has plagued humanity for thousands of years. The word hepatitis comes from a combination of the ancient Greek word hepar, meaning “liver,” and the Latin word itis, meaning “inflammation.” An epidemic of hepatitis was reported in China about five thousand years ago, and later an outbreak occurred in ancient Babylon. The Babylonians wrote of an illness that caused yellowing, fever, fatigue, and stomach problems. In Greece, in the first century BC, Hippocrates referred to a disease that yellowed the skin. The Hippocratic Corpus, a library of ancient Greek medical writings by many authors, described hepatitis at least seven times and predicted the outcomes of the disease according to a person’s degree of yellowness. In the second century AD, the Greek physician Aretaeus of Cappadocia studied the symptoms of hepatitis and wrote that the illness weakened “the liver’s power of nutrition.” Only recently has the yellowing disease been called hepatitis and been given alphabetical designations. In early 1969, when Peter’s face turned yellow, the hepatitis alphabet had stalled at B. While I lay unconscious, waiting for a transfusion in 1971, the medical system had yet to screen donated blood for hepatitis C. Scientists didn’t differentiate it from hep A or B until 1975.
Since that time, medical scientists have identified a string of viral diseases that attack the liver. The hepatitis alphabet now goes up to G. Each is a distinctive disease caused by a different pathogen:
•Hepatitis A: This is transmitted through food or water that is contaminated with feces. It’s common in children. It is usually a mild disease and can be prevented by a vaccine.
•Hepatitis B: Like hepatitis C, it is transmitted through blood. It can also be spread through sex with an infected partner. Only 5 percent of cases become chronic. There is a vaccine for hepatitis B but no cure for the chronic illness.
•Hepatitis C: HCV is passed along through blood-to-blood contact. As Dr. Radev told me, about 20 percent of those who are infected experience only acute hepatitis C. These lucky people clear the infection with no treatment, but though they develop antibodies, they can get reinfected. Another 80 percent of infected people develop the chronic form of the illness. Their infection continues until they die or are cured.
•Hepatitis D: This is a coinfection that occurs with hepatitis B. It causes severe liver disease.
•Hepatitis E: A common disease in India and many other developing countries, hepatitis E is transmitted through feces-contaminated food and water. It worsens any type of liver disease and may cause liver failure.
•Hepatitis F: This rare virus was found in 1994 in patients in Western Europe and India who had undergone blood transfusions. The virus was injected into rhesus monkeys and caused hepatitis. However, later studies suggested it was a mutation of the hepatitis B virus, and not all researchers recognize it as a distinct disease.
•Hepatitis G: This is transmitted through blood but isn’t known to do harm to the human liver. The infection, which produces antibodies, is usually cleared within two years. One of the few studies on this virus showed that it can infect marmoset monkeys, which may suffer liver damage.
A healthy liver is mushy like a jellyfish. In reaction to the hepatitis virus, fibrosis ruffles through the liver, forming branches of scar tissue. In a healthy liver cell, DNA in the nucleus sends out RNA. The RNA tells the cell how to turn specific amino acids into healthy protein. But when the hep C virus invades the liver, it forces liver cells to make copies of itself instead. The virus reproduces incredibly fast, producing ten to the twelfth power (one million million) copies of itself each day.
The normal liver weighs just over two pounds and is the body’s main blood-processing plant. It filters blood, removing harmful substances, such as alcohol. It also manufactures proteins that defend against infection and help the blood to clot; regulates the supply of vitamins, minerals, and hormones, including sex hormones; and produces, stores, and regulates glucose and fat. It makes and eliminates cholesterol and also converts it into lipoproteins that deliver energy to the cells. Altogether, the liver performs more than five hundred bodily functions. It continues to do these jobs during the early stages of fibrosis, but later, when the liver hardens into cirrhosis, it progressively loses important abilities.
WHEN DR. RADEV told me I carried hep C antibodies, I was so certain I had avoided the chronic form of the disease that even possible symptoms didn’t worry me. I felt I was healthy compared with friends who were aging in lockstep with me. I believed my joint problems came from a car accident many years before. I believed my acid reflux came from doing too much yoga, which I thought had pulled my esophagus out of place. I thought my muddy mind came from lack of sleep caused by the joint pain and from overwork, which retirement would cure. These were all mechanical lifestyle problems. A nasty virus could never get me, I believed.
Dr. Radev said an acute case of hepatitis C might seem like the flu. I recalled that about a year after I had noted Peter’s yellowness, we both came down with an awful flu.
Was it really the flu? Maybe it was hep, I thought as I left Dr. Radev’s office. Peter and I had both probably experienced the acute form of hep, I reasoned, and our flu-like symptoms were its manifestation. Now I was safe from the hep C virus forever. In fact, I was so confident I was healthy that the next week I submitted a formal letter to my employer. I’d be resigning from work as a teacher—and from a gold-plated medical plan that most people with hepatitis C would envy. I planned to celebrate my coming retirement with a vacation.
It was the end of the spring 2014 semester. I had been having trouble with my jobs, one at a university and the other at a college, so I had taken a partial leave. Together, the jobs involved teaching four courses to a total of ninety-plus students. I had been finding it hard to switch my mind from one topic to the next and from one student to the next. That had been easy in the past, but now it seemed inordinately complex and stressful. I was experiencing severe arm and shoulder pain at night. I thought the pain caused my sleeplessness, which in turn impaired my ability to multitask. The problem went beyond teaching and into my home life. The last couple of years before I knew I had hep C, I had begun to feel edgy any time I had to tackle more than one activity at a time. When my cell phone chimed while I was paying bills online, tremors would climb into my shoulders. One day I was putting socks on my dog, Zeena, to protect her chronic sore feet, and my husband asked about ferry times. Thinking about two tasks together made me jumpy. I scowled at Zeena and tried to hide my irritation from Al. Zeena loved the comfort of socks, but she must have sensed that something was wrong. She struggled to get away from me, twisting and yelping. Al glanced over and said, “Go easy on her.” Later I was sorting laundry and he asked for the car keys. I shouted, “Not now!” Similar scenes occurred again and again.
The most irritating task was cooking. Chefs, homemakers, and occasional cooks should know that preparing a balanced, several-course meal and serving everything on time, warm but not charred, can be one of the most complex multitasking exercises in the universe. I had always enjoyed cooking healthful, many-course meals. But with hepatitis C swimming though my system, inflaming my organs, and sending crazy messages to my glands, something went awry. One day a couple of friends came by and I volunteered to make dinner. I decided to prepare chicken with mushroom sauce, broccoli, and a salad. I had to time the chicken in the oven, stir and watch the sauce, cut and steam the broccoli, slice and dice veggies for salad, press a couple of garlic cloves, mix an oil and vinegar salad dressing, and toss the salad. Making sure each dish appeared at the same time on the table was too much for me. I grumbled at Al as he watched me chopping tomatoes at the cutting board. Our friends were outside on the deck, and I was glad they couldn’t see me as I bashed my elbow into the salad dressing, which splattered all over the counter.
In the meantime, the sauce for the chicken was burning. I lunged at the stove to turn down the heat and barked at Al, waking a snoozing Zeena, who looked at me as if I were a strange, threatening animal. Al wisely left the kitchen. As I checked the sauce again, I burned my palm and spilled half of
