Everyone hoped that Ani's kidney function would stabilize after that; it didn't. Measures of a chemical called creatinine, which indicates how well a kidney is working, were five times what is normal.
Joan was one of the first to know that her friend, a mother for barely a month, was in failing health and needed a new transplant. The waiting period for a kidney transplant in New York is two to five years. If Ani had to go on dialysis, it would not only affect her ability to work, but also to care for Madi, the daughter she had wanted so much.
In reply to one of Ani's e-mails, Joan sent one that was uncharacteristically short. It said, "Call me."
"So then I called her," Ani said. "And she kind of started crying, and she said, 'you know, I'm ready to donate my kidney to you.'"
Joan described Ani's response. "All she said was, 'really.' In the softest voice I've ever heard. And then we cried. And we laughed."
Joan told Ani she was serious about the offer. She believed she was meant to do it.
In that offer were echoes of the devastating emotions Joan had felt when her mentor died, the feeling of helplessness when confronted with the effects of a merciless disease like lung cancer. In the case of her friend Ani, there was something Joan could do, not only to offer her friendship and support, but also to offer a part of her life to return Ani to good health.
Determining whether Joan's kidney would be a match for Ani involved a series of tests. Among other things, the tests assured that their blood types were compatible and that Ani's blood didn't have antibodies that would attack a transplanted kidney from Joan. After two weeks of waiting, the call finally came.
"Dude!" Ani said to Joan. "We're a match!"
Dr. Alan Benvenisty, director of the Kidney Transplant Program at St. Luke's-Roosevelt Hospital, had performed Ani's first transplant. Because of the long relationship they had established, he was on board immediately to perform the transplant for which Joan had volunteered as a donor, although plenty of potential obstacles remained.
"There are many points along the way where the donor can have trouble," said Benvenisty. "The kidney may be anatomically unsuited. They may turn up some antibody that could preclude the transplant. The donor could be found to have some other medical problem."
Donors can live perfectly normal lives with only one kidney. Nevertheless, the families involved had their own issues. Joan's husband, Erik Paulsen, a composer and songwriter, held back on expressing his initial concern about his wife giving up one of her organs.
"It wasn't easy for me to hear that," he said. "I think the turning point for me was I had written a song for Joan, a love song ... and this thought came to me, 'this is why I wrote this.' Because Joan came to my rescue in my life, and it makes sense that she would come to Ani's aid. And I came downstairs from the studio, and I said to Joan, 'I'm all on board.'"
Joan actually went into physical training and onto a special diet for her kidney. Even her no-nonsense Brooklyn-Italian attitude broke down on the day doctors scanned her kidney for an image of it and she got a firsthand look at the gift she had volunteered to give.
"I'm looking at a kidney," Joan said, "but it's like giving her my heart."