Grateful transplant recipient: ‘What did I do to be the one to deserve this?’

Story by Liz Johnson

Photos courtesy of Laura Ruel

Laura Ruel is writing a letter. At least, she’s trying to. Every day she searches for the right words, the ones that might never be read but carry so much weight nonetheless.

“Thank you for saving my life” feels trite, insufficient. But what else is there but gratitude for this chance at a healthy future? What else do you say to the family of the organ donor who, in losing their own life, gave yours back to you?

Three months after a kidney-pancreas double transplant, Ruel is only beginning to process the ways in which her life has changed. She feels a tremendous sense of responsibility to take care of herself, to be happy.

To honor the chance she’s been given.

***

Ruel, a 59-year-old journalism professor at UNC-Chapel Hill, was on the kidney-pancreas transplant list for more than six years, due to chronic kidney disease caused by type 1 diabetes, which she has lived with since her 20’s. 

From the moment her name went on that list, she faced two contradictory truths: she couldn’t stop living her life, but she also had to be prepared to drop everything at a moment’s notice.

“It’s always in the back of your mind,” Ruel said. “My life is going to dramatically change at any minute, and I don’t know when that minute is going to be.”

After being put on the list, she made small lifestyle changes geared toward one goal: when the call came, she would be ready.

She hired a personal trainer to help her get in shape so her body would be ready for the surgery she wasn’t even guaranteed to have. She was even more precise with her already careful diet. 

She packed a go-bag. Reading material and toiletries, sweatpants and blankets, fuzzy socks and an extra long phone charger. Everything she could imagine needing in the hospital when the time came. 

She waited.

***

Someone is added to the transplant list every nine minutes, according to the Health Resources and Services Administration (HRSA). Seventeen people die each day waiting for an organ transplant.

But Ruel didn’t know any of that until after her surgery. While she waited, all she knew was that though she might never get the transplant, she would do her best to let that reality fade to the background, to keep living and to stay optimistic.

“There was no other way to be,” she said. 

She carried on at work, researching and teaching. Often, the only giveaway that she was sick at all was Trula, the diabetic alert dog she’d adopted in 2018 when her youngest daughter moved away from home. The 6-year-old shepherd mix went everywhere with Ruel, sitting at her knee beneath the desk at work, and going on long walks with her through Carolina North Forest near her home in Chapel Hill.

Tru could always smell when Ruel’s blood sugar levels were off, and she’d nudge Ruel’s hand with her nose to let her know. 

Her daughters, Amy and Allie, encouraged Ruel to get a service dog after Allie found her unconscious from low blood sugar in the middle of the night.

“It was extremely scary,” Allie said. “It was terrifying to think of if I hadn’t been there, if she was by herself.”

Now that Ruel is living alone, Tru has saved her life in the same way several times. 

Both of Ruel’s daughters also downloaded an app that sent them notifications if their mom’s blood sugar levels were off, and they got in the habit of exchanging good morning texts to check in with her regularly. 

Try as she might to proceed as normal, Ruel’s life while on the transplant list was laden with calculations. Not only did she monitor the carb and insulin levels she’d long been accustomed to tracking, now, she also had to measure the risk of taking even the shortest trip out of town. 

According to the HRSA, a properly stored kidney can last outside the body for 1-2 days. A pancreas lasts less than a day. But the sooner the transplant occurs, the more smoothly things go.

What if the call came when she was in Boston visiting family, and she couldn’t make it back in time for the transplant? What if the call came on the day of her daughter’s wedding?

If Ruel ever left the country, her name would temporarily be frozen on the transplant list, and there could be all sorts of delays in getting it reactivated again. This was a risk Ruel quickly decided she wasn’t willing to take. For all the years she spent on the list, Ruel traveled away from Chapel Hill only a few times.

Sometimes, doubt crept in. By the numbers, Ruel had reached end-stage kidney disease in the months leading up to her surgery. Thanks to her careful health regimen, she stayed well enough to continue without dialysis. But she always knew there was a chance the call would never come. 

