• Choose a category
• All
• Classic-Fiction

Payton flew to Rochester on December 17, checked in for a three-day stay, and underwent a bevy of tests. Albert J. Czaja, Mayo’s head of gastroenterology and hepatology, filed a detailed assessment of Payton’s symptoms:

Mr. Walter Payton, age 45, first developed nausea after eating in mid-August of ’98. There was also associated increased fatigue with justified frequent rest periods during the day. Additionally his sleep patterns became reversed and he was awake at night and tired during the day. Diarrhea subsequently developed on a daily basis. The diarrhea would be related to eating and was non-recurrent in the fasting stage. Usually it would develop within ten to fifteen minutes after the completion of a meal. But [it] could occur as early as five minutes after eating. The symptoms would be unrelated to the amount or type of food eaten and there were no specific food intolerances. There would be associated borborygmi, but no abdominal cramping, bloating, distention or urgency. The bowel functions were well controlled and the texture would vary to loose to soft in nature, with colors that were gray and pale brown. There was no evidence of mucus discharge, bleeding, oil or greasy stool. The episodes did not occur at night and there was no fecal incontinence. Concurrent with these symptoms there was a variable appetite. He would be hungry prior to eating, but there would be postprandial nausea that would limit intake. Vomiting was absent. The weight decreased from 221 pounds to 194 pounds over a four-month period.... He recognized the development of a generalized itch.... The itch could be associated with excoriation and was worse at night. There are no associated rashes. He would also experience intermittent mid-chest discomfort, as though the food lodged. And there would be inability to burp and relieve the pressure. He was seen by his local physician in September of 1998 and liver tests were abnormal but etiologic studies were negative. In October of 1998 he was seen by a hepatologist who identified stabile liver tests abnormalities and suspected possibility of toxic effects related to the use of a vitamin pack since March of 1998 that included Vitamin E and probably Vitamin A. These vitamins were discontinued in September of 1998 but the symptoms and abnormalities have persisted. Currently Mr. Payton feels fatigue. He continues to have postprandial mid-chest lodging of food, although the symptom has improved over the last two weeks since using wheatgrass. His diarrhea has become less severe and his stools are now solid and gray in color. He continues to have postprandial nausea and the itch is less intense, although apparent during quiet periods. His weight has stabilized between 190 and 193 pounds. He denies receipt of blood transfusions, contact with jaundiced individuals, homosexual contact or exposure to hepatotoxic medication or chemicals. He does not consume alcohol. There is no family history of significant liver disease. His past medical history is unremarkable.

The ensuing test results were not good. According to Dr. Greg Gores, a Mayo liver transplant specialist, something was wrong with Payton’s liver and bile duct, and it appeared to be primary sclerosing cholangitis (PSC). A rare (three of one hundred thousand people are affected) and mysterious disease, PSC scars the bile ducts, which carry bile from the liver to the small intestine to help digest food. When the ducts get blocked, bile backs up and migrates elsewhere. The body’s immune system then mistakenly attacks its own tissues. 22

A 10-French 9 cm biliary stent was placed in Payton’s body to keep the bile ducts open (the Mayo report: “The procedure was well tolerated and Mr. Payton is well this morning.”), though a momentarily optimistic Payton was informed the stent would serve as only a brief remedy. He was also prescribed Actigall, a drug normally used to fight gallstone disease, and was told to take 300 mg four times per day.

Wrote Gores in a report filed shortly after first evaluating Payton: “The findings were fully discussed with Mr.