It was time.

Nurses were ready to take the mother-daughter duo in for their transplant surgeries.

Lindsay Pratt, 26, would be giving her mom, Vera Pacca, 58, part of her liver after a relatively rare autoimmune disorder attacked and destroyed Vera’s liver.

“Hold on.” Lindsay told the nurses. “We’re not quite ready.”

Always inseparable, the two held hands one last time and locked eyes. There was so much to say. For months, Vera had been refusing to let her only child serve as a transplant donor for her. Every fiber in Vera’s being resisted. Mothers don’t put their children in harm’s way. And children – even those who are adults – do not risk their lives for their mothers. The other way around would have been fine with Vera. Of course, she would have done anything for Lindsay, but she refused again and again to allow her young, vibrant daughter to go through a tough surgery and give up part of her liver for her. Besides, Vera had had a good life. If her time had come, she was ready to die.

That did not fly with Lindsay. Usually serene, Lindsay felt desperate.

“I can’t just watch while this happens. I need to do something,” she told her mom. “What if you die and I could have saved you?”

Lindsay wanted her mom to see her get married someday, to watch her thrive in a career. And both wanted to keep riding horses together. When Lindsay was a little girl, she and her mom spent all their time together. And their passion was horses: loving and grooming them, riding English-style and jumping and competing at horse shows.

Now, on the day of the transplant, the nurses at UCHealth’s University of Colorado Hospital prodded the women. It was time. The doctors were waiting.

“Promise me you will fight,” Lindsay told her mom.

Both had had haunting dreams in the days before the surgery. Vera dreamt she awoke after surgery and her daughter had died. Lindsay had that same scary dream, but didn’t tell her mom. Awake, she feared the opposite. Vera was a spiritual person and Lindsay worried that if the surgery wasn’t going well, her mom might just let go and surrender to death.

“We’re making it through this, Mom,” Lindsay said. “Promise me, you won’t give up. Promise me you’ll come back.”

“I promise,” Vera said. “I’m going to be here for you.”

Then she squeezed her daughter’s hand and said, “See you when we wake up.”

Neither of them knew that day that the transplant would lead Lindsay to a new calling in medicine and a path to her future husband. They also didn’t know yet about a tall, gentle horse named Henry, who years later would leave them smitten and would reawaken their equine bonds.

A cosmic biological miracle

While Lindsay soars to nearly 6 feet tall, Vera is just 5’5’’. But she’s always been fearless. As a young teen, she would save up all her earnings and buy horses destined for the glue factory. It didn’t matter if some had been pegged as crazy and were seemingly impossible to ride. Vera would climb in the saddle and settle them.

Back in 2005, Vera was living on a ranch with horses north of Colorado Springs. She had just ordered a full truck of hay and unloaded it by herself. She’d always been healthy, didn’t drink alcohol and ate organic food so she could stay fit for riding, ranch work and yoga. A worker who was helping with fence repairs had left some stacks of wood around the property.

One night, Vera went out to check on the horses. She tripped over the wood and got what should have been a simple sliver in her thumb. Over days, the wound got very dark and appeared infected. Vera went to the ER and got it treated. But she wasn’t getting better. She was exhausted and became jaundiced. A nurse practitioner at her office urged her to get some blood tests.

The results were alarming.

“You need to see a hepatologist today,” the nurse practitioner told her.

Vera didn’t know what that meant. She soon learned more than she ever wanted to know about liver specialists.

Lindsay was living in Denver and working as a pharmaceutical representative at the time. She raced to Colorado Springs and went to the appointment with her mom.

The news was devastating. The doctor told Vera she had a rare autoimmune disease called primary biliary cirrhosis that had destroyed her bile ducts and caused her liver to fail.

“You’re at stage four,” the doctor told Vera.

Vera thought there were 10 stages and figured she was OK. But the doctor clarified.

“No. It’s four out of four. It’s incurable. I’m going to get you on the list for a transplant.”

Vera had never even heard of liver transplants. But Lindsay had. And she immediately stepped up.

“What do I need to do to be a donor?” she asked.

“I knew you could donate part of your liver,” Lindsay said.

The doctor told her to slow down, but Lindsay feared her mom had little time.

“I was frantic. I was so worried that something was going to happen to her. It felt like things were moving too slowly. I knew I wanted to be a live liver donor.”

Within months, Vera was evaluated and approved for a transplant.

“OK. When we can schedule the surgery?” Lindsay asked.

That’s when she ran into major resistance from her mom.

