Nurse with HCV tells of hardship and triumph

I didn’t know you could be that sick and still live’

On her third liver and having come about as close to death as one would care to brush, Diane Mawyer, RN, is a survivor with a mission: increase awareness of the threat of hepatitis C virus to the nation’s health care workers.

The 46-year-old former nurse said she was occupationally infected with HCV after a history of blood exposures and needlesticks in the 1980s, when HCV testing was a relatively crude attempt to identify "non-A, non-B" hepatitis, and needle safety devices were in their infancy. One of the principal speakers recently at the Frontline Healthcare Workers Safety Conference in Washington, DC, Mawyer described her ordeal in an interview with Hospital Infection Control.

Mawyer said one of her primary roles at the conference was to put a human face on the statistics. "People say, Oh, hepatitis C. It can be bad but often isn’t,’" she said. "But to think that one needlestick or one exposure could lead to these kind of medical problems for eight years is a surprise to a lot of people."

She recounted numerous blood exposures over a career that included 14 years of drawing blood and supervising phlebotomists with the American Red Cross in Charlottesville, VA. "From 1981 to 1987, I was directly involved in drawing blood from donors every day," she said. "Prior to 1985, when [CDC] universal precautions were issued, blood drawing was done with bare [ungloved] hands. There was a lot of exposure to blood."

In addition to skin exposures that left blood under her fingernails after a day’s work, she had six documented needlestick injuries over the course of her career. "I had a couple of occasions when I punctured my finger with a large-bore needle that was used to draw the donor blood," she said. "And on one occasion, a capillary tube broke in my hand and cut me. On another occasion, I was stuck disposing of a butterfly needle filled with blood."

All the injuries occurred before a there was a specific test for hepatitis C, however, and she wasn’t diagnosed with HCV until a liver specialist tested her with polymerase chain reaction in 1993. Although she began feeling bad in 1989 — with recurrent symptoms of fatigue and nausea — after the 1993 diagnosis, the disease began taking a rapid course.

"I just got sick really quickly at that point," she said. "My liver enzymes were sky-high. I became jaundiced." She quit work in January 1994 and that May received her first liver transplant after interferon treatment failed. "I had a lot of complications and almost died," she said. "I was in the hospital for six weeks but eventually started to get better and came home. I was relatively well for about a year and a half. Unfortunately, the hepatitis C came back really fast, and with a vengeance. Within three years I had cirrhosis again."

The two-year wait for her second liver transplant, which she received along with a kidney in June of 1999, was a period of unebbing illness. "It was two years of living hell," she said. "I didn’t know you could be that sick and still live." The results this time, however, bordered on the divine. "It was almost like a miracle," she said. "I started to get better right away. Even though I still show the virus in my blood, it is at a low level. I’ve had biopsies every three months since my transplant, and so far I don’t have any damage to my liver."

Medical bills top $500,000

Living daily with the knowledge that the HCV could recur, Mawyer is taking her case public, carrying a message of hope and a call to action to the podium. Though she had to fight initially to get her workers’ compensation claim accepted, she has reached a settlement with her former employer, and her considerable medical expenses are being covered, she said.

"I would really like to see legislation passed, both at the federal and state level, requiring needle safety," she said. "Having been a manager, I understand the cost constraints. But I can tell you, my medical bills have exceeded over a half a million dollars. It doesn’t take too many cases like that to make safety devices cost-efficient."