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When four generations of Weitzenbergs gather in Santa Rosa for their annual Mother's Day brunch, they usually raise a glass in celebration of family.

Today, they likely will honor friendship. And good health. And Olivia Lemen.

It was Lemen, a 32-year-old recreation manager for the city of Calistoga, who answered the call when a member of the Weitzenberg clan was desperately ill.

In the hour of Amy Weitzenberg Baghdadi's greatest need, Lemen did what she said felt natural, like the lesson most kids learn in kindergarten but sometimes learn to forget. Olivia Lemen shared.

Amy Weitzenberg Baghdadi and Olivia Roberts Lemen are not sisters or cousins or even classmates.

Six years separate their graduations from Santa Rosa High School, and they know each other mainly as a result of their mothers' close friendship after nearly two decades of teaching together at Monroe Elementary School in Santa Rosa.

The daughters hit it off six years ago when Lynn Weitzenberg spearheaded a mother-daughter team to participate in the Avon Walk for Breast Cancer in San Francisco in celebration of her own win over cancer.

Even though their mothers were the closest of friends, the daughters drifted back into their own busy lives — Lemen with her husband, Andrew, in Napa and Baghdadi with her young family in San Francisco.

Lemen learned of Baghdadi's grim cancer diagnosis last September. That was followed by updates about grueling but unsuccessful chemotherapy.

She knew the 39-year-old mother of two, Tarik, 7, and Aiya, 5, desperately needed a new liver, and she also knew that cancer was likely to kill Baghdadi before a cadaver donation would become available.

Baghdadi's only option, her only hope, was for someone with the right blood type and physical strength to donate part of their liver.

"I was talking to my mom and I remember I had my donor card in my wallet. Sure enough, I was Type O," Lemen said. "It's hard to describe. There was something that just sort of clicked at that point. It just all of a sudden felt like this is something I'm supposed to do."

Chilling diagnosis

The story began last fall with a recurring pain in Baghdadi's side after long runs from her home in San Francisco. The pain turned into something more, sending her to the emergency room in the middle of the night, then through scans and exams and medical conferences — six in 48 hours in those early days of tumult, pain and confusion.

Then one evening in September, at home with her husband, Khaldoun, the doctor's chilling words — "you have cancer" — came over the speakerphone.

"He said it was very serious, very aggressive. And very rare," she recalled.

The original diagnosis was angiosarcoma — cancer of the blood vessels in her liver. The sheer number of lesions that pocked her liver ruled out surgery.

The typical medical strategy with that cancer is control and contain, but not conquer.

The doctors at California Pacific Medical Center recommended Baghdadi see a specialist at the Cancer Center at Stanford Hospital. Those doctors, in turn, put Baghdadi through another round of examinations.

That lead to a new diagnosis. Baghdadi didn't have angiosarcoma, she had epithelioid hemangioendothelioma. Even more rare than angiosarcoma, this cancer is slightly less deadly and, unlike angiosarcoma, responds well to transplant.

"Now suddenly I had these other options," Baghdadi remembered.

Chemo &‘not working'

Chemotherapy was the first. But six weeks into doses of medication that left her drained of energy, the pain in her abdomen only increased.

"It was debilitating and it kept getting worse and worse," she said. "It was like being stabbed with a knife."

On the day of her third and final dose, Baghdadi and her mother traveled to Stanford for what Baghdadi expected would be a routine consultation regarding her progress.

"It's not working," the doctor told her. "It was growing. Basically, what I was feeling was not the cancer dying, it was the cancer growing."

Baghdadi needed a new liver and she needed it before the lightning-fast cancer spread to other organs.

Baghdadi began a second round of chemo with a different cocktail of drugs and got on organ waiting lists in California, Tennessee and Florida. Her husband was in consultation with a physician in Germany — anywhere a liver could be procured faster.

While Baghdadi's tumors were multiplying, her liver function remained high — putting her far down most lists for potential transplants from cadavers.

