classic scenarios, and of course, you can always join in on the conversation on facebook and twitter. i'm john quinones. "20/20" starts right now. . o tonight, a real life "rock kwi" story. >> you took it as the gospel. >> it is the. >> a hollywood player in the fight of his life. >> quick little feet. >> surviving an almost fatal medical mystery. >> he was on his near last breath. >> she said to me, you're probably going to die tonight, and you should text your loved ones. >> this is just so surreal. sca. >> his fiancee, recording it all in a video diary, faced with the grueling decision. >> they were, like, what? did he just say amputation? >> jonathan's life was in your hands. >> a virtual guinea pig for an

18-hour first of its kind hand tra transplant like luke skywalker in "star wars," but could it work with real flesh and flood? >> it was really the fight of my life. >> tonight we're showing you in realtime. >> i'll be able to play the piano after the surgery. >> the triumphant surgery of a man who would not give up. >> feel it. feel it. >> dude, good job. >> thank you for saving my husband's life. thank you so much. >> thank you, everybody. >> good evening. i'm david muir, and this is "20/20." reporting tonight, juju chang. >> reporter: if clean living needed a poster child, it could easily be jonathan koch. >> i don't drink. i don't smoke. i've never done drugs. i've never had a beer. i don't drink coffee, not because i'm against those things, they're just not for me. 5-5.

>> reporter: and the only thing tighter than his top spin grip -- >> nice backhand. >> reporter: -- is the bond he shares with his teenage daughter, ariana, his date for 14 straight father-daughter dances. >> you get into high school and those dances become very real because you know, you know you're -- you only have a couple of them left. >> reporter: the rest of his life is consumed by work. a modern day hollywood mogul. >> hey. how are you? >> what do you love about your job? >> my job is an opportunity every second of the day -- does anybody know what's going on in italy right now? >> cofounder of asylum entertainment, a production company he and his partner recently sold for over a $100 million. they have done dozens of hit tv shows you have undoubtedly seen. from sports -- to reality tv. >> i'm fat. >> reporter: and even scripted

dramas like "the kennedys" starring katie holmes. >> we're going to win. >> we're going to win. >> reporter: and we're not just name dropping. all his high-flying hollywood friends adore him, like the creator of the show "24," joel surnow. >> we all feel the same way jonathan. this guy is a treasure. this guy is a unique person. >> reporter: and the multiplatinum singer, songwriter jewel. >> he's a special person, you're lucky if he's your friend. there's a hell of a journey and a story that he just went through that is unlike anything i can ever imagine. ♪ >> reporter: with all he had going for him -- ♪ >> reporter: it's hard to imagine that jewel's song "hands" a haunting ballad about overcoming adversity could be considered his life's anthem. ♪ i never broken >> reporter: just two years ago, the master hollywood storyteller had no idea he was about to play the unwitting lead in his own reality survivor show. if someone pitched you the story

of your life, would you buy it? >> no because i don't know the end. >> reporter: he may not know the end, but the beginning is vivid. january 26, 2015. what were your first signs that something was amiss? >> i was getting ready to go on a business trip to washington, d.c. >> reporter: he's headed to a reality tv convention. when reality throws him a curve, this 6'1", and 225-pound tower of health is suddenly inexplicably ill. >> jonathan is not a guy who typically gets sick. >> reporter: his longtime girlfriend, jennifer. >> he is always healthy, he's always working out. >> reporter: but waking up that morning, out of the blue, he's so weak and feeling so awful. he tells jennifer to take him to the hospital. >> i felt like i had been hit by a truck. i laid down complete the floor, and i said, i cannot do it, i literally can't move. >> that's not something he would normally say, so immediately it set off alarms for me. >> reporter: at first, the real-life "iron man" tries

writing it off. >> so when you're heading to the er, how concerned are you? >> i just thought i need to go to the hospital and they need to check my oil and get me out of there. i just didn't really think too much of it. >> reporter: the couple wondered -- maybe it's something he ate? doctors thought it could be the flu. >> so at that point i kind of relaxed a little bit and thought, okay. i have never really had it like this, but okay. >> you decided well, it's a good idea to get on a cross-country flight? >> well, i did ask. and they said, you're -- you seem okay to us. i don't think anything's wrong. >> reporter: he rests in first class on the five-hour flight, and hopes a good night's sleep at the washington d.c. hotel will do the trick. the next morning, he powers on to the realscreen summit where some of the biggest tv deals are made. his team has been prepping all year, but he barely lasts one meeting. >> i was walking through the convention floor, and i was about to fall down and i started seeing, you know, three and four

