by Ben Marney
Isoniazid
I knew Marshall well and through the years, I thought I’d seen all of his emotions and body language, but what I was looking at was something new. Although he was trying hard to conceal it, there was a level of concern inside him that was screaming from his eyes and showing in every move he made with his body.
Instead of putting his feet up in the empty chair and leaning back, like he’d always done before, he was leaning forward, slightly rocking back and forth nervously. His wrinkled forehead seemed to be locked in a permanent scowl and his eyes never stopped moving. I didn’t know Brenda that well, but she appeared to be equally stressed.
“What in the hell is wrong with you two?” I asked.
Marshall glanced over at Brenda and then looked back at the ocean. “You’ll find out soon enough. Go ahead and get her on the phone. I want to talk to her.”
She answered on the first ring. “Hey...yeah, we’re out on my deck, but Marshall wants to talk to you before you come over.”
I handed the phone to him. “Hi Melissa...yes, it was a smooth flight. Would you do me a favor? I need you to gather up all of your medications and bring them with you. I need to see exactly what you are taking now. No, there’s nothing wrong with your health, I promise. I just need to check something. And if you have any old prescription bottles of something you used to take, even if it’s been years, before the transplant, I’d like to see that too. Okay, see you in a few minutes.”
Even though Melissa didn’t mind, I never drank alcohol around her, so when she got there, I poured out my beer and fixed us two Diet Cokes.
Marshall suggested we talk in the living room, so we all settled in there around the coffee table. Melissa and I were sitting together on the couch and Marshall and Brenda were facing us in chairs.
I couldn’t believe how many prescription bottles were in the sack she had brought over. For almost thirty minutes, we all sat in silence, watching Marshall methodically take out each bottle one at a time, carefully read the prescription, popped the cap and inspect the pills inside. When he finished with a bottle, he would set it on the table in a specific row and make a note on a yellow pad.
When he was through, the top of the coffee table was almost covered with brown prescription bottles of various sizes.
“I need to talk to Brenda for a second,” Marshall said. “We’ll be right back.” They walked outside to the deck and closed the door behind them.
“Do you know what’s going on?” Melissa asked, looking up at me. Her hands were trembling.
“I have no idea; he wouldn’t tell me anything. But don’t worry, remember he said it has nothing to do with your health.”
Her eyes filled with tears. “Then what’s this all about?” She pointed at her medicine on the coffee table. “It has to be about my health!” She leaned forward, holding her face in her hands and whimpered. “God, not again!”
I put my arm around her and pulled her close. “Whatever this is, we’ll get through it.”
When they came back and saw Melissa crying in my arms, Marshall didn’t sit back down in his chair. Instead, he walked around the table and sat next to her.
“I didn’t mean to frighten you with all of this. This has nothing to do with your current health situation. In fact, I talked to Dr. Shad yesterday and he told me that you are in perfect health. You are showing no signs of rejection and you have made a steady, upward, positive climb since the transplant. Please forgive me if I scared you. I never meant to do that.”
Melissa looked up at him and smiled. “Thank you, Marshall. I’m sorry for acting this way, but you did scare me.”
Although I was relieved to hear she was okay, I was angry at both of them for putting her through such a scare.
“If she’s perfectly healthy, then what in the hell is this all about? Marshall, she almost died two years ago! And then you two come in here with all the secret cloak and dagger shit checking out all her medicine and scare the ever-living crap out of her. Will you just stop with all the secret meetings between you and Brenda and just tell us what the hell is going on?”
Marshall glared at me, stood, walked back to the chair and sat down. “Just shut up for once in your life, calm down and let me do this my way, okay?”
Trying to lighten the mood, I looked back at him. “You know, Doc, your bedside manner sucks!”
“God damn it, Grant!” he screamed. “This is not a joke. It’s very serious! Please, for God’s sake, just shut up and let me talk!”
Marshall had never raised his voice at me in anger before, so I stopped talking and listened.
