Five Quarts: A Personal and Natural History of Blood

Five Quarts: A Personal and Natural History of Blood. Ballantine Books; 2005; 309 pages; $23.


"We're born in blood. Our family histories are contained in it, our bodies nourished by it daily. Five quarts run through each of us, along some 60,000 miles of arteries, veins, and capillaries." -- from Five Quarts

In the national bestseller Sleep Demons, Bill Hayes took us on a trip through the night country of insomnia. Now he is our guide on through history, literature, mythology, and science by means of the river that runs five quarts strong through our bodies. The journey stretches from ancient Rome, where gladiators drank the blood of vanquished foes to gain strength and courage, to modern-day laboratories, where high-tech machines test blood for diseases and scientists search for cures. Along the way, there will be triumphs: William Harvey's discovery of the circulation of the blood; Anton van Leeuwenhoek's advances in making the invisible world visible in the microscope; Dr. Paul Ehrlich's Nobel-Prize-winning work in immunology; Dr. Jay Levy's codiscovery of the virus that causes AIDS. Yet there will also be ignorance and tragedy: the widespread practice of bloodletting via incision and the use of leeches, which harmed more than it healed; the introduction of hemophilia into the genetic pool of 19th-century European royalty thanks to the dynastic ambitions of Queen Victoria; the alleged spread of contaminated blood through a phlebotomist's negligence in modern-day California.

This is also a personal voyage, in which Hayes recounts the impact of the vital fluid in his daily life, from growing up in a household of five sisters and their monthly cycles, to coming out as a gay man during the early days of the AIDS epidemic in San Francisco, to his enduring partnership with an HIV-positive man.

As much a biography of blood as it is a memoir of how this rich substance has shaped one man's life, Five Quarts is by turns whimsical and provocative, informative and moving.


From Publishers Weekly: Hayes uses his own encounters with blood's ability to save and destroy lives as a launching point for anecdotes in the larger story of blood. He launches into an account of the discovery of blood's components and its function in the body, and meanders through cultural perceptions of blood, from the sacred (the Eucharist) to the profane (Dracula). Hayes ranges far beyond red and white blood cells, platelets and plasma, taking readers inside a modern blood bank and to the bedside of a woman with hemophilia.... His sometimes irreverent commentary on misconceptions about blood doesn't shy away from the gruesome, particularly a cringe-inducing description of early blood transfusion techniques.


Bill Hayes was born in Minneapolis in 1961. "And then," Hayes said, on the day that we spoke, each from our California homes, "three years later, in 1964, our family moved to Spokane, Washington. We moved there because my dad bought a Coca-Cola bottling plant in Spokane. I had five sisters. I was the only boy. We settled in Spokane and went to Catholic school there all the way through. Then I went to a Jesuit university, Santa Clara University, outside San Francisco. In 1983 I graduated from Santa Clara. I majored in English. I had a series of jobs in nonprofits. Organizations and causes that interested me. One of my first jobs was at the Eureka Theater Company in San Francisco. I talked them into hiring me at age 24 as the marketing/public relations director. That was wonderful. Then I went to the San Francisco Museum of Modern Art, and then I worked in a series of jobs in communications and public relations. Then AIDS became significant in my life, and I began doing volunteer work at the AIDS Foundation and then started working there. I also worked for the Library Foundation, raising money for San Francisco's new main library. But all the while I was busy at various nonprofits, I was writing when I had spare time in the mornings and on weekends. And publishing here and there in magazines and newspapers."Mr. Hayes is the author of the national bestseller Sleep Demons: An Insomniac's Memoir. His work has been published in The New York Times Magazine and Details, among other publications, and at Salon.com. He lives in San Francisco with his partner Steve.


"Insomnia has defined my life as an individual, and insomnia was the subject of my first book. What I came to realize is that blood has also come to define my life. My partner Steve has HIV. Blood tests have been a nerve-wracking part of our life together over the past 15 years. "The idea for this book started in a mundane way three years ago. I was standing in our kitchen, slicing potatoes. I sliced too hurriedly. I cut my finger.

"I instinctively stuck my finger into my mouth. I'd done this many times before, but on that particular day, for some reason, the taste of blood triggered memories.

"I was struck by how blood had defined our lives as a couple but also realized that I had, over the past 15 years, come to fear blood and to see blood as a hazardous substance, a carrier of disease and a source of anxiety for Steve and for me.

"My own blood had become tainted by this perception. Even though I am HIV-negative. So the more I thought about it, I saw how, in writing the book, I could reclaim the goodness of blood and learn about its history and also see it for what it is, as this amazing substance. I started out knowing little about blood, its history, or its science. I learned a lot in the process of writing."

"You're getting good at science writing."

"Thank you. It has taken time. What I wanted to do was weave together a natural history of blood, stretching from ancient Rome on through the Renaissance and 19th-century England and up to the modern day and then weave it together with a memoir about how blood has affected my life.

