ILLNESS LINGERS, LOYALTY WANES
29 Nov 2002
Source: Baltimore Sun, August 26, 2002.
THE TRIALS OF A CITIZEN SOLDIER
Illness lingers, loyalty wanes
Second of two parts
By Gary Dorsey
Dressed in khakis and a dusty green canvas jacket, Rich Richmond (case 14) enters the medical center with an easy gait and bright countenance, like a country gentleman returning from a brisk jaunt in a wintry woods. Certainly no one in the waiting room would suspect that just four months earlier this man nearly became a fatal victim in Washington's anthrax attacks.
"It was a Friday," he recalls, sinking into a chair in Dr. Michael Nguyen's office in Woodbridge, Va. "Just like today."
On that afternoon, Oct. 19, 2001, Rich left his job at the Brentwood Mail Processing and Distribution Center in Washington, pulled into the parking lot of this same medical center and slumped over his steering wheel. It was a struggle to get out of the car. While he waited for an opening in his doctor's calendar, anthrax toxins ransacked his system, nudging him closer and closer to death.
Ask him how he is on this brilliant February morning, and his response is relaxed and amazingly carefree. Rich does not hesitate. "I am well, thank you."
He has a team of doctors who speak cautiously of a full recovery. X-rays show clear lungs and no evidence of internal scarring. His kidney, liver and stomach have suffered no residual damage. Doctors see no trace of the blood disease that caught them unaware. At 140 pounds, Rich is thin but close to his normal weight. He walks a mile a day and shows up for appointments cheerful and talkative.
Along with Dr. Nguyen, his primary care physician, whom he will see today, even the most skilled specialists assigned to the case express optimism.
"From what I've seen of other infectious diseases, I'd say he's through it, and he'll be fine," said Dr. Jonathan Rosenthal, the infectious disease specialist with the Mid-Atlantic Permanente Medical Group who helped coordinate Rich's treatment in the hospital and guides his treatment today. "The only caveat is we don't know whether some people who have serious problems with anthrax will have problems related to it five or 10 years later."
His future looks so bright that Rich has decided to play a more public role as an anthrax survivor. He agrees to nearly every media request for an interview, hoping his example will comfort Americans who still fear that anthrax cannot be managed. One week he appeared on Inside Edition; the next, he talked to the New York Times. On Jan. 24, Bayer Corp. executives opened the New York Stock Exchange, as the company's stock went public for the first time, and Rich joined them as an invited guest. Three months after he lay dying at Inova Hospital, he stood on Wall Street applauding the effectiveness of Bayer's Cipro antibiotic.
The gratitude he feels also extends into small acts of service. When he learned that researchers wanted blood from anthrax victims to make a better vaccine, he donated 10 vials to the military's premiere anthrax scientists at the U.S. Army Medical Research Institute of Infectious Diseases in Fort Detrick. When he visited a local blood bank a few weeks before, he thanked every donor.
His doctors marvel at his recovery. No doubt, some say, it is due, in part, to a positive spirit and sense of mission.
"Life is not fair, and sometimes you get the small end of the stick," Rich tells people, "but at least you still have a stick. It's a beautiful life out there. You have to do something to make a difference."
But today, as Dr. Nguyen escorts him to an exam room, the doctor will learn that Rich's public facade does not square with what his wife, Susan, has detected at home. Rich wears out after playing soccer with their son; on a bicycle, he is breathless in a few minutes; Susan and he have all but given up one of their favorite pastimes, dancing, because he tires so easily. It will soon become apparent that the full mystery of Rich's illness has yet to reveal itself. Something corrosive and indistinct continues to play havoc with his body.
For Rich, an admission that all is not well has come slowly. For all her efforts, it was not Susan's prodding that brought him to this point, though. It was meeting other anthrax survivors.
