On a warm, beautiful summer day in September, the kind of day when people say it is good to be alive, Dave Irland sat across from Prudy Burt on the porch of her simple home among the oaks in West Tisbury and said just that. It was no figure of speech; no idle reflection on the weather.
Three years ago Dave was dying, caught in the slow, inexorable failing of his kidneys, the result of a genetic disease that had killed his mother two years earlier — a progression he had watched as he cared for her in her final years. The dialysis that now kept him alive was also draining his spirit to live.
That was when Prudy, a landscaper with a long Island family heritage a and prickly nature that belies a softer side, offered a gift like no other — her flesh and spirit. Quietly and without fanfare, she donated a kidney and saved her friend’s life.
She told very few people about it at the time. “Somehow it offended my Yankee sensibilities to talk about it in a public way,” she said. Almost three years later, sitting with Dave in West Tisbury, she agreed to speak about her decision in the hope it would prod others to act when faced with similar circumstances.
A grim inheritance
For years, Dave, a soft-spoken, bespectacled guy, was a familiar figure in West Tisbury, where he owned and operated a bike shop behind Alley’s General Store, since converted into a farmstand. He and Prudy, a native Islander, would often sit and trade acerbic comments and observations on life. Their shared humor provided the foundation for a lasting friendship.
Dave left the Island for Lenox in the Berkshires in 2007 to care for his ailing and aging parents. “My parents were falling apart,” he said. “My father was in the early stages of dementia, and my mother was in the hospital for a broken hip, and she had already reached end-stage renal disease and was on dialysis at home.”
He arranged to move his father to a specialized Alzheimer’s unit in California near a sister. He cared for his mother at home.
Following a routine checkup, Dave learned his kidney function was “slightly down.” That led to a sonogram and a diagnosis of polycystic kidney disease, the same disease affecting his mother.
“Your kidneys grow cysts, and are basically huge lumps of cysts and no longer function as kidneys anymore — it’s genetic. I got it from my mother. My sister in California has it. My other sister doesn’t.”
At the time, one of Dave’s regular duties was to empty the fluid bags that were used in the dialysis process to collect the impurities from his mother’s body, so he was well aware of what he faced.
“I got diagnosed a few months before my mother called it quits,” he said. “She was in very bad shape.”
In early 2008, when his mother died, Dave received a grim prognosis: “The doctor told me when I was first diagnosed my kidney function was around 30 percent or so and I hadn’t had any real symptoms yet, and he said you’ll probably be on dialysis in six months.”
He decided he could alter the prognosis through changes in diet, exercise, and lifestyle: “I wanted to stop it; I thought I could reverse it — goddamn it, other people aren’t as determined as me.”
Prudy steps up
His health and kidney function remained steady for a few years. Then his kidney function began a precipitous slide. He became too weak to work out, and he stopped exercising. “I gave up and said, ‘OK, I’m ready for dialysis.’” It was April 2013.
Given his age, 56, and health, a transplant was an option all along. From the very beginning he told friends in the Berkshires and on the Island about his predicament.
“I had a group of theoretical volunteers, but Prudy was the only one who got in gear and did anything,” he said.
Prudy agreed to be tested in December 2011 for compatability. All signs pointed to a good match. As Dave recounted the details, Prudy interjected, “And it does kind of make you go, uh-oh, I’m on the hook for this thing,” she said with a hearty laugh.
But it is clear she knew what her friend faced. She reminded Dave of the fistula, a small tube that doctors implanted in his arm to provide a connection port for the dialysis machine, which is still visible just below the surface of his skin. “It is a nasty thing where they join a vein and an artery, and it’s just a circle that goes up to your heart,” Dave said.
That spring he began dialysis. On Memorial Day weekend he called Prudy. She agreed to give Dave one of her two good kidneys he needed to stay alive. But there were practical considerations. A landscaper, she could not afford to begin the preoperation ritual until November, which was when she traveled to Baystate Medical Center in Springfield and underwent a battery of tests over the course of three days — “They kept leading me from one machine to another,” Prudy recalled.
