THE DOUBLE TRIPLE

DARU SMITH WAS TALKING TO HIS DOCTOR AND SISTER ONE DAY LAST DECEMBER WHEN HE BEGAN TO DIE. He saw their forms grow dim, a dark curtain coming down on them and himself in his fluorescent-lit hospital room at University of Chicago Medicine. Then the 29-year-old was above it all, looking into a hole in the ground where a torrent of water was swirling like a giant draining sink.

And then he was in a hallway. At the end of it glowed a white light. He felt at peace. No more heart palpitations, no flutters, no aches. He saw pictures on a wall. Scenes from his life. His son being born. Himself cutting the umbilical cord. Changing the baby’s diaper for the first time. He loved that child so much he’d given him his own name and called him Junior.

It felt good, the light. Until Daru realized: This is what happens when you die. He turned around and began to run. Faster. The scenes spooled past now. The light pulled him. I gotta fight.

Daru had been so sick. A few weeks earlier, he’d gone to the emergency room with a cold he couldn’t shake. But he knew it was more than that. He could barely keep up when his son, 3 years old by then, pedaled his bike ahead of him. And whenever Daru stepped from the cab of the 18-wheeler he drove for a living, he felt the world go sideways.

There’s a macabre math that goes into such decisions: Does it make sense to use three organs on a single long shot?

“You need to call your family,” the ER doctor had said when the test results came back. Daru had a bad case of pneumonia, but that wasn’t the worst. He was in cardiogenic shock, a condition in which the heart can’t pump enough blood to meet the body’s needs. If not treated immediately, Daru would die. What’s more, he also had something called sarcoidosis, a rare autoimmune disease that can cause the body to overproduce certain cells that infiltrate and all but shut down organs—in Daru’s case, the heart, liver, and kidneys.

That meant Daru needed all three vital organs replaced. That particular triple transplant is one of the rarest procedures in medicine, so complex and risky that it lies beyond the capacity of all but a handful of the nation’s elite hospitals. Only 15 had been performed.

Still unconscious, Daru continued to fight the light. Then his eyes fluttered and opened. “Hey, man, where did you go?” Daru’s cardiologist, Bryan Smith, said. “Thought we lost you for a second.”

In his white lab coat, his square jaw dusted with a light beard, the 36-year-old Smith could have stepped off the set of a medical soap. Seeing Daru on rounds every day, Smith had grown fond of him, admiring how hard he fought.

When he discovered that Daru had been approved for the triple transplant, Smith was thrilled but worried. If the operation came off, Daru would have a new life. But before it could even be attempted, he