Sex, Drugs, and Public Health

I’ve got two stories for you about Hantavirus, and a greater story, which is information that will help you avoid this serious disease.

In 1993, we in Public Health discovered a new disease. This doesn’t happen very often. From the Four Corners area (where Colorado, Utah, Arizona and New Mexico are all near each other) reports came of a mystery disease that sickened some previously healthy people and killed several of them. Some were as young as 13 and several were Native American.

They got fevers, and then developed shortness of breath. One person described it as feeling like a tight band around his chest and a pillow in front of his face. By the time Public Health investigators had developed a full picture from all those states, they found twenty-four people who had become ill, many of whom lived in rural areas (like Mariposa County). Twelve of them died of Adult Respiratory Disease Syndrome (ARDS) in which their lungs failed to provide oxygen to their blood. Laboratory investigation implicated a new strain of virus: the “Sin Nombre” (Without a Name) virus in the Hantavirus family. All Hantaviruses are carried by mice and several cause human disease.

Since then, this disease (Hantavirus Pulmonary Syndrome) has hit people sporadically: individual cases from various widely scattered locations, rather infrequently. There have only been approximately 60 cases in California since we began watching in 1993.

Now we have another “cluster” of cases which, as the whole world knows, are strongly suspected to have come from a specific area in Yosemite Park. When, in early August, I went to Yosemite to inspect cabins in the Camp Curry area, all of us there found evidence of mice inside many of the cabins. But the epidemiological connection was with the fancy tent cabins which have hard wall interiors and stoves for heat. It appears that, in those tents, the mouse infestation may have been heavier than in other tents and cabins. Perhaps we’ll find that the space between the tent canvas and the walls has something to do with it. The exposure for campers could have been greater in those tents.

Here’s the greater story: the mice that carry Hantavirus are all over the California mountains. We have been warning people for years about this. Your house, garage, crawl space or attic could be infested with deer mice and, therefore, possibly have Hantaviruses in the mouse poop in your house. Testing has shown that about 14% of these mice carry Hantavirus.

You should prevent mice from getting into your house and other buildings. And if you find evidence of mice (feces, nests) you must protect yourself when cleaning up. Here is how to safely clean up a room with mouse feces:

1. Open all windows and doors to let air circulate through for several hours.

2. DO NOT SWEEP or VACUUM mouse feces.

3. Spray the feces well with a disinfectant solution.

4. Let the disinfectant soak into the feces for at least 15 minutes.

5. Wearing gloves, wipe the wet feces and dispose of in a plastic bag.

For more information, see our website at http://www.mariposacounty.org/health/hantavirus.

VI. Our Isolation, Invaded

A few weeks into the first semester, with mid-term exams looming like Godzilla over our little Manhattan Med School, the bald Dean took the podium again.

“Yesterday,” he seethed, “some students” (he almost spat this word) “from this Medical School walked down Fifth Avenue in a demonstration. A political demonstration.”

We all glanced left, then right.

“Now, I admit,” he admitted, “That you have the right to express yourselves. Even when you’re wrong. Very wrong. But you do NOT have the right to wear white coats with the school’s insignia on it. You do NOT.”

We were all looking only forward now. All looking innocent. Who would risk his medical school career doing that? I wondered.

“It was Ralph,” John later told me as we all buzzed about it. “Some anti-war demonstration downtown.”

“That’s a hell of a risk,” I shook my head.

“No kidding. For the next four years the only places you’ll find ME are in class, in lab, and in the library,” he said as he turned toward the library.

That afternoon, in Bio-chem lab, I leaned toward Ralph and asked him.

“Yep. I was there. So were some other students and even some faculty,” he added. “And people from every other Med School in town.”

“Aren’t you afraid they’ll throw you out? You’re risking your entire career.”

He looked at me a long time with his easy, natural smile.

“Don’t you think our involvement in Viet Nam is immoral?”

I waited for him to say more. But he was done, apparently.

“That’s for other people to decide. In Washington. My job, right now, is to get through Med School. Without flunking out or getting drafted.”

“If you do get drafted, what will you do?”

“Whadda you mean, ‘what will I do?’ It’s not like I’d have a choice. They’d order me to go, and I’d have to go.”

His smile, soft and gentle as it was, bore into me like a blowtorch. “You don’t have to do anything. You – all of us – choose what to do. Choose to support the war or choose not to…”

I snorted derisively.

“As someone who cares about people’s health, I’ve made my decision. Don’t you think war is bad for people’s health?”

“Sure. So’s smoking. But I’m not gonna quit ‘til I graduate and neither is anyone else,” I snapped. “Back to work.”

From the corner of my flask-focused eyes, I watched Ralph carefully remove his jacket and slide into his lab coat. Dylan. That’s who he looks like. Bob Dylan.

