The Anthrax Letters: The Attacks That Shocked America (16 page)

Dr. Topiel, an infectious disease specialist, was walking out the door of the hospital when he was paged by the emergency room doctor. “We have somebody here who I think you need to see. She’s from the post office and she’s short of breath.”

His white hair and mustache notwithstanding, Topiel looks and sounds like Richard Dreyfuss, the actor. “It was around 5 o’clock,” he said. “She was lying on a stretcher and looking very ill, didn’t seem like routine pneumonia to me.” Like most people, he was aware of the anthrax outbreaks in Florida and New York. As she listed her symptoms, he thought about the possibility that she had inhalation anthrax. The doctor who had seen Norma 2 days earlier had treated her illness as a viral syndrome and had not prescribed antibiotics.

When Topiel mentioned his suspicions to some associates, they were skeptical. “Marty, don’t be silly. This isn’t New York. This is Mount Holly,” one of his fellow physicians said. The reaction was reminiscent of the one heard by Dr. Larry Bush 2 weeks earlier in Florida. Like Bush, Topiel was persistent. “I think it’s anthrax until proven otherwise,” he said. When I told Dr. Topiel that Dr. Bush had used the same words—“anthrax until proven otherwise”—he grinned. “Larry Bush worked with me at this hospital before he went to Florida.” They had rarely seen each other since. He thought for a moment and wondered aloud, “What are the odds that the two of us would have seen the rarest of illnesses in a bioterrorist event?”

Over the weekend Topiel was on the phone with a number of physicians—the covering doctor, the radiologist, the lung specialist, people at the New Jersey Department of Health. Late Saturday, when a second chest X ray showed enlarging pleural effusions, he and the pulmonary doctor decided that Norma’s chest should be aspirated. On Sunday morning, on the way to a Jets football game with his 11-year-old son, Ben, Topiel stopped at the hospital. “I walked in when Norma was being tapped and I saw this bloody fluid being removed. My jaw dropped.” He felt all the more strongly that he was seeing anthrax. But there had been no confirmation yet from the CDC. During the football game, Topiel was continuously on his cell phone, wondering about the blood culture taken on Friday. In recalling that time, he tells of an experience he had 20 years earlier.

Following medical school at New York University, in 1979 Topiel began 5 years of training in infectious diseases at George Washington University in Washington, D.C. In 1981, after the assassination attempt on President Reagan, Topiel assisted in caring for James Brady, his press secretary, who also was wounded. He recalled: “What I learned then was that there is something called ‘V.I.P. medicine.’ That means that when you do things differently than you normally do in routine care, mistakes happen. Incorrect care is sometimes given.”

Norma Wallace had been fast tracked and given priority care—in Topiel’s vernacular, V.I.P. medicine. On Friday night, after Norma’s blood was drawn, he had contacted the state health department to say that her blood needed to be cultured for anthrax. Two days later, with no word about the results, he found out that neither the state nor the CDC had received her samples. Topiel’s voice lowered, reflecting his continued sense of disappointment: “Apparently the blood samples that were taken somehow remained in the emergency room, because everybody was running around. So we didn’t have the blood cultures to guide us at that point. That was the one time this happened in the 18 years I’ve been here.”

When the CDC finally obtained the samples, no anthrax could be cultured. Whether the negative finding was somehow a result of the blood sitting on the shelf for 2 days is a question Topiel still ponders. Fortunately, the delayed testing only affected the timing of CDC’s confirmation, not the treatment Norma received. She was already on intravenous Cipro, rifampin, and vancomycin and having fluids drained from her chest. It was only later, from tests conducted on her pleural fluid, that anthrax was confirmed. In any event, a week after her admission to the hospital, she was able to breathe more easily, and she began to feel stronger.

Just before being discharged, on the evening of November 5, Norma agreed to appear at a press conference at the hospital. Topiel walked into the conference room with her. “About 40 people were there,” he recalled. “I did a little speech, very short. Then she went up to the podium and gave an incredible, powerful message.” Norma recalls that evening clearly. What did she say? “We must not be fearful of the terrorists. We need to stand up against them. I just need to express that and not sit back about it.” Although still feeling ill, Norma felt emboldened by her experience. But the effect on a fellow worker at the Hamilton postal center was very different.

A turn onto Lanwin Boulevard in Princeton Junction leads to a stretch of spacious homes and manicured lawns. As I drove slowly down the street, a cyclist pedaled sluggishly along the roadside path. Two streets in from the boulevard, a white colonial-style house is set behind a row of perfectly trimmed hedges. Jyotsna Patel, like Norma Wallace, had been a postal worker at the Hamilton facility. Wearing a loose-fitting maroon blouse and black pants, she smiled weakly. “Please sit down,” she said, pointing to a firm white living-room couch. Her speech, though slow, carried the rhythmic sounds of her native India. She carefully lowered herself into a high-back chair at a right angle to the couch. Behind her the dining room was visible, eight chairs spaced evenly around a dark wood table. At Jyotsna’s right a small table supported a photograph of her and her husband, Ramesh, an architect with a construction company in New York City. They moved to the United States in 1980, shortly after their marriage in India. “The picture was taken 4 years ago,” Jyotsna said, when she was 39 and he was 43. Both faces appeared strong and vigorous. Until the fall of 2001, those images mirrored reality.

