The first year of medical school is a challenge, no matter the circumstances. It’s much more of a challenge when halfway through the school year, you donate a kidney to save your sister’s life. 

This is exactly what Amaris Elston, now in her second year in medical school at UAB School of Medicine, did. 

Amaris ElstonElston had already encountered a number of challenges on her path to her dream career as a doctor before she received the life-changing news that her sister, Dominique, then still a high school student, had a rare kidney disease that was causing renal failure. But Elston knew immediately that if she was a match, she would be a donor.

Amaris Elston grew up in a close-knit family in Jacksonville, Alabama, the oldest of five siblings. Her mother had aspirations of becoming a surgeon before unexpectedly becoming pregnant with Elston during her freshman year of college. Still, Elston’s mother was determined to complete her studies, and some of Elston’s earliest memories are of watching her mother juggle schoolwork and a full-time job. Her mother successfully completed a college degree, and works with special needs children at the local middle school.

Elston remembers wanting to be an actress, and at some point toying with the idea of becoming a lawyer. In middle school, she settled on the idea of becoming a doctor. She’d always made good grades, although her family’s financial challenges had made her formative years difficult. She got a job as soon as she was legally permitted to. “I knew my parents had struggled my whole life,” she said. “If I could help by contributing financially and not being as much of a responsibility, I wanted to do that.”

Balancing a job at McDonald’s with the demands of high school and running track wasn’t easy. She would leave school for work, work several hours, get home at 10:00 pm, shower, and then do her homework before rising early for school the next day. It was a punishing routine, one which would train her well for the demands of college. Still, she was able to keep her grades up. “It wasn’t that I was smarter than everyone else,” she said. “I just kept up with my work.”

High grades earned Elston scholarships to attend UAB, but she needed several of them to cover all of her expenses. After the first semester of her freshman year, her non-academic scholarship money ran out, and she got a job. When her expenses still outstripped her paycheck, she got a second job.

“I thought I wouldn’t be able to go to medical school at that point,” Elston remembered, “because I couldn’t sustain my grades while working two jobs and going to school. I thought about becoming a nurse anesthetist instead.”

She confided her change in plans to her father, who vehemently disagreed with the shift. He reminded her of how long she’d wanted to be a doctor, and told her that he knew she had what it took to reach her goal. 

But the finances of the situation were difficult to manage. As school progressed, Elston found that she needed three jobs to cover her cost of living and school: she worked at the Ann Taylor store, worked as a bartender in the evenings, and babysat on the weekends. 

“I knew my GPA wasn’t the greatest,” she said, “but I decided to take the MCAT anyway.”

Her first pass at the MCAT was a disaster. She knew her score wasn’t sufficient to get her into medical school. She remembers crying in the bathroom when she received the news, knowing that it would take time and effort to overcome this setback. She was preparing to finish her undergraduate degree with no clear idea of what would come next. 

At the same time, her younger brother, who had been having severe headaches for several years, underwent surgery in order to restore fluid flow to his brain. Elston picked up her cap and gown for graduation and met her parents in the hospital waiting room, where the doctor came to deliver the devastating news: surgical complications meant that her brother was non-responsive, and he couldn’t move his left side at all. 

Elston’s brother spent two months in the intensive care unit, unable to move or respond. Two weeks before she graduated he finally woke up, able to breathe on his own. Physical therapy ultimately restored his ability to walk, but the terror of coming so close to losing a sibling stayed with Elston.

In the aftermath of the MCAT disappointment, Elston reassessed her options. She had been told about a Master’s program at UAB in biomedical and health sciences, and thought that this might be a good intermediate step. While gathering materials for her application, she moved back in with her parents, and started work as a 9-1-1 dispatcher. After finding out she’d been admitted to the program, she moved back to Birmingham and started a job as an Uber driver. 

As she prepared to begin the master’s program, Elston found out that her grandmother had been diagnosed with early onset dementia – and that her sister Dominique was in late stage renal failure. Initial tests showed that Domnique’s kidney function was at only 19%, even though she wasn’t yet out of her teens. The cause at first was unclear: she had no contributing factors, such as a family history of illness or high blood pressure. Ultimately doctors diagnosed her with Focal Segmental Glomerulosclerosis - but they didn't know how she had developed the disease. The only plausible explanation seemed to be that she was genetically predisposed to the illness.  

Elston felt her world collapsing as the people she loved suffered. She volunteered for the initial testing that would determine whether she was a match for her sister, who was going to need a kidney transplant. At first doctors were concerned that, although Elston was a match, she might have the same predisposition to kidney disease as her younger sister, as they shared the same genetics, so Dominique was placed on the transplant list as Elston started her master’s program. 

Elston’s grandmother passed away in December of 2016, a tragedy that served as a poignant reminder of the importance of relationships with loved ones. “My grandmother was my whole world,” Elston said. “I didn’t take the final in one class so I could run to the hospital to be with her. I had to take the final after Christmas.”

Despite these challenges, Elston completed her master’s degree with a 3.9 grade point average. She moved back to Jacksonville to work as she began studying again for the MCAT. After taking the test, she was too nervous to look at the letter announcing her score. Her mom opened the letter instead. To Elston’s tremendous relief, her score was high enough to guarantee entrance to medical school. 

Ultimately, Elston was accepted to four medical schools, including UAB. UAB was her first choice, not only because of the quality of the school but because of its proximity to her sister, but it was also the last acceptance she received. Elston remembers that she was at work in January of 2018 when she got the acceptance call from UAB. She knew that if the work day ended without a call, that would mean she hadn’t gotten in.

The call came at 4:42 pm. She’d been accepted to UAB.

As Elston prepared for graduate school once more, testing revealed that she didn’t have the same genetic marker that had spelled renal disease for Dominique. A transplant was back on the table.

“I wanted to do it over the summer, before I started medical school,” Elston said, “but we couldn’t get everything ready in time. So I told them it would have to be over Christmas break.”

Elston’s final in her last class was on December 14. The transplant surgery was on December 18.

While the recovery time for a donor in a kidney transplant is roughly 6 weeks, for the recipient the rebound is much quicker. The day after her transplant, Dominique was out of her hospital bed. “Her skin looked better,” Elston said. “She was already healthier. She was like a whole other person.”

For Elston, coming back from the transplant surgery has been more difficult. The semester started in early January, before she physically equipped to return to class. She watched lectures by video – which, she said, is not her preferred way to learn. Adjusting to school after major surgery meant taking it slow, sometimes choosing between whether to take her pain medication or go without so that she could study. 

“I’ve been used to being superwoman,” Elston says. “But now I’m trying to take it slow, trying to balance recovery with school work.”

But there seems little doubt that she would do it all over again. Seeing her sister recover her health after the transplant is “incredible,” Elston said. While it didn’t seem like “a big deal” at the time she decided to donate a kidney, it’s been inspiring to be able to see her sister move from illness into health. And it’s redoubled her commitment to medicine, where she hopes to touch the lives of countless others she hasn’t yet met.