David Miller was about halfway home, driving Interstate 76 from Philadelphia to Pittsburgh, when he received word that his father needed an emergency liver transplant.
David knew that his father, 56-year-old Richard Miller (left), had been feeling poorly and assumed it was a minor ailment. Now his brother Jeff was on the cell phone with the stunning news that Richard was in critical condition.
“My father needed a transplant or in the next 15 hours he could or most likely would die. I was driving at 90 miles an hour to get home,” recalls David.
In a matter of days, Richard Miller had gone from good health to near death. What at first had seemed a mild stomach bug had been diagnosed as hepatitis A and there was a chance Richard’s liver would shut down completely.
About three weeks earlier, on October 12, 2003, Richard and his wife, Linda, had eaten lunch at a Chi Chi’s restaurant in Monaca, Pennsylvania’s Beaver Valley Mall. Many of the dishes on the menu included chopped green onions, grown in Mexico.
Soon after the Millers’ meal, green onions were found to be the source of a widespread outbreak of hepatitis A, which sickened more than 650 people in seven states, including the Millers and at least 13 of Chi Chi’s own employees.
More than 9,000 people who ate at Chi Chi’s that October had to be given immune globulin shots as protection against hepatitis and four people died from their injuries. Richard was among those who recovered, although that can be a relative term.
Those who, like Richard, have suffered serious liver damage can be grateful to have survived but often face a harrowing future in which, “the driving focus becomes staying alive, not actually living,” says attorney Drew Falkenstein of the Seattle law firm Marler Clark.
Hepatitis A is a liver infection caused by a contagious virus, most often contracted from food contaminated by an infected handler with poor personal hygiene. The acute period generally lasts ten days to three weeks, although the illness can persist for six months or more. Symptoms typically include muscle aches, headaches, loss of appetite, stomach pain, fever and lethargy.
Linda and Richard Miller began feeling sick in late October. Linda took to bed and was soon joined by Richard. For the next few days, the couple stayed home.
Linda’s discomfort eventually eased, although she was so sick she failed to notice her jaundiced skin. Richard, however, was definitely not on the mend. There was no let-up to his intense pain, chills and fever.
On November 3, Linda took Richard to the emergency room at the Medical Center of Beaver. Diagnostic tests indicated he had elevated liver enzymes – a characteristic of hepatitis A. Doctors figured Richard was “yet another victim” in the area’s hepatitis outbreak.
They gave Richard intravenous fluids and sent him home. That was fine with Richard – he had no desire to spend time in the hospital. He planned to relax and recuperate for a few more days, then get back to work.
Three days later, Richard was incoherent and unable to stand. Linda dialed 911, medics arrived and rushed her husband back to the ER.
Richard had developed a rare but severe and disabling complication known as fulminant hepatitis A, in which the virus kills liver cells after penetrating them and releasing toxins. In addition to loss of liver function, it can lead to brain damage and multiple organ failure.
The fatality rate for fulminant hepatitis A is about .3 percent, but it increases exponentially for those who, like Richard, are over 40.
In 36 years of marriage, the Millers had never faced such a crisis. High school sweethearts, they’d led a storybook life. Richard had served in the Air Force during the Vietnam War and then began a long, successful career in the railroad industry. The Millers’ three children – Jeffrey, Rebecca and David – were adults on their own and Richard and Linda were now doting grandparents.
Richard’s rapidly deteriorating condition prompted a transfer by ambulance to the University of Pittsburgh Medical Center, where his family gathered by his bedside. As Richard’s brain function worsened, he became agitated and tried to pull out his IVs. Finally he was sedated, intubated and placed on mechanical ventilation so he could breathe.
Waiting was a nightmare for his family. “It was gut-wrenching to see my dad on life support,” says Jeff. “I can’t even begin to count how many tubes and machines he was hooked up to … not to mention all of the wounds and bruises over his body.”
The family felt guilty, knowing that a miracle for Richard could come only through a death for some other family. Then, to their horror, they learned that a patient across the hall, also infected with hepatitis A, had died following his liver transplant.
Late on the night of November 7, Linda learned that a compatible liver was available. As Richard was wheeled into the operating room, the family hoped their prayers had been answered but feared Richard wouldn’t make it. “That moment was by far and away the worst experience of my life,” recounts Jeff.
During the seven-hour transplant operation, Richard suffered cardiac arrest and had to be revived. The transplant was successful, but he remained critically ill, sedated and paralyzed, covered with cooling blankets and packed with ice to reduce a high fever.
While the new liver seemed to be functioning, there were so many other uncertainties – over intracranial pressure, brain dysfunction, respiratory failure and pneumonia — that Richard’s family questioned whether he could regain basic motor or speech skills.
Gradually, Richard’s condition stabilized. He opened his eyes, murmured a few words and could follow simple commands. Despite several setbacks, Richard was eventually weaned from the ventilator. His new liver worked and he was neurologically intact.
Richard has no memory of his post-operative convalescence until November 16, when he awoke to see the ugly, stapled incision slashed across his torso. Soon he was aware that every move – even a cough — strained the incision and caused ripping, stabbing pain.
“It was pure hell … absolute hell,” he says, adding that he had nothing but horrible, helpless thoughts.
His rehabilitation needs were substantial. A paralyzed vocal cord made it difficult to swallow or talk, and required surgery and subsequent speech therapy. Physical and occupational therapy helped him relearn how to walk and regain self-care skills.
Throughout Richard’s nearly month-long hospitalization, the lives of the entire Miller family were put on hold.
Linda, still recovering from her own hepatitis A infection, left the hospital only twice, while Jeffrey, David and Rebecca had to take significant time away from work. Jeffrey, who was also juggling the demands of a new job, was only occasionally able to see his seven-month-old son.
When Richard was discharged from the hospital on December 2, 2003, he required a mountain of medications, including the anti-rejection drugs he will have to take forever to help prevent his immune system from destroying his new liver.
A tireless inventor with several patents to his credit, Richard is no longer as mentally sharp as he was before the illness. He has difficulty chewing and swallowing. He suffers from nerve pain in his arms and legs. There is always the chance he will need another liver transplant.
Richard must undergo frequent blood tests and regular examinations at the transplant clinic, including annual hospitalization to address various complications. His anti-rejection regime hampers his body’s ability to ward off infectious illnesses, such as influenza or pneumonia, and puts him at increased risk of cancer. He must vigilantly guard against high blood pressure, kidney failure, diabetes and anemia.
In 2004, Richard lost his job. He had been away too long, his employer said, and given his health challenges the company said it needed to look to its future.
Although not unexpected, the loss of his career was a crushing blow, not only to Richard’s identity as a capable, key player in his industry but to the Millers’ financial security. They knew their medical insurance would be terminated.
The Millers had assumed their lives would eventually return to normal.
But Richard no longer has the stamina to golf, hunt or fish – outdoor activities he had loved, nor can he help around the house with chores or home repairs. Travel or vacations are out of the question because of Richard’s need to remain close to the hospital.
“Instead of looking ahead to being completely healed, I have to look forward to the many possibilities of something going wrong,” wrote Richard in late 2004. Linda spoke to how food-borne illness can alter everything: “I now realize that while many people’s lives changed forever on 9/11, mine changed forever on October 12, 2003 after eating lunch at Chi Chi’s.”© Food Safety News