and artistic. In addition, it’s dadgum complicated. The tiny little quarter-pound kidney cleans the entire volume of blood—and it does it about every 45 minutes. It regulates blood and electrolyte levels and still has enough gumption leftover to secrete epoetin and prevent anemia! When you think about all these kidney functions, you have to marvel at how complex the structure of the kidney is. One normal kidney has 1.2 million functional units (nephrons) that are about three centimeters long, and each one of those has 13 millimeters of renal tubule. If you’re better at math than I am, you can calculate the length of renal tubule in one kidney—it’s a big number! It’s an incredibly complex organ, despite its small size.

 

What does all this have to do with my spiritual growth during my surgical recovery? The more I think about how complex these bodies of ours are, the more miraculous it is that medical knowledge understands as much as it does and can intervene as much as it can. I think both the design and the human intelligence to understand that design are beautiful displays of God’s invisible qualities. Yet, every day we roam around town running errands or having coffee and never think to stop and contemplate the miracle of the bodies we are walking around in. It reminds me of that famous C.S. Lewis quote from The Weight of Glory:

 

“We are half-hearted creatures, fooling about with drink and sex and ambition when infinite joy is offered us, like an ignorant child who wants to go on making mud pies in a slum because he cannot imagine what is meant by the offer of a holiday at the sea. We are far too easily pleased.”

 

How much infinite joy do we miss every day, just because we pass by the things around us without thinking about where they came from and how astounding their design is—that is, by focusing on the design and failing to focus on the Designer? As both a physician and a patient, I have a renewed focus on the Designer and the wonder of His creation.

 

A second spiritual lesson in this process was a humbling reminder of my own inability to save myself. It is a strange thing to have someone sacrifice a part of their body for you. Watching David recover from a surgery he didn’t need repeatedly reminded me of the ways in which David has selflessly lived alongside me for the last three decades. Even more importantly, it reminded me of the ways in which God knows, cares and provides, even for a need I didn’t know I would have. How can I justify worry about the daily cares of life when God showed up so dramatically in the biggest need I have had thus far? I have read Matthew 6:25-34 and heard it preached countless times, and yet that same old anxiety keeps sneaking back in. Despite Jesus’ words reminding me not to worry, somehow worry comes so much more naturally than trust. The humbling experience of watching God, through my husband, so clearly meet a need I could never meet for myself is a constant reminder to seek after Him rather than after the things of earth.

 

Of course, this means giving up control. When we are in control, we only need to trust ourselves, and somehow that self-sufficiency is comforting. The central problem, though, is that each of us is limited in what we can actually do. I can’t bring about a good surgical outcome for myself. Even more importantly, I can’t forgive my own sinfulness or cleanse myself from the wrongs I commit. I can’t sanctify myself or set myself on an eternal path. It’s a great irony, really—that I rely on myself to feel more in control and less anxious, but in that very self-reliance, I limit my growth and the good I can do in the world. In that very self-reliance, I forfeit the wisdom of God and those who have gone before me. I shun my access to the throne of grace, where love, mercy and eternal hope await me.

 

Lastly, this experience taught me in a whole new way about the body of Christ and community. I have never had a bigger need than I did during the transplant, so I have never had a bigger opportunity for God to show up in my life through His people. I was truly astonished at the ways in which our community was ready and willing to meet our needs. So many people offered so many types of support, and had I not been ill, I would never have experienced this. God truly works through His people to care for us in times of need, and I learned this in a deeper way in 2023. I think it’s probably not a bad thing if everyone has a major health issue every so often, just to remind them how much people love them and how well God cares for them. This experience certainly reminded me of those things!

 

I think the realities of life in a fallen world—where bodies fail us and need surgical correction, where relationships fail us and need legal adjudication, where minds fail us and need decision-making substitution—I think these realities simply take us to the end of our self-sufficiency. They take us to the places where we can no longer rely solely on ourselves. Those are the places where we find God waiting—in His word, in His people, in His presence in our spirits. He is there, reminding us we were made by Him and for Him. We were never made to do this life of our own strength. We were never even supposed to see it through those lenses. Before the tree of the knowledge of good and evil, reliance on a moment-by-moment relationship with God seemed beautiful and easy to Adam and Eve. It’s only through the twisted lenses of fallen humanity that it becomes so difficult to trust in that relationship.

 

As I live the second half of my life with one good kidney instead of two bad ones, I’m reminding myself to be grateful for the limits of my human abilities since they point me to the limitless God we serve.

 

Pull Quotes – Use These Scripture Verses As Needed in the Article Layout

“Do not worry then, saying, ‘What are we to eat?’ or ‘What are we to drink?’ or ‘What are we to wear for clothing?’ For the Gentiles eagerly seek all these things; for your heavenly Father knows that you need all these things. But seek first His kingdom and His righteousness, and all these things will be provided to you. So do not worry about tomorrow; for tomorrow will worry about itself. Each day has enough trouble of its own.”

—Matthew 6:31-34, NASB

 

“Before the mountains were born or you brought forth the whole world, from everlasting to everlasting, you are God.”

—Psalm 90:2

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About the Author

Autumn Dawn Galbreath, MD, MBA, is an internist in San Antonio, Texas, where she lives with her husband David. They have three children: a married adult son who lives, writes and performs in the United Kingdom, a married adult daughter who attends law school at the University of Texas and a 17-year-old daughter who is ready to finish high school. Though they met in medical school, David now owns restaurants in the San Antonio area. When they are not having major surgeries together, they love watching their son perform (whenever they can get to London), traveling with their kids, reading, eating good food, cooking good food and trying to keep their menagerie of pets from destroying the house. Autumn Dawn earned her medical degree from the University of Texas Medical School at San Antonio, where she also completed her internal medicine residency. She earned her MBA from Auburn University in Auburn, Alabama.