Case Study: Margaret's Story

“I went into denial for the first two years after I got the diagnosis of Hepatitis C and just pretended I didn't have it, “ says Margaret (not her real name), now a 61-year old woman, who was diagnosed with Hepatitis C in 1990. In her younger years, Margaret had been an actress and playwright in Los Angeles, but her early promise was cut short by drugs and alcohol. Margaret stopped injecting drugs in her late teens, after a bout with Hepatitis B, but continued to drink heavily until she was about 30. She moved away from Los Angeles to start a different life. So, when she was diagnosed, she had been clean and sober for many years. In the meantime, she had finished her education and became a college English instructor. She was well settled into a middle-class lifestyle, and life was going well.

However, for about 8 years prior to diagnosis, Margaret had felt “tired all the time,” and had gone to a doctor complaining of pain in the liver area and “extreme” tiredness. However, the doctor didn't do tests to determine the cause. Around 1990, Margaret found that she was feeling more fatigued and suffering from general malaise, so she went to have a physical examination with a different doctor. When routine lab work showed liver dysfunction, she had a test for Hepatitis C. The test came back positive. Because of her history, the doctor who tested her felt that she might have had the disease for about 20 years. Though there was no way to be sure, he associated her diagnosis with her earlier injection drug use. Because of Margaret's initial refusal to accept the diagnosis, she delayed treatment for 2 years, but her condition and her liver function tests worsened. Reluctant to take Interferon treatments, she opted to try homeopathic treatments for a year, but her condition continued to deteriorate, and she was referred to doctors at Stanford University Hospital in Palo Alto, California.

Margaret became frightened when she went to the medical library, researched the disorder and found that her life expectancy was 1 to 5 years: ”It might be interesting to note that I was extremely irritable as well, so much so, that at one point I asked [Jim] to have my dog put to sleep because she was old and her panting was driving me nuts. Of course, I felt better the next day, but at the moment, I was in tears from fatigue. When I related that story at Stanford, they didn't want to treat me without my taking antidepressants because a lot of people have committed suicide while on the regimen. I refused, and I got my therapist at the time to call them and say he would accept the responsibility so the hospital wouldn't be liable. I promised him I would only kill myself if it was clear I was going to die.”

In the end, the doctors at Stanford agreed to give the Interferon, and Margaret agreed to take it. She gave herself injections 3 times weekly for 6 months, the standard protocol at that time. “The shots rattled my teeth.” Margaret said that the shots caused severe chills and fever at first, and she was only able to work on the days when she didn't take the shots. However, the flu-like symptoms receded after a month or two and she was able to resume working full-time. When she returned to Stanford for follow-up tests, after she had completed the 6 months of treatment, the tests came back negative. Because she had responded so well to the treatment, the doctors believed that she may have had the disease for a shorter duration, possibly from sexual contact. Margaret had had a long-standing sexual relationship with a man, Jim (not his real name), who was also in recovery for addictions. Jim, like Margaret, had always felt tired and had been diagnosed with “non-A, non-B hepatitis” before it was designated Hepatitis C, but didn't think he still had the disease. Margaret and Jim never used condoms.

Margaret went for follow-up treatments after taking Interferon for “awhile” but finally received a letter from the doctors at Stanford saying that she was cured. When Jim finally sought treatment, he had developed cancer of the liver and died shortly thereafter. Now, Margaret is feeling well, certainly better than in the years preceding her diagnosis. Her lab tests remain negative, although her liver shows mild cirrhosis, perhaps from years of heavy drinking: “I'm very lucky. When I thought I was going to die, I moved up to the mountains. My plan was to get lost in the mountains and shoot myself if it got to the point that I couldn't take care of myself anymore. I've never liked being dependent.” Fortunately, the treatment worked, and Margaret is alive and feeling well enough to laugh about her contingency plans to shoot herself.

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The interferon treatment that Margaret received caused no side effects.