Then my brain was assaulted by “The Times They Are a – Changin.” That really pissed me off.

I don’t care about Changin’ Times and neither should any of us. Just study. Just become a doctor.

I tried to bump Dylan out with a different tune:

I said I’m gonna mix it up right here in the sink
I’ll slip it in his wine to cover up the bad stink

But Dylan wouldn’t shut up and it was all Ralph’s fault. I felt a really powerful need for a Marlboro, but I was trapped in lab. I tried to fit a glass tube into the rubber stopper of a flask. You better start swimming or you’ll sink like a stone – – – It wouldn’t go. So I pushed a little harder. Don’t criticize what you can’t understand – – – The glass tube snapped, the flask shattered, my Bunsen burner sizzled out.

“A little frustrated, are we?” the professor’s voice clawed against my neck like ice water.

My impulse was to whirl, slash his face with the broken shard of flask, then to slit Ralph’s throat. The fact that I’m telling you this story is your clue that I did neither. I did something else. More accurately, something else happened to me.

I began to laugh. I realized it was inappropriate, but I couldn’t quit. I began to slide to the floor, laughing so hard my abdominal muscle began to spasm. I stumbled, still laughing, out of the lab, down the hall, into a bathroom. A laugh room. The stupid pun made me laugh all the harder.

It took half an hour until I was able to stop it. A handful of my fellow students stood at the bathroom door, staring down at me.

“You OK?”

I stood up, smoothed out what wrinkles I could in my lab coat and said. “Yeah. I feel better.”

“What caused that?” John asked, very concerned. I could imagine him calling the psych unit.

“Don’t know,” I shook my head. “Too much library, maybe.”

* * *

Now, the hippocampus is important, but hidden deep in the brain. The visual cortex is crucial to what makes us human, but is all wrinkled into strange shapes. The ‘Tahl-a-moose’ as our Neuroanatomy prof pronounced the Thalamus is about as basic as a brain can get, but is impossible to differentiate visually from surrounding brain tissue. These, and about seven hundred other structures make up the human brain. And, they would also make up my final exam in Neuroanatomy. Which course was I most likely to flunk? It was a race between Physiology and Neuro. So I called my parents to tell them I wouldn’t be home for Christmas. I spent the week in the library. And I wasn’t alone in there, either.

“If I’m gonna flunk out of Med School, it’s gonna be next week,” I confided in John. No need to worry about next semester.”

“Aw, you’ll do fine,” he said in his Polly-Anna way. He’d bolster anyone. He’ll probably be a great doctor. “Just try not to do that laughing thing again, okay?”

“Laughing? At Neuroanatomy? There is definitely no synapse in the human brain that connects those two processes.”

The sun rose on January sixth. That may not have been news to most of the world, but it was a major miracle in my life and helped me go a long way toward understanding that Resurrection phenomenon the priests and nuns had been trying to explain to me.

Sunrise illuminated the 8-1/2 by 11 sheet on the bulletin board declaring that I had, unbelievably, made the Dean’s list that first semester.

“How’d you do?” Marshall asked me with his Zappa voice.

“I passed,” I said in a very long exhalation.

“Me too. One semester down and seven to go!”

“Actually,” I smiled broadly, “It’s all downhill from here.”

“How do you figure?”

“Now I know I can do it.” And I went away whistling.

Four hadn’t made it, and were gone. That news spread rapidly.

“Wonder if Ralph’s one of them,” I mused to John.

He looked at me with a cocked eyebrow. “Why’d you say that?”

“Well, if he’s not downtown doing demonstrations, he’s off at meetings about getting more Black and minority students into Med School. Not spending all his time studying, you know?”

John shook his head. “Straight A’s,” he pronounced. “Dean’s List.”

“Hm-m. So maybe it pays to broaden your horizons.”

“Not me. I got a job at the library, so I’ll be there until eleven every night. And I get paid for it!”

“Lucky you,” I said probably way too half-heartedly.

V. Bio – Chem

Sun, escaping the New York jungle of Central Park, shafted through the lab window and glinted off a Rube Goldberg cacophony of glass, test tubes, safety goggles, and Bunsen burners on my section of the bench. Valves protruded from the backsplash of the counter, all aimed at me like enemy machine guns. They were labeled:

“Gas; Water; Oxygen; Nitrogen; Unknown.”

From this, I despaired, I’m supposed to recreate the Krebs Cycle? Our livers had thirty thousand years to figure out how to do it and I get one week?

“How’s it going over there?” the small guy to my left asked, kind of friendly.

Some people are so quiet and innocuous, you don’t know they exist: wire rim glasses that made me unsure if he actually wore glasses, white shirt buttoned down, grey tie, tweed jacket beneath his lab coat. All pretty boring. Except his hair. Full, thick, and way past his ears, almost as far down as his sideburns.