of everybody in the room, and i thought, this is not going well. >> reporter: he stumbles out of the convention hall and into a cab, to george washington university hospital. >> there's no doubt that he looked like a sickly patient, he looked very ill. >> reporter: doctor lynn abell says jonathan walked into the er feverish, his heart racing, his blood pressure low. >> it was the end of january, the flu, viral illnesses were the common things that we're seeing in the emergency room. >> reporter: er doctors begin standard care. blood tests, urine cultures. they give him i.v. fluids and antibiotics. even hooked up to all those lines, jonathan keeps his sense of humor, sending this selfie to colleagues with the caption "conference not going great." when did you first get word that things were going south? >> we're texting and he -- you know, he's sending me photos or whatever of himself and he's starting to look a little bloated in the face. he was saying i'll be fine. i just have pneumonia. i'll be fine. it's fine.

>> reporter: but suddenly, doctors aren't so sure. >> he did not progress in the way everyone thought. what they were doing was not working. >> reporter: his white blood cell count starts to plummet, a sign the body's immune system is malfunctioning. and his feet? freezing cold to the touch. >> it wasn't obvious what was causing his cold feet. >> reporter: doctor michael seneff says jonathan's circulation was abnormal, as was something else, though they were pumping liter after liter of i.v. fluids into his body, jonathan is pleading for something to drink. >> we're giving him a lot of fluids, it's not having as much effect as we want because he has "leaky capillaries" it's going out into his tissues. >> reporter: doctors are dumbfounded. nothing is working. as day turns into night, jonathan's condition is so grave, they move him to intensive care. >> the concern level was very high at that point. >> whatever he's got is aggressive, and it's progressing at an alarming rate. >> he was scared out of his mind. why?

why is this happening? is exactly what he's saying to me. and i can't completely explain it. he was like, can i die tonight? and i was -- i had to be honest. >> she said to me, you're probably going die tonight, and you should text your loved ones. >> reporter: how do you say goodbye through a text? for at least one person he loved, that seemed unimaginable. you decided not to text your daughter cause you just didn't want to have that be her last message from you. >> nothing good could come from it. but that moment, when i decided not to, was really the moment that i decided that i just can't die. i can't -- i can't do it. she shouldn't grow up without her daddy. >> reporter: when we come back, how does the model of perfect health turn into a medical mystery, putting him at death's door in less than 24 hours? and the dramatic video diaries that capture every harrowing moment. >> i would just give him one

more kiss or one more hug or -- more kiss or one more hug or -- >> stay with us. >> stay with us. and we're the . we run our business from the boat. it's a really small space. this new surface go is the perfect size. ♪ i love having something that i can hold in my hand. we're proud of this way of life. we're proud of the work we're doing. ♪ ♪ ♪ ♪

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this is just so surreal, like a horrible, horrible, horrible nightmare. >> reporter: jennifer gunkel couldn't have felt more helpless or farther away from her boyfriend, jonathan koch.

she's home in l.a. while he's across the country in washington, d.c. in intensive care, clinging to life with only a 10% chance of survival. >> the doctors were saying, you need to call your loved ones now. >> reporter: like jonathan, she too was in show business, doing social media nor shows like "scandal" and "grey's anatomy." >> are you ready? >> no. >> reporter: she starts recording in realtime, nearly every moment of this heart-rending long distance ordeal. >> i'm just really scared. >> reporter: overnight, she'd received an ominous text to call him. >> he said that, things are really serious. this is more serious than i thought. and i said, i'm getting on a plane right now. >> reporter: back at george washington university hospital, jonathan's i.c.u. doctor, lynn abell, is baffled by her patient's mystifying illness. >> his heart, his lungs, his kidneys, his liver, his

