Gift from brother is hard to repay

Dr. Marcus Balters has saved lots of lives, but he doesn't know what to do for the guy who saved his own.

His brother.

Matt gave Marcus one of his kidneys in July to extend his life and preserve his career as a Creighton University Medical Center surgeon.

But Matt has his own health problem, one that a transplant can't fix.

The Balters brothers, now in their early 40s, are high-achievers with vastly different personalities and struggles.

Marcus operates on lungs, blood veins, chest trauma and other problems. He was one of two Creighton surgeons who helped save Officer Paul Latschar's life after a 2008 shooting.

Matt attended the Naval Academy, then flew jets as a Marine and commercial pilot.

Their late father, Hank, used to say that if the two boys rode the same bus, by the end of the trip Marcus would know the name of everyone and Matt would know every bus route.

Matt was somewhat similar to their dad, a quiet ex-Marine and voracious reader who became a psychologist.

Marcus, two-and-a-half years younger, behaved more like their mom. Sharon Buckles Balters is an outgoing woman who eventually earned a doctorate and became a dietitian at Madonna Rehabilitation Hospital in Lincoln.

As a boy growing up in Lincoln, Marcus annoyed Matt by tagging along with him to Woods Memorial Pool. Fortunately, Marcus had his own pals at the pool.

“He's just always had a humongous group of friends,” their mother said.

The brothers got along OK. They wrestled playfully, then they'd get angry and fight like brothers.

Marcus, 41, has fought health problems all his life.

A free blood-pressure screening revealed heart trouble when he was 6 years old. He underwent four heart surgeries between 1975 and 2006.

Matt never saw Marcus as sickly, despite the fact that Marcus had had two heart surgeries by the time he attended Lincoln Southeast High School.

Despite his heart problems, Marcus competed on the wrestling team. By then Matt was in the Naval Academy, where he acquired an odd passion for a midshipman: Russian literature. He said he identified with the “self-destructive stubbornness of the Russian soul.”

After college, Matt flew Prowler jets during a 10-year Marine career, then became a commercial airline pilot. He married and had four boys.

Marcus went to Texas Christian University, then earned a medical degree at the University of Nebraska Medical Center and became a surgeon. He married and had two sons.

But Marcus couldn't shake his heart problems.

In 1999, blood began pouring from his nose and mouth. A graft inserted into his aorta had eroded and ruptured. He believed he would die, but heart surgery saved him again. Seven years later he had yet another heart surgery.

The kidney problem came unexpectedly and might have had no connection to the heart problems, said Dr. Michael Morris, a member of the Nebraska Medical Center's kidney transplant team.

The formidable health challenges have tested Marcus. He and his family are religious, and he prays aloud with patients who want to do that. Still, there have been some “woe is me” moments, he said, and, “I can't believe this is happening — again.”

His kidneys began to fail in late 2006. His feet and ankles would swell by day's end because he was retaining fluid.

A biopsy in 2007 showed that he had a kidney disease called “ideopathic glomerulo nephropathy,” ideopathic meaning the cause wasn't clear. In time, his legs were swollen at the start of the day, too.

He began to itch because his kidneys weren't removing toxins. “I would just be rubbing against the walls because I would itch so bad,” he said.

In September 2008 he suffered another heartbreak: a stillborn child. His wife, Sarah Beth, had a normal pregnancy, but the umbilical cord wrapped around the baby's neck. That loss, Balters' wife said, was “overwhelming, something you never get over.”

Marcus and his doctors hoped he could avoid dialysis and receive a kidney from a donor. Dialysis generally isn't as effective for the long term as a kidney transplant, said Morris, the transplant doctor.

Further, Marcus said, dialysis causes weariness and is so time-consuming that it would curtail his career.

And so he made his request to Matt last fall.

Marcus said he felt more at ease asking for a kidney from Matt. “My brother, I have a lifelong relationship (with him), and he beat me up a lot in my childhood, so I felt like it was retribution.”

With dry humor, Matt recalls the conversation last fall this way. His brother said, “Remember when you told me you'd donate a kidney if I needed it?”

“I remember thinking to myself, ‘I never said anything like that. That conversation must have slipped my mind.'”

But there was no decision to mull over. Marcus needed a kidney, and Matt would provide it.

Marcus knew his brother was struggling with his own demon: chronic depression.

Marcus couldn't grasp the depth of Matt's problem, but the havoc was evident.

“My mind turned to mush for a while,” Matt said.