“Oh, great,” I lilted. “Just fine. And you?”

“Yeah,” he smiled. “I’m lost, too.”

You know how back in High School you go for the obligatory photo for the yearbook and the photographer says, “Smile! No, I mean, Smile. Don’t grin. Don’t grimace. Try to smile.”
And we struggle as hard as we can to smile, but the photo still stinks? Then, some other people, they just do it, naturally even before they sit down so all the photographer has to say is, “That’s great.” And they’re done?
That’s how his smile was. So natural, it relaxed me just to look at it.

“I think we’re supposed to put this stuff in the Erlenmeyer flask, and retort it into there, aren’t we?”

He pointed at my Rube Goldberg and, I realized, he was right.

Huh? Why was he helping me?

“Ralph,” he introduced himself.

I introduced myself back and, naturally, comfortably, we became side-by-side lab partners in Biochemistry while everyone else sneered and cussed and faked their way through the afternoon, isolated from their neighbors by two distances: the physical one created from the limit of their elbow’s reach, and the emotional effect of saying, “Do your own experiment. I’m busy here.”

As I cook-booked my way thru each step in our chemical mimickery of the human body’s processes, the tune and words of “Love Potion Number Nine” came out of nowhere and cycled around my brain. I couldn’t dislodge it, so I commandeered it:

I got a big old fear of Physiology
The nasty old professor makes me shake and pee
I need something good to sneak into his wine
I’m gonna mix a flask of – – Love Potion Number Nine

When the lab was over, Ralph smiled, and dissolved back into the swirling background of Med School.

That night, in the cafeteria, I asked my roommate if he knew Ralph.

“Oh, the short kid with long hair,” he said as he straightened his tie in the glass of the cafeteria’s dispensing machine. “The one who wears tweed jackets?”

“Yeah. You got something against tweed jackets?”

“So… out of fashion.”

“So, what’s in? I asked, still struggling to become a New Yorker.

He turned to look at me, incredulous. “Polyester, of course.”

“Oh.” I made a mental note for my next shopping trip.

“But that Ralph,” he continued, “is weird. And not from here.”

“Not from here?” I sought clarification.

He dropped coins into the machine, “He’s from out west somewhere.”

“How far west?” I asked, self conscious that I, myself, had gone to school in Indiana.

“You know, somewhere,” he waved his hand as if chasing a fly, “the other side of the Hudson River. West.”

“Oh, yeah,” I mused, “out there with the Indians and cannibals, right?”

I expected either a guffaw or outrage at my sarcasm, but instead, he just took his coffee from the Horn and Hardart dispensing machine and said, “Yep. Out there.”

IV. Histology

Oh boy, Oh boy, Oh boy. I get to use my microscope!

We all flowed into Histology lab, wooden boxes swinging from our arms. Fumble, fidget, plug it in, twirl the knobs, bounce excitedly on our stools.

“It’s a Bausch & Lomb 742,” boasted Dolin, in response to someone’s question, but loudly enough for the whole lab. He buffed his already shining new bifocal microscope, exuding both pride in his possession and cockiness that it, alone, would snag him an “A” like some magical biopsy tool. Somehow, he managed to secrete all this enthusiasm from a face permanently fixed in a scowl. No one had seen a smile from him since day one in the auditorium.

“You vill brick your fingers and zee blut you vill smear on zee slide,” the Histology prof directed. “Zhen find zee corpuscles of all zees different types,” he pointed to the board. Erythrocytes, basophils, neutrophils, platelets, macrophages, blasts.

Wow. I hope I find all of them. Well, not the blasts. That would be weird. Diagnose your own leukemia. That would be a bummer.

So I swabbed my left index finger with the traditional alcohol, held it up before me, picked up the sharp little lancet in my right hand, took deadly aim, and jabbed.

I missed.

My index finger jerked back, away from the arrow-like lancet. I snickered at myself. Well, it’s just an issue of will power.

I planted my left elbow firmly on the counter, index finger pointing ceiling-ward. Its vulnerable, fleshy pad exposed to my focused pupils and to the poised lancet. I firmed the muscles in my left arm to hold it there and, before my left hand could suspect what I was doing, lunged with my right.

Missed again.

Boy, my left hand is fast. Maybe if I…

A hairy paw grabbed my left wrist, and pushed my hand down flat onto the counter.

“Now you vill get your blut. You see, zehr is no vhere for your fing-her to go.”

Ouch.

While my eyes were buried in the microscope, sorting through my drop of ten thousand or so red blood cells, looking frantically for a white one – ANY white one, just one white one, I heard my roommate’s voice.

“Forgot to tell you. This was in the mailbox this morning.”

