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Diagnosing Hepatitis in Princesses and in Commoners

A Roman Clef Cautionary Fable on Risk Factors for Hepatitis

July 1998

When Christobel DuPont, the private secretary to Her Royal Highness Princess Margarita, telephoned me to set up an appointment for the Princess, I was somewhat surprised. I had assumed, like British royalty, that all royals traveled with a palace physician in their entourage. But the Princess was always breaking protocol and there was no physician accompanying her to Los Angeles. Her only traveling companion was Miss DuPont.

Miss DuPont explained that she had called the Los Angeles consulate to recommend a local physician and the Consul General, who has been a patient of mine since 1986, recommended me. Her Royal Highness was in town to open the new Botero exhibit at the Los Angeles Museum of Contemporary Art (LA MOCA). Since the Princess arrived in Los Angeles three days ago, she had been complaining of fatigue. Last evening, immediately after she had dinner, she began vomiting. According to Miss DuPont, the Princess drank a little camomile tea for dinner and only ate half of a Sarah Lee English muffin with raisins which she spread with a dab of unsalted butter and a spoonful of Seville orange marmalade. After vomiting these slight morsels the Princess immediately canceled her appearance at LA MOCA's big fundraising gala last night which must have been a bitter disappointment to her many fans, among which I admit being one of her most devoted.

The Princess was staying at the Peninsula Hotel in Beverly Hills and I arrived there at 7:48 in the morning. When I came to her suite, I was ushered in by Miss DuPont. The reception room was quite dark. Miss DuPont introduced me to the Princess and after a few minutes of delightful conversation, I asked Her Royal Highness if I could open the drapes to get some more light in the room to conduct an examination.

I opened the drapes and the early morning California sunshine flooded the room. I immediately noticed that the Princess's flawless skin had a familiar jaundiced cast and that the jaundice was beginning to tinge the corners of her famous violet eyes. The Princess was dressed in an exquisite blue and white peau d'ange gown that shimmered in the sunlight which was also captured in the magnificent sapphire brooch that was pinned at the neck of the gown. I assumed it was the infamous $2.5 million dollar brooch that Warren Beatty gave the Princess after they met in Monte Carlo during that party where that famous photograph of Madonna was taken. I'm certain everyone remembers the look in Madonna's eyes as she was photographed slapping Her Royal Highness in the face after Warren told Madonna that it was love at first sight when he met the Princess and that he was leaving the Material Girl for Her Royal Highness.

I began taking the Princess's medical, sexual, and drug history. Her health history was unremarkable except for her allergy to shellfish which she never ate. There was no history of liver or biliary disease. She had never had surgery or required a blood transfusion. Because of the jaundice, I asked about any jaundice or hepatitis among other members of the Royal Family or the palace staff. Neither the Princess nor Miss DuPont, who was present during the entire examination, could recall any such incident.

Her Royal Highness had never taken injection drugs but was very open about her cocaine use which had been reported in the tabloids for years. The Princess had checked into the Betty Ford Clinic two years ago and had remained substance free until ten days ago when she sniffed several lines of cocaine through a straw shared with several of her guests during the infamous houseboat party that she threw for the Cirque de Papouasie-Nouvelle-Guinèe when the troupe opened in Washington DC.

The Princess is a sexually active heterosexual with eclectic tastes in men. After she ended her two-year relationship with Macauley Culkin last April, she was not sexually active until the night of the houseboat party when she had relations with an aerialist, Siamese-twin lion tamer(s), a clown, and JoJo the monkey-faced boy.

Her physical examination was relatively unremarkable. Even though the Princess was only 4'8'' and weighed between 220 and 230 pounds, her vital signs were normal. She had a history of elevated blood pressure which she brought under control through a combination of Yoga and visualization. I noticed a rather large tattoo of Herve Villachaise in the nude about 9 centimeters in length by 5 centimeters in width on her posterior left buttock. The now deceased actor looked like he just stepped out of an X-rated episode of Fantasy Island, albeit on a nine inch portable TV. I noticed some inflammation around the tattoo and upon being questioned about it, Her Royal Highness admitted having it etched at a tattoo emporium in the nation's capitol.

I did the standard hepatitis screen and I received the results from the lab in record time (royalty has a strange effect on some people). The screening results confirmed my provisional diagnosis of hepatitis B.

I had tentatively ruled out the multiple sex partners at the houseboat party as a possible route of infection because by sheer coincidence I gave each member of the circus troupe their annual comprehensive physical exam that was required for the circus's insurance plan. And for some unknown reason, none of the circus members ever had a STD or any systemic infectious disease. Because of the increased risk factor for hepatitis A in primate handlers, I rechecked JoJo's medical history. There was no history of experimental surgery (chimpanzee organ transplants are all the rage in California). There was an entry that JoJo's hirsutism was genetic and that he had been celibate for several years prior to the insurance examination due to his chronic pediculosis.

While I was waiting for the lab results to come back, I did some checking on the tattoo parlor through a friend of mine on Donna Shalala's staff. Apparently the site called Durante's Inkatorum is frequented both by celebrities such as Cher and Tommy Lee as well as by male and female prostitutes who apparently can charge a higher rate with certain types of tattoos on specific parts of their bodies. I further learned that due to constant cutbacks in services in the District of Columbia caused by their well-publicized financial problems, there hasn't been a public health inspection of tattoo parlors for several years. While I don't have any direct evidence of the source of transmission, the 14-hour tattoo process necessary to produce that exquisite likeness of Herve Villachaise seems be the most likely culprit, although the shared cocaine straw should not be overlooked.

I am pleased to report that after several days of bed rest the Princess made a complete recovery and promised me that she would abstain from cocaine, limit her liaisons with the Cirque de Papouasie-Nouvelle-Guinèe to JoJo, and stay away from tattoo establishments.

Narud Narud, DO is the nom de plume of a former Angeleno who is currently enjoying the tropical sun on a Pacific island. This article is abstracted from Chapter 2 in his upcoming book, Margarita: The Tears Behind the Smile published in the fall of 1998 by Simon & Schuster. All profits from this book will go to the Princess Margarita Charities.

Editor's Note: Fables have been used from ancient to modern times to teach lessons. Quite often the subjects of fables are animals who are given human passions and feelings. In today's more sophisticated society, anthropomorphic woodland creatures have been replaced with royalty, rock stars, and other celebrities. We have replaced Aesop with Jackie Collins. Dr. Narud has replaced the fables of La Fontaine with the fabulousness of celebrity to teach a lesson about risk factors for viral hepatitis that may not be learned through other educational forms.

Modes of Transmission of Viral Hepatitis
Hepatitis A:
Common Fecal-oral
Household institutionalWater Mollusk
Hepatitis B:
CommonPerson to person (intimate contact)Injection drug usePerinatal
RareTransfusion of blood/blood productsOrgan transplantation
Hepatitis C:
CommonInjection drug useBlood transfusion prior to 1990
Less CommonHemodialysisMultiple sexual partners
Healthcare employment (needle stick)Perinatal exposure
Household/sexual exposure to known case
Data courtesy of American Digestive Health Association and the American Liver Foundation

©1998, Medical Publications Corporation

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This article was provided by International Association of Physicians in AIDS Care. It is a part of the publication Journal of the International Association of Physicians in AIDS Care.
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