At a television appearance in New York, he was introduced to Norma Wallace (case 11), a postal worker who contracted anthrax at the Hamilton, N.J., post office. As they chatted, Rich learned that Norma was plagued by persistent physical problems, aching joints, memory lapses - the same kind of insoluble ailments Rich has tried to ignore. Shortly afterward, he renewed contact with "George Fairfax," (case 17) the anonymous Brentwood supervisor and anthrax survivor, who confessed that he is so debilitated he can barely function.
So today, four months since his battle against anthrax began, Rich is willing to admit what he had tried to deny. He is still sick.
In public, Rich will continue to present himself as a good citizen soldier, not complaining, not casting blame. He does not want to cause trouble. But with the doctor, he speaks plainly: He is weak. He tires easily. His mind sometimes stalls out and loses connections.
After conferring and reviewing X-rays, Dr. Nguyen contacts Dr. Rosenthal and orders more tests. With this elusive disease, doctor and patient agree, they cannot afford to overlook a single detail.
"Can't cheat! Can't cheat!" yells Quintin. The boy has his dad squirming over a game of Uno in the living room. In the kitchen, Susan reaches for the phone but keeps an eye on a platter of fish in the oven.
It is now March. Almost five months have passed since Rich left the hospital. At home, everything looks settled again. Like a harbinger of spring, the houseplants thrive, green and healthy. Recent photographs of Rich with his father and brothers hang from the walls, picturing everyone as cheerful and secure. Voices of gospel singers chime softly on the stereo.
With both Rich and Susan still on leave from work, the family has fallen into a comfortable routine. On these cool days, they enjoy morning walks together, afternoon soccer with Quintin, regular dinnertimes, evening games and prayer. Beneath the gentle rhythm of life, though, illness intrudes.
"Rich!" Susan says. "The doctor called." Tests show his white blood cell count dropping precipitously. Dr. Nguyen wants to schedule a specialist.
Rich reaches for his pocket calendar and searches for an open date.
Susan keeps working quietly in the kitchen, but she feels like screaming. She is about to buckle.
A few days earlier, she had joined her 57-year-old husband at his appointment with Dr. Nguyen, and pulled the doctor aside in the hallway.
"You know he's having a problem with his memory," she said.
"I know," Dr. Nguyen said, "he'll be seeing a neurologist."
"And they need to test for fatigue - the stress. He's losing his strength!"
"Yes, I just talked to Dr. Rosenthal an hour ago."
"What's the panic point?" she cried. "I need to know the panic point! Nobody knows what's happening to my husband!"
Dr. Nguyen had nothing new to tell her.
Rich still presents a positive face to doctors, she says, now speaking softly in the kitchen just out of her husband's earshot. He still makes an effort to seem optimistic even when the facts don't warrant it. But doctors are not around, as Susan is, when short walks lead to long naps and conversations drift off subject or appointments go forgotten.
"The boy was sharp in October, and they took it from him!" she says. "I know he's old, but he was sharp in October, and they need to make him sharp again!"
The quake of desperation slowly recedes from her voice.
The days are a roller coaster, she confides. "Every time he goes to the store, I think, let him come back! And when he takes too long, I'm panicking. I call him and say, 'Rich, I'm not trying to baby-sit, but the doctors said any time that rare blood disease can come back, and it could be fatal. So just answer your phone when I call.' And he says, 'Sue!' And I say, 'Rich, I'm serious!'"
Financial worries also have started to plague her. Her leave from work is likely to end soon, and they think they have seen signs that the federal worker's compensation program, which covers 75 percent of Rich's gross salary, will start prodding him to return to work, too.
The Department of Labor recently sent a nurse to the house. The woman told Susan she would be Rich's health care "advocate" but needed them to sign papers giving access to his medical records. Susan would have nothing to do with it. "I've heard about nurses like you," she says she told the woman. "I don't see how you, having no experience with anthrax, can make a difference. He doesn't need you for an advocate when he has me!"
She refused to let the woman in the house.
