Hope fulfilled

Hunter Phifer checks in to the University of Arkansas for Medical Sciences Medical Center at 4:50 a.m. Wednesday, Jan. 21. He says he's not nervous, but a slight twitch of his eye suggests otherwise. He hasn't slept and says he's hungry.

Brian Smothers arrives at the Little Rock hospital just before 6 a.m. He's nervous but in good spirits. He's late, having overslept, and is rushed through check-in. He's all smiles, and he waves as the pre-op doors close behind him.

Phifer's mother receives a text message a few minutes later that eases her tension. "I'm pretty sure running late is genetic with me," Smothers writes. "Hunter may very well run five minutes behind from today forward."

At 7:57 a.m., the University of Arkansas for Medical Sciences kidney transplant team begins surgery to remove Smothers' left kidney, a three-hour procedure that would ultimately run long.

At 9 a.m., Phifer's surgery begins. A second team of surgeons has waited just long enough to ensure the kidney can be placed as soon as it's ready to be moved. That surgery is expected to run nearly six hours.

If something goes wrong during either surgery, the likelihood of Phifer getting another shot is low.

An estimated 26 million adults in the United States currently suffer from kidney disease, according to the Centers for Disease Control and Prevention. There are approximately 400,000 patients on dialysis. More than 100,000 patients are on the kidney transplant waiting list. Today, nearly 900,000 people are being treated for end stage renal failure.

Phifer is no longer any of these.

At 3:30 p.m., Phifer's surgery is declared a success as he passes clean, filtered urine for the first time in his life. In her excitement, his mother, Amber Atwood, takes a photo of the waste and posts it on Facebook.

Smothers and Phifer have been preparing for kidney transplant surgery since Aug. 28, a day when Smothers and partner Stephanie Olson found out Smothers was a blood match for Phifer, making him a candidate to donate a kidney to the ailing teen.

It was Phifer's 19th birthday.

HISTORY

Atwood and Greg Phifer knew their son was ill before he was born, but nothing could have prepared them for how sick he would turn out to be, Phifer said.

Hunter Phifer was born in 1995 at Northwest Medical Center in Springdale shortly after Atwood's seven-month ultrasound indicated that the first-time mom had no amniotic fluid surrounding the child and that he was "very sick," she said.

"He's been sick from day one," said Phifer's grandfather, Bill Andrews. "It was sad to see him so sick and small and to still see him so bad now."

Ten hours after birth, the infant was airlifted to Arkansas Children's Hospital in Little Rock where a team of doctors and nurses determined the severity of what they now know was near-complete renal failure, Atwood said.

He was put on dialysis immediately.

Phifer wasn't the first in his family to suffer from kidney disease. Paternal grandmother Norma Swanson battled kidney failure and received a new kidney 11 years ago. Atwood's uncle is still on dialysis after a kidney transplant failed. He is not a candidate for another surgery.

At the time of his birth, doctors told his parents to expect Phifer to remain on the treatments through childhood and that he would be in need of a kidney transplant by age 8, Atwood said.

Phifer defied the odds. He was taken off dialysis ten days after birth, and although he suffered from a heart condition and ADHD, the child grew into a teen with enough kidney function to avoid further treatment.

But it was not to last.

On May 9, 2014, Phifer was attached to a dialysis machine for the second time in his life. He would undergo the procedure nightly until the morning of Jan. 21, when the dimple-faced teen disconnected from the device for the final time before leaving for the hospital.

COMPLICATIONS

Smothers and Olson moved with 2-year-old daughter Emory to Springdale almost a year ago. They had no idea how that decision would ultimately change their lives and that of a boy they barely knew.

Smothers met Atwood in the summer of 2014 after enrolling his daughter in Amber's Lil Angels, a daycare program Atwood runs in her home.

After hearing about Phifer's struggles and "doing some soul searching," Smothers decided find out if he could donate to the teen, he said.

In late August, tests confirmed the 25-year-old was a match. Almost two months of intensive testing later, the UAMS kidney and liver transplant board was ready to schedule surgery.

Smothers and Olson shared the good news with Atwood, her husband, Tim, and her parents on Oct. 15, an evening Atwood said came as a complete surprise.

"I remember losing the feeling in my legs," she said. "I remember right then and there, looking at Brian in a whole new way. Before he was this young daddy who I kept a kid for. Now he was this man who was a hero, an angel -- our saving grace."

Phifer was told about the match soon after, but the teen wasn't all that excited, he said. He'd heard the good news before, only to be disappointed at the last minute because of some unforeseen complication.

Maternal grandmother Marla Andrews was a perfect match for the teen, but she was eventually ruled out due to the discovery of a small mass on one of her kidneys. Grandmother JoAnn Phifer also tried to donate but was ruled out at the last minute for a similar health reason, Atwood said.

