© 1999 by European Society of Cardiology
Copyright © 1999, European Society of Cardiology
Wasting away. What a waste. Part 1
University of Missouri-Columbia, Division of Cardiology, Department of Medicine, MA432 Medical Science Building, Columbia, MO 65212, USA
* Corresponding author. Tel.: +1-573-882-8580; fax: +1-573-884-4691 weberkt{at}health.missouri.edu
Received 5 July 1999; accepted 5 July 1999
Elizabeth Conrad was reading the Tribune. Husband Theodore was cleaning his pipes. ‘Says here that industrial pollution is no longer public enemy number one,’ noted Elizabeth. ‘I’ve recently heard the same thing. There’s a new threat to our environment, a public health menace of the first order,’ remarked Theodore. An episode that should raise public awareness occurred right here in Illinois not too long ago. Let me tell you about it. But first some relevant background.’
Monday, July 1, 1946. Two-penny nails. Brown paper bags. Ten nails to a bag. A task well suited for 17-year-old Dexter. At Tyrant’s hardware store in Hesler, Kentucky, a town northwest of Lexington, packaged nails sold for 25 cents. Dexter had worked in his father’s store full-time since his high school graduation 1 month ago. Life in Hesler was usually slow-paced. These days it was even slower as summer’s heat shimmered off hot asphalt, visible at 50 paces. Only lizards were comfortable, their darting tongues testing ambient heat.
Nonetheless, the town’s mood was upbeat. The big conflict had ended nearly a year ago. Men fortunate to have survived the brutalities and savagery of war had returned to their loved ones. Thursday’s July 4th celebration would be special: parades, softball games, hot dogs and apple pie. And even a dance at the Veterans of Foreign Wars Hall on Friday night.
As Dexter’s hands worked the nails, his gaze came to rest on the large Coca-Cola poster on the wall over his workbench. It featured a demure brunette in a two-piece bathing suit presumptively saying ‘yes’ to the bottled soft drink she’d been offered. Dexter gazed at her image with hardened affection – a rapture he often experienced in high school. However, most girls had learned to recognize when this testosterone storm front began brewing on the horizon. It easily could turn into a storm warning if a girl wasn’t careful. Most could see it forming and paid no attention. They only giggled at left-handed Dexter.
‘Dexx-terrr,’ boomed his father, startling the tall, skinny kid from his reverie. The cacophony resonated inside Dexter’s skull-one side to the other with little to impede its harsh harmonics. ‘Son, there’s nothin’ more powerful than the almighty dollar. And now that the soldiers have returned from overseas, it’s time to reap the benefits they’ll be receiving from President Truman. There’s prosperity in the air, boy. There’s gold in them thar hills. Raise the price on those nails. Hell, we’ll sell ’em for 35 cents a bag. Son, ya have to take. Ya don’t give. That’s for Albert Schweitzer and missionaries like him. And don’t give a damn about them ya take from. Never look back. To show as much as an ounce a’ human decency is a sign of weakness. To make it in business ya have to be on the take, even if it means destroyin’ a person and their family. The world’s your oyster. Learn to strip it clean like that coon we’ll have for dinner tonight. Surround yourself with those who think like you and then you can take on the world of business. I’m proud of ya, son, finishin’ school like ya done. But schoolin’ ain’t what it’s cracked up to be. Take that Mrs. Simkins, yer social science teacher. She thinks she’s so smart teachin’ ya about Margaret Mead and Rachel Carson, intellectuals worryin’ about humanity and the environment. Whadda they know? I got blisters on my hands from workin’ the farm, and now this store. Those writers sittin’ back East ain’t got a clue about life. Ya don’t need no more schoolin’. Them professors up the road in Cincinnati would only fill yer head with silly ideas.’
Dexter’s head was nodding in agreement, just like the bobber on his fishing line after he’d hooked a catch. ‘Yeah, dad, I’ll help with the farm and the store. You’ll see. I’ll not waste away. Make a big success of myself one day. Have my own farm. And dad, from now on call me Dex.’
‘Hey, boys, what’re ya two jabberin’ about?’ interrupted Dexter’s mother. ‘Whatever it is, your father must be right. He’s all knowin’. We wouldn’t have this store if it weren’t for his interest in the stock market. Always worryin’ about his investments, he is. He don’t confuse himself with book learnin’ or with them detailed reports on a stock’s growth and development. He knows better’n them others. Goes by his gut feelin’. And, of course, what he hears over at the butcher shop. But, say, I’ve got to get back to the kitchen and fix that coon for dinner. Your father found it just this morning lyin’ by the roadside. Still warm. Musta been one of the town’s weak-livered residents that ran it down. Can you imagine? There was skid marks in front of where it lay.’