But Susan knows they can only hold the Department of Labor at bay for so long. Most likely, Rich will have to retire rather than return to work. As for herself, she refuses to return to Brentwood. She has nightmares about work and distrusts the management. She is so afraid of anthrax she won't open her own mailbox - "You never know, today might be the day." She sees a therapist to help manage anxieties and has requested a transfer out of Washington so she can work closer to home. But even that would not be a real solution. A transfer, she has been told, would mean part-time hours and lower wages.
"Look, I'm 40 years old," Susan says. "I've got a 7-year-old, a 19-year-old daughter in college, a husband looking at retirement and a house note. Every time I leave home, I come back wondering if my husband's still going to be alive. What am I supposed to do?"
She takes dinner out of the oven and sets the table for supper.
In the living room, Quintin finishes playing and trots upstairs to wash. For a moment, Rich is free to talk.
He is not as stubborn as his wife sometimes thinks. Although he wants something positive to come from the sacrifice of anthrax victims, he is increasingly resigned to something less. Over time, he learns more about mistakes made in the Brentwood affair. He sees firefighters on television who have won recognition, reads about heroic airline passengers and brave Marines. Victims of Sept. 11 have a place in the collective heart of America. But postal workers and anthrax victims?
"You know, we're not heroes," he says, matter-of-factly. "A person who receives a bullet hole in the service of his country, that's a hero, because he's sacrificed for the right of freedom for those who follow. A person who gets anthrax in a terrorist attack may be helpful, but on a different level. Whether he lives or dies, the only good that could come of that is a better vaccine. That's the only good that will affect multitudes of people. Otherwise, you've just done your job. You've moved the mail."
On the other hand, he knows postal workers showed courage and patriotic resolve at a critical time. At Brentwood, some, like Joe Curseen (case 16), kept working even when they were sick. In New Jersey, Norma Wallace (case 11) left the hospital saying she felt chosen by God to be an anthrax survivor, hoping her example would send a message that terrorism in America didn't stand a chance. Not one of them went home complaining, blaming the Postal Service, harping at CDC or bemoaning their sorry luck. They thanked God and responded when scientists asked for their blood.
So he is left to wonder: Wasn't that a sacrifice? Postmaster General John Potter once described postal workers as "quiet heroes" in a statement to a Senate committee in November, but not a single public official in Virginia has contacted him. President Bush mentioned other heroes and victims in his State of the Union speech in January - but nothing about postal workers or anthrax. Has Tom Ridge, the head of Homeland Security, said one word about postal workers, he asks.
"It is curious," Rich says.
Observations like this are infrequent, though. Most days Rich prefers not to think about the sacrifice, whether it served a purpose or was heroic or if anyone remembers. If postal workers were victims like soldiers caught in friendly fire - one of those shameful mistakes of battle people later hate to acknowledge - he chooses not to pursue the inevitable questions. In the disorganization and lunacy of battle, whose victim was he? If he was a citizen soldier, moving mail through a national crisis, how should that be acknowledged? Who is responsible for the fate of those who died? Was he collateral damage in someone else's war?
Sometimes he consoles himself with hollow maxims. "He who expects nothing is never disappointed," he will say. Sometimes his comments are more pained. "I say whatever happens is for the best. If they tell me, 'Richmond, go back to work tomorrow,' I'll say, 'No problem, OK.' If they want to cut off my arm, I would not be troubled."
But occasionally, the barrier between denial and memory does give way, as it will tonight when something ordinary prompts a hurtful recollection.
In the living room, Rich points to a football autographed by the Washington Redskins. The ball sits perched on his stereo console like a trophy. Rich fixes on it momentarily; suddenly the relic becomes a revelation.
"The postmaster general sent me that," he remembers. "His P.R. person came to visit me at the hospital right before one of the games."
Rich pauses, sinking deeper into the recollection. The memory has been slow coming back. He recalls seeing a Postal Service executive on television at halftime and someone asking her how he was doing. He remembers she said he was doing fine: "He is watching the Redskins game and hoping they pull through."
He regards the ball, expressionless, then shakes his head and laughs, a hard little laugh. They did not care if he lived or died, he says - they only wanted people to think that he was happy watching the game.