Even though Vera’s skin was turning yellow and she was suffering from internal bleeding that kept landing her in the hospital ICU, she told Lindsay she couldn’t allow her to be a donor.  That’s when Lindsay put her foot down.

“I won’t be happy if I have to live without you,” she said.

So Vera started praying.

“It’s the hardest thing I have ever done in my life – putting her in danger,” Vera said. “I had to pray and pray and trust. She was doing such a kindhearted thing. It would not be God’s choice to hurt her. I had to pray nothing would happen to her.”

Finally Vera agreed and the dual surgeries were scheduled for Dec. 5.

Vera’s office in Colorado Springs was close to a church with a large congregation. Though Vera was not a member, thousands of people started praying for the mother and daughter. Another friend had ties to the Lakota Nation. They, too, began praying.

On the day of the surgery, after saying their goodbyes, Vera and Lindsay went into separate operating rooms.

Doctors cut out about 70 percent of Lindsay’s liver, then brought it to Vera’s doctors. Lindsay’s liver would regenerate over time.

In Vera’s room, doctors had little trouble removing her diseased liver. Lindsay’s donated liver nestled right in. Both mother and daughter thought about how special it was that Vera had once nurtured Lindsay in her belly. Now, part of Lindsay was coming back. Vera had given Lindsay life. Now Lindsay was restoring her mom’s health. It felt like a cosmic biological miracle.

‘To the moon and back’

Lindsay woke up from her surgery full of questions.

“Is my mom OK?”

“Yes,” one of her doctors told her.

“Can you take a note to her?”

The doctor tore off a piece of paper from a prescription pad and handed it to Lindsay.

On the back, she wrote: “Hi Mom. I am doing great. Love you and can’t wait to see you!” She signed her note with a big heart.

Soon, Lindsay got a note back from her mom.

“I feel your love. I’m so grateful you’re doing great,” Vera wrote.

Despite all their fears and the bad dreams, both surgeries had been successful and mother and daughter were recovering beautifully.

“We didn’t even need transfusions. There was so little bleeding,” Lindsay said. “They called us the dream team.”

Before the surgery, Lindsay had been fascinated with hepatology and was reading everything she could get her hands on about liver function. A pre-med major in college, she already had been considering leaving her job and applying to study to become a physician assistant. Prior to the transplant, she thought she wanted to work in women’s health.

Now she had a new passion. Her doctor, Igal Kam, had performed the first live donor adult-to-adult liver transplant in the western world at the University of Colorado Hospital in 1997. In Japan and Australia, doctors had been working on similar surgeries due to a lack of livers from donors who had died. Since the 1960s, the University of Colorado has been a pioneer in transplants with Kam’s mentor, Dr. Thomas Starzl, performing the world’s first successful liver transplant in a human patient.

Lindsay kept asking so many questions throughout the process that the transplant residents brought her medical text books to read as she recovered.

Lindsay pored over them and found inspiration for a new direction in her life.

“I had had such a unique experience. How many people go through having a transplant?” Lindsay said.

She decided she wanted to work in the field.

“Not only could I take care of patients, but I could also relate to what they were going through,” she said. “It seemed only natural that this was the direction I would go in. This is my calling.”

The recovery went so well that after just six days, both Lindsay and Vera were released from the hospital.

Vera attributed the seamless surgeries to all the support they had received.

“It was phenomenal. Thousands of people were praying for us,” Vera said.

For Lindsay, the results reaffirmed what she believed all along: it was fate that she help save her mom’s life.

Within days of the surgery, the two felt so good that they went out for a long walk. They exhausted themselves and needed to call Lindsay’s dad for a ride back. But they had begun to work their way back. Eight weeks after the transplant, Lindsay was running again and she did a 5K that May.

Vera quickly got back to her horses and was able to ride Faline, a sweet Thoroughbred who followed her everywhere and was named after Bambi’s mate.

“It was a night and day difference,” Vera said.

Both women experienced the euphoria of a life-altering experience.

Lindsay remembers running an errand at Target, looking around and seeing everyone rushing through their lives.

“Everything had slowed down for me. I felt like I’d been to the moon and back. I just felt this overwhelming sense of gratitude,” Lindsay said.

Vera noticed how the sky and trees looked so beautiful.

“It was such a miraculous thing,” she said. “Everything about living seemed enhanced. Life becomes very precious. You notice each moment. You never know how many moments you have left.”

The transplant surgeries left each women with scars that stretched about six inches from their bellies up toward their chests.

