Darla Engstrom was facing what her doctor called a "cliff."
Her kidneys were wearing out from an inherited condition called polycystic kidney disease, which was causing uncontrolled growth of cysts on her kidneys.
The results of test monitoring her kidney function were grim, indicating severe kidney impairment. She was feeling more worn out. Since February, she had been on the national waiting list for a kidney, normally a three- to five-year wait.
"I could tell there were somethings that weren't as easy," she said. "If I had 10 projects to take care of, I'd get through five. You're like, 'Gosh, why didn't I get through the other five?'"
Her doctor warned her about the cliff. Kidney patients can decline so gradually that it's hard to notice. But then one morning, she might wake with a headache and vomiting and other symptoms warning that her kidney function was plummeting. If that happened, her doctor said, she would need a port put into her neck and immediate dialysis.
For 22 years, Engstrom had known this day was coming. She and her brother had inherited the disease from their mother. She knew that if she didn't receive a donated kidney, she would have to go on dialysis.
And she wouldn't be alone. More than 101,000 Americans are on the waiting list for a kidney transplant, but only 17,000 people receive one each year, says the National Kidney Foundation. Every day, 12 people die waiting for a kidney, the foundation says.
The thing about Engstrom, though, is she wasn't afraid. She trusted her doctor, and she had an ace up her sleeve: Her boss at Douglas Machine, Jim Winkels.
Winkels, 47, a tall, lean, kind-eyed man, meets with his 24 employees one-on-one every month. In charge of purchasing for Douglas Machine, he believes every day is a new adventure. He has a bucket list of about 80 items, and has crossed off some of them, such as making his own cheese and writing a book. He also believes in helping others, sometimes berating himself for missed opportunities. He grew up in Duluth playing hockey and officiates at high school games. He has gone to Haiti four times on mission trips. He is vocal about his strong faith in God.
Engstrom began working at Douglas Machine five years ago. Two years in, she mentioned her kidney problems to Winkels during a one-on-one session. She wanted him to know so they could plan for her eventual absence for either dialysis or a transplant.
Last year, she told him that her disease was progressing and that she was looking at going on the waiting list for a kidney, which typically takes three to five years. He asked about donations and she told him donations typically come from cadavers, but sometimes they come from living donors, too.
"I said, 'Wow, that's a huge commitment for somebody to do that,'" Winkels recalled.
But the idea stuck in his head. He began looking up information about living donors. People can donate directly to a friend or relative. Or, if they are incompatible with that person, they can swap kidneys with another incompatible donor and recipient. Donors do suffer pain and, more importantly to Winkels, who was renovating his house, they can't lift more than 10 pounds for six weeks.
"That wouldn't be too bad," Winkels remembers thinking. "Yeah, it's an inconvenience, but look how it could help somebody, especially as nice as Darla, and her husband Jim, the nicest couple you could ever meet."
He told Engstrom he was considering being her donor. Once before, someone had offered to be her donor, but they'd had kidney stones in the past and were turned down. Winkels went through initial testing at the University of Minnesota and sent them a list of questions. In late May, Engstrom was sitting in his office during a work-related one-on-one when he got an email from the University of Minnesota answering his questions. At the bottom of the email was a bombshell.
"We're pleased to inform you, you're a direct match for the recipient," he read aloud.
"I'm like, 'This is totally unbelievable,'" Engstrom recalled. "You can't believe someone you work with on a daily basis is your match. We have so many characteristics they test for. It's not only blood. It's antigens, it's antibodies. Here my match to getting me healthy was sitting halfway across the room."
Still, she held back.
"Thoughtfully and prayerfully, this is something you have to decide," she told him.
Winkels, who had just gotten married, went home and talked it over with his wife, Vartsana. He asked her if he should do it. They prayed about it. That Sunday, Versana was ill so he went to church alone, to The Church in the Pines in Alexandria. That day, the pastor put a Bible verse up on the overhead projector, Galatians 6:10: "Therefore, as we have opportunity, let us do good to all people, especially to those who belong to the family of believers."
"I remember thinking in that moment, 'I think that's for me.' I just felt it," he said. Anxiety bubbled up in him, and he thought of all the reasons he shouldn't donate his kidney. Then he looked to his left and saw the church's picture of a calm Minnesota with another verse from Psalms: "Be still, and know that I am God."
He texted his wife, who texted back: "That's your answer. I'm all in."
"It was clear to us, we were both all in 100 percent," Vartsana said. "From that day we didn't have any doubts or hesitation."
Engstrom and Winkels are both busy people. Engstrom sits on the Douglas County Agricultural Association, which runs the county fair. She plays a key role in the August event, managing the fair's vendors and also handling its communications, and knew she needed to be active for that. Winkels was trying to finish his house project, which entailed gutting it and installing new everything: Sheetrock, flooring, carpet, appliances. It was a huge, dusty project.
To help speed up the remodel, Douglas Machine employees pitched in. One group helped gut the house. Others helped build a sidewalk and worked on the deck. Engstrom's husband mudded Sheetrock. Winkels' boss paid for lunch.
"Once word got out, there was incredible support from friends, from Douglas," Winkels said. "I have an awesome team."
His own bosses supported his decision, clearing the way for him to take time off and to work from home as soon as he was able. He said his own values mesh well with the manufacturing company's.
"We do what is right," Winkels said of Douglas Machine. "We treat others the way they would want to be treated."
That philosophy coincided with the empathy he felt for Engstrom.
"What if it was me who had kidney disease and about to go to dialysis?" he said. "Would someone stand up to help me?"
Meanwhile, Engstrom was hanging on. If she hadn't had a kidney donation scheduled, her doctor told her, he would start dialysis. But dialysis can make it more difficult to accept a kidney, she said, since her body becomes used to a machine doing its work.
She continued to monitor her health and diet carefully.
Engstrom's mother and brother had each had a transplant, theirs from cadavers. Winkels watched a kidney transplant surgery on YouTube, so he knew what to expect.
On Sept. 28, doctors operated on him first. When they were able to verify that his kidney was healthy, they began working on Engstrom.
Everything went smoothly.
"We were a textbook case," Engstrom said. "I have a very healthy, strong kidney from Jim."
Engstrom says she is doing just fine. Her test results are indicating that her new kidney is doing its job. She still faces the possibility of rejection, so she will be on anti-rejection drugs the rest of her life. Her kind of kidney disease tends to see good results from transplants.
"I'm extremely blessed to be able to be transplanted," she said. "There are so many people waiting for transplants."
She called Winkels "a very giving person."
"The people who work for him enjoy working for him," she said. She also acknowledged that while he was the donor, other co-workers also helped make it happen.
"Douglas Machine as a whole has a great value system," she said. "One of our values is in enriching lives and having a servant's heart and ownership spirit. We've gone some really good values at Douglas and we live those day to day not only at work but in our personal life."
Winkels, on the other hand, has been feeling kind of miserable. In the days since, as is common for donors, he has dealt with nausea, bowel troubles and bloating. His stomach muscles need to heal from the incision, so he has to push himself to a standing position. He and Vartsana take slow walks around their lake home, which has been radically transformed from the brushy, neglected lot it had once been. He drinks a lot of fluids. He has started replying to work email.
Vartsana tells him she is proud of him. A friend told Winkels that he had inspired her to donate bone marrow.
"I don't regret it," he said, at home six days after surgery. "Sitting here right now, as miserable as the last few days have been-yeah, I'd do it again."