But then, just as quickly, he changes the subject. A different tale has come to mind.
Early one morning recently, he says, when life had grown troubled, he roused Susan out of bed and led her to a window.
"What do you see?" he asked.
"The window's dirty."
"No, no, look beyond the window," he told her. "You see that? Can you see the sunrise? Why be troubled? I mean, my gosh! I have to smile. How beautiful it is!"
Tonight, as the family gathers for dinner, Rich tells the story again. He, his wife and son hold hands and say grace.
For a few hours, all seems well and, at least for the moment, life is good again at the Richmond house.
Since October's anthrax attacks, researchers at the federal Centers for Disease Control have made progress uncloaking the mysteries of anthrax. Using blood from Rich and other anthrax survivors, CDC's scientists and infectious disease specialists say they have a new perspective on chemical and biological processes that can advance the science and very likely save many more lives in any future attacks.
Last October's anthrax victims have, in a sense, become medical trailblazers.
Of the 11 Americans who contracted inhalation anthrax last year, five died, including Mo Morris (case 15) and Joe Curseen (case 16), Rich's friends at the Brentwood facility. Because the history of inhalation anthrax until now included few survivors, medical researchers have been eager to examine the clinical details of the six Americans who survived and study their progress.
"Their blood samples are extremely valuable specimens from a number of perspectives," says Dr. Bradley Perkins, CDC's lead anthrax researcher. It's being used to develop better diagnostic tests and to gauge new candidate vaccines. Eventually, Perkins says, the samples will help researchers assess "the entire repertoire of human antibody response [to anthrax] at the genetic level," leading to a more sophisticated understanding of what remains a very mysterious illness.
But while researchers are enthusiastic, several of the survivors admit they find little consolation in the news. They feel forgotten and wronged. Like Rich, most are still sick. They remain reluctant citizen soldiers, offering perspectives that might startle the very physicians and scientists who rely on their bodies for research.
Here is "George Fairfax," the Brentwood supervisor: "They say our blood will save the nation. But yet we aren't recognized. I didn't volunteer for this mess. I didn't sign up to be a guinea pig. I'm doing my job, the next thing you know, I've got the flu. The next thing, I'm scared to death will I see the end of the day. Will I see my birthday? Will I see next year? I'm treated like toilet paper."
David Hose (case 20), of the State's Department's mail facility in Sterling, Va.: "We're less than second-class citizens. They [doctors] act like they are afraid to do anything to treat me, like they don't want to mar a pristine case of anthrax, like they want to make sure I get all the symptoms that I would get without interference from them. I'm a guinea pig."
Norma Wallace (case 11), of the Hamilton, N.J. postal center: "I think we have been exploited enough. The research that CDC and the military are doing on me and other survivors does not benefit us. We get no closure. They get the accolades and the money and the recognition. But we're like experimental animals."
Unlike Rich, these survivors can barely conceal the bitterness they have for their employer. The fact that by midyear, the FBI had yet to make an arrest was also of concern.
"The people who bombed the World Trade Center, they were suicidal," says Wallace. "So as far as the government is concerned, they will never go to trial. But the person or persons responsible for the distribution of weapons-grade anthrax, where is the accountability for that? I am really angry about that. It's sending a message that we don't matter."
As for Rich, after eight months, he is still reluctant to criticize. He continues to give blood. He sits for X-rays, slips into brain-imaging machines, puzzles over diagnostic memory games. So far, his test results have left doctors confounded.
Rich is not anemic. There is nothing wrong with his liver or his kidneys. Overall, he seems OK. But he still feels weak, tires easily, experiences frightening lapses in memory. Particularly in conversation, it is evident that his train of thought tends to jump track and meander.
Rich does listen to what the others say. He has spent hours on the phone with fellow survivors. He talks with other Brentwood workers and has learned more about how the anthrax exposures occurred. He hears talk about his former colleagues meeting with attorneys over a potential lawsuit against the Postal Service, discussions that have sparked Susan's interest. Temperamentally, it is his way to stand beyond conflict. And yet the cacophony of bitterness, incomplete medical opinions and, in particular, efforts to nudge him back to work, make it harder for him to avoid a response.
