Often people infected with HCV (the hepatitis C virus) die from other causes, so there’s a possibility he may have been infected. Because his childhood bout with polio had affected his leg, he underwent frequent surgery that required blood transfusions. Those surgeries would have occurred in the late 1920s or early ’30s. Around that time transfusion blood was often collected from professional donors, who were told merely they should keep themselves in good physical condition, be careful about cleanliness, sleep in a well-ventilated room, and get daily exercise. They were never asked about hepatitis C. It wasn’t even identified as a virus until 1989.
The U.S. Army reports that doctors in the ’20s and ’30s noticed “epidemic jaundice.”1 If some of that had been hepatitis C, my father may have had hep C most of his life. It may never have resulted in symptoms, since hepatology researchers report that the earlier in life you contract the virus, the longer it will take to seriously affect your liver. Although there is only a slim chance that I could have contracted the virus from my father’s razor, it is possible. And if I had contracted it early in life, according to the research, that may be why I went for decades without symptoms.
CHAPTER 2
INTO THE FOG
THE SECOND TIME I visited Dr. Radev, the first thing I said to her was, “So I’ve got hemochromatosis?”
“No, it looks like something else,” she said. “You need another test.”
I was relieved that I might not to have to give blood frequently for the rest of my life, so I marched over to the lab without hesitation. I submitted another requisition to the medical assistant, lay on the cot, took a deep breath, clamped my eyes shut, and spread out my arm. The blood test was over in a literal pinch.
The idea that I might have “something else” sparked questions in my mind, but they fizzled away as I made plans for a vacation with Al in Mexico. Whatever the diagnosis was, it couldn’t be too bad. I had always been healthy.
A week later I got another call from my doctor, asking me to come into the office. I thought she probably wanted to tell me about a minor problem the test had found, or maybe she just wanted to say I was 100 percent healthy. The worst I expected to hear was that I had a vitamin deficiency or high cholesterol. Instead, Dr. Radev said, “You have antibodies to hepatitis C.”
“What?”
“Hepatitis C,” she said. “It’s a disease that affects the liver.”
I had heard about hepatitis C on the radio. I remembered listening to a documentary about a lawsuit over blood products that were infected with the virus, but other than that, I knew little about it.
“How could I have that?” I asked.
“You must have come into contact with it somehow. It’s transmitted through blood,” Dr. Radev said. Someone else’s blood that carried the virus must have mixed with mine, she explained. She said that hep C could linger in the body for decades without showing symptoms. The virus might eventually scar the liver to the point that it would stop functioning. The result would be liver cancer or the need for a liver transplant.
“What?”
“Don’t worry,” she said in her soothing Philippine-accented voice. “About 20 percent of people who contract hepatitis C come down only with the acute form of the virus. It goes away on its own. People who just get acute hepatitis C may turn yellow or feel run-down for a few days or weeks, but their bodies fight off the infection. After that they no longer have the disease. They continue to produce antibodies for the rest of their life.”
Dr. Radev asked if I had ever injected drugs. “No,” I said.
She asked if I’d ever had surgery. “No,” I said, “except for tonsils.” She seemed puzzled (perhaps because tonsillectomies seldom require blood transfusions). She said that in rare instances hepatitis C can be transmitted through sex. I recalled that Jessica’s father had once become jaundiced. Maybe Peter had contracted hepatitis C during his frequent flings and had passed the infection to me. “Jessica’s father may have had hepatitis,” I told Dr. Radev. “Maybe I got it from him.”
But I had never become jaundiced, and I was a lot healthier than he had been. He got little exercise and was careless about his diet. I did lots of yoga and never ate junk food. Even if I had contracted the disease from him, I was sure I was among the 20 percent able to shake it off.
ACCORDING TO JULY 2016 figures from the World Health Organization, hepatitis C infects up to 150 million people worldwide and causes an estimated 700,000 deaths each year.1 Between the United States and Canada, close to 3 million people are infected with hepatitis C. In 2015 Public Health England reported 214,000 cases in the UK, while Australia reported 230,500.
Despite these huge numbers, most people infected with hepatitis C don’t know they have it. Many of them don’t even remember they had any possible contact with the pathogen in their youth (the prime time to contract hep C) or suspect they might possibly carry the disease. I didn’t, not even when my doctor said I had the antibodies.
Hepatitis 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