Contents
Title Page
Dedication
Epigraph
SOMETHING IN THE AIR
THE DREAMING DEMON
TO BHOLA ISLAND
THE OTHER SIDE OF THE MOON
A WOMAN WITH A PEACEFUL LIFE
THE DEMON’S EYES
THE ANTHRAX SKULLS
SUPERPOX
Glossary
Acknowledgments
About the Author
Also by Richard Preston
Copyright Page
This book is lovingly dedicated to Michelle
Chance favors the prepared mind.
—LOUIS PASTEUR
SOMETHING IN THE AIR
Journey Inward
OCTOBER 2–6, 2001
IN THE EARLY NINETEEN SEVENTIES, a British photo retoucher named Robert Stevens arrived in south Florida to take a job at the National Enquirer, which is published in Palm Beach County. At the time, photo retouchers for supermarket tabloids used an airbrush (nowadays they use computers) to clarify news photographs of world leaders shaking hands with aliens or to give more punch to pictures of six-month-old babies who weigh three hundred pounds. Stevens was reputed to be one of the best photo retouchers in the business. The Enquirer was moving away from stories like “I Ate My Mother-in-Law’s Head,” and the editors recruited him to bring some class to the paper. They offered him much more than he made working for tabloids in Britain.
Stevens was in his early thirties when he moved to Florida. He bought a red Chevy pickup truck, and he put a CB radio in it and pasted an American-flag decal in the back window and installed a gun rack next to the flag. He didn’t own a gun: the gun rack was for his fishing rods. Stevens spent a lot of time at lakes and canals around south Florida, where he would spin-cast for bass and panfish. He often stopped to drop a line in the water on his way to and from work. He became an American citizen. He would drink a Guinness or two in bars with his friends and explain the Constitution to them. “Bobby was the only English redneck I ever knew,” Tom Wilbur, one of his best friends, said to me.
Stevens’s best work tended to get the Enquirer sued. When the TV star Freddie Prinze shot himself to death, Stevens joined two photographs into a seamless image of Prinze and Raquel Welch at a party together. The implication was that they had been lovers, and this sparked a lawsuit. He enhanced a photograph of a woman with a long neck: “Giraffe Woman.” Giraffe Woman sued. His most famous retouching job was on a photograph of Elvis lying dead in his coffin, which ran on the cover of the Enquirer. Elvis’s bloated face looked a lot better in Stevens’s version than it did in the handiwork of the mortician.
Robert Stevens was a kindhearted man. He filed the barbs off his fishing hooks so that he could release a lot of the fish he caught, and he took care of feral cats that lived in the swamps around his house. There was something boyish about him. Even when he was in his sixties, children in the neighborhood would knock on the door and ask his wife, Maureen, “Can Bobby come out and play?” Not long before he died, he began working for The Sun, a tabloid published by American Media, the company that also owns the National Enquirer. The two tabloids shared space in an office building in Boca Raton.
ON THURSDAY, September 27th, Robert Stevens and his wife drove to Charlotte, North Carolina, to visit their daughter Casey. They hiked at Chimney Rock Park, where each autumn brings the spectacular sight of five hundred or more migrating hawks soaring in the air at once, and Maureen took a photograph of her husband with the mountains behind him. By Sunday, Stevens was not feeling well. They left for Florida Sunday night, and he got sick to his stomach during the drive home. On Monday, he began running a high fever and became incoherent. At two o’clock on Tuesday morning, Maureen took him to the emergency room of the John F. Kennedy Medical Center in Palm Beach County. A doctor there thought he might have meningitis. Five hours later, Stevens started having convulsions.
