Like many chronic illnesses, the onset of kidney disease is insidious. Swollen ankles were all Penny noticed 20 years ago. I happened to be passing as she was climbing down from the coach on her return from a college field trip. Maybe some kind of insect bite, I suggested.
I was wrong. A visit to the GP became a visit to a renal consultant and then a stay in hospital. The diagnosis was chronic glomerulonephritis. For reasons unknown, Penny had lost three-quarters of her kidney function. And the outlook was not good. Eventually - it was impossible to give a timescale - Penny's kidneys would fail completely.
The consequences of complete kidney failure were all too apparent in the renal ward. There are only two treatments: dialysis and kidney transplant. Dialysis patients spend six hours a day, three days a week attached to a machine that filters their blood. They feel sick a good deal of the time and suffer many complications. Kidney transplants can be a miraculous escape from dialysis, but the demand for kidneys - mostly cadaver kidneys from car crash victims - greatly exceeds supply.
Our first brush with the brutality of kidney disease came many years later when we tried to have children. Kidney failure is associated with infertility and problems during pregnancy. We lost three children before our only son, Ollie, was born.
And the symptoms do catch up. One of the kidney's jobs is to excrete creatinine so the amount left over in the blood is a measure of kidney damage. Over the years, Penny's creatinine levels crept steadily upwards and she became increasingly weak and prone to bouts of illness and nausea. She suffered attacks of arthritic pain and spent sleepless nights plagued by itching skin and the tiresome condition known as "restless leg".
Her diet became increasingly restricted as she was advised to avoid foods high in potassium, sodium, phosphate, protein or calcium (which didn't leave much that was palatable). In January this year, her blood creatinine reached 700 and we were told that within the year she'd need either dialysis or a transplant.
Like any major illness, kidney disease is a disaster with an impact zone. Alongside the feeling of helplessness, as I watched Penny sliding into ill health, came a feeling of panic. I knew only too well that Ollie and I were in the same boat and wouldn't escape the approaching calamity. Penny had stoically soldiered on, even keeping down a job throughout her illness, but a normal home life would be impossible if she were pinned to a dialysis machine. So my motives weren't entirely altruistic when I volunteered to donate one of my kidneys.
Advances in anti-rejection treatment mean that tissue matching isn't as critical now as it used to be. Unrelated donors may provide a kidney, so long as the patient is blood group compatible. And the donor won't miss the kidney. We have considerable over-capacity in kidney function and can survive perfectly healthily with just one. But what clinched it for us was the fact that live kidney grafts survive much longer than cadaver kidneys. A cadaver kidney is often badly damaged by the time it reaches the recipient and often pegs out after a few years. But a live kidney can be directly transferred into the patient and may remain healthy for 15 to 20 years, or even longer.
The initial tests established that our blood and tissue were a reasonable enough match to go ahead. As the healthy half of the partnership, I thought I'd get an easy ride through the work-up programme. Not so, said the doctors. Surgeons are very reluctant to operate on healthy people and will do so only if they are convinced that the potential donor is as fit as the proverbial fiddle. I needed to provide a detailed medical history, countless blood samples and pots and pots of urine. A doctor, independent of Penny's consultant (who couldn't act for both the "accused and the defence"), was appointed to poke and prod me until convinced I had no hidden ailments.
I was subjected to chest X-ray, electrocardiogram, renal ultrasound, renal arteriogram (probably the least pleasant investigation) and forced to trot on a treadmill for 10 minutes while a physiologist kept track of my heart rate.
After surviving the tests, there is one further hurdle: Ultra (Unrelated Live Transplant Regulatory Authority). The case for live kidney transplant has to be scrutinised by a committee whose job it is to ensure that any proposed live organ donation is medically and ethically justified. We had to submit birth certificates and marriage certificate, wedding pictures and recent photos, all to ensure that the kidney donation was for love not money.
By June, we got the all clear and needed to set the date. Work commitments, holidays and childcare arrangements had to be fitted around the availability of the medical team. One of our priorities was to allow sufficient recovery time so that we were able to take Ollie along to his new school in September. We settled on early August.
After some final health checks, Penny was admitted on a Monday with the transplant planned for Thursday midday. I checked in on the Wednesday. That evening was uneventful but edgy. The lightest moment was when we collared the transplant sister and a fellow patient to witness (admittedly, rather belatedly) the signing of our wills.
The next morning was tense. Lots of smiles and wishes of good luck couldn't dispel our nervousness as the clock advanced steadily towards midday. I was first to go; Penny would have to endure an hour or two hanging around before she got the nod.
Finally, the theatre porters arrived. I changed into a surgical gown, hopped on the transport trolley, and was whisked briskly through the labyrinth of underground tunnels that connected the renal unit to the main hospital, and up into the surgical unit. The doors of the theatre were thrown open and I was greeted by the anaesthetic staff. We went through a series of well-rehearsed (at least for them) routines as medical lines were connected, an epidural needle was inserted into my back and my name and number were carefully recorded. I remember thinking "Why don't they just knock me out and get this thing done", and then I don't remember any more.
