I was at home in Hawaii, alone, relaxing after a dinner of leftovers from a party I hosted the night before: macaroni and cheese with manchego and chorizo, tossed greens, a glass of Rioja and a dark-chocolate truffle to finish. It was my favorite meal, and this was the last time I would eat it.
The attack started innocently, in the form of body aches. It progressed rapidly to nausea, vomiting and dizziness. Pain knifed through my gut. I pulled up my T-shirt and found a lump swelling below my ribs. The bigger it swelled, the harder it was to breathe. I panicked and called my husband, Adam, an M.I.T. professor who lived in Boston at the time. We had commuted all six years of our relationship. Hearing his voice calmed me down enough to act.
A friend drove me to the E.R., where I promptly blacked out. I woke up later in a hospital bed, my swollen body plugged with tubes. Doctors informed me that my levels of the enzymes AST andALT were sky high, signs that my liver was severely damaged and heading toward failure. The cause eluded tests. It took days to convince them that I wasn't an alcoholic.
Until that night my liver had done its work uncomplainingly and unnoticed, securely out of mind. But pain trumps denial.
As Dr. Gregory J. Gores, chairman of gastroenterology and hepatology at the Mayo Clinic in Rochester, Minn., explained in an interview, the liver provides innate immunity, which mounts the first response to invaders; absorbs nutrients and fats; and orchestrates many of the chemical reactions that sustain life. Its functions are so vital that nature endowed it the power to completely regenerate within months of injury. But if the liver fails, a transplant is the only option short of death.
The doctors sent me home the next day and called to check on me between twice-weekly clinic visits while they searched for the cause. But I wasn't safe alone because I could lose consciousness at any moment. Adam cleared his schedule and rushed to my side, remaining there for two months as my body and pride deflated — along with my old self-sufficient life.
This new reality took a few days to sink in. The pain was excruciating, but many drugs work only when the liver does. In my agony I ignored my doctor's words of caution and swallowed narcotic painkillers left over from a root canal. My liver retaliated by invading my dreams: I was flying a plane when, disguised as my co-pilot, it seized control and shot me in the face.
Then it ordered my new diet: organic rice porridge and broth. I survived on that for three months, twitching with cravings for sugar, bacon and spices. I hallucinated those into my bowl of bland white mush. My allergies vanished, and I lost 33 pounds.
In the second week my liver began barking at smells and substances I'd barely noticed before. I considered myself an earthy minimalist, but my house turned out to be a chemical minefield. I developed a doglike olfactory sense that guided me as I sniffed, recoiled and pointed out to Adam what had to go. He tossed out most of our bathroom and kitchen products, along with everything preserved or petroleum-based. (Even now, I continue to detect obscure odors, including what people eat and when they've had sex.)
Of course, there was nothing we could do about the metallic gases billowing from Kilauea volcano. My liver summoned me to cleaner air. The gall! Not even my husband had asked me to choose between him and Maui. But my liver wouldn't negotiate.
The cause of my liver attack remains a mystery, despite the efforts of a half dozen doctors in Hawaii and California. They poked and tested for every infectious agent they could, for cancer and even for some mental disorder. Nothing explained my symptoms.
Finally an infectious-disease specialist reached a diagnosis by elimination: hepatitis E.
The virus thrives in northern Brazil, spreading to people through contaminated water or animals. Two months before the attack, while I was touring the Amazon rain forest, a native boy pressed a wild sloth into my arms. It sneezed on me.
Though hep E remains the likely culprit, I don't know for sure because there is no clinical test. No matter to my liver. Whatever had assaulted it, it was no longer able to absorb the battering of modern life.
I caved in to my liver's demands. I switched to acupuncture for pain relief and help sleeping. I learned to eat like an old monk, take naps and meditate. I added the blood tests for AST and ALT to my annual physical. I followed my nose and left Hawaii, moving to Southern California with Adam. We spend evenings cuddling on the couch with our big dogs, my liver never happier. It's a less tainted, simpler life entirely on my liver's terms, and I'll take it.
Genevive Bjorn is a science writer in San Diego. Her blog about the sense of smell is at thedailysmell.com.
http://www.nytimes.com/2010/10/19/health/views/19case.html?