Lindsay has worked for years as a model and she kept doing swimsuit shoots after the surgery. For those jobs, she offered to cover the scar. But her clients urged her to show it. Like her, they saw the mark on her belly as a symbol of depth and character.

“To me, it’s a beautiful thing. I’m worried it’s going to go away,” Lindsay said. “It’s a sign of someone who has that much love inside.”

From patient to physician assistant

After recovering, Lindsay embraced her new passion and swiftly earned her degree at the University of Colorado School of Medicine as a physician assistant, graduating in 2010. Throughout her training, she honed in as much as possible on hepatology and started training with the people who had cared for her. She was evolving from patient to provider.

“They let me do as many rotations as I could in gastroenterology and hepatology,” Lindsay said.

Researchers are continuing to expand their knowledge of how vital and expansive liver function is. And of course it’s an essential organ.

“You can’t live without one. There’s no dialysis for liver failure,” Lindsay said.

After graduating from school, Lindsay worked for a time outside of the UCHealth system. But several doctors in the program had kept an eye on her and in 2012, when there was an opening in the transplant program for a physician assistant, they offered the job to Lindsay.

She was thrilled.

“I work with my second family,” she said of the transplant team.

Kam said Lindsay brings an extraordinary perspective to her job.

“The transplant redirected her life,” he said. Working in the same unit where she had her transplant “closes the loop in her life.”

Thus far, physicians at the University of Colorado Hospital have done about 200 live-donor liver transplants. Kam, former chief of transplant surgery for UCHealth, expects the program to expand under the leadership of Dr. Elizabeth Pomfret, the new chief and an expert in live-donor and multi-organ transplants.

“There’s such a shortage of organs. Patients can’t wait for deceased donors. It’s very hard to get to the top of the list. It’s like waiting on death row for an organ,” Kam said. “If patients want to continue with a normal life, they should probably look at this option.”

Currently, more than 600 people are waiting for liver donations in Colorado. Nationally, about 15,000 are on the liver transplant list.

Lindsay is able to counsel patients about the emotional and physical challenges and rewards of organ donation. Just like in her case, she finds that family members are usually eager to donate their livers while potential recipients can be resistant. Lindsay never pressures anyone to proceed. Donating a liver certainly carries risks. The risk of death for donors is about 1 in 500, Kam said.

For Lindsay and Vera, the results have been nothing but positive.

“It has enhanced the bond between mother and daughter,” Kam said. “It’s always nice to see how wonderfully they are doing.”

He said life expectancy for liver recipients is now outstanding. Vera can expect to live for decades with her new liver, he said.

Physician assistants in the transplant unit regularly see patients, perform procedures, evaluate patients for transplants and perform follow-up care. They are absolutely essential to the program, Kam said.

For Lindsay, the job reminds her every day about the miracle of transplantation.

“It’s such an extraordinary experience to go through. I tell patients that when they’re recovering, they should pay attention every day. It’s an experience that most people never have. It’s surreal and will forever change you.”

Lindsay loves building deep relationships with entire families.

“There’s a different kind of closeness. They’re dealing with such life and death issues.

“I remember what it feels like to have to go through having a very sick loved one, all that fear and anxiety. I can put myself in their shoes,” she said.

And she relishes the opportunity to work in a field that is rapidly evolving.

“It never gets boring. We can cure hepatitis C now,” she said.

While Lindsay’s professional life flourished after the transplant, she also met a person who perfectly understood all that she had experienced. Several months after the surgery, Lindsay met and started dating Dr. Thomas Bak, another one of the transplant doctors at the University of Colorado Hospital.

Just as Lindsay had hoped, Vera got to see her daughter get married. On a beautiful August day in 2012, Lindsay and Tom said their vows in Lake Tahoe. The lake glistened behind them as the peaks of the Sierra Nevada jutted up over the lake.

‘Let’s live’

The transplant left Lindsay and Vera with one key mantra: “let’s live.”

And for them, that meant getting back to horses.

Now 38, Lindsay received a gift of riding lessons from her dad for her 35^th birthday. Years earlier, she had sold her horse to go to college. And Vera had sold her ranch in Colorado and moved to live near a sister and brother at lower elevation in California, where she could breathe more easily. Vera rode until Faline died at age 22. Now 70, Vera continues to work full time, does power yoga every day and recently parachuted to celebrate her birthday. But she also developed some osteoporosis and compression fractures that have prevented her from riding in recent years.