The doctors performed a spinal tap on him, and the fluid came out cloudy. Dr. Larry Bush, an infectious-disease specialist, looked at slides of the fluid and saw that it was full of rod-shaped bacteria with flat ends, a little like slender macaroni. The bacteria were colored blue with Gram stain—they were Gram-positive. Dr. Bush thought, anthrax. Anthrax, or Bacillus anthracis, is a single-celled bacterial micro-organism that forms spores, and it grows explosively in lymph and blood. By Thursday, October 4th, a state lab had confirmed the diagnosis. Stevens’s symptoms were consistent with inhalation anthrax, which is caused when a person breathes in the spores. The disease is extremely rare. There had been only eighteen cases of inhalation anthrax in the past hundred years in the United States, and the last reported case had been twenty-three years earlier. The fact that anthrax popped into Dr. Bush’s mind had not a little to do with recent news reports about two of the September 11th hijackers casing airports around south Florida and inquiring about renting crop-dusting aircraft. Anthrax could be distributed from a small airplane.
Stevens went into a coma, and at around four o’clock in the afternoon of Friday, October 5th, he suffered a fatal breathing arrest. Minutes later, one of his doctors made a telephone call to the Federal Centers for Disease Control and Prevention—the CDC—in Atlanta, and spoke with Dr. Sherif Zaki, the chief of infectious-diseases pathology.
Sherif Zaki inhabits a tiny office on the second floor of Building 1 at the CDC. The hallway is made of white cinder block, and the floor is linoleum. The buildings of the CDC sit jammed together and joined by walkways on a tight little campus in a green and hilly neighborhood in northeast Atlanta. Building 1 is a brick oblong with aluminum-framed windows. It was built in the nineteen fifties, and the windows look as if they haven’t been cleaned since then.
Sherif Zaki is a shy, quiet man in his late forties, with a gentle demeanor, a slight stoop in his posture, a round face, and pale green eyes distinguished by dazzling pupils, which give him a piercing gaze. He speaks precisely, in a low voice. Zaki went out into the hallway, where his pathology group often gathered to talk about ongoing cases. “Mr. Stevens has passed away,” he said.
“Who’s going to do the post?” someone asked. A post is a postmortem exam, an autopsy.
Zaki and his team were going to do the post.
EARLY THE NEXT MORNING, on Saturday, October 6th, Sherif Zaki and his team of CDC pathologists arrived in West Palm Beach in a chartered jet, and a van took them to the Palm Beach County medical examiner’s office, which takes up two modern, one-story buildings set under palm trees on a stretch of industrial land near the airport. They went straight to the autopsy suite, carrying bags of tools and gear. The autopsy suite is a large, open room in the center of one of the buildings. Two autopsies were in progress. Palm Beach medical examiners were bending over opened bodies on tables, and there was an odor of fecal matter in the air, which is the normal smell of an autopsy. The examiners stopped work when the CDC people entered.
“We’re here to assist you,” Zaki said in his quiet way.
The examiners were polite and helpful but did not make eye contact, and Zaki sensed that they were afraid. Stevens’s body contained anthrax cells, although he had not been dead long enough for the cells to become large numbers of spores. In any case, any spores in his body were wet, and wet anthrax spores are nowhere near as dangerous as dry spores, which can float in the air like dandelion seeds, looking for fertile ground.
The CDC people opened a door in the morgue refrigerator and pulled out a tray. The body had been zipped up inside a Tyvek body bag. Without opening the bag, they lifted the body up by the shoulders and feet and placed it on a bare metal gurney. They rolled the gurney into a supply room and closed the door behind them. They would do the autopsy on the gurney in a cl
osed room, to prevent the autopsy tables from being contaminated with spores.
The chief medical examiner of Palm Beach County, Dr. Lisa Flannagan, was going to do the primary incisions, while Zaki and his people would do the organ exams. Flannagan is a slender, self-assured woman, with a reputation as a top-notch examiner. Everybody gowned up, and they put on N-100 biohazard masks, clear plastic face shields, hair covers, rubber boots, and three layers of gloves. The middle glove was reinforced with Kevlar. Then they unzipped the bag.