Monday, July 1, 1996. A hard rain pelted the wire-reinforced glass window to Cadwalider Obediah Jones’ office. C.O. was assistant medical examiner in Chicago’s Department of Forensic Pathology. Oblivious to the rain, he sat at his slate gray metal desk, pondering his most recent postmortem examination. Tendrils of smoke wafted skyward from his favorite Danish pipe. Not quite the open-and-shut motor vehicle accident it initially seemed. Police called to the scene theorized it a suicide because there were no skid marks on the roadway where his car had gone off. The deceased, 42-year-old Ignacio Delgado of Madrid, Spain, was a visiting professor in the Department of Ichthyology, University of Illinois–Urbana. He was an expert on aquaculture and fish toxins. Dr. Delgado’s car had run off a country road and down a ravine, where it had crashed into a tree. Death occurred as a result of head trauma and internal injuries sustained on impact.
As he studied police photographs of the accident scene, C.O. was struck by several inconsistencies. First, the right rear taillight and bumper were damaged. Why? The car was new, a rental. It had plunged down the ravine, traveling along a course that bore no obstacles other than the tree. Second, the car’s trajectory down the ravine was at an angle quite acute to the roadway, as if it headed back in the direction from which it had come. Finally, the sole of the professor’s right shoe bore the imprint of the brake pedal, indicating he had forcefully jammed his foot on the brake in trying to avoid impact with the tree.
Like a clarion’s blare, the telephone’s ringing startled C.O. and broke his train of thought. Marceine, his secretary, was on the line.
‘C.O., Dr. Litwak just called. He wants to see you in his office right away. Something about an important case.’
‘I’m on my way,’ he replied, and quickly emptied the embers of his pipe into the large ashtray that sat at the center of his desk.
C.O.’s knock on the metal door to Litwak’s office evoked a ‘Yeah! Enter.’
‘What’s up?’ C.O. inquired. He rushed in, carefully closing the door behind him. Like his own cubicle located just down the speckled gray linoleum-paved corridor, Litwak’s office was formed by cinderblock walls painted pale green years ago. Four-drawer filing cabinets were positioned along the east wall. Upon each lay brown manila folders of ongoing cases. Some would prove homicides. Stretched at various angles on metal shelves, their spines in scoliotic contortion, were well-worn textbooks of pathology, histology, forensic pathology and toxicology. Cy Litwak busily chewed an unlit Parodi cigar as he sat slouched forward in a metal chair and stared at the screen to his personal computer. Woven leather suspenders buckled forward, as if too large for the barrel chest of his 6-foot, 3-inch frame.
‘Thanks for coming over, C.O. I just got a phone call from Chief Benton down in Quincy, Illinois. He was quite distressed. Over the past month and a half, a number of people have died in Hawk Point, a town just north of there. More deaths than expected for a community of 5000. Dead were two men, including the town’s family practitioner and a trucker from Indiana who was visiting friends, and two women and a child, each of whom were residents of Hawk Point. Maybe all were from natural causes. But Benton is puzzled. He can’t exclude foul play, the workings of a serial killer. I’ve known Floyd Benton since grade school. Seen him at high school reunions. He’s a seasoned, thoughtful police chief. Ten years’ experience. He’s not impulsive.’
‘When did all this begin?’ asked C.O.
‘From what I can gather, it began to unfold in late May, right after Memorial Day. Several succumbed within days of each other. Only limited autopsies were performed. No medical examiner in that part of the state. Essentially gross examinations.’
‘So what do we have to go on at this point?’
‘Precious little, I’m afraid. Copies of the death certificates faxed over by Chief Benton don’t tell us much.’
‘I can tell you want me to visit Quincy and assist Chief Benton. When do you want me to leave?’ asked C.O.
‘Today’s Monday. How about your driving over tomorrow, spending a day or so down there? I’ll alert Benton you’re coming and that he should make himself and his staff available to you. Be back in the office on Friday to brief me with your findings.’
C.O. nodded. No superfluous questions were asked. No fanfare. No whining excuses, such as he and Violetta Integra had tickets to Friday evening’s concert by the Chicago Symphony. Vi, as he affectionately called his latest flame, was an Italian-born sculptress now living by Lake Michigan in Evanston.
