The Anthrax Letters: The Attacks That Shocked America (4 page)
Read The Anthrax Letters: The Attacks That Shocked America Online
Authors: Leonard A. Cole
Tags: #History, #Nonfiction, #Retail
Dr. Wiersma has a vivid memory of the call he received from Jean Malecki that Tuesday afternoon: “We never used the word ‘anthrax,’ but we both knew what we were talking about. I keep thinking back to that and how peculiar it was that we never said the word.” In fact, Wiersma was initially dismissive:
Jean said that she heard from a clinician, Dr. Larry Bush, who had seen a patient who is critically ill, has meningitis, and he claims there’s a Gram-positive bacillus. I mean, we get calls like this, and I think, “Oh yeah, right.” So I think, “There are plenty of alternative explanations.” So I say, “Are you sure this is Gram-positive and not Gram-negative
diplococci
?” You know, that’s the usual call we get on meningitis cases. And I got Jean to waver a little bit. I think she may have started to question herself; in fact, at one time she said, “No, it was Gram negative.” So there was some confusion.
I mean that was okay with me. I could put this back into my comfort level and think, “Well, this is probably
Neisseria meningitidis
, a Gram-negative bacterium associated with meningitis, which we get called on a lot. I think I maybe purposely confused her because that’s kind of what I do. You know, I try to put holes in people’s stories. Of course, even if it was a Gram-positive bacillus, it didn’t necessarily mean anthrax. But that’s why she called me with such urgency—because she was thinking this could potentially be anthrax. But see, no one mentioned the word “anthrax.” She didn’t mention the word to me, and I didn’t mention it to her.
Dr. Wiersma says he doesn’t know why they never said the word, but the symbolism seems obvious. Trying to “put holes” in a claim of anthrax would be a perfectly appropriate role for the state’s chief epidemiologist. Moreover, his seeking a “comfort level” with an alternative diagnosis seems understandable. But failure to utter the word reaches beyond science and medicine to raw fear and avoidance. Wiersma and Malecki were engaged in a peculiar dance of denial. Mentioning “anthrax” would somehow make the worst possibility more likely—that the bug actually was
Bacillus anthracis
. Their avoidance is a measure of the enormous significance they knew such a diagnosis would have. It is also clear that while Jean Malecki may have wavered, as Wiersma suggests, she was more inclined to believe the worst than Steve Wiersma was. Her recollection of conversations with him and with other state and federal officials was unadorned: “When I said ‘I think we may have anthrax here,’ nobody believed me.”
Dr. Wiersma decided to speak directly with Dr. Bush and “kind of play the same game I did with Jean”:
So I call Dr. Bush and basically play dumb with him. I say, “Dr. Malecki just called and I understand you’ve got this patient. What do you think this is?” He says, “Meningitis.” I say, “Great. You’re getting Gram-negative
diplococci
?” He says, “No, no. Gram positive.” Then I went through some other Gram-positive species, and I say, “Do you think this is maybe strep pneumonia?” He responds very strongly, “No, no, not strep pneumonia.” The way he said it sounded as if he meant, “You idiot.”
Dr. Wiersma chuckled as he described Bush’s reaction. “But that was my purpose. I was testing him. By the end of the call, it was clear this was something unusual. It was something he had not seen before, and further work needed to be done—looking at the organism.” By then the organism was on the way to the state lab in Jacksonville. Wiersma eagerly looked forward to confirmation that the bug was not anthrax. Bush and Malecki eagerly awaited confirmation that it was.
The next day, Wednesday, Bush called Phil Lee. The microbiology lab technician told Bush that the organisms had just arrived and that he would have results of two of the tests by midafternoon. The gamma-phage test could not be completed until the next morning. Later in the afternoon, Lee called Bush and told him that the capsular test was positive—the organism had a capsule. But the second test result, for polysaccharide in the cell wall, was equivocal.
“How soon can you repeat the cell wall test?” Bush asked.
“It takes a couple of hours,” Lee said.
At day’s end they spoke again: “I’m still getting an equivocal response,” Lee said.
“Are you willing to call this
Bacillus anthracis
based on what we have?” Bush asked.
“No, not at this time. I can’t.”
Jean Malecki was also in touch with Lee and was hearing the same message. Lee promised both of them a gamma-phage result the next morning, probably by 8:30. But she was already so convinced of the probability that she decided that afternoon to open a formal investigation. Meanwhile, Bob Stevens’s condition was worsening, now showing signs of kidney failure. He was unlikely to regain consciousness soon, if ever, so Malecki could not expect information from him. That Wednesday she and five members of her department practically spent the night at the hospital. They reviewed Stevens’s medical records from prior years, spoke to doctors and hospital staff, and interviewed his wife, Maureen, intermittently through the evening, until 2 a.m.
Malecki’s report cites all of Bob’s recent activities outside of work, to the extent that Maureen could recall them. References go back to June, when they visited England and “had taken a couple of walks in the country.” A daily summary begins with an entry for Saturday, September 22, five days before they left for North Carolina. On that day Robert Stevens:
Possibly went fishing (place unknown). His usual fishing spots include the pier at Boynton Beach Inlet (saltwater, ocean fishing); Loxahatchee Wildlife Preserve (fresh water); and also Lake Osborne in Lake Worth. He does not use a boat; he fishes from the banks. He does not hunt.
