Inside the Hot Zone: A Soldier on the Front Lines of Biological Warfare
336
Inside the Hot Zone: A Soldier on the Front Lines of Biological Warfare
336Hardcover
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Overview
Product Details
| ISBN-13: | 9781640121423 |
|---|---|
| Publisher: | Potomac Books |
| Publication date: | 01/01/2020 |
| Pages: | 336 |
| Sales rank: | 665,625 |
| Product dimensions: | 6.10(w) x 9.10(h) x 1.30(d) |
About the Author
Read an Excerpt
CHAPTER 1
Beginnings
Kelly's odyssey will continue later, but in the meantime, how the hell did I end up here, keeping the lid on the deadliest virus on the planet in the nation's "Hot Zone"?
Despite my shaking hands and unsettled gut, my years of training and experience up to this point had prepared me well to handle the situation if I trusted my instincts.
I spent my early years in London, Toronto, and Istanbul due to my father's work as a university professor. We moved back to the United States when I entered first grade. Living overseas at a young age gave me an appreciation for other cultures and foreign languages, which would help me later in international work. My parents put a strong emphasis on education and constantly pushed me and my five siblings to achieve. Although money was a frequent stressor, I was incredibly fortunate to have educational opportunities on par with the Kennedys.
My parents tried to peg our future careers based on our respective talents. My eldest brother was the "engineer," the next one the "writer." I was third, the "doctor," because I excelled in math and science. Although I started out wanting to be a scuba diver, I did have an early fascination with medicine, frequently perusing the clear plastic images of the human body in our home edition of the Encyclopedia Britannica.
As the shy one in the family's upper tier, I often refereed dinner-table arguments between my more vocal and opinionated older brothers and father. My willingness to listen and be less judgmental would serve me well later as a doctor and a leader.
Although I was shy, I had early independence thrust on me. I showed talent on the violin, so at age twelve I boarded a smoke-filled bus every Sunday for the one-and-a-half-hour ride from New Jersey into New York City for violin lessons. Feeling scared and lonely, I channeled my way through bustling crowds and the subway maze uptown to West Seventy-Third Street. I dreaded the Sunday commute, but the experience gave me skills maneuvering around a city and remaining alert to my surroundings.
Performing for an audience helped me overcome some of my timidity. For two summers I attended the Meadowmount School of Music, a Juilliard-quality summer strings camp in upstate New York, which was attended by the likes of Joshua Bell, Pinchas Zukerman, and Itzhak Perlman. Having accomplished friends, some of whom were already famous, probably helped me later not to be intimidated by army generals.
My violin opened numerous doors for me. Most importantly, I played in a youth symphony that rehearsed at the Lawrenceville School, a prestigious boarding school in New Jersey. My father told me to apply for admission. A timely phone call he made to the director of admissions landed me nearly a full tuition scholarship when another boy backed out. It showed me the importance of chance and timing, but also the value of picking up the telephone to solve a problem.
Lawrenceville challenged me and laid the academic foundation for my future pursuits. During my first year, I decided I wanted to be a high jumper on the track team, so during spring break, I crafted a makeshift high-jump setup by piling two old mattresses on top of each other, building two wooden stands, and buying a piece of bamboo for the cross bar. I spent the break practicing. When I got back to school, the effort paid off. I made the track team. Two years later I won a gold medal in the state championship. This achievement added another lesson for success: persistence. One teacher gave me the ultimate compliment: "Kortepeter is a scholar athlete."
Eventually, I embraced the idea of pursuing medicine. It helped to have a family member to emulate. My uncle was a seasoned cardiologist who had served as a navy doctor with the marines in the Vietnam jungles. While I was in high school, I saw patients with him and watched him conduct treadmill tests and heart catheterizations.
After shadowing my uncle, I wanted to become a cardiologist too. I had multiple "windows" into the heart, hearing its "lub dub" with a stethoscope and watching the squeezing doughnut-shaped muscle and fluttering heart valves open and close with an ultrasound probe. Electrocardiogram tracings on pink graph paper were as confusing as hieroglyphics, but my uncle interpreted them as skillfully as the Rosetta Stone.
