By her count, Sarah Hyland, 28, has had about 16 surgeries. Six in the past 16 months or so—including a second kidney transplant, laparoscopic surgery for endometriosis, and surgery to correct an abdominal hernia.

Her first kidney transplant from 2012 was already public knowledge—her dad gave her one of his when she was 21. But much of the rest of her health history is not. After a few years of occasionally referencing medical issues without going into specifics, she is ready to share more. I’m in Los Angeles to interview her about it.

We’re tucked away in a back booth on the patio of the Polo Lounge. Magenta bougainvillea dot the space, but tree trunks wrapped in fairy lights and a slight bite in the air hint at autumn. Many of the Polo Lounge’s diners are familiar enough to make my brain itch. Hyland fits right in, having become a household name years ago thanks to her role as Haley Dunphy on ABC’s Modern Family, the award-winning ensemble comedy that has been running for nearly a decade.

Our conversation, in many ways, is like any other conversation in which a writer (me) interviews a famous 20-something (her) for a celebrity profile (this one). We go to a fancy restaurant for an hour, and talk about the usual things that you’d expect from a story like this: career, love, family, body image, workouts, beauty routines. You know the drill—those mundane (yet somehow fascinating!) details of daily life for a normal celebrity with millions of Instagram followers.

In some important ways, though, this conversation is different. For Hyland, it is impossible to discuss the standard celebrity profile details without also discussing her lifetime of living with chronic illness, which has colored every facet of her life.

About that luminous career: When she started dialysis in February 2017, she chose a center near the Modern Family set, so she could more easily balance work and life. About that love: She met her current boyfriend in person for the first time just three days before undergoing a second kidney transplant in September 2017. About those beauty routines: She’s big into skin-care, and always trying out the newest beauty gadgets that might help with her facial swelling, a side effect of the medication she has to take for the rest of her life. Her health conditions don’t define her, of course. But they certainly have had an impact on the day-to-day.

As we talk, I keep noticing Hyland’s enormous eyes, framed in a fan of long, glorious lashes. Her large gold glasses magnify them, making them look even bigger. She reminds me of a woodland creature that has evolved to peak cuteness as a survival mechanism. I imagine David Attenborough narrating a nature show about life and death in an unforgiving landscape.

But being cute as hell and strong as hell aren’t mutually exclusive, an obvious fact that resonates more deeply the longer we talk. Hyland’s body has put her through the wringer, forcing her to confront her own lack of control and adjust her goals, expectations, relationships, and self-image to make space for her medical needs. Throughout it all, she has exhibited near-superhuman strength and perseverance. And yet, as Hyland points out, something she wishes more people would understand: “I’m just a human being.”

Hyland was born with kidney dysplasia, which essentially means her kidneys didn’t develop normally when she was in the womb. Kidney dysplasia causes your kidneys—those critical bean-shaped organs—to grow cysts. Those cysts can disrupt the kidneys from doing their job of filtering waste products out of your blood.

Some people with only one dysplastic kidney go on to have few, if any, health problems related to the condition. But Hyland’s kidney dysplasia was so severe that she went into kidney failure. Eventually, she needed a transplant. Her father donated one of his.

To the public, that was pretty much it: Hyland needed a kidney, her dad gave her one, case closed.

But here is what you don’t know.

In October 2016, Hyland’s body began to reject the kidney her father donated to save her life. “When you have an organ transplant, it’s basically a foreign thing in your body,” she explains. “Your immune system will want to attack it and be like, ‘What is this? This is not supposed to be here.’” She was overcome with fatigue, and experienced frequent fevers and infections. A visit to the doctor revealed that her level of the waste product creatinine, which your kidneys are meant to remove from your blood, was higher than it had been before the transplant.

“We did all of these tests and all of these treatments to try and save the kidney,” Hyland says. She shuttled in and out of the hospital for months. “Christmas break, New Year’s, Thanksgiving, my birthday, all of that spent in the hospital,” she says. None of the treatments took. Her medical team compared the transplanted kidney to a home that had caught on fire. As Hyland notes, “You can’t un-burn a house.”

On Valentine’s Day of 2017, Hyland went on dialysis, which is when a machine filters blood for you because your kidneys can’t. It was her first time on dialysis. This required implanting a device called a port into her chest to connect to the dialysis machine. The chest port was visible underneath Hyland’s skin, leading a lot of people to think she had an injury like a broken collar bone. Nope. Just the port. “I called it my tube titty,” Hyland says.

Dialysis was a life-saving slog; Hyland was hooked up to a machine three times a week for four hours per session. Her weight dropped, prompting invasive public speculation. She got sciatica (severe pain radiating from the lower back). Her face swelled up due to immunosuppressant drugs, and fluid retention caused her blood pressure to spike enough to damage her vision, which already wasn’t great.

Hyland responded to this new medical dependence by exerting her independence wherever she possibly could, such as by fitting in dialysis around her shooting schedule. Hence her choosing the dialysis center closest to the Modern Family set. “That’s why I’m so independent,” she says. “In some areas of my life, I literally have no choice but to be dependent. I’ve been going through this for 28 years, and I still am learning how to let go of control and how to be patient.”

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