circulation all were failing. >> reporter: agitated, and now wracked with pain throughout his body, doctors fear jonathan is in full septic shock. things get so dire, doctors resort to putting in a breathing be but first, doctors have to sedate him, putting him into what is essentially a medically induced coma. >> he just begged to have us try to hold off, until his fiancé arrived. he was on his near last breath. >> i wish i could have talked to him. i wish i would have gotten here sooner. if i could just give him one more kiss or one more hug or -- >> reporter: as agonizing hours turn into days, there are still no answers, and yjennifer, his medical proxy, has to okay every medical test, every procedure, knowing those decisions could affect his daughter too. >> yeah, i just kept thinking

about his daughter and just like she can't be without her dad -- i was trying to do the best for her future. >> reporter: but it's the pictures that tell the story. and jennifer is there documenting every moment, capturing the before, not even sure there will be an after. by his second day in the i.c.u., a terrible sign -- his limbs are turning black. gangrene is setting in, because his vital organs are literally stealing the blood from his arms and legs to survive. >> his fingers are blue and his feet are blue. [ crying ] >> reporter: then, as things are at their most desperate, doctors propose something that, to jennifer, is unthinkable. >> they also talked about amputating your fingers and toes. i asked them why. please try to fix it. >> lisa, his sister, and i, we just turned and looked at each other and we were like, "what? did he just say amputation?" and we were shocked. i just thought "i will just that decision for him." >> reporter: if anyone knew what kind of fighter jonathan could be, it was his sister, lisa.

after all, their survival story began long before this. >> i always felt like we were a team, the two of us going through it. >> reporter: a team with her brother. growing up in the pennsylvania town of state college, home of penn state. raised by a loving mother, but a father who jonathan says had no use for him. >> my father had a very domineering, almost sadistic way about him. >> reporter: take the time when jonathan was about 4, and he says his father showed him how to tie his shoes just once, then banished him to the basement. >> and he said, "go downstairs and don't come up until they're tied." and it took me a long time. probably, i don't know, 10 or 12 hours. i could hear my mom crying out the door. >> reporter: but jonathan says there is one gift he credits his dad with giving him. he took jonathan to a drive-in when he was 11. a transformational movie, called "rocky." >> "rocky" really changed my life. >> reporter: it might seem cliche to some, but not if

you're a downtrodden kid from the keystone state, who'd come to l.a. with dreams of stardom, only to end up a hollywood heavy weight. not unlike the italian stallion himself. you took "rocky" as gospel. >> it is the gospel. >> what are the lessons? >> well, first of all, he didn't win. rocky didn't win. but to me, he accomplished what he set out to accomplish which -- he wanted to last the entire fight. to me, that was everything. >> reporter: but did jonathan have enough fight in him to beat whatever mysterious illness had breached that otherwise healthy body? finally, after 2 1/2 days in the i.c.u., dr. seneff says it's one of the young doctors, a resident making rounds, that has an ah-ha moment. >> the more detective work we did, the more likely it seemed that this really was the diagnosis. >> reporter: a lymph node biopsy confirms it. >> the appropriate term, i think, is hemophagocytic lymphohistiocytosis.

a rare and aggressive immune rod >> it is basically your immune system in overdrive. and there's some trigger, often times viral, but it's mostly seen in pediatrics. >> reporter: they immediately reverse course on treatment. what they had been doing was making things worse. they start chemotherapy and massive steroids to kill off toxins. >> and over the short course of time, over just a few days, he started making a quick recovery of his organ systems. >> you opened your eyes three times today which was amazing. i saw the light in your eyes, your beautiful blue eyes. honey, squeeze your hand again. >> reporter: like the prize fighter he idolized, jonathan survived the fight of his life. but the damage was done. gangrene had literally starved his limbs to death. at a minimum, his left hand would need amputation. when you emerge from that coma, what's the first thing that you think? >> the first thing i thought was

that i wanted to marry jennifer. >> and yet before that, you weren't planning on getting married? >> no. >> what changed? >> all of a sudden it was just about us. >> reporter: when we return, they saved his life, but they can't save his limbs. >> i didn't understand how this could happen when i lived my life the way that i did and all the exercise. >> reporter: but little did he know there was yet another hollywood twist in store. what does the miracle on the hudson have to do with this medical miracle? stay with us. fidelity is redefining value for investors. introducing zero account fees for brokerage accounts. and zero minimums to open an account. we have fidelity mutual funds with zero minimum investment. and now, only fidelity offers two zero expense ratio index funds directly to investors. because when you invest with fidelity,