Tuesday, July 2. It was late Tuesday morning, and only after he had completed his paperwork at the office did C.O. drive down to Quincy, his keen and inquisitive mind filled with possibilities about the deaths in Hawk Point. Could there be a sinister plot? Homicides? The act of some heartless monster? He left Chicago traveling southwest, first to Joliet, then Peoria. What about a public health outbreak? Pathogens that killed quickly? Hantavirus? Botulism? Chemical toxins?
The sun was beginning to set as C.O. finally arrived in Quincy, a town of 40 000 located along the western border of Illinois formed by the Mississippi River and just north of Hannibal, Missouri, home to Samuel Clemens (aka Mark Twain). He would stay at the Conestoga Motel. Quite a deal at $22.95 a night. Cy Litwak would be pleased with his budget-saving choice. After checking in, C.O. inquired about local eateries from the student attending the front desk. The young man pointed eastward in the direction of a tall multi-toned sign that overlooked the roadway. ‘Very convenient, sir, just up the highway. The Flying F Travel Plaza. It’s got everything, including a restaurant.’ With a sly smile he added, ‘You might also want to try its Mystic Lounge.’
‘Think I will. Thanks.’
C.O. drove his BMW onto the gravel-lined parking lot at the Flying F. The Plaza offered travelers, including truckers, a full service center. Sixteen wheelers were parked everywhere, including those refueling at well-lit gasoline stations where moths swarmed around headlights in seemingly reckless abandon. T-shirt-clad truckers stood around with hands in their jeans, making idle conversation about their arduous, all-day journeys across country. As he made his way to the restaurant, C.O. seemed a bit out of place in his office-based attire of navy blue blazer, gray slacks, regimental striped tie and buttoned-down blue oxford shirt.
After a dinner that featured Caesar salad, grilled steak – medium rare – and fries, C.O. stopped by the Mystic Lounge. A nightcap, he reasoned, before what was certain to be a demanding few days with Chief Benton. Much to his surprise, there was live entertainment on Tuesday nights. Performing this evening was Al Synovitis and the Lot Lizards, three sisters all in their twenties: Sharhonda, Rodonda and Dadonda. Comfortably seated at the bar, sipping a single malt served up by a friendly bartender, C.O. listened to the group’s rendition of Get a Job, ‘sha-rho-da-da, pause, sha-re-da-da.’ The gals, clad only in tight black leotards, leopard skin vests and black high heels, were undulating to the primal rhythm created by their electric guitars and Al’s drums. Wild cheers and cat calls greeted their titillating dance and instrument mating. His neck clad in gold chains, a breathless Al used the cordless microphone to announce that before intermission he and the gals would conclude this set with a classic Louisiana blues number, Laisser Le Bon Temps, Roliler (‘Let the Good Times Roll’). He invited the audience to join in. ‘Come on, baby, let the good times roll. Come on, baby, let me thrill your soul,’ began the trio. And join in the tired truckers did, with loud enthusiasm, their pointed metal-reinforced boots stomping to the rhythm, outstretched arms waving their hats to these provocative lyrics and the trio’s implication of stress relaxation. The set now completed, the Lot Lizards disbanded quickly to disperse amongst aroused customers, their tongues flickering provocatively in all directions.
Al sat at the bar, where he took the remaining seat next to C.O. As it turned out, Al was nearly done in by the heat of his recent exertion. His gold-chained neckwear twisted together, interwoven with sweaty chest hair. He dabbed at his brow, careful not to disturb a toupee that bore a marked resemblance to a stuffed muskrat C.O. had seen at the taxidermist’s office on State Street.
‘Can I buy you a beer?’ offered C.O. ‘You look like you could use one.’
‘Right neighborly of you,’ responded Al, catching his breath. ‘So what brings you to these parts? You don’t look like one of our usual customers.’
‘I just drove down from Chicago. Need to spend a few days,’ responded C.O.
‘You must be in sales, dressed in a shirt ‘n’ tie ‘n’ all.’
‘Actually, no. I’m here to investigate the illness or illnesses that have appeared in this region since late May.’ C.O. was careful not to suggest either the possibility of homicides or his employment with the medical examiner’s office. ‘It seems a number of men, women and children have gotten sick. Some died.’
‘Thank goodness you’re here,’ replied Al. ‘I’m from Hawk Point, and our local doc hasn’t put it together yet. I lost a sister to whatever it is. And another’s been deathly sick for weeks. Might lose her, too.’