"Anyway, after the bleeding stopped and I bandaged my finger, I started to give this idea some thought. I realized that the first thing I needed to do was make sure that I had the emotional arc or personal narrative that would drive the book. So the first step I took was to start looking back on my life and finding places where blood left a mark. Does that make sense?"

"It does."

"From earliest childhood through adolescence and into adulthood I knew that I would write from the unique perspective of being an only boy in this devout Catholic household, growing up in close quarters with five sisters.

"I knew, inevitably, that I would write about the sister to whom I've always been closest, Shannon. She was a devoutly religious girl. So it was a natural way to tell that story of how blood plays such an important role in the Catholic sacrament. And we were a devout family. I was an altar boy. She was involved with the church.

"In working on the book I was constantly searching for different angles to come from. Whether it was science or history or looking at blood metaphorically, or looking at blood in terms of personal stories."

"Your writing about your involvement with the Roman Catholic church and transubstantiation and the Eucharist was interesting."

"This was belief that on one hand I once had taken for granted but also turned my back on, since I haven't been a practicing Catholic for many years. So it gave me a chance to dig into the history of the Catholic Church just in the specific circumstances of my own family."

"I got a kick out of the scenes," I said, "like those in Sleep Demons, when your dad would take you to do 'manly' things."

"Those scenes are so vivid in my memory. I had such a strong sense of how we were all one family and yet this feeling that I was being raised differently, that being a boy, and the only boy, was special. I was forbidden from doing the dishes or doing any housework. Of course, that made me just want to do housework. I used to go over to my friend Chris Porter's house and ask if I could wash the dishes with them, since all the Porter brothers had to do housework like my sisters did."

"There's something powerful in your particular story about being the only boy in the family. It can't keep itself out of a book."

"Exactly. But finding different ways to tell it, looking through the lens of blood, made it more challenging for me with this book."

"Did you come to understand all this business about mass cells and stem cells?"

"Somewhat. It took me a lot of time and research; as with my insomnia book, I approach science as a layperson. I began by reading. My great resource is the UCSF medical library -- both through contemporary books and textbooks and their Rare Books Room of 17th- through 19th-century books. Of course, I talked with doctors and scientists."

"Tell me the story of how blood cells are produced."

"There are stem cells in the bone marrow that --"

"And the bone marrow is like the marrow one digs from the bone with a marrow spoon?"

"Right. Bone marrow is a nursery for cells, these hot, dark, warm rooms where cells of different types are produced. Stem cells [an unspecialized cell that gives rise to a specific specialized cell] can produce different cells for different parts of the body. But some, for example, are genetically triggered to create red blood cells. It's in the bone marrow where these red blood cells are actually produced. Once they're at a certain stage, the red cells squeeze through the bone itself, and in the process they rid themselves of the nucleus, which is sort of the brains of the operation [a red blood cell in the blood of vertebrates transports oxygen and carbon dioxide to and from the tissues. In mammals, the red blood cell is disk-shaped and biconcave, contains hemoglobin, and lacks a nucleus]. That's why red blood cells, unlike white blood cells and most other cells of the body, do not have a nucleus and thus do not carry DNA."

"They're not big thinkers."

"They're not big thinkers. Sometimes they are called 'dumb cells' because they don't have those brains. White cells are different [any of the colorless or white cells in the blood that have a nucleus and cytoplasm and help protect the body from infection and disease through specialized neutrophils, lymphocytes, and monocytes. Also called leukocyte, white cell, white corpuscle]. White cells have DNA. They're much smarter in that way; they're the army of the blood who go out and fight infections and viruses. But their smartness is also a liability because it is in the nucleus that a virus, like HIV, for example, can then hijack and take over to produce its own millions of copies of its virus."

"Like a computer worm."

"Exactly. So learning things like that, for this book, was fascinating to me."

"So the red blood cells clean the blood?"

"Red blood cells carry oxygen to all the cells of the body. The hemoglobin that's part of the red blood cell is literally a working pigment."

"It's the chlorophyll."

"Yes. It's the equivalent to the green in plants. It carries the oxygen to all the body cells. Once it's deposited its oxygen, it picks up waste and carbon dioxide in return and makes its way through the veins, back to the lungs. It travels in circuits throughout the body for about 120 days."

"I was surprised by that."

"All the different blood cells have life spans. Red blood cells live for about 120 days. And then sure enough, right around 120 days, they start to drop off, and their parts are efficiently recycled within the body by the spleen, and the parts of the cell that can be still used are sent back to the bone marrow."

"And the white cells?"

"There are different ages for white cells. There are all different kinds of white cells."

"Aren't 'white cells' a garbage-can term for many different white cells?"