***

Late at night on Jan. 31, 2022, Ruel woke to the sound of her cellphone’s ringtone splitting through the dark. She squinted bleary-eyed at the clock. 11:48 p.m. She rolled over and shut her eyes. 

But then came that nagging thought, the one that’s been in the back of her mind for more than six years, surfacing with every spam call and unknown number. This could be the one.

She rolled back over to listen to the voicemail.

In an even tone, the nurse on the other end of the line confirmed her hopes: Ruel needed to report to UNC Hospitals in just seven hours to have her blood drawn. A kidney and a pancreas were available, and they just might be a match.

At 12:01 a.m., Ruel texted her boyfriend, John Clay, to share the news. 

“Just got a kidney call!” she wrote, explaining the nurse’s instructions for the next morning’s blood sample. “Not sure what will happen from there, but I’m hopeful!” 

Ruel tried to keep these hopes in check. Not long ago, she’d received a similar call, only to find out she was temporarily ineligible because she had just received her first COVID shot. 

Even if the initial blood test proved to be a match, she (and the donor organs) would have to go through dozens of other exams before anything got the green light. The past years have made Ruel an expert in waiting, and she knew it wasn’t over yet. 

***

Morning rolled around, and Ruel texted her daughters an update before heading to the hospital for the test. Her oldest daughter, Amy, is a nurse in the neurology unit of the same hospital. She was leaving her night shift right around the time Ruel walked in.

Ruel left the hospital with no clue when she might get the results of the blood sample. 

The day stretched out uncertain before her. So she did what she always did, what she’d been doing for the past seven years: Laura Ruel kept going. 

As she waited for the second call, she logged into Zoom meetings and went back to work. She interviewed a candidate for the position of dean, she made small talk. She began a class. 

But she didn’t teach for long. Less than ten minutes after taking roll in her 9:30 a.m. digital storytelling class, she was interrupted mid-sentence by her cell phone’s cheerful ringtone.

Her students waited as she muted herself on Zoom and spoke silently into the phone. One hand pressed to her chest, she nodded along to the voice on the other end of the line. A smile lit up her face. 

It was good news.

***

Ruel fetched that little black suitcase, packed and waiting, then called the friend who’d long been on standby to take care of Tru. Finally, Ruel returned to the hospital. 

The rest of the day passed in a blur. She updated her boyfriend and daughters: Amy and John joined her at the hospital, and Allie, who lives in Boston, searched for red-eye flights with her husband, waiting for the go-ahead to book one. 

Ruel went through test after test, waiting for someone to tell her something definitive, to say “yes, this is finally going to happen.” As things began to appear more certain, she updated her class Sakai pages, granting access for Scott Geier and Kate Slate, who were already arranged to fill in. 

At about 7 that evening, Ruel’s transplant nurse provided yet another vague but promising update. “Things are looking good,” she said. If Ruel didn’t hear from her again, that was a good sign. 

She finally learned that the surgery was scheduled for about 3:30 a.m., but she kept bracing herself for something to fall through. 

There was just one moment, in all this waiting, in which she felt afraid. 

“All of a sudden, I just thought, ‘am I going to die?’” Ruel said, remembering the panic that twisted in her gut at that moment. 

It would be a long, major surgery, about seven and a half hours. What if she didn’t wake up? 

But as with all the doubt she’d ever felt about getting off the transplant list, Ruel tried not to dwell on this possibility. She’d made it this far, after all, and she trusted her doctors completely. 

“You have to just surrender, you know,” she said. “This is what’s going to happen.”

As much as she tried, she didn’t get a moment of sleep, instead passing the time talking politics with John, watching “Seinfeld” and going for walks through the halls with Amy.

At one point on their stroll, they passed a display of stories from organ transplant recipients, describing their lives after surgery. This could be Ruel’s future, and it was finally in sight.

At 2 a.m. the nurses wheeled Ruel back to prepare for surgery, and she was certain at last.

***

Shortly after the surgery, before all the medications had worn off, Ruel jotted down her early thoughts on the past few days.