"I wasn't going to get high enough for at least a year and a half and then in all likelihood it would have metastasized," she said.

Long wait on list

Khaldoun Baghdadi was more blunt.

"It was pretty clear that if she didn't get a transplant, she was going to die," he said. "It was very clear. If it takes like seven months or a year, we are going to lose."

More than 16,150 people are waiting for livers in the U.S. More than 10,200 of them have been on the waiting list for more than a year.

In 2010, 1,464 people died while waiting for a liver transplant.

Baghdadi's only viable option was a living donor.

So the call was issued.

"The thought of somebody putting themselves at risk to save my life — how do you ask that of somebody? How do you ask them to put themselves in danger? But how do you not, because I'm going to die," she said. "I really struggled with it."

Baghdadi, who established a system of email updates for friends and family, began sending out word about her need for a living donor.

In all, eight people passed initial screens and volunteered to become a donor.

"You can start by saying &‘thank you,' but you can't encapsulate to the degree to which I felt indebted to them for even being considered," Khaldoun Baghdadi said.

"I wasn't surprised by the willingness, the outpouring for her," he said.

"Everyone who interacts with Amy, it's not a minor impact on their life," he said. "She just has a real gift to enrich the lives of everyone she comes in contact with. But I'm biased."

A perfect fit

From the beginning, of the eight potential donors, Lemen seemed the perfect fit.

A lifelong swimmer, she puts in more than two miles a day in the pool, is a vegetarian and crucially, is 6 feet tall, meaning the risk to her health would be reduced because a smaller percentage of her liver would have to be removed to be implanted into Baghdadi.

The recreation manager for the city of Calistoga has been a registered organ donor since earning her driver's license as a teenager in Santa Rosa.

Lemen said she went into it with questions and some concerns, but they were answered every step of the way.

"One of my major concerns was the effect of surgery on my fertility. What were the long-term effects of surgery? Medication? Would it restrict my diet? Would I have to stop drinking? What affects on my body?" she said. "I'm an incredibly healthy, active person, and if they would have said, &‘You can never swim again,' that would have been an issue."

Her family rallied behind her.

"People would say to me, &‘Oh this must be so scary,'" said Lemen's mother, Jill Earl of Santa Rosa. "I wouldn't say that I didn't have dark moments in the middle of the night, but they were so few and far between, and in the light of day we were all just marching forward and saying &‘This is supposed to happen.'"

From head to toe

Lemen was given the preliminary green light and her ability to handle the process emotionally was examined almost as closely as her physical attributes.

"I had PET scans, chest X-rays, echocardiograms. They checked me from head to toe, looking for anything that could be a potential risk or hazard to my own health," she said.

They also assigned her a patient advocate — a social worker who looks out for the interests of the donor. That person, as well as other officials assigned to the case, repeatedly pulled Lemen aside, making sure she wasn't being pressured.

Lemen was unflappable, said Khaldoun Baghdadi.

"She made a building full of Olivia fans at UCSF," he said.

Lemen investigated the effect of surgery on her insurance coverage.

"I would have to declare it as a pre-existing condition but that was something we were willing to do," she said.

On Jan. 10, with spouses and parents in the room, Dr. John Roberts, chief of UCSF Transplant Services, said the surgery was on — but not before asking Lemen one more time if she was sure.

"From that point on it was like a freight train," Lemen said.

Beneficial anomaly

Surgery was scheduled for Feb. 11, with no guarantee of the outcome.

The day began with Baghdadi and Lemen holding hands from their hospital beds. Roberts handled the removal of Baghdadi's cancerous liver, first determing that the cancer had not spread while Lemen waited.

Dr. Nancy Ascher, chairwoman of the surgery department at UCSF, oversaw the division and then removal of Lemen's left lobe — about 40 percent of her liver.

