- The Washington Times - Tuesday, June 21, 2005

The infections were growing worse. The lethargy was intensifying. His body was growing more bloated, his skin was turning gray and the telltale odor of ammonia was building.

It was at some point during that debilitating spiral, toward the end of a nearly three-decade fight with liver disease, that Washington Redskins strength and conditioning coach John Hastings accepted death.

Hastings appeared muscular and physically fit. But inside his liver was being ravaged by auto-immune hepatitis (AIH). The end was near.

“I came to terms … with death,” Hastings said. “I don’t want to sound too morbid, but you just come to terms with it. I put it all in God’s hands. ‘If that’s the road You want to take me, then that’s fine.’ I just basically prayed that my family was fine with it and that they would be fine.”

The 11th hour came in May 2004. Hastings went to the University of Pittsburgh Medical Center to see about getting dual-listed (listed at more than one facility) for a liver transplant. Tests revealed the disease had advanced at an alarming rate. He was told he had just months to live.

Within weeks, Hastings’ six-year stint on “the list” ended, and he received a new liver. Today, 40 years old but feeling 20, he is back to torturing Redskins players with his notoriously intense workouts and innovative — some would say “crazy” — training techniques. It is impossible to detect the effects of his ordeal.

“You know, we haven’t really talked about it,” said Redskins H-back Chris Cooley, one of the few players courageous enough to work out exclusively with Hastings. “Mostly I just hear other coaches in there like, ‘Slow down.’ He’s like, ‘I’m fine.’ So it hasn’t been a big deal.”

Maybe not to most folks around Redskin Park. But Dr. Paulo Fontes, co-director of Pittsburgh’s renowned liver transplant program, said Hastings was a “walking bomb.” The doctor now champions Hastings as an illustration of just how full life can be for liver-transplant recipients.

“When families see somebody like him, he [can say], ‘This is real. I got my transplant. Now I’m able to do all these things,’ ” Fontes said. “They listen.”

A lucky appendectomyw

Hastings’ saga began when he was 13 or 14 and living in Lancaster, Pa. He felt abnormally tired and went to see a doctor. The initial diagnosis was mononucleosis, but the symptoms persisted, and Hastings eventually was sent to Bethesda’s National Institutes of Health.

There doctors discovered AIH, a disease of uncertain cause (Hastings thinks he might have been exposed to something as a child) in which the body’s immune system attacks organs it should protect. His liver and colon were under siege.

AIH develops slowly over time, and drugs permit sufferers to live for years with manageable symptoms. But suppressing the immune system hampers the body’s natural defenses, and infections become a major problem.

“That’s really what we were living with [for years],” said Hastings’ wife, Lori. “It was just always a fear of getting some kind of infection — every time he got cut. He was in and out of hospitals a lot.”

Nonetheless, the longtime physical trainer seemed to be in great shape — such good shape, in fact, that his condition was largely masked.

An appendectomy in 1998 dropped the veil. Doctors opened up his body cavity and saw that cirrhosis — dangerous, irreversible scarring of liver tissue — had wracked him secretly. In San Diego, where Hastings worked on the Chargers’ strength staff, he joined “the list” and began a long wait.

Fontes calls the list “a very fair system,” but for patients it’s a roller-coaster ride through pitch blackness. After undergoing a battery of tests, patients endure an agonizing wait with little indication of whether they are rising or falling on the list.

Once, after joining the Redskins in 2002, Hastings got a 3a.m. call from Inova Fairfax Hospital, where he was listed locally. He was told not to eat or drink anything and to wait by the phone. But the transplant fell through, and his name sank mysteriously back down the list.

As of June 30, 2004, there were 17,368 patients nationally waiting for liver transplants, according to the Scientific Registry of Transplant Recipients. In the year preceding, 5,935 patients received new livers, while nearly 1,700 patients died.

“Being on the list is very frustrating because we never saw any progress,” Lori said. “You’re living by the seat of your pants. You never know when the call’s going to come. And he was getting sicker by the day.”

Some friends and family urged Hastings to use his position as an NFL coach to maneuver up the list. But Hastings wouldn’t consider it. In the final days before his transplant, he refused even the optimism of scheduling an “angel flight” to Pittsburgh. He made his peace with death and grimly waited.

“My hardest thing was someone’s got to die for me,” Hastings said.

Cricket house

As the years passed, Hastings spent more and more time in the hospital. His myriad symptoms — infections, lethargy, ammonia buildup (which leads to a form of dementia) — were building.

“I remember one time falling asleep at a red light,” Hastings said. “It wasn’t a long red light, either.”

Life eventually was reduced to work and fitful sleep. With the Redskins in recent years, Hastings often was so tired that he went to bed as soon as he got home. On diarrhetics to help flush his system, he slept fitfully and lost 15 to 20 pounds each night. Each morning he stared apprehensively at the alarm clock.

Meanwhile, his liver was shrinking. One of the organ’s primary tasks is to filter virtually all the fluid that enters the body. When the liver becomes cirrhotic and no longer can process all that blood, the body builds vessels to circumvent the organ. These vessels can be seen, large and in sharp relief, on the patient’s abdomen.

“It was a cricket house,” Hastings said with a laugh. “I was playing around [with my daughter Taylor]. I pretended I ate a cricket one year when she was 4, so from then on she thought I had crickets.”