‘Tell me about it,’ C.O. prompted.
‘My oldest sister, Gertrude, developed heart failure last year, some months after her heart attack. She was takin’ lots of medications, ya know. A heart pill, a strong water pill, and some sorta blocker. They kept her more or less stable and outta the hospital. I was in Des Moines at the time doin’ a gig, but my younger sister Cloress told me what happened. Outta the blue, Gertrude gets really bad diarrhea. No obvious reason. Several days later she calls Cloress, complainin’ of leg cramps. Died in her sleep that night, she did. Poor gal, at least she didn’t suffer. And Cloress ain’t much better. She’s got breast cancer. Takin’ chemotherapy. She got the bad diarrhea, too. Been sufferin’ with it for weeks. She’s miserable and Doc Parsons can’t figger out why. He ran all kinda tests. Negative. When I called him, Doc Parsons told me some other Hawk Point residents had developed watery diarrhea since late May, but he wasn’t sure how many. In a bunch of ’em it’s been steady, with bad cramps in the belly. Some’s had to be hospitalized.’
‘My condolences on the loss of your sister. This appears to be quite an outbreak of acute gastrointestinal illness,’ noted C.O.
‘And Doc Murphy died not long back,’ added Al. ‘Took care of several generations of the Synovitis family over the past 30 years.’
‘Do you know if he also had this diarrheal illness?’ inquired C.O.
‘Don’t know for sure. Do know he went fishin’ one day in late June with his old friend, Joe Skinner, but didn’t come back. Joe said Doc Murphy’d seemed troubled lately, and suggested a mornin’ of fishin’ over to Mark Twain National Wildlife Refuge. Thought it might do Doc some good. Relax him at bit. He ‘n’ Joe had been fishin’ the creek for years. They’d wade the water for hours, catching trout. But this time Joe had to do his fishin’ from the bank on account of his leg was casted. Broke it after a bad spill. Damnedest thing happened, Joe told me. After several hours of fishin’, Doc Murphy came outta the water with sores on his legs. Wasn’t talkin’ right. Seemed confused, but didn’t want to bother Joe for a ride home. Left in his own car, a new sedan he’d just bought to enjoy his retirement in. Claimed he had somethin’ to do at his office, fill out some reports or some such. Said he’d be okay. But he never made it home. Police found his car down in a gorge the next morning, wrapped around a tree. Poor Doc Murphy. A right kindly fella. Always sacrificin’ for his patients. Lately, he’d been complainin’ to Joe about being hounded by some administrator from the HMO that’d moved into Quincy. Police thought he may have committed suicide, bein’ there weren’t no skid marks where he went off the roadway. Maybe his judgement was outta whack.’
‘Let me get you another beer, Al,’ C.O. offered.
‘No thanks. Gotta get back to the set. The show must go on. Besides, we had a special request from the guy sittin’ down front. Steady customer and successful realtor in this part of the state. Name’s Hugh G. Studde. Give me a ten dollar bill with his request. Wants me and the gals to do Texas Willies.’
‘Would you like another single malt, neat?’ asked the bartender.
‘Yes please,’ C.O. replied.
As he poured, the bartender added, ‘Couldn’t help but overhear your conversation with Al. About his sisters takin’ ill and all. I got a preschooler over to Daisy’s Day Care Center. She had bad diarrhea, too. Started in early June. Doc Parsons called it intestinal flu, but nearly all 16 of Katie’s classmates came down with it, too. Musta been somethin’ in the school’s water, I reckon. Can you imagine, with so many kids and adults getting’ sick, sales of across-the-counter diarrhea medicine musta jumped through the roof.’
‘Very interesting,’ remarked C.O. ‘This whole affair is filled with sadness and intrigue. Would you give me your name? I’d like to keep in touch as we try to get to the bottom of this.’
‘Sure, glad to help. It’s Mike Hunt.’
When C.O. got back to his motel room, he quickly took notes of his conversations with Al and Mike. He formed a list of questions, and made a list of people he would ask Chief Benton to invite over to police headquarters tomorrow morning. He wanted to speak to Dr. Parsons, the town’s veterinarian and pharmacist, and the operator of the water treatment facility. He also formulated a questionnaire he would recommend Chief Benton have police officers use during telephone interviews they would conduct on Wednesday and Thursday.
What is your provisional differential diagnosis and what questions would you look to address?
[To be continued.]
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