He picked up a prescription bottle off the table and held it up for her to see. “How long did you take Isoniazid?”
Melissa thought for a moment, “Ah...I’m not exactly sure, maybe four or five years. That’s an old prescription. I haven’t taken it since my transplant. Why do you ask?”
Marshall shook the bottle. “Do you know what this medicine was for?”
She thought about it a second. “Not really, I can’t remember. Truthfully, I don’t know what most of them are for.”
He smiled. “That’s what I thought.” He opened a bottle and took out a pill and laid it down on the table. With his index finger, he pointed at the lined-up bottles. “This row is what you’re taking now. This row, minus a few bottles, was what you were taking before the transplant. In my opinion, you don’t need most of what you’re taking now and we’ll talk about that later.” Then he picked up the Isoniazid pill. “But you never needed to take this one.”
Her eyes widened. “Really? Why not?”
“Because you never had hepatitis and have never been clinically depressed. That’s what this is prescribed for and one of the reasons Brenda and I are here today.”
“You came here because of that pill?” I asked. “Really?”
He dipped his head. “It’s one of the reasons.” He picked up three other prescription bottles and handed them to me. Then he handed me the Isoniazid bottle. “Read the prescriptions on these bottles and I think you’ll understand.”
I looked at the first three bottles and read the prescription carefully. Then I read the Isoniazid bottle and saw it immediately. I glanced up at Marshall. “Is this the only one he prescribed?”
“Yes. Out of all of these, it’s the only one.”
“It’s the only one what?” Melissa asked, “What are you talking about?”
I handed her the bottle. “It’s Jerry’s prescription. Of all of your prescribed medicines, this was the only one he prescribed...and...the only one you didn’t need to take.” I looked back at Marshall. “What are the side effects?”
He took a deep breath and sighed. “Before I get into that, I need to ask Melissa something.”
He leaned forward and stared into her eyes, “Melissa, I hope you understand that we’re here because we care about you. So please don’t get upset at my questions. But if we’re going to get to the bottom of this, I have to know the absolute truth, even if it’s embarrassing or painful to admit. I can’t express how critical it is for me to know the truth.”
She looked up at me with wide eyes, then turned back to face Marshall. “The truth about what?”
“According to your medical records, when you were pregnant with Molly, in your 28th week, you tested positive for hepatitis C, is that correct?”
She dipped her head. “Yes, but that turned out to be a false positive.”
“Yes, I know,” he said. “After the birth, you tested negative. Now think hard. Was that about the time you started taking Isoniazid?”
She opened her eyes wide. “Yes, I remember now. Jerry didn’t trust the tests that showed I was negative and insisted I take it in case the tests were wrong. I can’t believe I forgot that.”
“I think I know how that could have happened. It wasn’t long after that you started showing signs of liver failure, correct?”
She tilted her head and lowered her eyebrows. “Are you saying taking Isoniazid cau
sed my liver to fail? Jerry poisoned me? He was trying to kill me?”
He held up his hand. “Hold on, you’re getting ahead of me. Before I explain, I need to ask you the question I was talking about earlier, the one that you have to be completely honest about. Are you ready?”
She looked at him and nodded. “Yes.”
“Isoniazid is not a poison. It’s actually a very good medicine when used properly. And that’s what I have to ask you about. I know you don’t drink alcohol now, but after you gave birth to Molly, did you drink then?”
“I’ve never drank much, and didn’t drink at all when I was pregnant, but after she was born, I would have a glass of wine after dinner with Jerry and maybe one or two drinks when we would go out.”
“Jerry saw you drinking and didn’t try to stop you or say anything?” Brenda asked.
She raised her head slowly and stared at Brenda. “Stop me? Why would he stop me? I wasn’t pregnant. Why couldn’t I drink?”
“I’ll explain in a minute,” Marshall said, “but do you swear that’s all you drank? You have to trust us; we are not here to judge you. Were you drinking more, and I mean a lot more, during this time...maybe drinking privately and hiding it from everyone?”