Dr. Baksh Patel (no relation to Jyotsna and Ramesh) thought back to Tuesday, October 16, 2001, when Jyotsna visited his Hamilton office with chest pain, shortness of breath, and fatigue. As her primary care physician, Patel had known Jyotsna to be focused and energetic. “Bronchitis,” he decided. “Don’t worry. Go home and get some rest, and everything will be fine.” He prescribed levofloxacin, whose brand name is Levaquin. Like Cipro, Levaquin is in a class of antibiotics known as quinolones, which are effective against many of the same bacteria.

In our interview, Dr. Patel said, “Don’t ask me why I gave her Levaquin.” He realized of course that a different choice could have been useless against
Bacillus anthracis
, the bug later determined to be the cause of Jyotsna’s illness. In short-sleeved khaki shirt and gold-rimmed glasses, he looked past the pile of charts on his desk. “It was a gut feeling that I can’t explain.” His satisfaction about his choice of drug was obvious.

Despite the prescription, the next day Jyotsna’s condition worsened. On Wednesday evening Ramesh became frightened: “Around midnight she started to choke, couldn’t breathe. When she talked she was confused. She was making no sense.” After 20 minutes she recovered somewhat, and they decided to wait until morning to contact the doctor. When Ramesh called on Thursday, Dr. Patel said Jyotsna should stop at Capital Imaging, a radiology center near his office, to have a chest X ray taken and then to bring it to him.

By the time Jyotsna arrived at Dr. Patel’s office on Klockner Road, it was 3 p.m. She could hardly stand. When the doctor looked at her X ray, Ramesh recalled, “he was really worried.” Dr. Patel told them, “Her chest is filled with fluid. She has a real bad pneumonia.” He turned to Jyotsna: “I’m calling the hospital. They’ll be making arrangements for you, so go there right now.”

That was on Thursday, October 18. By then, it was public knowledge that anthrax letters had been processed at the Hamilton postal facility. “I work on a sorting machine there,” Jyotsna had told the doctor, expressing her concern that the letters might have something to do with her illness. The notion seemed far-fetched to Dr. Patel. And why shouldn’t it? Health officials had not considered postal workers to be at risk from the letters. Nor could he have known that on that same day the CDC would confirm that another New Jersey postal worker had cutaneous anthrax. Teresa Heller, the woman with the skin anthrax, had nearly recovered by the time her diagnosis was made. Still, the implications were ominous. Heller was a mail carrier based in the West Trenton post office, which received mail directly from the Hamilton center on Route 130.

When Dr. Patel saw the white mass on Jyotsna’s chest X ray, he thought it might be a malignancy. He knew there was a strong history of cancer in her family. Still, he was leaning toward pneumonia, certainly not anthrax. The news about Heller had not yet reached the public.

Jyotsna went directly from Dr. Patel’s office to the Robert Wood Johnson Hospital in Hamilton, a half mile away. Ramesh and Jyotsna continued to worry about the diagnosis. “At the hospital, I insisted they check her out for anthrax,” Ramesh said. Her nostrils were swabbed and a blood sample was placed in a nutrient growth medium, but neither sample grew
Bacillus anthracis
. As Ramesh later learned, the antibiotics she had been taking for 48 hours could have killed the bacteria, while their toxin continued to poison her body. He recalled that even 3 days after she had been admitted to the hospital, “they were still saying, ‘pneumonia, pneumonia.’” In fact, her treatment would have been much the same had the diagnosis been anthrax. Jyotsna was now receiving intravenous Cipro and azithromycin, and fluids were being drained from her chest.

Days before Jyotsna entered the hospital on October 18, newly discovered anthrax infections in New York City were being reported by the city’s health department. Then on the day that Jyotsna was admitted came the word of the first New Jersey cases, Teresa Heller and Richard Morgano, and on the next day a third case, Patrick O’Donnell. All were postal workers. This prompted DeFerdinando’s decision to call in all 1,200 workers connected with Hamilton for testing and to start them on Cipro.

Ramesh had previously informed Jyotsna’s supervisors that she was in the hospital with pneumonia. But on Saturday he received a call from postal authorities wanting to know why Jyotsna had not reported to the RJW-Hamilton Hospital for testing and to receive Cipro. Ramesh replied with a mixture of anger and amusement: “What do you mean she hasn’t reported? She’s been living in that hospital. Same hospital. She’s in Room 21, and she’s been there for 3 days.”

After a week in the hospital, Jyotsna’s symptoms had improved, and on October 26 she was discharged. Meanwhile, as the anthrax outbreak had become more clearly related to the mail, Jyotsna’s diagnosis came under scrutiny. Even though her nasal swab and pleural fluid tested negative for anthrax, her symptoms seemed similar to the other inhalation victims. On the last day of her hospital stay, the CDC reported that the immunohistochemical staining was positive for samples from her pleural fluid and her bronchial passage. She had anthrax. Although deemed well enough to leave the hospital, for Jyotsna and her family the misery continued. Nine months later Ramesh said, “We have been through hell. You have no idea.” He recounted the continuing toll:

Ramesh reflected on the effects on Plita, at 19 the older of their two daughters. A sophomore at New York University, she can hardly bear to call home. Whenever she does, Ramesh said, “She would cry over her mother for an hour.” In the midst of the ordeal Plita developed colitis, all while trying to attend to her studies. “For us,” Ramesh says, “like I said before, it has been hell.”

The Hamilton postal distribution center, 20 miles north of Willingboro and 5 miles south of Princeton Junction, had sunk the lives of Norma Wallace and Jyotsna Patel into a dismal morass. Along with the center on Brentwood Road in Washington, D.C., it would prompt Americans to think as never before about their mail and the system that delivered it.