•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 the lumpy liquid on the floor. The guests were now chatting twenty feet away in the living room. Fortunately, they didn’t notice the gooey spoon I hurled at the floor and my muffled cry of “Crap!”
While I could hide most of my edginess at home, I had a hard time concealing it from students. One of the joys of teaching had been getting to know them personally. I had discovered early in my career that once I knew a bit about individual students, I would like them, which would motivate me toward better teaching. During the first class, I would ask students about their hobbies, part-time jobs, travels, and ambitions. As they took turns introducing themselves, I would memorize their names and distinctive qualities.
In the past I had learned two-thirds of my students’ names as they chatted on that first day of class, and I’d learn the other third within a week or two. But during the two years before my diagnosis, it seemed there were far too many names to learn at once. I become increasingly unable to remember who was Jean and who was James. I couldn’t recall which student bred labradoodles, which one worked as a house painter, and which in which class came from Thailand. By the middle of the semester, the year before I learned I had hep, I could recall only five or six names out of the ninety-four students I taught. It was maddening.
The semester before my diagnosis, I decided to give up on the memory work. Why try to remember names when you know you’ll forget them in an instant? It got to the point that when a student raised a hand, I’d just nod. It wasn’t a great way to establish rapport. I started drawing little pictures of my students’ faces on index cards. I added arrows to facial features and labeled them “honey-brown hair” or “squinty eyes” and made notes such as “born Thailand, high school England, trekked through Italy with her dad.” That helped somewhat, but it was hard to riffle through a stack of cards when a student or two raised their hands.
I knew I didn’t have Alzheimer’s because my grandmother, who was stricken with the illness, experienced different memory problems. Her memory lapses had been like sudden gaping holes that filled themselves with confusion and hurled her backward into earlier times. I remember visiting my parents’ home in Manhasset, a chichi suburb of New York City. I had just reconnected with my parents after avoiding them for almost a decade. My grandmother, in her late seventies, had moved in with them so they could help her through her dementia. In her lucid moments she was a jolly white-haired lady, but those moments could dissipate fast. Once she took me to her room and pulled a shoe box from under her bed. “I’ve got some nice ribbons for you. You can wear them in your hair,” she said, yanking a tangle of ribbons from the box.
“Thank you,” I said, unraveling a length of inch-wide blue satin. “This one’s nice.”
She grabbed it from me. The kindness in her face evaporated and fury replaced it. “You’ve been stealing from me! Give that back,” she wailed. Later that day she dressed in her finest blouse, hat, and gloves, and she slipped out the door. My mother found her wandering along a sidewalk a few blocks away in a neighborhood of sprawling single-family homes, muttering, “I’m looking to rent an apartment. Where is the apartment building?”
No, I didn’t have