But Smothers was different. The tests were clear, and the transplant board set the surgery date for Dec. 10.

However, only days before, Atwood received news that the operation would not happen. She was given no explanation, she says, but was told the "board would reconsider at their meeting after Christmas."

The transplant board met again on Dec. 29, and after careful consideration, rescheduled the kidney transplant for January.

"It's been a roller coaster of emotions for everyone," Atwood said. "God knew all along what the outcome would be, who it would be and when it would be. We just had to be patient."

With tentative hope, the families looked forward to Jan. 21. Smothers had been waiting nearly five months to undergo the surgery. Phifer had been waiting 19 years.

Pre-Op

A half hour after arriving at the hospital, Phifer walks unaccompanied into the second floor pre-op wing at UAMS. Although his donor has yet to arrive, a nurse inserts a central line into the teen's hand.

Phifer's family paces the waiting room, anxiously awaiting word from Smothers. He's late, and no one has heard from him since the night before.

At 5:50 a.m. Smothers explodes off the elevator and barrels towards the check-in desk. He giggles and gasps for air as he announces to a surprised staffer: "I'm Brian Smothers, and I'm here to donate."

Amid cheers and words of encouragement, the young father rushes back to pre-op and is prepared for the invasive surgery. It's only then he starts to look scared.

Ten minutes later, staff members announce the patients may see visitors. Two at a time, family and friends enter pre-op. They share prayers, tears and laughs with the men and each other.

In Room 8, Phifer seems calm but eager. In Room 9, Smothers talks a mile a minute.

"I can't believe I slept in after maybe only 30 minutes of sleep," he says with an anxious laugh. "I'm ready for this to happen, but I am feeling a little nervous. But I think it will be OK. I'm ready for this for Hunter. But I wish I could have eaten. I could really use some pizza right about now."

Olson holds Emory as they say goodbye to Smothers. His partner keeps from crying, but his mother, Peggy Smothers, is less composed. Terrified for the health of her son, she prays by his bedside and before leaving tells her son she's proud of him.

His last words to his family are "I love you."

Meanwhile, Phifer accepts a steady stream of well-wishers. Little brother Tanner arrives at the hospital just in time to tell his brother "good luck." Each grandparent kisses Phifer's forehead, and his father and stepfather stand in support of Atwood, who can't stop shaking.

Phifer maintains a calm demeanor, begrudgingly giving up his cell phone before kissing his mother and father goodbye.

"He deserves a little normalcy," says Tim Atwood. "It's time for him to feel like everyone else. This is his chance." Tears fill his eyes as he looks back at his stepson for what could be the last time.

Waiting

With these goodbyes, the family members settle in for what has already been a long day.

Amber Atwood sits at a table near the front of the waiting room, intermittently checking her phone and rubbing her hands with anti-bacterial hand lotion. She'll do this all day.

Olson has her own nervous ticks, but chasing after her daughter seems to take up a majority of her energy. The two play games on the floor and eat yogurt-covered raisins as they wait for word on the most important man in their lives.

Brad and Peggy Smothers are quiet most of the day. So are Phifer's grandparents, who charge themselves with running short errands for the waiting families when not praying quietly on their own. A dozen other friends and family play cards or read, and all snack aimlessly on homemade sugar-free cookies.

There are a total of 65 people anxiously awaiting word on about 15 patients, and each group has been issued what looks like a restaurant pager. The bustle of the busy waiting room comes to a halt whenever one sounds. The buzzers announce there is an update from an operating room.

At 8:04 a.m. the first update arrives for Smothers, announcing the surgery began just a few minutes earlier. Twenty minutes later, Atwood gets confirmation that her son's tandem surgery has also begun.

The morning drags on into the afternoon, and the two families continue to wait. But perhaps most importantly, they are waiting together.

Smothers and Phifer had only met four times before Jan. 21, but their bond will last a lifetime, they've said. The families seem to feel the same as they wait for their lives to change.

Little Emory runs to Amber Atwood, all smiles and looking to her favorite playmate. Brad Smothers talks with Greg Phifer over one of their cell phones, and Olson plays a new card game at a table with Marla Andrews.

Bound by the generosity of one man and the perseverance of another, the families are forever tied by the bonds of a medical miracle happening in Little Rock.

"We get so busy in life that we forget what makes the world go round," Tim Atwood says just before 3 p.m. "It's the giving spirit of people like Brian and the strength of someone like Hunter. It's the goodness and the little miracles."

"It's the Lord and love and hope," Amber Atwood adds, and her pager buzzes the final time.

Allison Carter can be reached by email at [email protected] or on Twitter @NWAAllison. More about Hunter Phifer's recovery will appear March 5 in the Our Town section.