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>> reporter: back home in los angeles, there's little relief for the recovering, beleaguered hollywood executive. >> it feels like someone is holding a bic lighter under my fingertips all day every day. >> reporter: his hands in this video, so diseased from gangrene, we've concealed it. he's spent more than 85 days in two different hospitals. his four blood-starved limbs are all but dead. as bad as it looks, it feels even worse. >> how did you get through all that pain? >> i've prepared my whole life to push myself past, you know, the norms, past what i think i need to do. >> you didn't look in a mirror for months? >> i chose not to look in the mirror because i could tell by the reaction of people around me

it wasn't going great. >> reporter: he's stuck in a wheelchair, 40 pounds lighter, a sickly shadow of his former self. with virtually no use of his hands and feet, jonathan's well of optimism fills with doubt. when did the term transplant enter your vocabulary? >> i actually can remember right where i was. i was standing in the hall. the attending that was on just said, i think they are doing hand transplants now. you should google that. you should check it out. >> reporter: and she does. jennifer learns one of the world's leading hand transplant pioneers, dr. kodi azari is just 20 miles away from their home at ucla. >> the hand is probably the most remarkable i'd say instrument that i've ever seen. >> reporter: as surgical director of ucla's hand transplant program, dr. azari's passion often inspires him to wax poetic about his favorite appendage. >> if there is any evidence of divine intervention, it would -- it would be the human hand.

this same hand can break bricks. it can also have the precision to be a concert pianist. >> reporter: which is why trying to replace has been so imperfect. from a hook like this one, to even a state of the art prosthetic, dr. azari says there was room for improvement, but it would take just the right patient. >> when i first saw jonathan he was -- he was actually incredibly frail. he hadn't showered for months because he had open wounds. >> reporter: but azari had a plan - a new innovative procedure, a type he had never attempted before where the amputation of the hand is placed closer to the wrist than the elbow. the arm is then prepped specifically to receive a new hand. each and every nerve, tendon, vein and artery is extended and bound together. the arm is then sutured closed until it's later reopened and attached to a donor hand. the benefits -- more functionality and range of motion. a much better quality of life for jonathan.

>> he was dependent on his wife for every single aspect of his daily existence. you know, personal hygiene in those situations is not personal anymore. >> reporter: azari wonders could jonathan be the one for his dream procedure? he had plenty of doubts. >> it takes a lot of effort to rehabilitate the hand, and you want somebody to put in that effort. otherwise it could have been a waste. >> reporter: jonathan, brimming with enthusiasm, had no doubt. >> i was like, oh my god. this guy is our guy. like let's do this. do you have any hands here we can choose from or can we just get one right now before we leave, or how is this going to work? >> and he was like just chill. slow your roll. >> reporter: azari laid out a blunt sering b hwohi surgn. fotershe havto regain his strength and rebuild trscott zeller pyed coach mickey to jonathan's inner rocky. >> i learned to trust scott very quickly.

he understood not to baby me. >> we'd do a set of something, and then he'd fall asleep on the table. >> i had 270 milligrams of morphine coursing through my body every day. >> i kind of have to shake him awake to get him back on again. and then we'd do another set of something and then he'd fall asleep. >> getting ready for the hand transplant was literally the fight of my life. >> reporter: his mind perhaps more battle ready than his body, but within only two months of training, dr. azari thinks jonathan is ready for the next challenge. >> it'll sound strange to say it, but i wanted them to cut my original hand off. it was horrible. it was hurting me, and it's dead and it's very hard to live as along as i did with dead limbs. >> reporter: in the summer of 2015 the process begins, dr. azari amputates jonathan's totally useless left hand, and just the fingers on his partially-functioning right. but while he's emotionally divorcing himself from parts of his own body, jonathan makes good on the promise he'd made, waking from his coma.