I pulled my eyes out of the microscope sockets to find him holding a white envelope. The return address was my Draft Board. I almost puked on my microscope.

“Open it.”

“Naw,” I shook my head. “Think I’ll hide it behind the right kidney of my cadaver.”

“Why?”

“Cause we’re only gonna remove the left one. Don’t have to dissect them both. We’re gonna leave the right one in.”

“No, I mean…”

“I KNOW what you mean!” I said way too loudly.

I waited for everyone’s eyes to fall gradually back into their eyepieces again, then I mumbled, “If they’re yanking me out of Med School, I don’t want to know.”

“Open it. Not reading it won’t change what it says.”

“Blah-blah-blah… deferred until Medical training completed… blah, blah, blah.”

“That’s great,” my roommate smiled. “One less worry.”

“Yeah. Now all I have to worry about is Physiology, Anatomy, Physiology, Histology, Physiology, Bio-chemistry – ”

“Are ve vorking or are ve chitty-chatty?” the professor boomed pretty much toward us.

III. The Lion’s Den

“Here we go,” John said, taking an audibly deep breath. “Physiology lab.”

The specter of failing, as had the eight from last year, now known throughout the school, unimaginatively, as ‘The Eight’, hovered over all of us like a plastic shroud that someone could drop on us at will.

Groups of four were assigned to tables with anesthetized dogs who’d been unlucky enough to be strays, and we were ordered – ‘instructed’ was the term the Physiology Prof used, but with his history so well known, ‘ordered’ was how we took it – to do a dozen things we’d never done before, just to start the experiments.

“Who’s gonna insert the catheter?” I asked my group, figuring if I asked first, someone else would volunteer.

“You,” barked a kid named Marshall, his face stubbly with three days’ growth, his hair curly and disorganized, his tie stained and askew. He made me think of that Frank Zappa guy.

“Why me? I’ve never done this.”

“I’m attaching electrodes to this transducer. You think I know what I’m doing? Look confident. The Prof’s watching.”

The room descended into murmurs and busy looking clueless elbows moving decisively within white coats. There were, I later learned, three people in the room who had done this before and the lucky tables where they worked actually got real results to record.

“This is awful!” suddenly rang out.

All eyes shot, not to the source of the outburst, but to the Physiology Prof. He stood, clipboard in hand, white-coated, at a table near us, and didn’t flinch. Didn’t even look up. Just continued his instruction, getting ever nearer to finishing with that table and then arriving at ours.

As the murmuring took over again, I looked over at the student who had erupted. It was easy to find her. She was the tallest one in the room, and blonde – an irrelevant detail that all the guys had noted since day one.

“This poor animal!” she followed up, disrupting the murmuring again.

“Now that,” whispered Murphy to the other three of us, “is why women don’t belong in Med School.”

Something moved in our peripheral vision and all four of us dropped our eyes and hands to our sleeping dog, entangled in its net of wire and catheters.

“What is the arterial pressure?” the Professor asked us.

“Uh-h-h,” was the way I started.

“Ninety millimeters,” Zappa shot back, in a voice implying his annoyance at the professor’s intrusion.

“Hurry up with the venous catheter,” the Professor ordered. “We have to begin the infusion.”

He was about to move to the next table when Murphy opened up. “Did you hear that girl, Professor?” he chuckled. “Pretty annoying, huh?”

“Happens every year,” the Prof droned. “Women are different, which you should know Mr. Murphy since you’re married.”

“How did you know that?” he reared back.

Shut up, Murph, I said to myself.

“Shut up, Murph,” Zappa shushed from the corner of his mouth.

“You think I don’t read your files?” the Prof raised his eyebrows. “All of them?” He fixed Murphy’s eyes. “Loyola College,” he turned to Zappa, “N.Y.U.,” he looked at me, “Notre Dame,” he finished with John, “Columbia. I expect good work from this table.”

Finally he swiveled to move on, and the three of us began to turn on Murphy. But the Prof stopped and turned his head back to us. “Oh, and Holly over there? She who annoyed you with her outburst?”

We all hung in the silent moment.

“Harvard.”

When the Prof was out of earshot, John beat Zappa to the punch.

“Nice work, Murphy. What were you trying to do? Kiss a little professorial butt?”

“Are we almost done?” Murphy slumped. “I need a drink.”

And I suddenly had a bad vision of the future for our red-headed, freckled faced, sad-eyed Irishman.

“So Marshall,” I asked, my pen poised over our lab notes. “What was the arterial pressure again?”

“I don’t know,” he snapped. “Make something up. Like I did.”

And a sense of dread, like some onrushing cloud of radiation, began to engulf me. If I don’t get drafted out of Med School, the Physiology Prof will flunk me out. My whole life will be fried to a useless crisp because here, I have no Fallout Shelter to run to.