Josiah Harrell woke up nine hours after the darkness began. To him, it seemed like an instant.

He was groggy. The last thing he remembered before his induced slumber was lighthearted jokes with doctors that their anesthesia wasn’t working. The fight was multiple rounds, but ultimately Harrell’s consciousness tapped out.

While in that darkness, Harrell underwent a complex surgical procedure that, simply put, rerouted the blood flow to his brain.

The more sophisticated, detailed description of what happened really puts into perspective the seriousness of the surgery.

“They took my skull off, drilled a hole through it, took a vein from outside of my skull, threaded it through the hole, attached two extra veins at the end of that, then they used that to make blood flow to the top of my right side of my brain and the side of the right side of my brain,” Harrell recently told MMA Junkie. “Then, they put the skull back on and put a titanium plate over it and just took the ends of the vein that they threaded through it. They just kept that on my skull. So now I’m getting blood flow a little bit from the base of my skull still, until that closes up all the way. And I’m getting it from the outside, as well.”

Harrell, 25, hit the pause button on his MMA career days after he caught his big break. After he was signed for a short-notice UFC 290 bout in July, Harrell found out his pre-fight medicals were flagged. His first-ever MRA testing showed a rare brain condition called moyamoya disease.

The surgery should allow him to resume fighting by the end of the year, though nothing is guaranteed. Former UFC signee Vince Murdock also underwent the procedure at the same hospital in 2019. Murdock resumed fighting in 2020 and has helped advise Harrell throughout this process.

Harrell praises Murdock, his manager Maurice Blanco, of First Round Management, and the group of doctors at Stanford Medical Center for immediately pushing him in the correct direction, as well as those who donated to him GoFundMe.

“Dr. (Gary) Steinberg and his group are top notch – best in the world,” Harrell said.

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Despite the seriousness of the situation, Harrell’s sense of humor was not tampered with by the doctors (nor was his hairline, he joked) during the highly-invasive procedure.

“I woke up with an erection and I was gone for about nine hours,” Harrell said. “All my joints and my bones hurt – everything. I was just moving hurt, in general. It was dark. It was a nine-hour surgery. Then there was light and I woke up from all the drugs. It was painful but erotic, you know?”

Harell has combated all the doubt, uncertainty, and negative thoughts that come with a serious health scare. Two of his main weapons are positivity and humor. This attitude is nothing new to him. It’s how he’s always been, and it seems to be working well in the face of adversity.

“At this point in my career, I feel like everything has led up to this,” Harrell said. “It’s more like fate. It’s my responsibility to take care of me, be patient, and start this road to recovery, so we can get where we’re destined to be. Yes, I had the fear of ‘what-ifs,’ but also I had to grab me by the nuts and go, ‘This is our only option unless you want to die at 40 or 45.’”

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It’s step-by-step for Harrell, who lives in Florida for the time being, while undergoing his rehabilitation. The recovery hasn’t been totally smooth. His wound became infected, leading to multiple seizures.

Again, Harrell keeps it light. As much as antibiotics are a helpful form of medicine, so is laughter.

“There’s nothing wrong with a little dance party,” Harrell said. “What did I call it? Ah, ‘The Thriller’ or ‘The Harlem Shake,’ whatever you want to go with. But then we got antibiotics and we’ve been good since.”

Jokes aside, Harrell is motivated. The goal hasn’t changed, though the timeline has. As far as he knows, Harrell remains on the UFC roster. His promotional debut is just one doctor’s clearance away. Harrell hopes to be back in six months.

“We have about five days or six days until we can run, then three months until we can get punched in the face,” Harrell said. “I know a lot of people don’t ask those questions, but I do. I go, ‘How many weeks until I get punched in the face?’ They go, ‘About three months.’ I go, ‘Beautiful.’ That is music to my ears.”

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While getting punched and kicked in the face may seem arbitrary to Harrell, this past year has given him new perspective. Living with a life-threatening condition, undergoing advanced surgery, and dealing with foreign aftereffects, Harrell no longer considers his physical well-being the paramount item on his list – at least not without effort and drive.

“You get to a point to where this is pretty much all I think about: I don’t want to let myself down by being scared of what could and couldn’t happen,” Harrell said. “I just got to a place, and maybe the surgery helped – I don’t think it made it worse at all – but it’s enlightening to know how close you are to death. It’s enlightening to go through a seizure and not panic because you’re not scared to die. You’re just almost talking yourself through it like, ‘I don’t want to fight this.’ Even though it’s hard to speak and hard to breathe and you can’t control your body at all, if you could smile, you’d be smiling through it. This is what people go through. It’s understanding that sort of stuff. The first seizure, I didn’t even know it was a seizure. The second seizure, I was like, ‘Oh, I’ve dealt with this before.’

“You get to a place where you’re like, ‘OK, I’m not scared to die. I know that.’ I had a million times as a kid where I felt like I was going to die. Obviously, it’s over-exacerbated because you’re a kid and you don’t know what’s going on and you’re trying to figure out life. But I’m not afraid to die. I am afraid to not reach my potential though. Maybe it got me closer to, ‘Hey, you can go at any time.’ I would say yes, actually, now that I’m walking and talking through it. I don’t think about it too much. But yeah, I’d say it’s probably made me appreciate life a little bit more.”

Harrell is motivated by his long-standing dreams and aspirations, but in seeing the kindness and assistance he has received from others throughout this process, he’d also like to give back to the universe.

“If anyone can take any bit of light or hope away from this, that would make me happier than me being able to fight again,” Harrell said. “Hopeless people scare me. It’s not even that, but it’s difficult to be in a hopeless situation and not think you have an out. If I can help those people, that would make me happier than being able to fight again.”