he and jennifer are married in their backyard, in a ceremony so simple there isn't even a cake. >> it was so simple and perfect. it was 38 seconds in the backyard with four people, and we laid down and got something to eat, like we always do. >> yeah, we had honey nut cheerios. >> reporter: but next came perhaps the biggest and most costly of dr. azari's challenges before jonathan could get a new hand, the cruelest kind of exchange -- azari tells jonathan there's something he can't fix. he would have to lose his leg. >> well i said, jonathan, i can't do your transplant until you've had your amputations of your legs, and you're up and moving around with your prosthetics. >> reporter: why? so he could be healthy and strong and steady on his feet, so as not to stumble and injure his new hand. so the very next day after getting married, back to the hospital for the amputation of his right leg. >> we had our honeymoon in the hospital. it was lovely. >> it was. >> reporter: there was reason to

be hopeful. so many high-profile success stories. oscar pistorius breaking records on those blades, a double amputee nearly taking home the mirror ball on dancing with the stars. you'd think an optimist like jonathan would be prepared, but it seems nothing prepares you for the moment when you're staring down at an expanse of bed sheet where your leg used to be. >> it took me by surprise that i was so emotional about having my leg amputated. when we left the hospital and i was getting into jennifer's car and i realized that i didn't have a right leg below, you know, i was shocked. >> reporter: so upset that jennifer was forced to pull off the road. >> and then i just burst into tears, which was the first time during this entire thing that that had happened, and you know, after that we came home, and we got to work. >> oh my god!

>> reporter: undeterred with even fewer limbs, but now fitted with a prosthetic leg the moment of truth. >> on the first day he got his prosthetic, he got up and walked, and i've never, ever, ever seen that before. >> what was that moment like when he learned to walk? >> i was overwhelmed with joy. he hadn't walked in 11 months. >> yeah, we trained really hard, but i was so happy. >> reporter: all the while, jennifer's video camera trained on some unsteady strides, and surprisingly few stumbles. that old swagger back intact. >> i was incredibly impressed by the speed of his rehab. i didn't think there could be somebody that was this eternal optimist that would work so hard. doesn't smoke, doesn't drink, i didn't think that person exists, and yet, there's jonathan. >> reporter: and with that, dr. azari finally gives the green light to place jonathan on the donor recipient list for a hand, and when we come back the call comes.

>> i was like, this isn't happening. this isn't happening. jonathan's going to get another man's hand. >> reporter: the hand is on its way, packed in ice, in a cooler like this one. but it can't survive long without blood. >> well, we all know about the notorious l.a. traffic. >> reporter: and an unforeseen visitor causes an unexpected delay. a critical race against time, next. next. ew cultures to explore. with two times more detail than any other dna test... you can connect more deeply to the places of your past. and be inspired to learn about the people and traditions that make you, you. savor your dna story. only $59-- our site's lowest price ever. you're going to do your thing. and no period is gonna slow you down! with tampax, you get protection that moves with you

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>> reporter: look carefully. you're watching jonathan koch bench press using the stump of his left wrist. remarkably, pushing past the familiar, ever-present pain.

>> come on. >> reporter: this unwavering drive -- >> good job. >> reporter: is about to pay off with a new hand. >> if i wasn't ready, then what dr. azari did and all of his genius would have gone potentially, you know, to waste, and so that wasn't okay. >> reporter: but dr. kodi azari had to be ready too. he trained 18 years for this moment, and not unlike jonathan, he too had a silver screen hero. >> birds. >> whoa. >> reporter: "sully" about the hero pilot, chesley sullenberger's miraculous plane landing on the hudson. azari says he watched it repeatedly, taken by the striking similarities between their two professions. >> we're expected to do the operations perfectly every single time. yet, the human body throws curveballs our way, and when that happens, you've got to have

the composure to do what's right, to do what's best, and you have to make judgments at very critical times. >> and lives can often be on the line. >> and lives. the movie really resonated with me. >> in many ways sully's like a hero to you. >> i think he's a hero to many people. >> reporters: and like pilots in a simulator, azari and his team gathered multiple times to practice jonathan's operation in a surgical anatomy lab. >> the search for a donor is not easy. >> the hand is different. it's an external organ. so you need to match for size. you need to match for color. you need to match for hair pattern. imagine my hairy hands on you, juju. i don't think you would accept this as yours. >> that would be a little off. >> reporter: after a seven-month wait, jonathan and jennifer get the call, the one they hope will change their lives. >> i still don't believe it. i was like, this isn't happening. this isn't happening. and then, finally, you know, we

