Nearly all Belinda's pain treatment involved acetaminophen. January 2006 ... February 2006 ... it's listed on her charts. Her liver failed for the first time in of March 2006 - acetaminophen toxicity.
Occam's razor: The name of an episode of the medical drama "House." In that episode, younger doctors debated with the gruff middle-aged sage specialist. Like Belinda, the patient presented with respiratory and abdominal distress. He rapidly declined. Like Belinda, that patient accidentally took a toxic prescription. And it was killing him. "Occam's Razor," House told the younger doctors. "The simplest explanation is almost always somebody screwed up."
Somebody screwed up.
In all of Belinda's liver failure hospitalizations, tests showed high levels of acetaminophen. More than 200 over-the counter medications contain acetaminophen, known by the brand name Tylenol.
It's in seemingly benign elixirs, like DayQuil. It's also a key ingredient in Vicodin, Belinda's prescription. Prolonged use of the analgesic can create toxicity. Ingesting the equivalent of six extra-strength Tylenol tablets a day over several weeks is enough to do damage, according to the American Liver Foundation. A liver plays many roles. It assists blood clotting, processes nutrients, eliminates toxins, and metabolizes most medications. Excessive acetaminophen harms because, as it runs through the body, a metabolite in the medication depletes the liver's natural antioxidant, damaging cells, leading to liver failure.
Acetaminophen toxicity is among the most common causes of fulminant liver failure in the Western world. FLF is rare, its exact incidence unknown, but it affects around 5,000 people each year. It attacks people with no prior history of liver disease - primarily adults between the ages of 20 and 45. It onsets rapidly, causing mass destruction to the organ, the body and, often, the brain. Mortality among patients with FLF is high - with an overall survival rate around 20-30 percent. Without a new liver, Belinda would almost certainly die. Medical management, without a transplant, is mostly unsuccessful.
Not that anyone offered medical management for Belinda's weakened liver. Cedars just let her out the hospital, warned her not to take Vicodin, and let her go. Then they gave her more acetaminophen. For years, before, during and after her first brush with death, doctors prescribed Belinda acetaminophen and Vicodin. Her liver failed again in July 2007. By September 2007 she was back on Vicodin.
Even if the doctors did not grasp what was happening to Belinda, she often contemplated her mortality. "I shouldn't be alive right now, but I am, and every day from now on is a gift I don't plan to waste," she wrote on her MySpace after leaving the hospital in March 2006. "Live in the moment - because the moment is all you have."
In her 2003 song "Time", Belinda wrote these prophetic words
Here I sleep (Here I sleep)
Every breath I take is killing me (Every breath I take is killing me)
In your keep (Safe in your keep)
And the shadows all that I can see (And the shadows all that I can see.)
Belinda said a doctor told her she wouldn't last long. She wouldn't make to 30 - she told a few friends. "It's almost a self-fulfilling prophecy if you tell somebody something like that," Avi said. "It's almost depriving them of their hope."
Even if Belinda thought she might die, it did not mean she had to. Her name wasn't on a transplant list until November 3, 2007. She was a status level "1A" then, according to United Network for Organ Sharing (UNOS). A "1A" patient skips to the front of the transplant line, because without a liver she'll live just hours to days. Belinda got a new liver almost immediately, but still too late.