Lindsay decided it was her turn to get them back in the horse game. A matchmaker of sorts who pairs horses with potential owners had been keeping her eye out for a horse for Lindsay. In March of 2016, she called from a horse show in central Florida with an urgent message.

“I’ve found your horse. You’ve got to fly here now,” the woman told her.

Lindsay was skeptical. Nonetheless, she jumped on a plane and found her way to the small city of Ocala.

When she arrived, she was instantly smitten. Waiting for her was a handsome fellow she would later name Henry. He’s an 18-hand warmblood and a beautiful bay with a striking white blaze on his face. The marking looks like a heart and that’s why his formal name is King of Hearts. His father was named Dr. Love and that explains Henry’s personality. He’s sweet and friendly like a giant chocolate lab. He loves nuzzling with Lindsay and follows her everywhere.

“He’s my dream horse,” Lindsay said.

He’s also a natural jumper. Most horses don’t jump on their own, but if Lindsay turns Henry loose in an arena full of jumps, he’ll canter around and leap over them for fun.

She bought him on the spot and keeps him now at stables in Parker where ponderosa pine trees spread over rolling hills. Lindsay spends time with Henry every day and Vera jokes that he’s become her “grandkid.”

Owning a jumper has reawakened Lindsay’s love for riding and competing. Vera first put Lindsay on a horse when she was just 9 months old. By age 6 she was jumping on a black and white pony named Chocolate Sundae.

As a teen, Lindsay remembers loving competitions and always wanting to win. These days, whether she’s at a show or just hanging out and riding Henry for practice, Lindsay has a totally different attitude. Yes, competing is fun. But she approaches each show with gratitude that she can participate in her sport. She also revels in the pure joy of jumping with Henry and having such a special horse as her partner.

On a recent weekend, Vera flew to Colorado for a visit and a horse show.

On Friday, Lindsay took a lesson with her trainer in preparation for the competition. She worked on her posture and counted strides that Henry would need between jumps. While the best riders make it look easy, jumping is a mix of math, muscle and mastery. In competitions, judges can demand new combinations on the spot and riders have to move through the jumps in the proper order while making it all look effortless.

After Lindsay finished her lesson, she urged her mom to climb up on Henry’s back just to see how it would feel. Vera strapped on a brace to protect her back and got a lift since Henry is so tall. She instantly felt right at home. She walked him around the arena, settling into the saddle, then after a few minutes, Vera did what came naturally and took Henry over a jump. Her posture was perfect.

Both mother and daughter were overjoyed.

“That was on my bucket list,” Vera said.

After dealing with compression fractures, Vera wasn’t sure she could ever ride again. But she felt great and took Henry out on a trail ride the next day.

Then on Sunday morning, Vera stepped up to serve as Lindsay’s groom, helping her get Henry saddled and brushed before the competition. For shows, Lindsay competes in formal riding attire. In addition to her riding abilities and Henry’s jumps, they both get judged on how spiffy they look. So having her mom’s help was essential to keep her riding boots polished and her pants, jacket and helmet free of dust.

The morning began with a little mishap. As Lindsay warmed Henry up in an outdoor arena at the Colorado Horse Park south of Parker, he stumbled while trotting in dirt mixed with synthetic fibers. He caught his shoe in the footing, fell down and hit his nose in the dirt. Lindsay stayed on Henry and managed to pull him up.

Henry ended up with a bruised knee, but Lindsay was a little shaken up.

“Just breathe,” Vera said, as Lindsay calmed down and studied the course.

When the time came to compete, Lindsay and Henry moved through the course beautifully. At the end, she patted him and leaned forward in her saddle to kiss him. Henry was declared show champion and won a blue ribbon, complete with a sash to drape over his body. Together Lindsay and Henry lead their division and age category in the Colorado Hunter Jumper Association’s rankings.

While the victory was fun, Lindsay was still relishing the joy of seeing her mom ride again.

“That was such a big moment,” she said. “For her to get to jump again, especially on this horse who is my soulmate and I trust completely. That was amazing.”

The moment seemed to sum up everything about the transplant.

“That’s why you do it. It’s about being able to do your passion again,” Lindsay said.

Vera chimes in.

“It’s difficult to explain to anyone how huge a gift this is, to risk your life to save someone else’s. How can you thank someone who has done that for you?” Vera says.

For Lindsay, there was never a question about being a donor.

“I faced losing you. You were dying before my eyes,” she told her mom.

“I can honestly say it’s the best thing I’ve done in my life.”