Foodborne Illnesses / Hepatitis A /

Real Life Impacts: The Story of Richard Miller

Richard Miller made a lunch date with his wife, never dreaming that a meal at a favorite Mexican-food restaurant would end up nearly killing him. But in 2003, Richard, along with hundreds of others, were infected after eating green onions contaminated with hepatitis A at a Chi Chi’s restaurant in Pennsylvania. Richard’s infection developed into fulminant hepatitis A, which required a liver transplant to save his life. Three other victims were not so lucky.

On October 12, 2003, Richard Miller and his wife, Linda, ate lunch at a Chi Chi's restaurant in Monaca, Pennsylvania. Many of the dishes on the menu included raw, chopped green onions. Not long after the Millers' lunch, green onions were reported to be the source of a widespread outbreak of hepatitis A infections, an outbreak that eventually grew to include more than 650 infected people in seven states, including at least 13 of Chi Chi's restaurant employees. More than 9,000 people who ate at Chi Chi's during the exposure-period for the outbreak had to get immune globulin shots as protection against hepatitis. Tragically, four people ended up dying as a result their hepatitis-A infections.

Linda and Richard Miller began feeling sick in late October. Suffering from severe fatigue, a hallmark of hepatitis, Linda took to bed and was soon joined by Richard. For the next few days, they both felt extremely ill with fever and awful muscle pain.

After a few days, Linda began to feel better. Richard, unfortunately, did not improve; he continued to suffer severe chills, fever, and intense pain. On November 3, Linda took Richard to the emergency room, where tests confirmed that he was infected with the hepatitis-A virus, something that the ER doctors were seeing a lot of due to the growing outbreak. Richard was given IV fluids and sent home to recover there, since most hepatitis-A infections are ultimately self-resolving. But instead of getting better, three days later, Richard became incoherent and was unable to stand. Linda called 911 and medics rushed her husband back to the ER.

Richard had developed a rare but severe complication known as fulminant hepatitis A, in which the virus penetrates the liver cells and releases toxins, killing the cells. In addition to the severe 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 a matter of days, Richard Miller had gone from good health to near death. What at first had seemed like a mild case of flu had now been diagnosed as a life-threatening condition, with there being a real chance that Richard's liver would fail. In 36 years of marriage, the Millers had never faced such a crisis.

Richard's rapidly deteriorating condition prompted a transfer by ambulance to the University of Pittsburgh Medical Center, where Linda and their three children, Jeffrey, Rebecca, and David, gathered by his bedside. As his brain function worsened, Richard became agitated and tried to pull out his IVs. He finally had to be 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," recallsJeff. "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 terrible that a miracle for Richard could come only through a death for some other family, that being the only way for a liver to become available for the needed transplant. 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 had become available. As Richard was wheeled into the operating room, the family hoped that their prayers had been answered but feared Richard would not make it through the surgery alive. "That moment was 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 operation was successful, but he remained critically ill, sedated and paralyzed, covered with cooling blankets and packed with ice to reduce a high fever.

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. The first thing that he remembers is, on November 16, waking up to see the ugly, stapled incision slashed across his torso. Soon he was hyper aware, as 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.

When Richard was discharged from the hospital on December 2, 2003, he left with a mountain of medications, including the anti-rejection drugs that he will have to take for the rest of his life to protect his new liver from rejection.

Formerly 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.

The Millers had assumed their lives would eventually return to normal. But Richard no longer has the stamina for the 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 foodborne 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."