She gasped and her mouth flew open, horrified. “No, I swear! I’m telling you the truth, I’ve never been drunk in my life! Not even in college!”
“That’s what I thought. I’ll be right back. I have to get something out of my carry on.”
When he returned, he had a blue folder in his hand. “Melissa, before I show you this, I want you to know that Brenda and I believe you. We do not believe one word of what is written in this file. But before you read this, you need to understand more about Isoniazid. When you take this medication, especially at this strength, you cannot drink alcohol. None. Not even a glass of wine. If you do, it can cause severe damage to the liver.”
The three of us sat in silence as Melissa slowly studied the files in the folder. When she finished, she handed it to me, stood up and excused herself. “I need to go to the bathroom.” Although she had closed the door, we could hear her crying through the walls.
When I opened the folder and scanned the reports, I couldn’t believe my eyes. I didn’t comprehend most of what I was looking at, because they contained a lot of numbers of liver and blood test results, dating back four years, but the handwritten notes on the bottom of the pages from her doctor were easy to understand. I read most of them, but the last one, one week before her transplant, said it all.
This patient has obviously continued to ignore the warnings I have discussed in detail with her husband, who is also a medical doctor, of the dangers of taking the drug Isoniazid and the consumption of excessive amounts of alcohol. As a result, it’s my opinion her liver will fail soon. Unfortunately, due to her obvious alcoholism, I cannot in good faith place her on any national liver transplant list.
I handed the folder back to Marshall, leaned back against the couch and sat there in stunned, shocked silence. The only sounds in the room were Melissa’s muffled whimpers coming through the bathroom walls.
“I’ll be back in a minute,” Brenda said. We heard her knock on the bathroom door and go in.
“I think I need a break, “I said. “Lets go outside and give them some privacy.”
About thirty minutes later, Brenda and Melissa appeared in the doorway and joined us on the deck. Melissa wasn’t crying anymore, but her eyes were red and wet. She forced a smile and squeezed my hand when she sat down next to me.
“I’m sorry, I didn’t mean to...” her words choked off. She dropped her head to hide her embarrassment.
I lifted her hand and kissed it. “Hey, it’s okay. We all understand.”
Her tear filled eyes glistened in the moonlight. “It’s just that...it’s not every day you find out your husband has been trying to kill you.”
For almost five minutes, no one said a word. We all just sat there quietly, listening to the waves crashing on the beach, absorbing her astounding, atrocious, but unfortunately accurate words.
“Marshall,” Melissa said breaking the silence, “How could he have done this? I mean, the alcohol part. How did he do it if I didn’t drink it?
“When your liver started showing the first signs of failure, did they put you on an IV drip?” he asked.
Her eyes flew open. “Yes! Jerry said it was to help build up my immune system. It wasn’t all the time, maybe three or four days a week.”
“He did it at night, right?”
“Yes.”
“Do you remember feeling groggy or sluggish the following day?”
“Yes. And I always had a terrible headache. Jerry said it was just a side effect of the medicine.” She frowned and stared across the table at Marshall. “But was that really a hangover?”
“I think so. That IV bag was more than likely a mixture of glucose and vodka.”
Her eyes filled with tears again and she grew quiet, thinking. “May I ask you a medical question?”
Of course.” He said.
“What is my true life expectancy? How many years will this transplant give me?” She sat up erect and stared at him. “The truth. Please Marshall, tell me the truth.”
He glanced over at me before he answered. “Melissa, there’s no real way to know for sure, but I can tell you what the statistics say. You were thirty-one when you had the transplant. The studies show that for both men and women patients that are liver transplant recipients, between the ages of 17 and 34, once they pass the critical six-month period, they live an average of twenty-eight years.”
She wiped her eyes and looked down at the table. “That means...I won’t live to see sixty. And I may never get to meet my grandchildren.”