Sometimes he will hark back to conversations he had in the hospital with Dr. Arthur Friedlander, one of the nation's leading anthrax specialists at Fort Detrick. He remembers Friedlander mentioning that in experiments with primates, anthrax toxins appeared in monkeys' brains after death. Occasionally, Rich wonders if dormant toxins have entered his brain, too.
So far, tests have not identified the source of his problems. But physicians are concerned, especially because they hear almost identical reports from the other survivors. Wallace, Hose and Fairfax continue to suffer many of the same ailments. The two men, in particular, have had such trouble breathing that even simple conversation is sometimes punctuated by gulps for air.
"So these symptoms lack objective correlates," says Dr. Rosenthal. "But I also think they are completely real. It's entirely conceivable there's something about this disease that results in these chronic problems."
For Rich, it has been like this from the beginning. Ever since anthrax exploded in his life, he has struggled with enigmas.
Most importantly, just as the physical mystery remains, his central quandary - why this happened to him - also persists. In some ways, the solution should be simple, since he does not have to rely on memory or speculation for answers. He could simply turn to the public record. And yet the reason why he, Leroy Richmond, was drawn into the violent inauguration of America's terrorist era remains difficult for him to grasp. It stays tangled up in time, mired in the uncertain response to last fall's terrorist attacks when straight answers were often clouded by fear and surging patriotic fervor.
In late October, while Rich was still in the hospital, Congress held hearings that addressed the question of what happened at Brentwood. Sen. Joseph Lieberman, chair of the Senate Committee on Governmental Affairs, concluded that the facility should have closed Oct. 18, three full days before postal officials shut it down. That was three days before Mo Morris (case 15) died, a day before Rich was diagnosed with anthrax and Susan called in her warnings to close the plant.
District of Columbia Rep. Eleanor Holmes Norton remarked about how "people who are paid to take risks - government officials - take no risks and the people not paid to take risks [postal workers]" were told to keep working.
Although the postmaster general wanted to calm a panicky American public about the safety of its mail, the hearings showed there could have been no such assurance. When the anthrax-tainted letter passed through Brentwood the morning of Oct. 11, no one had seen it coming, and when it left, no one had a clue what it might disperse.
One senator, after listening to testimony, called it "a bureaucratic snafu of the first order."
Yet transcripts from the hearings also reflect what has become the central dilemma of Rich's struggle: Through days of questioning, participants made a remarkable effort not to cast blame for the tragedy. In a time of fear and fervent flag-waving, anxiety and patriotic zeal, congressmen and investigators, scientists, physicians, even representatives from postal employee unions tiptoed around the issue of culpability.
The most startling example was William Burrus, president of the American Postal Workers Union, the largest postal union, who refused to point a finger at either Postal Service management or CDC officials. It would be senseless, he said, to compare the decision to close congressional buildings with the decision to leave postal facilities open. The impact of closing the Postal Service, he suggested, would have been more profound. Rather than question mistakes, the union's position, he said, was to "move beyond blame."
I've tried to focus our members on the real culprit in this situation," Burrus testified. "It's not the CDC, it's not the United States Postal Service or local health authorities. Although perhaps, looking backward with perfect vision, some mistakes were made - retroactive mistakes. But I find it serves little purpose for me to impress upon my membership that their national union is in major disagreement with their employer because those employees go to work every day being psychologically challenged, wondering, is this the day? Do I contract anthrax today? And I believe that anything that moves them off that fine line perhaps may lead to the closing of the United States Postal Service."
The Postal Service was in crisis. The country was in crisis. And the mail had to move.
The hearings concluded that a bureaucratic problem had occurred: competing interests - CDC, the FBI, the military - failed to communicate their varied assessments of the danger. Beyond that, there was little to say about tragedies that occurred. Whatever clamor that had arisen over the deaths and illnesses of postal workers waned almost immediately. The nation's attention shifted to Afghanistan, the Middle East and Wall Street. Anthrax victims - postal workers - dropped from sight.