Recovery was pretty horrible. I woke up in pain, confused and retching, with a plastic oxygen mask clamped over my face. Nurses surrounded me asking if I was OK. I could only groan in reply. The next hours were spent in a confused and semi-conscious state of discomfort. I vaguely remember Penny's trolley being wheeled back into the ward and shouting across a feeble "Hi Penny" (which, she says, she never heard).
Dawn broke and though I escaped the oxygen mask, I remained pinned to the bed by a fluid drip, the epidural line and a urinary catheter. Not that I wanted to move. The hospital pain team had recommended an epidural for my kind of wound pain and although it did the job, pain was always lurking around the corner of any careless move. Penny was banished to the far end of the ward. Apparently this was to prevent mutual fretting over each other's health. We were briefly united when she was wheeled past my bed on the way to an X-ray. Her eyes were clear and sparkling. I hadn't seen them so bright for years.
The news from the team was terrific. Penny's blood creatinine level had plummeted from 700 to 80 within an hour of the operation. Apparently my kidney was wasting no time getting stuck into the task of clearing Penny's blood of the toxins that had been poisoning her for years. And it seemed I'd given her the better kidney since my creatinine level was 120 (within normal range).
By Saturday, with the help of a nurse trailing a tower of drips and bags, we were tottering around the ward. On Sunday, we were both freed of all our lines. For me, removal of the urinary catheter was the great escape, but it was also a relief to discover that the wound pain was within limits that could be controlled with paracetamol and codeine.
By Monday, the doctors gave me the all clear and my sister drove me home. But the first night back wasn't easy. Once between familiar sheets, my body resumed its nightly routine of twisting and turning but was met by volleys of intense pain. In the morning, I sent out for more pillows and, to curtail my movements, I spent the following nights wedged between six of them.
Penny was discharged on the Tuesday. Her first meal at home was Marmite on toast, forbidden for many years. Neither of us felt up to cooking but survived on a fridge that had been well- stocked with ready meals. By Thursday, we were fit enough to forage in the local stores, but as we were both barred from driving - a routine consequence of major surgery - our range was limited to those shops that we could reach within a 10-minute walk. Friends, neighbours and family were a great help and a local supermarket's home shopping service was a godsend.
What we missed most was our young son Ollie. Friends and relatives had kindly stepped in to organise a four-week relay of childcare. But although Ollie is quite independent for a seven year old and was looking forward to a whole month of sleepovers, he did get homesick after several days. And mornings weren't quite the same without his cheery face as he tried to steal into our bed.
The first weeks following the transplant are critical to its eventual success, so Penny had to attend the renal clinic every morning. I tagged along occasionally to have my wound dressing changed and to keep a check on my kidney function.
Transport was a problem. We couldn't drive and the drugs that Penny was on to prevent her immune system rejecting the kidney also made her very susceptible to infection. She had to avoid anyone who might be harbouring a cough, cold or flu and was advised to steer clear of public transport. Fortunately, the NHS still has the resources to provide a patient transport service that collected us each morning.
The doctors always warned us that there would be ups and downs, and we hit the first (and hopefully only) down at the end of the second week. Quite suddenly, Penny became pale, weak and anaemic. The doctors were puzzled but put it down to blood loss from the surgery. A blood transfusion was arranged but Penny's haemoglobin levels continued to drop. Even more puzzling - her blood group (previously group A) appeared to have changed. Apparently she had developed the haematological equivalent of a marital tiff. The white blood cells carried over in my (blood group O) kidney were making anti-group A antibodies that attacked Penny's red blood cells ("Just like a man," a friend commented. "Invite them into your life and they try to take over"). We waited anxiously for the blood battle to subside and fortunately, after about a week, it did.
We're now four weeks on from the surgery. Ollie is at home, Penny's anaemia has cleared up, and she is much stronger. Her eyes haven't yet regained that brightness of the first day, but they're getting there. And yesterday I was cleared to drive.
Giving a kidney isn't the easiest thing to do. It does hurt. Four weeks on and walking isn't a problem but I don't bend too easily at the middle and twisting (for instance, while reversing the car) still hurts. Running, swimming or tennis are probably a few weeks away yet. But otherwise, I feel fine. And I hope to manage a few days at work next week.
I will always have a 10-inch scar to remind me of what I've done. But yesterday Penny strolled into town with a friend to do some shopping - something she couldn't have done five weeks ago. Nights are free of itching, arthritic pain and the exhausting pacing brought on by restless leg. And we can enjoy our meals without the tedious checking of levels of sodium, potassium, phosphate, calcium and protein.
Penny will have to take drugs every day for the rest of her life to prevent rejection. But there is one dialysis machine at the hospital renal unit that is left free to help another patient. It's early days. But though we haven't yet dared uncork the champagne bottle, we have dared to hope that Penny, Ollie and I have indeed escaped that unremitting slide into disaster. Whatever else happens, it was worth it.
• For more information about live transplants contact the UK Transplant Coordinators Association, tel: 07071 223171