I arrived at Harvard overconfident and struggled with mediocre grades my first two years, which knocked my ego down several notches. Working on the side to supplement my scholarship probably didn't help.
In our dorm, my roommate Ed and I chowed down on Korean food made by his mom, while huddling on a threadbare olive-drab couch with other doctor wannabes to view nightly reruns of M*A*S*H. We all admired tv army doctor Hawkeye Pierce's surgical skills and compassion, as he and Trapper John cut through an endless stream of blown-up limbs with humor. I was tall, thin, and gangly, like the actor Alan Alda, so one year I dressed up as Hawkeye for my dorm's Halloween party wearing blue scrubs and tinfoil dog tags. The thought of actually joining the army, though, had not yet crossed my mind.
By junior year I had matured. My first job in the library had paid a measly $2.65 an hour, but by junior year I accepted more menial labor cleaning dorm bathrooms in exchange for a raise to $5.15 an hour. Less time working for the same total pay freed up my schedule. I refocused on my classwork, and it paid off, but the earlier years at Harvard had shattered my confidence. I feared I wouldn't get into medical school, and I lost opportunities to compete for prestigious travel scholarships. I resolved that if I did get accepted into medical school, I would prove that I deserved it by doing something important to make a larger impact beyond just patient care. I also felt a burning desire for the adventurous travel I missed out on by failing to win the scholarships. Only now, in retrospect, do I realize how strongly my early failures influenced my drive and future pathway.
I was elected vice president/treasurer of my 250-person dorm. The position required me to speak in front of the dorm council, but the real value came from observing my more outgoing friend, Jim, run the council meetings. Learning how to run a meeting would prove one of the most valuable skills that I learned in college and applied years later leading different departments and research organizations.
I regained some of my confidence in medical school. I found the work conceptually easier than college. But medical school was a lonely and depressing period, although a close circle of friends made it tolerable. Living on loans I shared an apartment with four roommates, shivering in a basement room as cold as a meat locker. I strung sheets of plastic around my bed during the winter in a feeble attempt to keep the heat in, generated by my anemic space heater. Every day I feared my rusting Fiat would break down in the heart of the Newark, New Jersey, ghetto while I was driving to school.
One thing Newark did have in abundance, though, was sick patients, which every medical student needs. The bustling emergency room held a nightly chorus of patients dying of sepsis, gunshot wounds, or fungating cancers. The myriad drug overdoses were stacked in the corridors to detoxify rather than being admitted to the hospital.
The seeds of my future interest in infectious diseases were planted on the Newark hospital wards. One of my female African American patients left an indelible impression on me. Deathly ill from pneumonia, feverish, shaking, and coughing up sputum that looked like butterscotch pudding, she couldn't even muster the energy to sit up in bed.
I took a sample of her sputum down to the lab and performed a "Gram's stain." Named after Danish bacteriologist, Hans Christian Gram, it's a simple procedure that even a medical student can do. Start by smearing a drop of sputum on a glass slide, then hold it over a flame for a couple of seconds to "fix" the sputum tightly to the glass. After that pour on some purple dye, followed by iodine, and then watch lines of purple rinse away with a quick squirt of alcohol. Finally, flood the slide with a second, pink stain.
Certain bacteria retain the purple dye in their cell wall, so they appear "Gram positive" (purple) under the microscope. In others the alcohol rinses away the purple dye, so they stain "Gram negative" (pink) instead. This simple distinction drives important treatment decisions, because some antibiotics kill Gram positive and others kill Gram negative bacteria.
When I peered through the microscope at my patient's sputum, I saw the telltale signs of pneumonia: sheets of white blood cells that looked like fried eggs, with purplish single or multi-lobed "egg yolk" nuclei surrounded by grainy pink and purple dotted "egg whites." Lawns of much smaller purple dots came into focus under higher magnification as "lancet" shaped bacteria in pairs — rounded on one end with the other pointy ends kissing. Some bacteria had been gob-bled up, like Pac Man, by the white blood cells.