In the first weeks after leaving the hospital, as Rich went from doctor to doctor, nurses would sometimes greet him at reception desks as if he were a hero. "How are you, Mr. Richmond!" they would say, enthusiastically. By spring, though, with the anthrax episode becoming a distant memory, their greetings were less inspired, and Rich's response was simple and straightforward.
"Who am I to complain?" he would say with a wan smile.
If you looked closely, sometimes you could see he was still wearing a pin bearing the insignia of the U.S. Postal Service.
It is a fine morning, late in May, when Rich pulls into the lot at Dr. Nguyen's office. Susan jumps out of the car and rushes into the building. The Department of Labor has again sent a nurse to seek access to Rich's medical records.
It is the first time Susan has seen the nurse since she showed up on their doorstep in February. Susan takes the woman aside, speaks sharply to her. Then Rich, Susan and the nurse disappear down a hallway to see Dr. Nguyen.
The weather is warm and sunny. It will soon be summer. And doctors still do not have a clue what's wrong with their patient.
The nurse asks for a full report on his health, but Rich will not authorize it. Dr. Nguyen wants to protect his patient from potential harassment or pressure to return prematurely to his job. He offers her only a summary. It's apparently not good enough. The meeting ends abruptly.
Dr. Nguyen schedules more blood work, an MRI and additional tests to assess Rich's memory problems, then directs him to the lab downstairs for a chest X-ray.
In the waiting room, Susan meets Rich's daughter, Pia.
"The Labor Department sent us a note saying they'll stop his check," Susan says, anger still in her eyes. "And your Dad's talking about, 'Well, I'll go back to work,' and I'm telling this nurse from the Labor Department, 'We don't need you saying you'll interrupt his money. We don't need you stressing him out. We don't need you!'"
"Some of that stuff is really just none of her business," Pia replies.
"He was getting ready to sign a release letting her go talk to [his psychiatrist]. I said no. He's just too easy. He's easy!"
"But, see, she's coming off like she's an authority," Pia says.
"That's true, your Dad does respect authority. He just does. That's how he is."
But there's a subtle change in Rich today. Maybe it happened on the drive over, when he swerved on the road, slipped onto the shoulder, crossed the center line and, once, stopped for no apparent reason. Or maybe it's what he now remembers of a Brentwood supervisor who visited him in the hospital. The man had remarked how bad Rich looked at work the week he got sick. Rich has been left to wonder: "Why didn't he say something then?" Or maybe it's this sense that he is being pressed to go back to work.
Whatever it is, at last Rich seems to be putting the pieces together for himself. He has reviewed the record and reflected on his experience. He now understands the mistakes that were made. And he is finally prepared to consider legal action.
When he finishes with the X-ray, he enters the lobby to meet Susan and Pia. He looks uncommonly somber.
"I don't want to see this in court or anything like that, to be honest with you," he says. "But I am leaning in that direction."
Filing a lawsuit is a step he has quietly contemplated for weeks now. But not to recover something for himself, he says. No, not for him - for Pia.
"Her main objection to the post office is they have been so silent and unresponsive, and act like we are nonexistent," he says. "That's hurting her. She wants some acknowledgement and for them to say, 'Look, man, you've suffered enough, get out of the post office.' "
But if legal action would be for Pia's sake, what about him? Wouldn't the admission of mistakes allow him some personal resolution, free him from the continued responsibility of being the good citizen soldier?
Rich starts to answer. He lists grievances, points out errors that were made. He sounds firm and insistent. But suddenly he stops, just short of anger. A puzzled look comes to his face. His brow folds.
"I ... " He stares into space a moment, then turns back. Something has escaped him.
"I don't know," he says.
The look of puzzlement gives way to a flash of fear. He tries to shake it off, but it's too late. He's lost again.
"I don't remember what ... What? I'm sorry, what was the question?"