POSTAL INSPECTOR'S SEVERE ILLNESS
19 Dec 2002
Source: Baltimore Sun, July 15, 2002.
Postal inspector's severe illness defies diagnosis after 9 months
He was exposed to spores on the job, but tests fail to show he has anthrax
By Scott Shane, Sun Staff
Bill Paliscak has a cross-shaped scar on his chin: a horizontal cut opened some years back by a hockey puck, and a vertical scar made later by a hockey stick.
It's a symbol of the ferociously healthy life he left behind in October, when he spent several days working around anthrax-contaminated mail-sorting equipment in Washington. His exposure was swiftly followed by a devastating, debilitating illness that has never been officially diagnosed and has never been cured.
Before he got sick, says Paliscak, a 38-year-old criminal investigator for the U.S. Postal Inspection Service, he played ice hockey twice a week with fellow federal agents. He lifted weights three times a week. He ran in races. He missed three days' work in nine years.
"I didn't have a doctor," says Paliscak, who sports a tattoo on his bicep from his four years in the Marine Corps. "We didn't even have a thermometer in the house. My theory was to sweat an illness out -- sweat it out playing hockey."
But as he describes this previous life, he is lying in a sixth-floor room at Sinai Hospital in Baltimore, his home for nearly four of the past nine months, as doctors have struggled to find out what is wrong with him.
He has been on two or three antibiotics since October. He's on anti-inflammatory drugs and powerful painkillers for intense pain caused by pleurisy, inflammation of the membrane around the lungs. He's on steroids for glandular dysfunction that has left him dizzy, unsteady on his feet and occasionally halting in his speech and erratic in short-term memory.
His face and body appear swollen, and he walks like a man twice his age.
An oxygen tube clipped beneath his nose makes up for low blood oxygen, which doctors can measure but not explain. The bouts of breathlessness -- that is the worst thing of all, he says.
"It's like someone's holding you under water," he says. "They let you up for a second and push you down again."
There is little doubt that Paliscak breathed in large numbers of spores of Bacillus anthracis, spilled in the Brentwood mail processing center from a still-unidentified terrorist's letters to two U.S. senators. He remembers dust showering down on him as he removed a filter above a mail-sorting machine that was later found to be grossly contaminated with anthrax.
There is no doubt that he got very sick a few days later, that some of his symptoms resemble the symptoms of inhalation anthrax and that his illness is not psychosomatic. Objective lab tests show several organ systems are out of whack.
But sophisticated testing for anthrax by the federal Centers for Disease Control and Prevention in Atlanta failed to detect either anthrax bacteria or antibodies to the bacteria or toxin in Paliscak's blood, according to a CDC spokesman.
"I think we've exhausted anything we can possibly do in this case," said the spokesman, Llelwyn Grant. He said CDC doctors -- who recently issued a report saying that eight deaths of Brentwood postal workers since last fall were unrelated to anthrax -- were unwilling to discuss Paliscak's case or the reliability of the anthrax tests with a reporter.
Paliscak's physicians at Sinai, Dr. Gary Kerkvliet and Dr. Tyler Cymet, can't say he has anthrax because the tests don't show it. But after hundreds of tests ruling out everything from Legionnaire's disease to AIDS, they can find no explanation for his relentless illness other than exposure to anthrax.
"I wanted to find another reason," says Kerkvliet, an internal medicine specialist and assistant professor of medicine at the Johns Hopkins University. "I said, 'Bill, I can't say this is anthrax.' But to my mind, more than ever, it's related to his exposure to anthrax.
"I've come as close as I can to saying anthrax caused the illness. But I don't have the organism."
The doctors wrote his case up for a medical journal in January, hoping to find other cases of inexplicable illness in people exposed to anthrax spores. They found no one like him, although they are intrigued that several of the people who survived confirmed cases of inhalation anthrax last fall have reported continuing health problems, including severe fatigue.
"Bill Paliscak is in a class by himself at this point," says Cymet, an osteopathic physician who heads family medicine at Sinai and is also on Hopkins' faculty.
Kerkvliet and Cymet are reluctant to criticize the CDC, which has been under intense pressure since five people died of anthrax in the mail attacks last fall. CDC specialists did visit Paliscak briefly in December.
But despite the serious implications for public health if anthrax can cause severe disease that is not identifiable with existing tests, there has been no sustained attempt by anyone other than Paliscak's doctors to analyze his illness.
"It would seem to me [the CDC] would be interested in studying his case more closely," Kerkvliet says simply.
While anthrax has long been studied in animals, few cases of inhalation anthrax in humans have occurred in the developed world in recent decades. In the United States, the scientific literature is based chiefly on studies of a few woolen-mill workers conducted in the 1950s and 1960s, as well as on the still-emerging data from the attacks in the fall.
Cymet, who has been consulting the doctors treating the anthrax survivors, says scientists still have much to learn about the anthrax bacterium and the toxin it produces. "I definitely think we need better test methods," he says.
On June 3, after several months of battling by Paliscak, his family and the Postal Inspection Service, the U.S. Labor Department reversed itself and accepted his illness as work-related. The department approved three diagnoses: disease of the pericardium, the sac that encloses the heart; partial collapse of the lung; and pleurisy.
It also approved a grim quintet of medical problems for coverage under workers' compensation: swelling of both legs with fluid, low blood oxygen, coughing up of blood, chest pain and abnormally low blood pressure.
Kerkvliet immediately wrote back to tell the Labor Department that he considered its ruling "very narrow" and to list a dozen more of Paliscak's "myriad symptoms," saying "his condition continues to defy definitive diagnosis by me and a host of consultants."
"It is not entirely clear to me that the [Labor Department] is acknowledging my patient's exposure to an agent of bioterrorism [anthrax]," he wrote. "This agent of bioterrorism has killed other patients and has seriously compromised my patient's health."
Paliscak's fellow postal inspectors have rallied around him, visiting him at the hospital and at the house on the water he shares with his wife, Allison, in Edgewater near Annapolis.
Once last winter, he mentioned to his colleagues that he'd run out of firewood. "About 12 guys [from work] got up early one Saturday -- some from Virginia, some from Pennsylvania. They cut two cords of wood and delivered it and stacked it," he says, marveling at the generosity.
That's partly because of Paliscak's work ethic, says Shaun M. O'Hara, assistant inspector in charge of the Postal Inspection Service's Washington metropolitan division.
"Bill's always been a dependable, hard-working, tenacious investigator with good judgment," O'Hara says. "A day doesn't go by that you don't hear someone ask how Bill's doing. We're all very distraught. We just want to see him get better."
Paliscak acknowledges being deeply frustrated by the severity of his illness, its unpredictability and the reluctance of medical authorities to acknowledge that it was caused by anthrax.
"All I want to do is get better and go back to fighting crime," he says. "I miss my job. I miss my co-workers. I'm begging the CDC to help me get better."
Awaiting possible exploratory surgery this week to find a cause for his diminished lung capacity, Paliscak finds it hard to be hopeful. But he knows some of his colleagues are working with the FBI to find the anthrax mailer, and if they succeed, he has an idea.
"I'd like to get better in time to make the arrest," he says. "I'd just love to slap the bracelets on the guy who did this."