Amerithrax (22 page)
After five days of fever and headache, the unidentified Brentwood postal employee rang the Kaiser medical advice line. While Leroy Richmond’s illness had manifested itself in breathing problems, his coworker’s sickness exhibited it- self through visual disturbances. He was suffering from pho- tophobia and his vision was intermittently blurred. Like Richmond, he rushed to the emergency room at Inova Fair- fax. When he arrived his pulse was 127/min, and respiratory rate 20/min. Admission laboratory results were normal and
no organisms were seen on a gram stain of his cerebrospinal fluid. However, a front-to-back chest X ray showed widen- ing between his lungs, especially on the right side. Next a noncontrasted CT scan of his chest displayed vast amounts of fluid in the pleural space on both sides. Admission blood cultures grew
B. anthracis
within fifteen hours. Ciproflox- acin, rifampin, and clindamycin were begun as treatment.
Washington Health Commissioner Ivan Walks refused to identify the postal worker hospitalized at Inova Fairfax. He reported to the press only that his symptoms were “suspi- cious” and that he was being tested for anthrax while under treatment. Officials said it was too early to draw any links between the letter that arrived at Daschle’s office, the an- thrax finding at the Ford building, and the sick postal worker.
At 4:39 a.m., Sunday, October 21, Thomas Morris made an emergency call to 911. He was short of breath and sounded frightened. He had rung for an ambulance a few minutes after he began vomiting. It was obvious that he already suspected an anthrax infection was the cause of his difficulties. He remembered a colleague handling a letter containing a suspicious powder the week before.
“Um, my name is Thomas L. Morris Jr.,” he began. “My breathing is very, very labored.”
“How old are you?” the operator asked.
“Um, fifty-five... Ah, I, I don’t know if I have been, but I suspect that I might have been exposed to anthrax.”
“Do you know when?”
“It was last, what, last Saturday a week ago... at work. I work for the Postal Service. I’ve been to the doctor. Ah, I went to the doctor Thursday, he took a culture, but he never got back to me with the results.”
Morris explained that “there was some hang-up over the weekend... Now I’m having difficulty breathing and just to move any distance, I feel like I’m going to pass out.... My breathing is labored and my chest feels constricted. I am getting air, but I—to get up and walk and what have you—it just feels like I’m going to pass out if I stay up too long.”
“O.K., which post office do you work at?” asked the operator.
“This is the post office downtown, um, Brentwood Road, Washington, D.C., post office,” Morris said, then paused. “A woman found an envelope [on October 13, 2001], and I was in the vicinity. It had powder in it. They never let us know whether the thing [had/was] anthrax or not. They never, ah, treated the people who were around this particular individual and the supervisor who handled the envelope. Ah, so I don’t know if it is or not. I’m just, I haven’t been able to find out, I’ve been calling. But the symptoms that I’ve had are what was described to me in a letter they put out, almost to a T.. .” The dispatcher had given him a letter by the Postal Service describing the symptoms of anthrax. “The doctor thought that it was just a virus or something, so we went with that, and I was taking Tylenol for the achiness. Except for the shortness of breath now, I don’t know, that’s consistent with the, with the anthrax.”
“O.K.,” said the operator, “you weren’t the one that han- dled the envelope—it was somebody else?”
“No, I didn’t handle it, but I was in the vicinity I
don’t know anything...I couldn’t even find out if the stuff was or wasn’t. I was told that it wasn’t, but I have a ten- dency not to believe these people.”
“And did you tell your doctor that this is what hap- pened?”
“Yes, I did,” said Morris. “But he said that he didn’t think it was that. He thought that it was probably a virus or something.”
“I’m going to get the call in to the ambulance.”
There was a long pause. Morris was breathing with great effort now.
“Did the doctor give you any kind of medication or any- thing?” said the operator.
“No,” said Morris, “he just told me to take Tylenol for the achiness.”
“Hold on a second. I have an ambulance dispatched so it should be there shortly.”
“O.K.”
“If there’s anything, if your condition starts to worsen, have your wife give us a call back, O.K.?”
“All right.”
“All right then.”
“Thank you,” said Morris, ending the call at 4:50 a.m.
Early Sunday morning, Joseph Curseen arrived at an emergency room at Southern Maryland Hospital Center. He’d been vomiting and sweating profusely. His white blood count was slightly elevated, but he had normal serum chem- istries and coagulation values. His past medical history in- cluded asthma. His chest X ray was initially read as normal, but later review noted an ill-defined area of increased den- sity due to a mass in the right suprahilar region. He was discharged after receiving intravenous hydration.
An ambulance rushed Morris to the Greater Southeast Community Hospital. Morris reached the emergency depart- ment with worsening symptoms, including chest tightness, fatigue, chills, myalgia, nausea, vomiting, and shortness of breath. His temperature was “38.9
°
C, pulse 93 to 150/min and irregular, respiratory rate 20/min, and blood pressure 119/73 mm Hg.” The doctor observed signs of respiratory distress. Examination findings included:
rales at the right base with diffuse wheezing and tachy- cardia. WBC count was 18,800/mm3 with a differential of 73% segmented neutrophils, 6% bands, 11% lympho- cytes, and 8% monocytes. Hematocrit was 55%.
A chest X ray showed soft tissue fullness around his trachea and the condition of the middle and lower lobe of his right lung seemed compatible with pneumonia. Fluid was steadily building up in the space between his lungs. An elec- trocardiogram disclosed atrial fibrillation. The patient was intubated, ventilated, and administered levofloxacin, dilti- azem, and insulin.
