Jim Grant/Nevada Appeal James Patterson, 15, pictured with his grandmother Virginia Patterson received a heart transplant in 2009 and will be taking a Hawaiian cruise with his family through the Make-a-Wish program.
More than a year after his heart transplant surgery, a banner still hangs in the living room. "Welcome home James. We love you."
Printed in black ink on white paper, it has almost faded into the surroundings. But it's a reminder to celebrate despite tragedies the family could not possibly forget.
"They all take it just like me - one day at a time, basically," said James Patterson, 15.
The Dayton High School sophomore crashed his dirt bike in 2007. What seemed like a standard road burn from the crash developed into a staph infection, one resistant to the antibiotics usually used to treat them.
He spent two months at Madara Children's Hospital, in a coma for the bulk of the time. While there, doctors discovered he had cardiomyopathy, a disease that weakens and enlarges the heart muscle.
About a month after his release, his mother, Michelle Patterson, who had posted vigil by his side during his illness and recovery, died from complications after viral pneumonia left her with an enlarged heart.
James, his twin brother Jacob and their two siblings Carlos and Sarah Robledo moved in with their grandmother Virginia Patterson.
As the family tried to adjust to new circumstances, James's health started deteriorating. He was tired, dizzy and vomiting.
Doctors in the emergency room thought he might have pneumonia, but the X-ray revealed his heart was failing. He was flown to Primary Children's Hospital then to the University of Utah, where he spent the next 10 months.
A mechanical pump kept his heart functioning until he was able to receive a new heart in June of 2009.
"I was nervous, but I knew all the doctors who were doing it," he said. "So I knew they would do a good job."
With no complications after the surgery, he was back home in Dayton by August, where he attended online classes until returning to school in November.
He said the transition back to school has been "pretty easy," with his friends welcoming his return.
This year, he's back to his old self, playing football, baseball and wrestling.
"I can do whatever I want," he said. "That's what the doctors said."
Although he has to pay closer attention to his heart rate, starting slow at first then building up, he said he doesn't think much about the transplant organ.
"It feels just like my heart," he said.
But just as James is embracing all life has to offer, his twin, Jacob, is taking a step back.
While James was in the hospital, doctors tested his siblings for the genetic heart condition. Jacob tested positive.
Because it was caught early enough, he can be treated with medication but will likely need a transplant sometime in the future as well.
As such, he cannot compete in organized sports.
"It hurts," he said. "But I've gotten used to it."
He said it was "devastating" to watch his brother go through the process and knows what's in store for him.
"It's scary," he said. "I know I'll have to go through it, but when it happens it happens. I just have to go through life the same way. I can't change anything."
Despite the hardships they've gone through and the challenges that remain, Jacob is determined the family will overcome.
"We came through it," he said. "We still live life. We don't let it pull us apart."
And James feels a responsibility to make the most out of his second chance at life.
"I think anything's possible now that the doctors did this," he said. "I know I can do whatever I want. If I don't, I'll just be cheating myself."
The family will take a break this week with a Hawaiian vacation provided by the Make-A-Wish Foundation, which grants the wishes of children with life-threatening illnesses.
"It will take a lot of stress off of all of us," Jacob said. "We won't have to worry about anything, just having fun."
When they return, life will resume.
"They miss their mom and I do, too," Virginia said. "I just have to take care of them the best I can. They're good kids.
"God is in control, so you just have to say, here we go again."