get in the car and we go. >> and so you're driving to the hospital. what's going through your mind? >> well, first of all, obama was in town. so that wasn't great. >> reporter: 9:30 a.m., the surgical team is at ucla medical center waiting on jonathan and jennifer, but they didn't bank on this. >> president obama will be fundraising in l.a., once again. >> and that means traffic delays as you head to work. >> and so it's l.a. traffic. >> yeah. >> you're stuck in gridlock? >> yes. >> reporter: they're relying on a g.p.s., but on a day like this, it's more like o.m.g. >> we decided to follow waze, but, of course, everybody in l.a. follows waze. so we were on these back roads with all these stop signs with literally as much traffic as there was on the freeway. >> so we were 45 minutes late to my own hand transplant. >> reporter: meanwhile the donor is on life support at another sohe california e ere the s >> and i actually got to meet the donor's brother and i got to meet the donor's pastor, and to

me that was an incredibly emotional time because i can truly sense their loss. jonathan got an organ from somebody that was truly an incredible person. >> reporter: 2:58 p.m. -- azari texts jennifer. all is going well. we have left the donor hospital en route to ucla, but timing is now critical. traffic delays from the president's motorcade could be catastrophic. dr. azari has a helicopter on standby. >> the organ or the hand for this instance is not getting blood supply so over time it's deteriorating. so there's a ticking clock. >> reporter: a ticking clock on what will already be a marathon, almost 18-hour surgery, but today, in the city of angels, an angel just might be watching over them. >> and do you get stuck in traffic? how do you get back? >> there was no traffic. imagine that, coming back to ucla there was very little traffic. >> how are you feeling about your hand transplant surgery?

>> very peaceful and hopeful that everything goes well. >> jonathan had no concerns going into the surgery, but i did. i mean, this is an 18-hour surgery. this is a big deal. >> i actually told dr. azari, i said, you take care of my husband. you better take care of him. >> don't lose him? >> yeah. you bring my husband back to me. >> reporter: 3:57 p.m. -- azari joins his team of 13 surgeons, 4 anesthesiologist and 8 nurses from competing southern california hospitals now in the o.r. for one of the first of its kind hand transplants. before now, it was the stuff of science fiction. luke skywalker got one in "star wars." but this procedure, if it works will be ground-breaking. a complex surgery that would allow jonathan to recover with greater coordination and more sensation than in previous hand transplants. you volunteered to be a guinea pig, essentially. >> i did volunteer to be a guinea pig, and it's really my

job to make sure that i have the best chance to succeed so that other people can have the same opportunity moving forward. >> reporter: but the possibilities for complications are inevitable. >> there's always the fear that maybe rejection will set in or some other complication might set in. >> that's right. initial fears are that the vessels are going to clot and blood is not going to move through the hand. >> reporter: 4:15 p.m. -- two surgical teams work simultaneously, side by side, every tendon, artery, nerve is tagged and labeled. kind of like stereo wires waiting to be re-connected. there's no margin for error. >> nerves are like coaxial cables, except there's no red to red, green to green, yellow to yellow connection. you have to figure out how they fit within each other so that the parts of the nerve that are for sensation match up and the parts of the nerve that are for motor function match up. >> and so one wrong move and it can affect the way his hand moves? >> the way his hand moves.

the way his hand feels. >> reporter: 11:01 p.m. -- the new hand is now attached. tourniquets and clamps removed. did it work? the surgical team holds its breath. and what was that moment like when you saw the pulse return to his wrist? >> when you see this dead hand, it's cold, it's white, and it's not moving, and once you connect the vessels, including arteries and the nerves, then you see it start to swell up with blood. it's like a new life. it's magical. >> reporter: 9:07 a.m. -- the next morning the operation is over. jonathan wakes with one pressing question for dr. azari. >> i asked dr. azari, did you do it? and he said yes, and then i started to sing the rocky theme. ♪ >> reporter: coming up, would jonathan's new hand function as dr. azari hoped? >> we're going to try to move

your thumb tip. >> reporter: would he be able to feel the touch of his wife's hand in his again? the day after jonathan's surgery is jennifer's birthday. there was only one gift she wanted. >> that's amazing. >> reporter: stay with us. your mornings were made for better things than rheumatoid arthritis. before you and your rheumatologist move to another treatment, ask if xeljanz xr is right for you. xeljanz xr is a once-daily pill for adults with moderate to severe ra for whom methotrexate did not work well enough it can reduce pain, swelling and further joint damage, even without methotrexate. xeljanz xr can lower your ability to fight infections, including tuberculosis. serious, sometimes fatal infections, lymphoma and other cancers have happened. don't start xeljanz xr if you have an infection. tears in the stomach or intestines, low blood cell counts, and higher liver tests and cholesterol levels have happened. your doctor should perform blood tests before you start and while taking xeljanz xr, and monitor certain liver tests. tell your doctor if you were in a region where fungal

