FORT WORTH, Texas (AP) — Randy Gideon spent last Christmas Day in a respirator mask, seated alone, watching his family celebrate the holiday from across the living room.
He breathed with help from an oxygen tank. He was weak, but even if he had been strong enough, Gideon couldn't cross the room to join his loved ones because he couldn't risk catching a virus.
If he got any sicker, his family knew, he could not undergo a lifesaving double lung transplant.
Just that month, Gideon had temporarily been removed from the organ donation waiting list at the University of Texas Southwestern Medical Center at Dallas after coming down with the flu.
No one wanted that to happen again.
Gideon had spent much of the preceding weeks isolated in his west Fort Worth home.
Gideon, 60, an architect whose many projects include the Fort Worth Police & Firefighters Memorial, the Intermodal Transportation Center and the Tarrant County Family Law Center, had been diagnosed with pulmonary fibrosis four years earlier. It's a disease in which the lungs become damaged or scarred and stop functioning properly.
Often doctors cannot pinpoint the cause, and Gideon's case is one of those mysteries.
He has never smoked.
He exercised three times a week.
Over time, Gideon's condition worsened until merely getting dressed was a time-consuming, utterly exhausting task. He needed air from his oxygen tank to have the energy to move.
On Dec. 9, 2011, he was placed on the organ donation waiting list. His doctors expressed confidence that lungs would become available, but he knew that his situation was dire.
He and his wife, Beth, prepared for the worst, discussing his wishes and finalizing paperwork with an attorney.
The uncertainty hovered over Gideon's family that Christmas Day: Would it be his last?
"I had to come to the reality that I may not be able to have the transplant in time," Gideon said.
After the Gideons went to sleep that night, they awoke to a late Christmas gift — a phone call summoning them to the hospital.
A few hours later, surgeons were lowering new lungs into Gideon's chest cavity.
One year later, those lungs breathe strong.
Gideon is up and walking, even returning to work. He arrived home from a successful one-year checkup Monday and found that friends had decorated his front yard with balloons and handmade signs celebrating the upcoming anniversary of his transplant.
Inside, his home is decorated brightly for another Christmas.
Loved ones — his three adult daughters, a 16-year-old son and a whirlwind of other relatives — will gather once again, sharing gifts and embraces.
He will be right in the middle of it.
"It's going to be special," Gideon said.
It started with shortness of breath.
Gideon noticed it about five years ago when he exerted himself hiking or working out. It seemed strange because he considered himself in fairly good shape.
He eventually went to a pulmonologist, who diagnosed him with fibrosis. Gideon learned that the disease can plateau for a long time — or worsen quickly. Many people live only three to five years after diagnosis, according to the American Lung Association.
"It's a scary thing, but you really have to think about it logically and what you want to do," Gideon said.
His condition worsened over time. A doctor recommended that he go to UT Southwestern to explore clinical trials, but Gideon didn't fit the programs. By fall 2011, he could no longer walk across the room without stopping to rest.
His lungs had essentially lost the capacity to push enough air through his body, he said.
He went from 175 pounds to a bony 138. His skin looked pale, unhealthy.
His family's fear level rose sharply, Beth Gideon said.
"It was a very rapid decline," she said. "We had always been so active; it was scary to see the toll it was taking."
She and her husband's physician began working toward adding Gideon to the list for a double lung transplant at UT Southwestern. After a period of evaluation, Beth Gideon said, doctors held a meeting, reviewed the case and agreed that he was a good candidate.
His lungs were failing so quickly, she said, that they put him at the top of the list.
Last Christmas night, Gideon's friends surprised him by singing carols outside his home. Beth Gideon opened the back door so he could hear them.
After everyone had left the house, the couple watched television, then retired early to bed.
Randy Gideon awoke at 6 a.m. to a buzzing noise, which he realized was his wife's phone, vibrating. He shook his wife awake and told her that he heard the phone.
Impossible, she said. She had turned up the volume on the ringers before bed.
"You're dreaming, honey," she told him. "Go back to sleep."
But he insisted. When she got up and looked at her phone, her heart sank. Three missed calls. All from UT Southwestern.
Transplants have a small window when they can be performed. They knew they would have three hours at most to get to the hospital once the call came. Beth Gideon, realizing that she had somehow turned the ringer off instead of up, felt full-blown panic.
Was it already too late?
She dialed back the transplant coordinator, who assured Beth Gideon that she had been calling for only 20 minutes.
"But how fast can you get here?" the coordinator asked.
Beth Gideon hurriedly dressed herself and her husband, a process that reminded the Gideons of what happens when a woman goes into labor and her husband prepares for the trip to the hospital.
In the Gideons' case, she scrambled from room to room while he focused on breathing.
Beth finally got her husband and his oxygen tanks into the car. She backed out of the driveway, but the car handled strangely. They heard a dashboard warning sensor activate.
A rear tire was low on air.
Beth got out of the car and stared. The tire was nearly flat but still round enough, the couple decided, to make it to the nearest gas station on White Settlement Road.
That would be faster than reloading Gideon and his heavy oxygen tanks into another car.
If the tire wouldn't hold air, they would call an ambulance.
At the station, she stuffed quarters into an air machine and filled the tire. Then they were back on the road. At that hour, the day after Christmas, the highway was mostly empty.
"My wife drove safely," Gideon said. "But very fast."
At St. Paul University Hospital, Beth Gideon climbed onto her husband's bed and curled against him while waiting for the transplant to begin.
The lungs were arriving on an airplane. The Gideons hadn't called many family members yet because they had been warned that false alarms happen.
They didn't want everyone to drive to Dallas and then learn that the lungs weren't a match after all.
But the doctors said the surgery was a go. And it was time to start.
The Gideons knew the risks. Three percent of double lung transplant patients die within 30 days.
"We said goodbye and it got a little teary," Beth Gideon said. "But mostly, it was a peaceful time.
"We felt it was going to be OK. We had great doctors, amazing support from our friends and our community. We felt their prayers."
The surgery took six to seven hours, said Dr. Fernando Torres, director of the lung transplant program at UT Southwestern. Surgeons connected the new lungs to the bronchi and two large blood vessels, the pulmonary vein and the pulmonary artery.
Doctors weakened Gideon's immune system so his body would accept the new organs, Torres said. That's why the patient cannot have an infection like the flu during a transplant. The infection would spread with the immune system so low.
UT Southwestern performed 50 lung transplants last year and has done 63 this year, Torres said.
Gideon's surgery went "very well," Torres said. Afterward, he was taken to the intensive care unit connected to a breathing machine. He had a tube in his throat and tubes draining fluid from each side of his chest.
Gideon does not remember exactly when he became alert in the hospital. But at some point, when he was off the ventilator, he remembers blinking to clear his blurry eyesight.
Then he realized that he could breathe.
It felt amazing, he said.
The holidays will bring not only the one-year anniversary of Gideon's transplant but also the end of another important period.
Transplant officials ask that organ recipients wait at least one year before contacting the donor's family.
Gideon said he believes that the wait is meant to give the family time to grieve, as well as to see how the transplant patient recovers. If the patient dies, that could add to the family's trauma, he said.
As of now, the Gideons know nothing of the person, just that he shared a blood type.
"I don't know if it was a young person or a little older," he said. "I don't know where they lived."
But he knows that the holiday gift he received last year was almost certainly the result of a heartbreaking Christmas for another family.
So he has asked transplant officials to find out whether the family members will accept correspondence from him.
If they will, he is not certain exactly what he will write. But he said the letter will try to convey what his family feels this holiday season: