He knew the importance of singular focus in these situations, to block out emotion and not let his mind wander.

Just this once, he allowed it.

One out from victory in his baseball team’s final game of the season, Joey Carney took a walk behind the pitcher’s mound.

His thoughts drifted to her, then to his father, and he quickly scanned the crowd to find the man who never gave up on him as a ballplayer even when it seemed as if everyone else had.

ADVERTISEMENT

Even with another season of eligibility remaining, Carney knew his career could be ending.

“This,” he told himself, “could be the last batter I ever face.”

Earlier in the season, before he learned how to better control the roiling of nerves and adrenaline when he entered a game, Carney might have faltered.

Now, he confidently strode up to the rubber. He nodded at the sign from the catcher, twisted his taut 6-foot-2 frame and delivered a perfectly placed cutter that induced an easy grounder to the second baseman.

He had his fifth save of the season.

Next: the most important save of his life.

The words came in a whisper from the pre-op area inside the UC San Francisco Medical Center.

“Dad, I’m scared.”

Nauseous from medication, his face flush, his eyes blinking furiously in the effort to stem a tide of tears, Joey Carney struggled to control his breathing.

No more than 15 feet away, on the other side of a curtain, lay his mother, Paula. Her thinning brunette hair tinged with gray, her eyes dark and sunken, her arms crossed tightly over a belly swollen by liters of toxic fluid.

Distracted by family members, she remained composed until the gurney carrying her Joey passed on its way to the operating room.

“I love you,” he declared.

“I love you!” she called out.

Not quite two hours later, a gurney carrying Paula was led to the same OR.

It had been two years and three months since her diagnosis, when she was told she probably had about two years to live.

At first, she blamed the aches and fatigue, the unsettled stomach, on middle age. Another person might have seen a doctor, but she didn’t have the time.

Joey was transitioning from high school to college and trying to keep his baseball-playing career alive; younger son Justin wasn’t old enough to drive to appointments; and husband Dale relied on her to keep the books for his burgeoning refrigeration and air-conditioning company.

Paula had been the consummate sports mom, an ebullient and outspoken fixture at the games. If an umpire’s call didn’t go the right way, she might chirp. If a loudmouth wisecracked about any of the boys, she most definitely would scold.

“Always there, always supportive,” Joey said.

By the time Paula got sick enough to seek help, it was too late.

The liver processes food and liquid for energy or elimination. Paula’s was so scarred that it was barely functioning.

She had developed end-stage liver cirrhosis.

The condition carried a stigma because it is often associated with long-term alcohol abuse. Paula enjoyed a glass of wine, but she knew heavy drinking couldn’t be the cause of her illness — even if some of the medical professionals she’d met had made up their minds.

Only much later, after she had been forced to attend Alcoholics Anonymous meetings as a term of her treatment, were the Carneys given a reason they considered plausible.

Paula suffered from NASH, non-alcoholic steatohepatitis, which stems from obesity. She had been overweight in the past, though she had gradually lost more than 100 pounds.

She needed a liver transplant.

She needed a donor.

Joey Carney and his mother, Paula, walk to UC San Francisco Medical Center's transplant unit.

Joey Carney was like so many high school stars who strive to compete at the top level of college ball. His potential didn’t seem to fit the goal.

He hit well, was solid defensively and could even pitch. But he wasn’t good enough at any one facet to attract his “dream school,” the University of San Francisco. Or any other NCAA Division I team.

After he’d spent two injury-plagued years at Skyline College, a junior college a few miles from his family’s Millbrae, Calif., home, his only real Division I option was 3,000 miles away, in upstate New York.

Siena College didn’t offer a scholarship, but it gave a roster spot and he took it — for a few weeks. Shortly after he started classes in the fall of 2014, Carney returned home when his girlfriend’s family suffered a tragedy.

During the visit, he noticed how quickly his mother’s health was failing. Simple tasks exhausted her. Some days, she spent 20 hours in bed. So Carney left school, choosing to be by Paula’s side at her many medical appointments and stepping in to help with the family business.

For baseball, he played catch with his father and hit in batting cages with his brother. “Little League stuff,” he said. “Back to square one.”

When he enrolled at San Francisco in the fall of 2015, his chances of playing baseball were next to none. The best USF’s coaches could do was invite him to an open tryout shortly after classes began.

“I had one shot to show them what I had,” Carney said, “and I spent most of a year thinking about it.”

He wasn’t told that no player from an open tryout had ever made the team.

It had been well over a year since he had thrown off a mound with anything on the line. Now everything was on the line.

“Everyone I’d talked to told me I was an idiot for leaving Siena,” Carney recalled. “I was at a Division I college and now I’m trying to walk on at another Division I college, one that didn’t want me before? ‘It’s not going to happen.’ That’s all I heard for a year.”

During his tryout, he pitched with pent-up aggression, mustering all his strength on every pitch. “I thought I did all right,” he said, “but the coaches really didn’t say much to me.”

He was between classes later the same day when a text message directed him to the head coach’s office. “That was quick,” Carney thought. “Can’t be good news.”

But it was. He’d been added to the fall roster. No promises about making the team for the regular season in spring, but he had earned an extended look.

Carney left the office in a daze, his emotions bottled until he called his ball-playing partner from the year he was without a team.

“I broke down; my dad broke down,” Carney said, his voice cracking at the memory. “Then I spoke to my mom and she cried. My grandparents couldn’t believe it.

“At that moment, it was the greatest accomplishment of my life.”

They lost track of the number of hospital visits. Every two weeks, Paula went in to be drained of the toxins that left her stomach so bloated she strained to breathe and could barely eat.

“About 20 pounds worth,” she said. “I weighed myself before and after.”

Other times, she was rushed to the emergency room, retching red vomit from blood vessels that ruptured because her liver wasn’t doing its job.

“At the end of the day, the worst case scenario is I die on that table. I'm completely fine with that as long as I'm doing this to help my mom.” — Joey Carney

On countless occasions she lost consciousness, sometimes for minutes, sometimes for days. So, for their wedding anniversary last year, Dale bought her a stuffed toy: two bears, their arms interlocked over a bright red heart.

The gift had a function. If Paula woke up alone in a place she didn’t immediately recognize, she would look for the bears. If they were with her, it was a signal that her family was close by.

Once, at home, Joey was convinced he was watching her die.

He returned from a long day of baseball and classes at USF to find her “a little loopy,” which wasn’t entirely unusual. Except this time, as he headed out of her bedroom, he was stopped by a bloodcurdling scream.

Rushing back, he found Paula sitting up in bed. “She looked at me right in the eye with the blankest face, the blankest white pale face, a face that haunts me to this day, and says, ‘I love you,’ he recalled. “Then she collapses.

“I shook her, I yelled. But she wasn’t responding, not for a while. Then she awakens but isn’t really there. She’s completely out of it.”

Dale tried to calm his wife, telling her time and again, “You’re fine,” though she clearly wasn’t. When help arrived, all Paula could do was mimic his words.

“Whatever they asked her,” Joey remembered, she’d say, ‘I’m fine, I’m fine, I’m fine.’ It was the weirdest thing.

I thought, ‘This is it. She’s going to die right here.’”

A MELD score, determined by a variety of factors, is used to prioritize patients waiting for a liver transplant. The higher the score, the greater the urgency.

By the middle of last year, Paula’s rating allowed potential living donors to be brought in for testing, a costly endeavor that can span months.

First up was her older brother, who sailed through the process until the end, when it was determined that the shape of his organ was not suitable for a transplant. Three others were tested, including Dale, who was eliminated for the same reason.

Joey had started at USF but made time for bedside chats with his mother. As donors were crossed off the list, he witnessed her despair.

“It looked like she was almost giving up,” he said. “Like, ‘This isn’t going to happen. I’m going to die.’”

Joey begged from the start to be tested, arguing that he had the fewest responsibilities. He didn’t have to work and, unlike Justin, then 15, didn’t have to go to school. His parents wouldn’t hear of it.

Paula was already guilt-ridden that her son had left baseball at Siena because of her illness. She didn’t want to be the reason he quit again.

“Let’s hold on,” she told him, “if you make the team we’ll get you tested after the season.”

But Joey insisted, threatening to start the process on his own if necessary.

He didn’t know then that he would become the first player from an open tryout to make USF’s team. Or that he might be the first college athlete to become an organ donor.

All he knew was that she had suffered enough.

Joey Carney looks at a wedding photo of his mom and dad, Dale and Paula Carney, before leaving his home in Millbrae for surgery.

Nino Giarratano has won more than 500 games as a head coach, but his San Francisco Dons are not one of the college game’s juggernauts.

More than the victories, he treasures visits from former players who credit successes in their family and professional lives to lessons learned in his program.

Control what you can control. Don’t let the moment overwhelm you. Trust the work you’ve put in.

Those catchphrases spoke volumes to the new pitcher with the weight of the world on his shoulders.

“A lot of what the coaches said to me during the year had a bigger tie to me in my personal life than it did my baseball life,” Carney said. “It directly affected what I was going through at that moment, and it guided me.”

Giarratano spoke from firsthand experience. In 2011, he donated a kidney to his father, Mickey, then 80.

“There’s nothing greater than being able to give back to your parents,” he told his pitcher. “If you can do it, we’ll support you. Whatever it takes.”

Carney was on the team bus, headed for a game in Portland on the first Friday of May, when he received a call saying he had qualified to be his mother’s donor.

He set the date right then: June 2, after the season was over.

His parents had just arrived at the Portland airport when he called with the news. “The doctors said yes. The surgeons approved it. I set a date. It’s happening,” he gushed.

Paula was overwhelmed. “It was like, ‘Wow, after all we’ve been through this is going to actually happen,’” she said. “And it’s going to be my son, my hero.”

Two days before the scheduled transplant, he had been all swagger. He would just be asleep, he explained to a visitor. The pressure was on the surgeon. Nothing for the donor to worry about.

“If something bad happens,” Joey said, grinning, “I just don’t wake up.”

His tenor changed as afternoon became evening on the day before surgery, after he and Paula checked into the hospital. Silence replaced chatter. His brow furrowed as he stared into his cellphone.

Geri McDonald laughs with her grandson Joey Carney.

Someone asked about the well-worn teddy bear sitting close to him. He said it was a gift he’d received when he was 5 and recovering from being mauled by a dog. The bear was capable of reciting the lyrics of a classic children’s nighttime prayer:

Now I lay me down to sleep

I pray the Lord my soul to keep

If I should die before I wake

I pray the Lord my soul to take.

The battery was missing, and maybe that was best.

The next morning, his confident facade cracked entirely. On the way to pre-op, the man pushing his gurney asked if he was nervous.

“Yes,” Joey readily admitted.

The surgeons for son and mother were the wife-husband team of Nancy Ascher and John Roberts. Ascher is chair of UCSF’s department of surgery and a nationally renowned transplant specialist. Roberts is chief of UCSF’s transplant service, one of the largest in the country.

Each of the experts focused solely on their patient. Joey, 22, had Ascher; Paula, 50, had Roberts.

Joey’s liver was larger than most, allowing the entire left lobe — about 40% of the organ — to be removed during the transplant. Over time, the portion he kept and the part he donated were each expected to grow to about 85% of the liver’s original size.

That was if all went well. Plenty could go wrong.

In the weeks leading up to the transplant, Joey was often asked what would happen if he got sick or his mother’s body rejected his liver.

His reply: “I know if I don’t give her my liver she’s gonna die.”

Dale Carney visits his son Joey in the intensive care unit the morning after he had surgery.

Every hour or so Dale’s cellphone buzzed and all eyes in the waiting room shifted toward him. Updates from each of the surgical teams.

The reports were not detailed but had the desired effect. They calmed his nerves and kept him busy passing information to family and friends inside and outside the hospital.

At a few minutes before 3 p.m., he received word that Joey was out of surgery. Dale was at his side as Joey tried to speak while being wheeled toward an intensive care unit.

The words were mostly unintelligible, but Dale was sure he had an accurate translation: “Where’s Mom?”

Joey Carney visits his mother, Paula, in her room for the first time after the procedure. (Dale Carney)

She was still in surgery.

Just after 8 p.m., some 11 hours after she entered the OR, Paula was finally taken to recovery.

At first, she struggled to keep her eyes open. With a breathing tube down her throat, she couldn’t speak.

“You’re OK, do you understand?” Dale said to her. No response.

“Paula, Joey is OK.” Her eyes opened wide. “Do you understand?” No response.

He held up a new photo of Joey sitting up in his bed. “Joey is OK. If you understand, nod yes.”

She nodded.

It had been 12 days since her son’s last pitch.

It would be eight weeks before he might resume physical workouts.

It was 272 days until next season’s opener.

mike.hiserman@latimes.com

Twitter: @MikeHiserman

Hiserman is a deputy sports editor for The Times. His son, Matt, is San Francisco’s pitching coach.