There are many known contributing factors of cirrhosis: alcoholism, drug abuse, genetic predisposition, and previous liver disease. She had all of these:

     My mother was an alcoholic for several years. I was a very young child at the time and don’t remember much about it. In retrospect some aspects of my childhood make a lot more sense with that knowledge.

     After she became sober, my mother constantly took acetaminophen (ironically the drug most likely to cause liver damage) much more often than the recommended dosage allowed to control migraine headaches (that were most likely caused by alcohol withdrawal).

     Apparently, in our family there are a lot of ancestors who developed and later died from cirrhosis complications; some were known drinkers, others had never tasted alcohol their entire lives.

     And then, in 1989 my mother nearly died after contracting hepatitis C. When she was diagnosed, the doctors called it “non A, non B;” there was no actual classification for it at the time. As best we can tell, my mother was exposed to the virus in nursing school and, her liver being weakened by previous alcoholism and pain medicine overuse, she quickly became ill.

     She spent weeks in the hospital, at least part of it comatose. I was six years old; I remember going to the hospital a few times to visit her and wondering why Mommy wouldn’t ever wake up. But eventually she did; her recovery was a miracle.

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     Symptoms of cirrhosis range from jaundice, fatigue, loss of appetite, weight loss, nausea, and swelling due to fluid retention, to easy bruising and bleeding, and hepatic coma. My mother’s increasing jaundice was most noticeable in retrospect. It should have been an alarm, blaring long and loud that something was wrong.

     Instead, it was a creeping, progressive thing; she didn’t just wake up one morning looking like an orange. None of us even noticed the severity of it until we looked back at pictures and compared them to some that had been taken several months earlier.

     The hepatic coma, however, was a defining event in her illness. We already knew that my mother had cirrhosis, but no one, including her, realized how severe it had become until the coma in 2003. A hepatic coma does not have a sudden catalyst such as a head injury. Rather it is an event in which a person goes from feeling fine to progressive states of confusion and disorientation, and eventually complete unresponsiveness.

     My stepfather was at work when it happened, but he felt a severe urge to go home shortly after lunch, something completely out of character for him. My mother had begun to get ready for work (she was on the second shift), but had started to vomit blood. He found her sitting on the edge of the bed in a stupor, her feet in a puddle of blood and her scrubs still clutched in her hand.

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     Cirrhosis of the liver is not reversible. Diagnoses for life spans after cirrhosis onset can vary widely from a few years to decades, depending on the amount of liver damage present. These diagnoses can be dramatically altered by other health events and the patient’s diet and adherence to prescribed medications. My mother was not a candidate for transplant. I can’t even remember why.

     Her outlook was very promising until the coma. At first, we were told she probably wouldn’t wake up. Several days later, much to the amazement of the medical staff, she did. Another miracle. But after that, her outlook was not as promising. The doctor’s exact words: “it could be ten years, it could be ten days.”

     It turned out to be nineteen months, every day of which she had to take blood pressure medicine and stomach acid reducers (to keep her esophagus from bleeding again), fluid pills (to try to reduce swelling in her legs, because the excess fluid could allow for infection), potassium pills (because the fluid pills messed up her mineral balance), and liquid laxatives (so that her digestive system would act as a purging system to reduce bile buildup). Even with the medicines we knew the eventual outcome, but we were grateful for each extra day.

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     My mother was unable to go back to work. It took several weeks for her to even regain enough strength to be alone for any length of time. In the nineteen months after the coma, she was admitted to the hospital several times. A side effect of cirrhosis is a greater likelihood of cellulitis. Such infections in a healthy person would be a moderate inconvenience; in her, they could be fatal.

     Her last bout of cellulitis went septic. She went to the emergency room at the first sign of infection; still, it spread to her kidneys, then to her lungs, in a matter of days.

     She went into another coma. We didn’t get a third miracle. She was only 49 years old when she died.

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     My mother’s official cause of death was cardio-respiratory failure due to septic shock. On her death certificate cirrhosis is mentioned third on the list, an underlying cause. It always bothers me, the way it’s written. I don’t know why. I guess it always will.