Live Free and Not Die

"Live Free or Die" is the motto of New Hampshire. This motto was a shortened version of "Live Free or Die; Death is Not the Worst of Evils". These words were stated by General John Stark, who was New Hampshire's most famous Revolutionary War hero. Sylvie Preble always thought that the motto was shortened to fit the automobile license plate. Silly girl. Sylvie somehow came up with this whack idea when she was studying the case of Wooley v Maynard, 430 U.S. 705 (1977) in her civics class at Keene High School. In Wooley, George Maynard, a Jehovah's Witness, covered up the "or Die" part of his license plate motto. He was convicted for altering a license plate. The United State Supreme Court in a 6-3 decision held that Maynard had a right to his free speech. Maynard believed in his church's teaching that life was eternal and that "die" was not an acceptable concept.



At this point in her life Sylvie has increasing concerns about death. It's not that she's sick or even looks sick. Quite the opposite. She is a fit, former Keene State College soccer player, who still has the dirty blonde draw she had when she was twenty. Just the sight of her makes most guys push their lips out a little. It's a primal thing. Her problem is rooted in some lousy blood test. Sylvie volunteered to give blood at the New Hampshire teacher's Blood 4 Life campaign at the Hampton Beach convention last month. She was told she had an elevated liver enzyme test, which led to hepatitis testing. She is positive for Hepatitis C. Bummer.

Dr. Orville Pappandreas, a bloat of man, is the liver shaman in lower New Hampshire. He's one of those doctors who advocate "do as I say, not as I do." While some might call Pappy a hypocrite, doctors like him are given a w i d e berth. Not only is the Greek derivative 150 pounds overweight, he smokes and drinks, both to excess. And he smells like a blend of cigarettes and onions. Despite his overall physical decrepitude, Sylvie likes him. Only a deity could understand.

Hepatitis C is an interesting disease. 10% of persons infected with Hepatitis C clear the virus and develop immunity. The other 90% develop a chronic illness. In about 80% of those persons, the disease does not progress to cirrhosis or liver cancer. It runs an indolent course. In the other 20% of persons, the disease develops into a serious, life threatening illness in the form of cirrhosis or liver cancer. Since it is impossible to predict which persons will develop a life threatening condition, it is prudent to offer treatment to all. The treatment with interferon (weekly injection) and ribavirin (tablets by mouth twice a day) is successful in only 60% of cases. And the treatment is problematic. Side effects galore can arise; malaise, viral symptoms, weight loss, anorexia, anemia, muscle aches and more. Ugh.

Treatment may extend anywhere from 3 to 12 months. This depends on the responses to treatment and the genotype of the Hepatitis virus with which the patient is infected. Genotype 1 responds less well and it requires longer therapy. Genotypes 2 and 3 respond better and require shorter therapy. Sylvie has genotype 2. A good thing as things go.

Sylvie is thirty-seven and has been teaching English at Keene High School, her alma mater, for twelve years. She married Brandon Preble eleven years ago. While she was a devoted wife, Brandon was a devoted player. She so wanted children, she put up with Brandon's shenanigans for at least three years beyond the useful life of their marriage. She kept thinking that if she and Brandon could oven one, they would come back together as a couple. It never happened. They divorced two years ago.

Brandon, among other bad habits, frequented strip clubs during the marriage. Although Sylvie doesn't know it, Brandon still does. At one point, Brandon fell hard for a dancer named, Primavera. This led to two unwanted results. The first was the precipitation of the divorce. Despite an intervention, Brandon could not rid himself of his desire for Primavera. The second was more slow footed. Primavera has hepatitis C and Brandon got hepatitis C. And now Sylvie has hepatitis C. Sylvie would bet the ranch that they all have the same genotype. Oh yeah.

Sylvie isn't sure of what to do. Her options include doing nothing, taking the interferon and ribavirin or getting a liver biospy. The latter may guide treatment pending the stage and grade of the disease. The biopsy procedure has a small associated risk, but on balance is a reasonable alternative. Pappy favors treatment. He doesn't think Sylvie has advanced disease and he further believes he has a good chance of eradicating the virus. Sylvie has read about some doctors using high dosages of an herb, milk thistle, to treat hepatitis C. Pappy has no faith in it, but he is used to attempts at cure from herbal remedies. When Sylvie told him about the milk thistle remedy, the portly physician screwed his face up like he had Limburger cheese stuck in his left nostril.

Sylvie is angry at the stupid Brandon and the conniving Primavera. Primavera and Brandon don't know it yet but they are both going to meet Sheriff's deputy, Roscoe P. Warmtrane, of Cheshire County tomorrow. He is going to personally serve them. Sylvie's lawyer, Donald Cheatham, filed suit for negligent infliction of emotional distress against them and the Fantazee Club. The suit lists pain and suffering and possible death as damages. Cheatham is seeking one million dollars. Whew.

Cheatham is going to learn that Primavera isn't the only hepatitis C carrier working at the Fantazee. Indeed, two other dancers are spreading joy. In fact, by the time it's over, six other Keeners will be diagnosed with hep C and they, too, will be meeting the Greek god. And Sylvie dosen't know it yet, but her biopsy will reveal minimal disease, grade 1, stage 1. And even better, she will repsond to treatment and she will clear the virus. Best of all, the Fantazee Club insurance carrier, Yankee Ltd., will settle her case for $250,000. Ah, she will live free and not die. Just like Mr. Maynard.