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>> reporter: 21 arduous months after jonathan koch first felt sick, a moment that would have been inconceivable at the start -- he awakes from surgery with a newly transplanted left hand. i was told that an hour after surgery, you were moving fingers. >> it was jennifer's birthday when i got out of surgery, and she said, i just want one thing. i just want you to move one of

your fingers. or i think you said move your thumb. >> that's amazing! >> and i didn't think there was any chance that i could. but i thought about it, and it moved. >> what a birthday present! >> yes. it was the best birthday present. >> then all of the sudden this guy comes on. and that's where it began. every hour, something would come back. doc, will i be able to play the piano after the surgery? it was incredible. >> reporter: a new hand, yes. but what kind of new life lies ahead? remember, he also lost fingers on his right hand, and a leg to that insidious disease. >> it's in my heart that if you, you know, you set your mind to something and you're willing to get through the pain, anything is possible.

>> thank you. >> boom! >> that's awesome. >> about one week in he's gripping a tennis ball and throwing it. >> what? >> reporter: from the opening serve, his doctor says, it was advantage koch. >> unbelievable. >> so, better than expected? >> better than expected. next thing you know he's -- he's got this little video that he shows me where he picks up a glass of water and he takes a drink. and he goes, ahh. jonathan has met, or in the vast majority of cases, exceeded all of my expectations. the classic one was, i told him jonathan, it's gonna take you maybe a year and a half to two years before you can tie your shoelaces. at two months he sends me a video of him tying his shoelaces >> reporter: that moment loaded with symbolism - for the man who'd told us he first learned to tie his shoes in that basement, under the duress of his dad. you don't have a lot of patience for this. >> no it's -- >> because you said i - you know, my doctors are telling me i'm a year ahead of schedule but i don't feel like i'm a year. >> well, i don't 'cause i'm just

doing what's in front of me. >> reporter: for months now, he's put more in front of himself than many would. >> now you have full extension. remember you didn't in the beginning? >> that was the most difficult one. >> reporter: at ucla, an exacting rehab regimen to build up the hand itself. and at the gym. >> dude, good job. >> there's constantly something new on the horizon that we're trying to accomplish. >> reporter: an exhausting workout schedule to restore his whole body. >> ten, one, come on. seeing him do new things after his hand transplant, quite a few of them brought tears to my eyes. ready, go. >> reporter: but maybe the greatest reward of all, doing anything with his daughter ariana. >> i'll get you next time. >> how cool is it to be able to work out with ariana again? >> oh, i love it. you know, doing those things now with her are just extraordinary. >> reporter: like in february, a milestone that seemed implausible.

they attend ariana's last high school father-daughter dance. you made it to a father daughter dance again. >> i did. father-daughter dances are amazing, and ariana was incredible. she took care of me the whole night. okay, let's do this. >> reporter: but i got to share a pretty special thrill with him too. perfect. a rally on his beloved tennis courts. yes! how's it feel? >> it feels good, i just can't really feel my grip that well yet. >> reporter: as if playing tennis alone isn't amazing enough, the natural righty had to learn to do it left handed. >> yes! >> yeah, i'm not great. but i am working on it. and i'm having a blast relearning tennis. >> good job. >> you're amazing. >> reporter: it's not without issues, his heart and lungs are not at the levels they once were. and like any transplant recipient, there is a lifelong looming possibility of rejection. curiously, jonathan says he's lost a lot of his taste for