I took her hand and squeezed it. “You can’t think about that. And I know it doesn’t seem fair, but the truth is, none of us are even promised a tomorrow. My dad used to tell me ‘It’s not how long you live, it’s how well you live.”’
“I’m sorry, Grant, but I’m not in the mood for another dear old Dad story right now,” she said, jerking her hand away. “I’ve heard all that before. I am thankful for this transplant and the years it’s giving me, but don’t you understand...I did not have to have it! Jerry did this to me!”
When I looked into her eyes, I didn’t recognize her. I’d seen her angry many times before, but what I was looking at was much more than anger, it was rage.
She looked across the table at Marshall, clinching her fists. “Jerry has taken away twenty years of my life. How can I make him pay for this?”
“Melissa,” Brenda said, “look at me. I don’t think you are in any frame of mind to make a rational decision about this right now.”
“OH MY GOD! PLEASE STOP WITH THE PSYCHOANALYSIS!” she screamed, jumping to her feet. “I love you guys, but seriously how did you expect me to react? ‘I’m not in the right frame of mind to make a rational decision?’ Are you serious? You come here and tell me my husband tried to kill me and in the process destroyed my liver. What frame of mind would you be in?”
Suddenly, she collapsed to the floor and curled into a fetal position, crying. Wailing through her tears, she whimpered, “I want him to pay for this! I want him to suffer!”
I jumped up, lifted her off the floor and carried her to my bed. “Molly...” she whispered.
“Don’t worry, I’ll send the babysitter home and go get her right now. You just rest.”
When I got back with Molly, I put her to bed on the couch in my home office. I told Charley to watch her, so he and Donna curled up together, lying next to the couch on the floor. When I stuck my head in my bedroom to check on Melissa, she was sound asleep and Brenda was sitting in a chair next to the bed reading a magazine.
When Brenda saw me, she held up a finger to her lips. “Shhhhh. Quiet, she’s asleep. I’ll watch her for a while.”
I walked to the refrigerator, grabbed two beers, walked outside and plopped down in the chair across from Marshall. I handed him
a beer, popped the top of mine and chugged it.
When I finished, I crushed the can in my hand, tossed it in the trash, leaned back and smiled at him. “Enjoying your trip so far?”
He grinned. “Now you see why I couldn’t tell you all this on the phone?”
“Yes…I sure do.” I said, nodding. “So, is she gonna be all right? She freaked out there pretty bad.”
“Actually, she handled it much better than I expected,” Brenda said behind me.
I turned around to look at her standing in the doorway. “Really? What did you expect?”
She handed me a bottle of wine and an opener. “I don’t know how to use this new wine opener. You do it.”
I popped the cork and filled her glass.
“I expected much more anger and rage,” she said.
I lifted my eyebrows. “More than that?”
She smiled. “Oh yeah, much more directed at Marshall and you.”
“Me?” I said shocked. “Why would she be angry at me? What the hell did I do?”
“Because she loves you and you love her. You were trying to comfort her and she was in a rage. She needed to smash something, hurt something. So she lashed out and tried to hurt you, and then she tried to hurt me. It’s a basic human reaction, but it’s not her true nature and she couldn’t really do it, so instead, she broke down emotionally.”
“So what’s going to happen when she wakes up?” I asked.
“She’s not actually asleep right now. It’s like a sleep, but more of a brain rest more similar to a coma. It’s a healing process. That’s why she went out so quickly. Melissa experienced a slight emotional breakdown. In the old days, they called them ‘nervous breakdowns’, but that’s not an accurate description. The body can only handle so much stress, anger and rage. When it gets to a breaking point, something will happen. That can manifest in many different ways, depending on the individual. Stress is the number one cause of heart attacks and strokes. Long-term uncontrolled stress that turns to anger and then rage is why you hear about normal people that just seem to snap one day and do uncharacteristic things, like smashing up their property or shooting strangers. Stress or rage is a characteristic all humans possess, but fortunately, most never see. We all got to see a small part of Melissa’s tonight.”