Now the cricket house is gone, replaced by a giant, wishbone-shaped scar. The swap is thanks in no small part to the Redskins’ head strength coach, John Dunn, whom Joe Gibbs hired in 2004 and who, after hiring Hastings to the Chargers in 1990, was one of Hastings’ few peers with intimate knowledge of his condition.

After an evaluation last spring, doctors at Inova recommended that Hastings attempt to get dual-listed. He looked into Pittsburgh’s Thomas E. Starzl Transplantation Institute, which has done more liver transplants (more than 6,000) than any other facility in the world. A visit was planned for June, but Dunn said he “forced” his friend to go sooner.

“If he had waited until the summer, he might not have made it,” Dunn said. “That’s the scary part.”

By the time Hastings got to Pittsburgh, tests painted a grim picture.

“His liver was horrible with blood flow,” Fontes said. “I closed the door and said, ‘This is not a party. You have to get on the list right away.’ ”

‘You’re up’

Hastings was listed at Pittsburgh following the surgeons’ next board meeting, and the first call came about four days later — again in the middle of the night.

“You never get used to that call,” Hastings said, choking up with emotion.

Hastings and Lori jumped into the car and drove five hours to Pittsburgh, but the transplant didn’t work out. It wasn’t until several days later, after another car trip to Pittsburgh and a stint on standby that he finally got the transplant.

On the latter trip, the patient first in line was deemed unfit for the liver. Hastings’ wait suddenly was over.

“I sat there for 12 hours,” Hastings said. “The doctor came in and said, ‘You’re up.’”

Among the many rules governing liver transplants, the liver must be removed and iced rapidly. Hastings’ liver came from across the country and was on ice too long. His relative fitness made him a better candidate than the other patient, who got a new liver several days later.

In this manner, actually getting a liver is tricky even after rising to the top of the list.

The potential donor, for instance, must suffer brain death — commonly from a car accident or gun shot. Then the donor’s family must consent to donation. Fontes said that knocks out about half of potential donors. The donor also must be of the same blood type and approximate size as the patient and must not have ailments like HIV.

Because the Starzl Institute is so advanced, it receives livers from all over the country, many times because they are rejected by closer but less capable facilities. Fontes said his institute once used a liver from an 85-year-old donor and that it can do as many as five transplants in a day.

Hastings was in an induced coma for five days after surgery, in the hospital for several additional days and then placed in a “family house” for transplant patients. Because his immune system was bombarded with drugs to inhibit rejection, infections again cropped up.

“I felt like I went forward two steps, then I’d get knocked back with an infection,” Hastings said. “But overall, I feel very blessed.”

The donor’s name remains secret, but Hastings sent a letter to the donor’s family through a nonprofit mediator. He has no idea whether the letter was received.

“There is not a day that goes by that I do not think of your loving gift,” the letter reads in part. “My promise to your family, and mine, is to live each day to the fullest in honor of your family.”

Long road back

When Hastings returned to Redskin Park, he had shed 50 pounds from his formerly 225-pound frame and looked like a “skeleton,” according to Dunn.

“I guess that’s when it really hit me,” Dunn said. “If you’ve ever seen an elderly person in a nursing home, with their arms — all you can see is bones. That’s kind of the way he looked.”

Much of Hastings’ lost weight was fluid. He laughingly reflects that, although he thought his muscles were fairly well-defined before the transplant, in fact they were simply swollen with liquids.

Throughout rehabilitation, Hastings constantly pushed to do more, which caused a hernia last winter. Now he finally is back to his old workout routine, which includes unique lifts like swinging 50-pound “kettle-bells.”

Fontes said Hastings’ outlook is excellent, though there are some lingering medical issues and the permanent threat of liver rejection. The AIH appears to be gone but could return.

In November, Fontes met with Hastings before the Redskins-Steelers game in Pittsburgh. The doctor called it “one of the most emotional meetings of my career.”

“It’s not every day you operate on somebody who’s such a good athlete,” Fontes said. “A lot of our guys are not healthy enough to run around on a football field. I told John, ‘This is the best present you could give me — being healthy, doing your job, living your old life.’”

Redskins players might say, with a wink, that it’s a mixed blessing. Guard Randy Thomas believes Hastings has helped him get in the best shape of his career, but he admits he won’t work out with Hastings every day. Even Cooley sometimes wonders why he and offensive lineman Jim Molinaro always choose Hastings.

“By the time we’re done, we’re leaning over garbage cans puking,” Cooley said with a laugh. “But once you walk out, you feel good. I know I’m in a lot better shape.”

Everything in life has been made better by Hastings’ newfound health. He comes home each day eager to see Lori and play with his kids, and he wakes up each morning and goes for a brisk walk with the dog.

“His energy now is amazing,” Lori said. “Before, he’d come home and say, ‘Can I take a 10-minute nap before we go to soccer?’ Now I can’t get him to lay down and rest. He’s got something to do every minute of the day.”

In fact, life is so good that Dunn laughingly wonders whether his co-worker is a bit too perky.

“The amazing thing about him is his positive outlook on life,” Dunn said. “He still wakes up in the morning and says, ‘Isn’t it a beautiful day? Look at the sunshine.’ He’s always going, ‘Isn’t that sky blue?’ And I’m like, ‘Sky blue? Shut the [heck] up.’ ”

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