Soon after admission, Morris became hemodynamically unstable. He went into cardiac arrest and died just before 9:00 a.m., only hours after his eleven-minute call for help. Like Stevens, his blood cultures would grow
B. anthracis.
Autopsy findings would include hemorrhagic mediastinal
lymphadenitis, and immunohistochemical staining that would show evidence of disseminated
B. anthracis.
At what time government officials informed the Postal Service of what they knew about the Brentwood employee and the implications of his infection isn’t known. A USPS spokesman said the service learned on Saturday night. Se- nior vice president Deborah Wilhite said it was earlier, in the afternoon, before the three sorting machines were cleaned with compressed air.
At 10:00 a.m., just before he was about to appear on a news talk show, Frist learned that a patient’s test results had come back with a diagnosis of inhalational anthrax. The local public health office fully mobilized and within hours began testing Brentwood employees at a site made available by Washington Mayor Anthony Williams. By afternoon, groups of twenty at a time were being frantically shuttled from station to station for testing.
As the number of known cases of exposure to anthrax grew, the press began speculating that the anthrax could have come from foreign terrorists—but which group and which country? However, the authorities were unable to even identify the quality of the Daschle sample. Was it weapons grade or not? Were the spores nearly pure or adul- terated? As federal experts investigated the residual Daschle sample, the picture became fuzzier, not clearer. Everyone said it was unprecedented and unthinkable that a sealed let- ter could produce inhalation anthrax. There were no hard and fast rules in these days after 9-11.
The Hart Building contamination proved that key gov- ernment buildings could be totally immobilized for several months. The Daschle letter showed how mail processing in sorting centers could produce cross-contamination. But based on their limited experience, they again made a deci- sion not to close the Brentwood postal sorting office, a sprawling building that handles most of the mail in the na- tion’s capital. And when workers there started getting sick, some were told they had the flu and sent home.
Leroy Richmond was suffering respiratory distress from the fluid buildup. He was treated with diuretics and systemic corticosteroids, which limit platelet function much as aspirin
after.
Morris’s inhalational anthrax was confirmed postmortem on October 23 at the Prince George’s County facility. He was the first postal worker to die from anthrax. And no one had believed him.
“He died needlessly because of the negligence,” said Johnnie Cochran, the lawyer his family later retained. Tara Underwood, Morris’s stepdaughter, said the family heard the 911 tape, but she would not say whether the family was upset with the Postal Service or was considering any action against the agency.
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“We’re not making any statement at this time,” she said. A Kaiser statement said Morris died “because someone put anthrax into an envelope and sent it through the mail.” Five months later (March 26, 2002) his family would file a multimillion-dollar lawsuit accusing a Maryland medical center of misdiagnosing Morris’s symp- toms three days before his death. The case would be settled out of court for an undisclosed sum.
Late on Sunday, after Morris’s frightening and haunting 911 call for help and his terrible death, as sudden as a bolt of lightning, the Brentwood plant was closed. Bags of mail were trapped inside. Traces of anthrax were discovered at several offsite mail facilities that served government of- fices—the space agency NASA, the White House, and the Supreme Court. Scores of technicians moved through those
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When Morris’s 911 tape aired on television on November 8, 2001, he was called a “victim of terrorism.”
Norma Wallace’s fever persisted. Fluid was now escap- ing on both sides of her rib cage through small apertures. Doctors changed her antibiotics to ciprofloxacin, rifampin, and vancomycin. Sometimes two or three antibiotics proved more effective than one at eliminating a pesky bacteria. Meanwhile, Jyotsna Patel’s cell pathology was about to test positive for
B. anthracis
cell-wall and capsule antigens by immunohistochemical staining.
On Monday, Brentwood postal worker Joseph Curseen made his way falteringly to a Maryland hospital. He com- plained of flulike symptoms, but was sent home. That eve- ning he visited the emergency room again. This time he reported muscle aches, chills, indigestion, another spate of vomiting, and a second fainting episode. Curseen looked ill, his skin was mottled, and it felt cool to the touch. His ab- domen was mildly distended and he was in respiratory dis- tress and wheezing on both sides. His signs:
Temperature 35.6
°
C, blood pressure 76/48 mm Hg, heart rate 152/min, and respiratory rate 32/min. Curseen’s white blood cell count was 31,200/mm3.
Doctors administered penicillin and ceftriaxone. Ceftriax- one should not have been used for treatment of anthrax.
B. anthracis
isolates produce a wide-range antibiotic that in- hibits the antibacterial activity of ceftriaxone. By now Cur- seen was suffering from respiratory distress. Tubes were placed in his trachea and mechanical ventilation was begun. Soon after, the doctor observed signs of abdominal cavity inflammation.
Chest and abdominal CT scans showed that, like in Wal- lace, fluid was escaping on both sides of Curseen’s rib cage, but through larger apertures. A CT of his head was normal. With growth of
B. anthracis
from clinical specimens, a treat- ment of rifampin and levofloxacin was begun. Within eigh- teen hours gram-positive bacilli would be visible on the
buffy coat blood smear, and blood cultures would grow
B. anthracis.
Joseph Curseen died in the early afternoon the day after Morris and within six hours of admission to the hospital. Postmortem findings included prominent hemorrhagic me- diastinal lymphadenitis and evidence of systemic
B. anthra- cis
infection by histopathologic and immunohistochemical tests. Again, confirmation was on October 23. Two other postal workers remained hospitalized. Nine others were ill with symptoms. Officials were still testing twenty-two hun- dred postal employees.