food, and he overheats a lot. so he carries a fan, even during our interview. >> i'm just going to cool down one second. >> yeah, sure. >> reporter: but wherever jonathan goes, he is a living breathing inspiration. >> i feel very much that i'm, you know, the test pilot for this. you know, that my hand is my hand but it's really all of ours. >> reporter: and speaking of pilots, remember the one who'd inspired the whole world with his heroism? i have a little surprise for you >> reporter: well we asked. >> am i about to be pranked? >> reporter: and he agreed. >> come on in. >> reporter: to pay dr. azari a surprise visit. >> good afternoon! >> cool. >> dr. azari. >> sir, how are you? >> nice to know you. >> reporter: captain sully. >> evacuate! >> reporter: the high-flying hero who makes a down-to-earth cameo in our little hollywood movie. >> i cant tell you how many times i've cried watching that movie. that was an incredible day for america. >> i think at a time when we all needed it. it gave us all hope. >> oh, my goodness. jonathan, how are you?

>> good, how are you? >> jennifer, it's a pleasure to meet you. >> pleasure to meet you. >> it's pretty remarkable isn't it? >> it is amazing! >> it's been an incredible experience. as something happens almost every day that changes it. >> it's amazing how complex the human body is. >> shake? >> that's lovely. >> it is. >> reporter: when we come back this photo of another handshake, and why it's so very special. >> what's wrong with your left hand? >> reporter: plus, how does one learn how to play guitar wit and then the people go inside. do you understand charlie? mom? yeah? can i have a peanut butter sandwich? yeah, you sure can. can charlie have one, too?

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depression is multiple symptoms that can hold you back. my doctor prescribed trintellix. a prescription medicine for depression. trintellix may help you take a step forward in improving your depression. tell your healthcare professional right away if your depression worsens or you have unusual changes in mood, behavior, or thoughts of suicide. antidepressants can increase these in children, teens, and young adults. do not take with maois. tell your healthcare professional about your medications, including migraine, psychiatric, and depression medications to avoid a potentially life-threatening condition. increased risk of bleeding or bruising may occur, especially if taken with nsaid pain relievers, aspirin, or blood thinners. manic episodes or vision problems may occur in some people. may cause low sodium levels. the most common side effects were nausea, constipation, and vomiting. ask your doctor if it's time for a change to trintellix. are so thick... so fluffy... so delicious... (whisper) karen, karen you've got to try this

...they're just too good not to share l'eggo your eggo statake an extra 20% off!'s friends & family sale save on vans shoes - starting at $55.99 reversible comforters are just $31.99 and a power air fryer is $127.99. plus, get kohl's cash! starting thursday - at kohl's. ♪ my hands are small i know ♪ but they're not yours they are my own ♪ >> reporter: when jewel wrote her top-ten hit "hands", she didn't even know jonathan koch. ♪ and i am never broken >> reporter: but now the song is almost a soundtrack for his life. >> nobody gets through life without pain. not one of us. we're all going deal with heartbreak, death, trauma. and so i really wrote that song about not being a victim. about taking your happiness in your own hands. >> use one finger to hit both strings. >> reporter: and with that new left hand, his first stab at

playing guitar, part music lesson, part life lesson. >> wow. this feels really good. >> wow. >> i really like being -- >> you just learned a chord, dude. >> thank you, everyone. >> reporter: jonathan koch, the man who made a fortune telling other people's stories, now telling his own, as inspiration. >> none of this is ever going to happen to you, you're never going face it, but things are going to, and good things and bad things and i just would like you to be ready, and some day when you're feeling challenged, that you look back at this and you'll say to yourself, you know what, i can push through this. i can do more than i thought i could. it has already helped, you know, a lot of people, and that means everything to me. >> reporter: but on this day, he takes us back to where it all began. the last time jonathan and jennifer went through this door, they were heading out to an uncertain future. now they're heading back in. >> oh, my gosh! wow. >> hey! [ applause ] >> reporter: cherishing the chance to say thank you to those same doctors and nurses at george washington university

hospital. >> thank you. >> reporter: they may never know what triggered his medical mystery -- >> i'm so happy for you. >> thank you. >> don't come back. >> reporter: but seem just as thrilled as he is that they solved it. >> jennifer thank you for saving my husband's life! thank you so much! just for everything. >> we can know report tonight that jonathan recently met the family of his hand donor. they wish to remain private, but they are allowing us to show this photo tonight, touching their loved one's hand once more, now jonathan's hand. that's our program for tonight. i'm david muir here at "20/20," and for all of us at abc news, good night. night.

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