The surgery was scheduled for January 29, 2014. It was a difficult winter for both. At the same time as she was anticipating surgery, Prudy was caring for her father, Otis Burt, who was ill and would die on Feb. 19. Dave’s father died that January.
An Islander to her core, most comfortable on the rural roadways of West Tisbury, Prudy described the most worrisome aspect of agreeing to the transplant. “Comically, the thing I was dreading most about this surgery was the to-ing and fro-ing of being off-Island,” she said. “I mostly dread having to navigate the off-Island world.”
A cousin, Jess Miller of West Tisbury, offered to do the driving.
“Once I knew that I had my cousin Jess on deck to do the driving, etc., I could just relax and get down to business,” she said. “Jess was the perfect person for me to have along on this little adventure.”
The surgery was uneventful — “Baystate Medical is the A-Team,” Dave said. Prudy returned to the Island, where her mom, Ann Burt, a nurse at Martha’s Vineyard Hospital for more that 50 years, helped her recover.
Prior to surgery, Dave was living with approximately 10 percent kidney function. His blood creatinine level, a measure of kidney health which should have been around 1 on a scale of 0 to 10, was near 8.8.
“I was sitting around waiting to die for five years,” Dave said. That changed in one day.
Immediately after the surgery, Dave’s kidney function was near normal, and his creatinine level had dropped to 1.5.
Asked to reflect on the moment when Prudy agreed to his request, Dave said his only sense was of relief, knowing as he did that “you’re on dialysis and your life hangs in the balance.”
Dave described the regime of dialysis as “horrific.” On that warm West Tisbury day in September, it was all behind him. Dave sat on the porch chatting casually, just feet away from the woman who had quite literally saved his life. “It’s all surreal,” Dave said. “I still can’t wrap my brain around it.”
“I think a lot of it is I felt like I was in the hands of other forces. I could neither appreciate them or question them, nor get away from them — you lose your choices — and of course I was massively grateful … and it’s still a thing I can’t process, it’s just something that happened and Prudy was part of it. And OK, I’d be dead without this kidney, but what’s that like?”
They both laughed at that notion. He admits that it was more complicated than dying.
Dave said there was a long recovery process, but he moved forward slowly, making progress each day. Now living in Great Barrington, he said, “I had some good people in my life.”
Prudy downplays her participation as though she had only given up a cord of wood. She recalled friends she had lost and an uncle who benefited from a liver transplant from the victim of an auto accident, as though her actions constituted a repayment and not an act of generosity. “I do not consider myself to be a particularly altruistic person,” Prudy said.
Prudy told her cousin Jess, who accompanied her to the surgery, that she had the harder job — hanging around Springfield for three days.
The experience made her aware of “living donations,” the term applied when a donor such as she offers up a kidney. Her major concern was how the donor surgery might affect her lifestyle. All of the literature for donors she found in the hospital lobby depicted people in offices. She was worried she might not be able to work.
“I cut three cords of wood a year for my woodstove — would I be able to do that again? So I was nervous about that … I have a landscape business, I live alone; I have my own income, I am responsible for it — there were no stories like that,” she said of the available literature. “It was all, ‘I was back at my computer in three weeks’; well, great, what about your chainsaw, your rototiller?”
Prudy wants others to learn from her experience. “It’s not such a big deal that you can’t do it,” she said.
Prudy, a longtime member of the West Tisbury conservation commission, is outspoken and active in town affairs. Asked if she thought her contribution of a kidney had made Dave more ornery, she said, “I think the answer is yes,” noting that he had recently attended a public hearing on a large-scale development in Great Barrington.
“As Dave was never one to get much involved in things like that before, I like to think that my kidney had something to do with it,” she said. “It is my evil intention to slowly take over the world with my pesky townie-ness, one bodily organ at a time.”
For information on kidney disease, transplants and becoming a kidney donor go to the National Kidney Foundation at kidney.org.