When Ascher opened Lemen's abdomen, she found an anomaly — Lemen's liver had two separate blood supplies, meaning there was less reconstruction during the transplant.

"That was very sweet," Ascher said. "It made it easier. It was right there. It looked like somebody up there wanted part of her liver to go to her friend."

Mortality rates for donors in similar transplants are three out of 1,000, Ascher said.

"That is not trivial," she said. "She put herself at risk and she did so willingly and lovingly for this other woman. ... She is a hero."

About 15 live donor liver transplants are done at UCSF a year, compared with 120 cadaver donations, according to Roberts.

Surgically, working with cadavers is easier because surgeons can work with all of the blood vessels and bile ducts, without having to leave major veins intact in the donor.

"We don't like to do the transplants where we have to put nice people like Olivia at risk," Roberts said. "If we have enough cadaver transplants, we wouldn't have to."

Organs in demand

An average of 18 people die every day waiting for an organ transplant, said Anthony Borders, spokesman for the California Transplant Donor Network.

"Donation has not kept up in terms of demand," he said. "Medically there is much more that we can do these days in terms of transplants."

In the days following the surgery, Lemen and Baghdadi took slow, recuperative walks in the hospital hallway.

On one such walk, Lemen's mom, Jill Earl, recalls a conversation she and her daughter had with an older man who was in the hospital as a follow-up to his own transplant surgery. He said he had struggled to reach out to the family of the cadaver donor who gave him another chance at life.

After a few talks, the man approached Lemen.

"I can't thank my donor, so I'm thanking you,'" Earl recalled. "It was just amazing."

Lemen's recovery has been remarkable for its brevity and lack of complication. She was back at work in Calistoga three weeks after the surgery and now is at full power in the pool and on her bike.

Baghdadi is walking daily, picking up her two children from school and getting back to the job of living. Doctors said they are pleased with her latest scans, done about two weeks ago, which showed no obvious cancer.

Contrasting scars

One recent afternoon, the two women laughed as they compared scars, with Lemen suggesting she augment hers with an elaborate tattoo.

Lemen's scar is a purplish cord that runs from just below her breastbone to her bellybutton. Baghdadi's is an upside-down Y that stretches across her belly.

Lemen isn't overly eager to tell her story, but she is thankful for what the experience has meant to her and her husband. They are celebrating four years of marriage this month.

"How often do you truly get the opportunity to save a life? Most of us never get to do that and to have so many positive things come out of it," she said. "The process was so rewarding for me and my husband. We are so much closer because of that gift."

Khaldoun Baghdadi, the driving force behind his wife's navigation of scans, biopsies and the eventual transplant, said he's become closer to his two children and more connected at home.

"My job tended to be a little unpredictable but sure enough, I've been able to make it predictable," said Baghdadi, a law partner with Walkup, Melodia, Kelly and Schoenberger in San Francisco. "When you are worried about whether or not your wife is going to live or die, you just don't have room for other things."

The usually loquacious Baghdadi struggles to describe what Lemen has meant to him.

"I got a second chapter in my life with my family thanks to her," he said. "And I guarantee you Olivia never wanted us to spend the rest of our lives being dedicated to her. Olivia wanted us to spend the rest of our lives dedicated to each other."

Two mothers' bond

On this Mother's Day, Lynn Weitzenberg ponders her deep friendship with Olivia's mom, Jill, and how that tight bond has touched their daughters' lives.

"To have one of your oldest friends' daughter say, &‘I know I'm the one' — what a gift,'" she said. "Olivia is an angel."

Amy Baghdadi, who yearns for the day when her life will return to normal, said there is nothing normal about what Lemen did for her and what that gift has meant to her family.

"I'm not a religious person," Baghdadi said. "The fact that somebody would subject their own body to that for me was just completely beyond me. She was this angel that kind of appeared and was going to save me."

You can reach Staff Writer Kerry Benefield at 526-8671 or kerry.benefield@pressdemocrat.com.

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