Matt, 43, has no idea when he began to sink. Maybe he always was inclined toward gloom, for it seemed throughout life he thought this change or that move or another achievement would finally bring him satisfaction.

His mother suspected the trigger was a 1993 car wreck in which Matt, then 26, was a passenger and a young woman died. “I just don't think you ever recovered from that,” she said.

But Matt, who just got scratched up in the accident, has no idea if there was any trigger.

“My ex-wife used to say, ‘Just snap out of it,'” he recalled.

She lined up a psychiatrist appointment without Matt's knowing. She dropped him off, saying he would either see the psychiatrist or she would leave. Matt said the psychiatrist told him he had a textbook case of untreated depression.

Their dad died in December 2007, and Matt and his wife had son No. 4 the next month. Maybe the stress played a role in his mental slump, Matt said. A hurricane flooded their home. He owned properties and the housing market went to pot.

He lived in Florida but flew out of the Midwest, so he had to fly across the country to start his workweek and travel back to Florida at the end of it. His wife didn't want to move, even though Matt wanted to return to the Midwest.

In 2008, he filed for bankruptcy and broke up with his wife after 13 years.

He had no recollection of flying across Nevada one time because he was daydreaming of killing himself. He was placed on disability because of his psychological problems.

He lay in bed for long periods. He took a gun with him to end his life but couldn't pull the trigger. Even hanging out with his sons didn't lift him from loneliness.

Anti-depressants didn't help. Neither talk therapy nor shock therapy curbed the depression.

If he couldn't find help for his own misery, though, he could help another guy in pain.

His brother needed a kidney. Of course he'd come through for Marcus.

Matt first had to undergo three CT scans over several months. His lymph nodes were swollen and doctors worried he might have cancer, but ultimately they gave him the all-clear.

The brothers met at the Nebraska Medical Center on July 21. There were no profundities spoken, no “Hallmark card” moments that morning, Matt said. Marcus reminded his brother that he didn't have to do it.

Matt went into surgery and Dr. Lucile Wrenshall removed his left kidney through a 3-inch incision above his belly button. The transplant team iced the kidney, then took it down the hall to where Marcus was being prepared for his two-and-a-half-hour surgery.

Dr. R. Brian Stevens placed Matt's kidney inside Marcus through a 6-inch, hockey-stick-shaped incision. The kidney was placed well beneath his right kidney and connected to a vein and an artery in his pelvis that supply blood to his right leg. His old kidneys will stay intact and atrophy.

After the transplant, the brothers felt extremely sore for a few weeks.

Stevens said the first three months can be hard for the recipient. Determining the right dose of anti-rejection medicine takes time. Marcus' incision leaked, and he suffered cramping.

A biopsy of the kidney 10 days ago revealed no rejection. Still, some lab-test results worry him and he is due to have some additional testing this week.

The one-year success rate for a kidney transplant is about 94 percent, and Stevens predicted Balters would do well in the long run.

Matt recovered at their mother's house in Lincoln. Physicians told him not to lift anything heavier than a jug of milk for several weeks. He took slow walks around the house and neighborhood.

Matt said it's easy to say I love you, but actions prove it. “I'm pleased that I was able to do it,” he said of giving Marcus a kidney. “How could love do anything different? ... I would not have done it for a stranger.”

Matt plans to enter a program in Pensacola, Fla., to become a registered nurse. His isn't a simple story of overcoming a challenge. He still talks about the seeming pointlessness of life and of how 100 years from now, nobody will remember him.

You can have great kids and good health, he said, but those things don't drive off depression.

“None of that helps,” he said with tears in his eyes. “It doesn't stop the pain.”

His mother hopes doctors can find Matt the right medication or treatment. It doesn't matter if your kids are 4 years old or 40, she said, choking up. To see them in pain makes a mom miserable.

Marcus said he'd do whatever he could for Matt, but he admitted it's hard to say what that might be. He'll listen and talk with him if that's what Matt wants, Marcus said. “I feel for the guy.”

Marcus plans to play his electric guitar, read medical journals, then return to work in a few weeks. When he gets back at it, it won't be part time. It's not that kind of job, he said. The demands are great, and the surgeries long.

He and his wife have something else to look forward to, something that gives them hope and faith in restoration: They expect to have a baby in October.

World-Herald librarian Jeanne Hauser contributed to this report.

Contact the writer:

444-1123, rick.ruggles@owh.com

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