The lancet shape and color were characteristics of Streptococcus pneumoniae, or "pneumococcus." Nicknamed "Captain of the men of death," in the pre-antibiotic era, pneumococcal pneumonia had a well-deserved reputation as a feared killer. If she had delayed coming to the hospital one more day, my patient probably would have died. Once my Gram stain demonstrated what she had, choosing the right antibiotic was simple.
After she had received two days of intravenous antibiotics, I watched stunned and elated as my patient got out of bed, like an awakening Lazarus. I couldn't believe that the care I had provided had such an immediate, life-saving impact.
The tiny bacteria fascinated me. They grew and changed color on petri dishes as they coalesced like water droplets or morphed into fluffy, shiny, or slimy globs. Some gave off inviting grape fragrances, while the smell of others turned your stomach like a putrid, dead squirrel. But captured inside the world of the microscope lens, they became beautiful clusters of purple grapes, pink boxcars, or blue safety pins.
Just as I started on the medical wards in 1985, HIV mowed down the Newark intravenous (IV) drug-user population like a field combine. My classmates and I feared we would be the next HIV victims. I drew blood on my patients with bare hands back then because I could feel the puffy elongated shapes of the veins easier, but I spilled blood on my hands more than once when putting in an IV catheter. My roommate once said to me with frightened resignation, "Mark, you know we've all been exposed."
My HIV patients entered the hospital feverish, coughing, and over the next couple of days, their chest x-rays "blossomed" from black to white as if filled with cotton. We watched helplessly as they gasped for breath and suffocated, despite our antibiotics. Feeling chagrined that I couldn't do much for my HIV patients, I moved studying infectious diseases to a back burner. Getting one step closer to becoming the next Hawkeye Pierce became a reality, though, when I realized what a good deal my medical-school roommate had when he was awarded a military scholarship that paid his tuition. I decided to apply, but I had missed the deadlines for the navy and air force programs, so it was complete serendipity that I applied only to the army. Once accepted I signed nervously on the dotted line. Committing to give the army four years after medical school seemed like a lot then, but my attitude changed when I flew to Hawaii my senior year to train at an army hospital for a six-week student rotation.
I arrived in Honolulu the weekend of July 4, a spanking-new "butter bar" second lieutenant (nicknamed for the rectangular bronze insignia on the shoulder) in a crisp green uniform, not even knowing who, or how, to salute. From the moment I got off the plane, heard the chirping birds outside, and was engulfed in the perfumed fragrances of tropical flowers, I knew I had made the right decision.
I couldn't start on the hospital wards without "in-processing," but the administrative offices had closed for the long weekend. So I asked myself, "What to do in Hawaii?" For starters a fellow medical student and I drove east past Diamond Head out to Hanauma Bay, where the ocean side of a burned-out volcano had eroded, leaving a crystal-blue bay teaming with brightly colored tropical fish and coral. We basked in the sun on tatami mats on a white sand beach among Japanese tourists, surrounded by lush green cliffs. My friend turned to me with a grin and said, "Doctor, do you realize you are being paid fifty dollars a day to sit on this beach?" "Wow!" I said. "The army isn't such a bad deal, after all." "It's good to be the king," he laughed, quoting from Mel Brooks's History of the World.
When I graduated from medical school in 1988, the army helped me escape as far from Newark as possible and sent me to San Francisco for my transitional internship. When I arrived as a new army captain, on my first day on the hospital wards, my bald, overweight neurology resident, who outranked me as a lieutenant colonel, pulled me outside during his hourly smoke break.
"Here's how this works," he said in between drags on his cigarette. "For this month, basically, you are my dog."