"Exactly, yeah. There are different kinds, and they serve different functions. Some white cells last days, and then there's a type of white cell called the 'memory cell,' which is the ally in vaccinations, and that can last indefinitely.

"The 'memory cell' contains the genetic code to recall whether it has met up with a virus before. It will recognize it and then send signals to other white blood cells, other soldiers in the army of the blood, to go and fight it. So it operates as the cell with the collective memory for the body. And the different memory cells may have different recollections of the bacteria and viruses that strike the body."

"So they remember if you had chicken pox?"

"They remember it for the rest of their lives. And when they pass away, then they pass on the memory. Just like in families."

"And then platelets that are necessary for..."


"They also just last a few days. About ten days, I think. They're colorless. As their name would imply, they're shaped like tiny plates."

"There are so many kinds of white blood cells."

"Monocytes and leukocytes and neutrophils are one of the reasons that white blood cells were discovered later than red blood cells, because they are basically transparent. They aren't white. You have to stain them. They're also much smaller than red blood cells; they're harder to see. So it wasn't until stronger microscopes were created that white blood cells were discovered."

"And when was that?" "Well, let's see, one of the discoverers of white blood cells was Paul Ehrlich [1854-1915]. He was one of my favorite characters in the book. I find myself interested not just in the science, but in the scientists themselves. I still remember, early on, the first time I saw a photograph of Paul Ehrlich in a history of hematology. It showed this elderly man with a big, fat cigar in one hand and a book in the other, sitting in his study surrounded by books and papers and dwarfed by these books and papers. He looked so intense on what he was reading. The cutline read, 'Paul Ehrlich in his study.' I said to myself, 'I've got to know this man's story.'

"He was this brilliant scientist, now considered the father of hematology and immunology and chemotherapy. He came up with the notion of using chemicals to combat diseases. He also discovered a cure for syphilis, the sexual plague of the 19th Century. The more I learned about his story, the more I found that he was a great humanist."

"He was the Flaubert of blood cells."

"He was. And a quirky, quirky, wonderful man. And so any personal details I could find about him I just loved."

"Do you and Steve spend a lot of time looking at his blood-test sheets?"

"We do. He has to get blood tests every three months. Steve and I have been together for 15 years, so it's been at least that, if not more often during periods when he was sick. That's been a constant in our lives, not only going to the phlebotomist and getting his blood drawn."

"I understand that they count blood differently than they used to now that they have computers."

"That's right. They used to do it by hand. Or by eye count with a microscope and a counter. In some parts of the world, it's still done that way. But now it's done by staining the blood and with computers."

"Does living with someone who's HIV-positive change the way that you deal with blood?"

"Oh, absolutely. It's always been something that both of us have feared as a source of infection, as a carrier of disease, but also just emotionally as a source of anxiety."

"The anxiety rings all through the book."

"The author is. So that's probably true. As I said earlier, I think that's something that drove me to write the book, this realization that blood had become this substance that I feared. And saw as hazardous and dangerous. So strongly that it even tainted my perceptions of my own blood."

"Murderers must feel horrified by the blood that comes out."

"When I told a friend I was working on this book about blood, he shivered and he said, 'You know, I like blood as long as it's in the body.' I think most people feel that way. You're not used to seeing it, and when you do see it, well, inevitably it's a sign of danger or injury or wounds. Seeing blood is not usually a good sign."

"But we like it in our meat."

"I interviewed a dietician for the section on vampires and put the question to her, 'What would be the risk of someone actually drinking blood, like, say, a vampire?' She paused and said, 'We eat blood all the time, in the meat that we eat.'"

"But beef," I said, "if it's not well-done, blood runs out on the plate."

"Exactly, and some people love that. It's much easier to call it 'juice,' but you know they used to call blood 'juice,' this special 'juice,' 'human juice.'"

"Where did you get the title -- Five Quarts: A Personal and Natural History of Blood?

"Five quarts is the amount of blood that runs through the average person. The general rule is that for every 30 pounds of you there is one quart of blood. I am 150 pounds average weight. So in me are five quarts of blood."

"How is this book different from the first book?"

"Aside from the subject matter, I made a conscious effort to try to make the book as fluid as possible. That was my goal. Sleep Demons had the fractured, frantic quality of an insomniac's state of mind. I don't even know exactly how deliberate it was, but when I look at it now, even the transitions seem sharp and bright. I made an effort with this book to just make the thing flow, so that one subject led into another. And my goal, what I would think about would be, 'I want to write the book so that even if I didn't have chapter titles and section breaks, I could take all those away, and it will still be 300 pages flowing from one to the other.' Especially knowing that I would be weaving back and forth between memory and history and science and that sort of thing."

"What does blood taste like?"

"Metallic, kind of like change."

"That's iron and the copper."

"Yes, the copper and the iron, which is literally in it. In fact, two-thirds of the body's store of iron is in the blood. It's no surprise that blood has that metallic taste."

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