“I feel as if it is a big blur. I know that someday I will have perspective, but now I’m just dumbfounded. After years of waiting, everything just happened so fast.”

But recovery, it seemed, would not move so quickly. In the two and a half weeks she spent in the hospital, Ruel barely touched that suitcase. As she slowly and painfully began to recover, it was too exhausting to watch TV, much less read the books she’d packed. 

Just as she had surrendered to the doctors who performed the surgery, now she surrendered to her own body’s healing process. She kept reminding herself: no matter how much pain she was in now, it was more than worth it for the healthy life to come. 

***

Ruel and her family spent years awaiting this transplant. But no amount of preparation could have gotten them ready for the drastically different lifestyle of recovery she would be thrown into next. 

After two and a half weeks in the hospital, Ruel returned home, still reeling. Her new schedule includes multiple daily doses of anti-rejection drugs, hospital visits three days a week, and all sorts of adaptations for her newly weakened immune system. For at least the first three months, reusable dish towels, food prepared by others, and going out in public are all off limits. 

Most significantly, because she now has a functioning pancreas, Ruel is no longer diabetic. There are some foods, like feta cheese and lunch meat, that she can’t eat until at least three months after the surgery. A few, like grapefruit, are off the table forever. But the low-carb diet she stuck to since her diagnosis 30 years ago is a thing of the past.

She must still prioritize healthy foods to take care of herself and her new organs. But now, she can make rice for dinner without thinking twice. She can eat chocolate cake on her boyfriend’s birthday without monitoring her insulin levels.

Ruel and her loved ones are still adjusting to this new way of living, breaking old habits and building new ones. In conversation, Allie catches herself using the present tense when discussing her mom’s diabetes, reminding herself it’s a thing of the past. When Ruel eats something sweet, she catches herself still tracking carb intake. Ruel’s cousin Janet keeps offering to make meals when she visits, forgetting that this kind gesture would endanger Ruel’s weakened immune system. 

Even Tru has a long road ahead of her. Ruel no longer qualifies for an alert dog, and Tru is too old in service dog years to be moved to another family, so she’s getting an early retirement. Ruel has hired a trainer to help teach Tru how to be, well, a dog. So far the results are mixed: she still can’t be left home alone, and she never leaves Ruel’s side. 

Soon, with the doctor’s approval, she’ll be able to end her isolation and venture into public again. She could attend faculty meetings in person, or maybe she’ll just get lunch with a friend. 

She’ll be teaching a course online in May, but she has the summer to help Tru adjust, and to let herself adjust as well. After so long spent surrendering herself to the transplant list and the countless doctors, trusting in the process and praying for a match, Ruel is finally getting her life back. She’s still figuring out exactly what that means.  

***

As Ruel struggles to compose her letter to the donor’s family, she writes down the questions she has no answers for. 

“Why did I get so lucky?”

“What did I do to be the one to deserve this?” 

She doesn’t know if she’ll ever fully wrap her head around how fortunate she has been. But she does know that the best thing she can do to be deserving is to live, to spend time with her loved ones and to appreciate the little things. 

For so many years, she’s been battling diabetes and chronic disease, putting on a strong face and working through it all. But now all that is gone. 

“All of a sudden, I’m not in survival mode,” Ruel said. “It’s just a time for me to sit back and think a little bit more, not about how am I going to survive, but what do I want to be and what do I want to do?” 

For now, her life is still riddled with doctor’s appointments and blood tests, handfuls of pills and dietary restrictions. She’s in a strange sort of limbo between her two realities: no longer diabetic, no longer chronically ill, but still emerging from post-operation recovery into the rest of her life. It’s a long, indefinite journey, and some of those pills and appointments are here to stay. 

But Ruel is in no rush. As she processes the past few months and prepares her mind and body for what’s next, it’s enough just to set down the weight of that phone call, the weight of not knowing.

It’s enough to sit on the couch with her cousin and eat homemade chocolate chip cookies, reaching for a second or third without having to measure carbs or insulin. 

Though she’s missed traveling internationally with family and for her job, she feels no need to make any big plans yet. It’s enough just to know that one day, she can.