Suppressing my desire to tell him exactly where to shove his cigarette, I did the work for both of us while he smoked away his days. I would stumble out of the hospital at midnight in search of fast food and return early each morning to start over again. The internal medicine guys on call took pity on me when we ran into each other in the radiology suite in the wee hours, and I decided I wanted to be one of them. I wasn't surprised when my resident was later fired for incompetence and banished to a remote army base in Alaska.
My first month as an intern, on a Saturday morning, a petite Asian American pharmacist named Cindy summoned me to the pharmacy to sign a prescription for a patient I was discharging. A year later, before I shipped off for Hawaii, we eloped to City Hall on her lunch break. We hadn't even bought rings yet. We later held our formal wedding in San Francisco, just four days after the 1989 earthquake. Why she decided to hitch a ride with me, I'll never know. Perhaps the earthquake foreshadowed some of the unexpected excitement and challenges to come.
I arrived in Hawaii for the second time in 1989 excited and more than a bit nervous to launch into my internal medicine residency training. Tripler Army Medical Center served as the referral hospital for tens of thousands of military forces stationed throughout the Pacific. Framed by the lush green Koolau Mountains, the coral-colored "pink palace" hospital stares down on Pearl Harbor like a formidable, giant Buddha statue.
My fellow residents-in-training at Tripler had already worked together for a year and probably wondered whether they could trust the "new guy." One morning one of my colleagues was cornered by our attending physicians in a merciless "shark attack" while presenting a case at our daily case conference. Usually, when "blood was in the water," the other residents cowered on the sidelines, lest they become the sharks' next targets. Training through embarrassment seemed juvenile and unnecessary, so I decided to throw a wrench into the process. I was beginning to overcome my timidity and just happened to have a good case that I had not yet presented. When the staff served up my bloodied fellow resident for another meal, I jumped boldly into the fray, offering to present my case instead. My colleague gratefully yielded his place on the stage. My presentation went well.
The next day I was summoned to an "emergency" residents' meeting. As I took my seat in the conference room, the chief resident called me up to the front of the room. As I stood there, surprised and confused, he read off a citation mimicking a military award. "Ladies and Gentlemen, attention to orders."
All the residents stood at attention in unison. The chief resident awarded me the inaugural "Shark Attack" medal, "for demonstrating courage to enter shark-infested waters to save a fellow resident." They pinned a paper badge on my white coat with a red "no sharks" circle and diagonal line overlying a sketch of a shark — a mere strip of paper but more valuable to me than Olympic gold. I had earned the trust and respect of my new colleagues.
While at Tripler, Colonel Joel Brown, an infectious disease doctor and Vietnam veteran, revived my interest in infectious diseases. Tall, with a straight back, shaved head, and imposing military bearing, he enthralled me with exotic-sounding diagnoses, like malaria, dengue fever, leptospirosis, and leishmaniasis, for our patients flown in from all over the Pacific Rim. The idea of working with treatable, as opposed to chronic, diseases, in addition to their link to travel, sold me. I wanted to study infectious diseases like Colonel Brown.
(Continues…)
Excerpted from "Inside the Hot Zone"
by .
Copyright © 2019 Mark G. Kortepeter.
Excerpted by permission of UNIVERSITY OF NEBRASKA PRESS.
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Table of Contents
List of Illustrations Preface Prologue: Exposure 1. Beginnings 2. Germs as Weapons 3. The Six “Chessmen of Doom” 4. Hoofbeats 5. The Queen Strikes 6. The Nation’s Bio-Emergency Hotline 7. The Pawn Comes Calling 8. Bioweapons 101 9. Preparing for Biological Warfare 10. Disaster from Within 11. Bow to King Smallpox 12. On the Front Lines 13. Desert Pneumonia 14. The 4M Disaster 15. Countermeasures 16. The Slammer 17. On the Hot Side 18. Descent into Hell 19. Suspicion 20. The Aftermath 21. Down for the Count 22. Behind the Scenes of Pandemic Response 23. Looking Forward—the Challenges Continue Afterword Acknowledgments Glossary Notes Index