The CDC team lifted the body up, gripping it beneath the shoulders and legs, and someone snatched the bag out from underneath it. They lowered the body back onto the bare metal deck of the gurney. Stevens had been a pleasant-looking man with a cheerful appearance. He was a bluish color now, and his eyes were half open.
Heraclitus said that when a man dies, a world passes away. The terribly human look on the face of the deceased man disturbed Sherif Zaki. It was so hard to picture this man in life and then to connect that picture with the body on the gurney. This was the toughest thing for a prosector, and you never got over it, really. Zaki did not want to connect the living man with the body. You had to put it aside, and you could not think about it. His duty now was to identify the exact type of disease that Stevens had, to learn if he had inhaled spores or perhaps had become infected some other way. This might help save lives. Yet cutting into an unfathomed body was difficult, and after a hard post, Sherif Zaki would not feel like himself for a week afterward. “It’s not an uplifting process,” Zaki said to me.
The team rolled Stevens onto his side and inspected his back under bright lights for signs of cutaneous anthrax—skin anthrax. They didn’t find any, and they laid him back down.
Dr. Flannagan took up a scalpel and pressed the tip of the blade on the upper left part of the chest under the shoulder. She made a curving incision that went underneath the nipples, across the chest, and up to the opposite shoulder. Then, starting at the top of the sternum, she made a straight incision down to the solar plexus. This made a cut that looked like a Y, but with a curved top. She finished it with a short horizontal cut across the solar plexus. The opening incision looked rather like the profile of a wineglass.
Dr. Flannagan grasped the skin of the chest, and pulled it upward, peeling it off. She laid the blanket of skin around the neck. She pulled the skin away from the sides of the chest, revealing the ribs and sternum. She took up a pair of gardening shears and cut the ribs one by one, snipping them in a wide circle around the sternum. This was to free the chest plate, the front of the rib cage. When she had finished cutting the ribs, she pushed her fingertips underneath the chest plate and pried it upward, as if she were raising a lid from a box.
As Flannagan lifted the chest plate, a gush of bloody fluid poured out from under the ribs and ran down over the body and poured over the gurney and onto the floor.
The chest cavity was engorged with bloody liquid. No one in the room had ever done a post on a person who had died of anthrax. Zaki had studied photographs of autopsies that had been done on anthrax victims in the Soviet Union, in the spring of 1979, after a plume of finely ground anthrax dust had come out of a bioweapons manufacturing facility in Sverdlovsk (Yekaterinburg) and had killed at least sixty-six people downwind, but the photographs had not prepared him for the sight of the liquid that was pouring out of this man’s chest. They were going to have quite a time cleaning up the room. The bloody liquid was saturated with anthrax cells, and the cells would quickly start turning into spores when they hit the air.
Dr. Flannagan stood back. It was the turn of the CDC team.
The CDC people wanted to look at the lymph nodes in the center of the chest. Working gently with his fingertips, Zaki separated the lungs and pulled them to either side, revealing the heart. The heart and lungs were drowned in red liquid. He couldn’t see anything. Someone brought a ladle, and they started spooning the liquid from the chest. They poured it off into containers, and ultimately they had ladled out almost a gallon of it.
Zaki worked his way slowly down into the chest. Using a scalpel, he removed the heart and parts of the lungs, which revealed the lymph nodes of the chest, just below the fork of the bronchial tubes. The lymph nodes of a healthy person are pale nodules the size of peas. Stevens’s lymph nodes were the size of plums, and they looked exactly like plums—they were large, shiny, and dark purple, verging on black. Zaki cut into a plum with his scalpel. It disintegrated at the touch of the blade, revealing a bloody interior, saturated with hemorrhage. This showed that the spores that had killed Stevens had gotten into his lungs through the air.
