Crowder fit Montgomery's specialty in hard cases, as tissue sensitivity tests showed that she would be compatible with just 1 percent of the population. Hopkins found a reasonable match through swaps involving patients in two other states. A kidney from her husband, Jeff, was removed that morning and flown to Portland, Maine, in exchange for a kidney that matched someone at St. Barnabas Medical Center in Livingston, N.J., who was related to a donor whose kidney was a reasonably good match for Wendy Crowder. Her donor's kidney was driven down that afternoon from New Jersey packed in ice, pale, hovering between life and death.
Montgomery has removed and transplanted about 1,000 kidneys, but he said he's not over the charge of that moment when, having sewn kidney to artery, the clamps are released to let the blood flow. If all goes well the organ pinks, pulses. It's alive.
For that vivid moment the body has not rejected the organ. Still, the patient has miles to go. They're never really out of the woods, Montgomery said. The months after surgery are critical, then the patients stay on immune-suppressing medications for the rest of their lives.
Later in a hospital lobby, he told members of Crowder's family to be prepared for complications. "Transplantation can be a little bit of a roller coaster," he told them.
Crowder and her husband say they knew the risks but felt there was little choice. The mother of three who had been working as manager of a doctor's office described life on dialysis: "It sucks."
Sitting in a chair in her hospital room days after the surgery, she described Montgomery in words that would embarrass the grandest medical ego. While he doesn't sugarcoat the risk, she said, "he just radiates this calmness. … It's almost as if he's floating above you when he talks to you."
Montgomery is quick to acknowledge that this work is, frankly, strange. On the one hand, there is that moment of the kidney's awakening: "It's mystical … Frankenstein stuff. … It's something I never take for granted."
On the other, he spends much of his time performing surgery on perfectly healthy people, the donors, a "unique phenomenon in medicine." Then, to save the recipient's body, he fights it.
"There's tremendous drama," he said. "There are tremendous saves, and there are patients who die. It's not like being a plastic surgeon or a dermatologist. It's a different deal."
Dr. Robert A. Montgomery
Title: Associate professor of surgery; chief of the Division of Transplantation; director of the Incompatible Kidney Transplant Program at Johns Hopkins Hospital
Born: January 22, 1960, in Buffalo, N.Y.
Marital status: Married to opera singer Denyce Graves
Home: Bethesda and Fells Point
Education: University of Rochester School of Medicine, Rochester, N.Y.; Balliol College, University of Oxford
Passions: Fast cars, rock and roll, food, red wine