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Last Updated

08 Nov 2003

Source: Wall Street Journal, November 27, 2001.

Anthrax Victims' Fate Varied By Their Hospital and Doctor


On Oct. 21 -- one day after the mayor of Washington, D.C., announced that a worker at the Brentwood postal center possibly had anthrax -- two other Brentwood workers showed up at hospitals 26 miles apart. Both complained of run-of-the-mill flu symptoms. Both were actually suffering from inhalation anthrax.

By the end of the day, one of the men was diagnosed with the flu and sent home, where he died the next day. The other man was put on the antibiotic Cipro -- hours before tests would confirm that he had anthrax. He's now resting at his home.

At times, medicine is still more art than science. Even when presented with common illnesses, doctors have a woeful record of following one proven, successful course of treatment. Getting the right treatment can sometimes be like a game of Russian roulette. The role of luck is even greater when facing the rare illnesses wielded by bioterrorists. Especially in the initial stages of attack, life or death may come down to which hospital a patient chooses, and which doctor is on duty.

The inhalation-anthrax death last week of a 94-year-old Connecticut woman heightens the pressure on doctors and hospitals. Ottilie W. Lundgren (case 23), who came to the hospital with a fever and what she thought was the flu, didn't fit the profile of a person who could have been exposed to the bacterium. Doctors ran blood tests in order to prescribe the most appropriate antibiotic for her, and the results revealed anthrax the following day. She died four days later, despite being put on Cipro and two other antibiotics. It's not clear that putting her on antibiotics a day sooner would have made any difference.

Now, on the eve of flu season, Mrs. Lundgren's death shows that doctors have to be extra vigilant for anthrax even in cases where patients wouldn't appear to be at risk. Investigators are also examining other Connecticut hospital deaths since Sept. 11 to see if anthrax could have gone undiagnosed in other patients.

In the Washington cases, four postal workers from the Brentwood Road facility were infected with inhalation anthrax. The two who were diagnosed correctly, and who survived, both went to the same hospital for help: Inova Fairfax Hospital in Falls Church, Va. Remarkably, Inova kept those two anthrax victims alive after they already showed symptoms -- even though the expected death rate is more than 85% within three days of symptoms appearing, according to medical literature.

The first Brentwood employee to check in with a doctor wasn't diagnosed with anthrax. Thomas L. Morris Jr., 55 (case 15), went to his doctor's office at a facility belonging to Kaiser Permanente, a health plan, in Maryland on Oct. 18, before Washington's mayor raised the alarm about anthrax and postal workers. Mr. Morris didn't feel good and believed he had been exposed to anthrax at Brentwood. His doctor called the state department of health, which told him that mail employees weren't at risk and that antibiotics should not be prescribed.

Mr. Morris was sent home by his doctor, with directions to take Tylenol for his aches and pains. He died a few days later in a hospital after calling 911 from home and telling the operator he feared he had been exposed to anthrax.

On Oct. 19, the day after Mr. Morris went to his doctor, 56-year-old Leroy Richmond (case 14) went to the emergency room of Inova hospital. Anthrax was certainly not on the mind of emergency-room doctor Cecele Murphy when she came upon Mr. Richmond. The ER was hectic, well on its way to treating nearly 300 patients that day, and Dr. Murphy had already seen dozens of patients on her busy, 10-hour shift.

Dr. Murphy, a tall woman with short blond hair and crystal blue eyes, didn't think Mr. Richmond had much to worry about. His symptoms -- sore throat, some difficulty breathing -- seemed common enough. She suspected pneumonia after an X-ray of his chest showed a slight abnormality.

Dr. Murphy was planning to send Mr. Richmond home with a few pills. But then, on the noisy ER floor, where 33 sick bays ring a lively administrative desk full of doctors and nurses, the man said: "I'm from Brentwood, you know."

"What's that?" she asked.

It's a postal facility, he explained. Most of the mail he handled, he told her, goes to the U.S. Senate.

Dr. Murphy grew concerned. Her daughter's friends had recently crowded into her home because they had been shut out of the Senate building where an anthrax-tainted letter was opened by an aide to Senate Majority Leader Tom Daschle.

Dr. Murphy decided to give Mr. Richmond a CT scan of the chest, to look for a widening of the mediastinum, the area between the lungs. It turned out that Mr. Richmond's mediastinum was indeed wider than normal, a potential sign of anthrax. She took some blood and sent it to the hospital's microbiology lab to test for the bacteria. And she immediately put Mr. Richmond on Cipro.

Dr. Murphy told Mr. Richmond: "I don't think you have anthrax, but we're going to treat you as if you do until we know more." Then, Dr. Murphy, who believes that patients' positive attitudes play a role in recovery, said to him, "You will be fine."

Dr. Murphy is modest about her role in saving Mr. Richmond's life. "Was it the grace of God? Luck? I wish I could tell you," she says. "I just listened to my patient. He said, 'I know my body, and something's just not right.' "

Two days later, on Sunday, another Brentwood employee, Joseph Curseen, 47 (case 16), drove himself to Southern Maryland Hospital Center in Clinton, Md. He'd been feeling sick for nearly a week, and thought he had the flu. A chest X-ray was judged to be normal, so doctors concluded Mr. Curseen had stomach flu, gave him intravenous fluids and discharged him after three hours. (Experts say chest X-rays aren't always helpful in diagnosing anthrax; chest CT scans are recommended instead.) The doctors didn't ask if he was a postal worker. He died the next day.

Meanwhile, back at Inova, Mr. Richmond wasn't out of the woods. Susan Matcha, the infectious-disease doctor who took over Mr. Richmond's care, worried about the grim statistics on survival of anthrax patients as she drove to the hospital that Sunday morning. Dr. Matcha, a 35-year-old Kaiser Permanente employee, asked herself, "What can I do for this man?" What she knew about anthrax patients was that many appear to be getting better, then get bad very quickly and die. "It was daunting," she says.

Dr. Matcha talked to doctors at the Centers for Disease Control and Prevention in Atlanta. "We started to discuss different drugs. They gave me several suggestions that made a lot of sense to me. But ultimately, the decisions were mine," she says.

Dr. Matcha decided to put Mr. Richmond on rifampin, an antibiotic used for tuberculosis that also works well against "gram positive" organisms such as anthrax. She also put him on clyndamycin, which is known to intervene with certain bacteria's production of toxins, a particularly harmful result of an anthrax infection. And she increased the dose of Ciprofloxacin, or Cipro, to every eight hours from every 12 hours -- higher than the guidelines recommend. "We didn't have anything to lose," she says.

But now she had another problem. An emergency-room doctor paged her, saying he had a patient complaining "of the worst headache of his life." A lumbar puncture test, which took fluid from the spine, was negative for meningitis. The ER doctor was at a loss, so he asked Dr. Matcha if there could be some infection that would cause such a horrible headache.

There were plenty of infections that could cause severe headaches, but by now, Dr. Matcha had only one thing on her mind. "Where does he work?" she asked.

"I think he's a postal worker," answered the ER doctor.

"Go ask him where. I'll hold on," she told him. When he came back to the line, the ER doctor said: "Someplace called Brentwood."

"Take his blood and put him on intravenous Cipro," Dr. Matcha ordered. Hours later, the postal worker's blood showed the anthrax bacteria.

The antibiotic cocktail that Dr. Matcha chose for Mr. Richmond as well as the second man, who hasn't been identified (case 17), appeared to have a major role in saving their lives. Both have been released from the hospital and are taking oral antibiotics. Anthrax is gone from their blood.