Out to dinner with friends at Roadhouse Grill in Boynton Beach. He had steak, a small sirloin.
The entry for the next day, Sunday, September 23, reads: “6:30 to 8:20 a.m. Bicycling with friend at John Prince Park, Lake Worth. Later to Lake Worth Beach with 11-year-old granddaughter to possibly the public pool or arcade there.”
While not mentioning anthrax, the report pointedly cites items that might have carried spores. Stevens visited the Fortune Cookie Oriental Store, where “they have fresh meats, including goat meat” and an Indian store and restaurant in West Palm Beach—“there is also goat meat there.” He recently bought “leather shoes at the Rack Room in the Boynton Beach Mall.” Another entry notes: “Within past month he pulled weeds out of an overgrown area where he keeps herbs in pots.”
None of these activities or visits explicitly suggested a connection to terrorism. But Dr. Malecki, like Dr. Bush, doubted that the anthrax bacteria that had presumptively infected Mr. Stevens would have come from a naturally occurring source. (Their suspicions arose from their knowledge that inhalation anthrax in the United States is extremely rare.) In any case, even their belief that Mr. Stevens had anthrax was still not widely shared by state or federal officials.
What neither Bush nor Malecki knew was that after Philip Lee’s second equivocal cell wall result, he did the test again. But for this one he decided to grow more vegetative cells before testing them. He placed the bacteria in a nutrient mix and incubated them for one hour at 37° Celsius (98.6° Fahrenheit). More cells grew, with more cell walls to test for polysaccharide. Shortly after 10 p.m. on Tuesday evening Lee had a result. This time it was unambiguously positive.
Lee immediately called the CDC in Atlanta and left a message that he needed to speak with a senior official. The agency had been aware of Bush’s and Malecki’s concerns since Tuesday when notified by Steve Wiersma, the state epidemiologist. On Wednesday CDC officials repeatedly spoke with Wiersma and then with Phil Lee to keep abreast of his lab findings. Like Wiersma, the CDC people were skeptical. Since 1998 they had analyzed hundreds of materials and specimens ostensibly containing anthrax. Many, as cited in press reports, were powders accompanied by letters claiming that the reader had been exposed to anthrax. All had proved false. Accordingly, CDC officials were not about to jump to a hasty conclusion. But they did request a sample of the material that was being tested in Florida, which Lee sent out earlier that afternoon. The package was expected to arrive the next day, Thursday.
By 10:30 Wednesday evening, Lee had spoken to several CDC people about his positive cell wall test, and they all decided to wait for the gamma-phage results due the next morning. An hour later, at the end of a 15-hour day, Phil Lee left for home. He was tired and anxious about what the results would look like the next day. Actually, the test was already under way. He had inoculated a culture of the bacteria with gamma phage and placed it in an incubator. The mystery remained whether that night the viruses would invade the bacterial cells, feast off them, multiply, and cause them to burst.
On Thursday, October 4, at 8:15 a.m., Lee donned his gloves, protective outerwear, and clear plastic face hood and prepared to bring the culture into the isolation lab. The gamma phages had now lain with the bacteria for some 12 hours. He set the culture plate under the microscope and stared. “When I saw it, my heart rate went up.” Beneath his eye lay fields of decimated bacteria exploded by battalions of viral parasites. That moment Lee knew with certainty that the bacteria cultured from Robert Stevens were anthrax. “All I had going through my mind was the hope that this was a natural case rather than a terrorism incident.” But time, circumstance, and his own training left him doubtful that the cause was not man-made. He took off his laboratory outerwear and headed back to his office to call state and CDC officials. As he walked through his office door, the phone rang.
“Phil, this is Larry Bush. How’s your gamma-phage test?
“It’s positive.”
“OK, now are you going to call it anthrax?”
“Yeah,” Lee said, uncomfortably. Then he added, “I think I should have told the state people and Dr. Malecki before I told you.”
Bush, characteristically impatient with bureaucratic niceties, answered, “What’s the difference? So you’re going to hang up the phone from me and call them. Look, I’m the treating physician. I sent you the organism. You had the obligation to tell me.” Bush later offered a more sympathetic assessment:
I guess he felt he should call the people he had worked for first. I thought it was odd, but of course the implications are bioterrorism. Here’s a guy who recently comes from CDC training to set up their lab training-and-response network and gets an organism they are set up to look for. What that means in his mind, and obviously in mine, is bioterrorism. So we get off the phone. I call Jean Malecki. He calls the CDC. I tell Jean. She calls him. Within 10 minutes we all had the same information.
Phil Lee’s worry that he had violated protocol was short lived. The enormous implications of the findings quickly overtook such mundane concerns.
While Lee and Bush were on the phone with each other, Jean Malecki was in the middle of a conference call with Steve Wiersma and other state officials. They were reviewing what was known so far. By now she was convinced that Bob Stevens had anthrax, though others on the call remained doubtful. Malecki recalls Wiersma saying, “We still have to wait. It may be negative.” Another official on the call agreed: “Well, you know, it’s not in his lungs, nothing respiratory.” Malecki answered: “You can still have 50 percent of these cases present this way.” “OK, but there are other organisms,” the official insisted. Malecki thought to herself, “But I don’t know which other ones they could be at this stage of the game.”