When they had finished the autopsy, the pathologists gathered up their tools and placed some of them inside the body cavity. The scalpels, the gardening shears, scissors, knives, the ladle—the prosection tools were now contaminated with anthrax. The team felt that the safest thing to do with them would be to destroy them. They packed the body cavity with absorbent batting, stuffing it in around the tools, and placed the body inside fresh double body bags. Then, using brushes and hand-pump sprayers filled with chemicals, they spent hours decontaminating the supply room, the bags, the gurney, the floor—everything that had come into contact with fluids from the autopsy. Robert Stevens was cremated. Sherif Zaki later recalled that when he was ladling the red liquid from Stevens’s chest, the word murder never entered his mind.
THE DAY BEFORE Robert Stevens died, a CDC investigation team led by Dr. Bradley Perkins had arrived in Boca Raton and had begun tracing Stevens’s movements over the previous few weeks. They wanted to find the source of his exposure to anthrax. They believed that it would have to be a single point in the environment, because anthrax does not spread from person to person. They split into three search groups. One group flew off to North Carolina and visited Chimney Rock while the other two went around Boca Raton. They all had terrorism on their minds, but Perkins wanted the team to make sure they didn’t miss a dead cow with anthrax that might be lying next to one of Stevens’s fishing spots.
Working the telephones, they called emergency rooms and labs, asking for any reports of unexplained respiratory illness or of organisms from a medical sample that might be anthrax. A seventy-three-year-old man named Ernesto Blanco turned up. Blanco, who was in Cedars Medical Center in Miami with a respiratory illness, happened to be the head of the mail room at the American Media building, where Robert Stevens worked. Doctors had taken a nasal swab from him, and the swab produced anthrax on a petri dish. Blanco and Stevens had not socialized with each other. The only place where their paths crossed was inside the American Media building.
The zone of the suspected point source shrank abruptly, and the CDC team went to the American Media building with swab kits. (A swab kit is a plastic test tube that holds a sterile medical swab, which looks somewhat like a Q-tip and has a thin wooden handle. You swab an area of interest, and then you push the swab into the test tube, snap off the wooden handle, cap the test tube, and label it. Later, the swab is brushed over the surface of a petri dish, and micro-organisms captured by the swab grow there, forming spots and colonies.) When they were running very short of swabs, Perkins and his people made a decision to test the mail bin for the photo department of The Sun.
The swab from the mail bin proved to be rich with spores of anthrax. It was brushed over a petri dish full of blood agar—sheep’s blood in jelly—and by late in the afternoon of the day the autopsy took place, colonies and spots of anthrax cells were growing vigorously on the blood. The spots were pale gray, and they sparkled like powdered glass—they had the classic, glittery look of anthrax. Something full of spores must have arrived in the mail. It meant that the point source of the outbreak was nothing in nature. On Sunday night, October 6th, Brad Perkins telephoned the director of the CDC, Dr. Jeffrey Koplan. “We have evidence for an intentional cause of death of Robert Stevens,” he said to Koplan. “The FBI needs to come into this full force.”
Communiqué from Nowhere
OCTOBER 15, 20
01
AT TEN O’CLOCK on a warm autumn morning in Washington, D.C., a woman—her name has not been made public—was opening mail in the Hart Senate Office Building, on Delaware Avenue. She worked in the office of Senator Tom Daschle, the Senate majority leader, and she was catching up with mail that had come in on the previous Friday. The woman slit open a hand-lettered envelope that had the return address of the fourth-grade class at the Greendale School in Franklin Park, New Jersey. It had been sealed tightly with clear adhesive tape. She removed a sheet of paper, and powder fell out, the color of bleached bone, and landed on the carpet. A puff of dust came off the paper. It formed tendrils, like the smoke rising from a snuffed-out candle, and then the tendrils vanished.
By this time, letters containing grayish, crumbly, granular anthrax had arrived in New York City at the offices of NBC, addressed to Tom Brokaw, and at CBS, ABC, and the New York Post. Several people had contracted cutaneous anthrax. The death of Robert Stevens from inhalation anthrax ten days earlier had been widely reported in the news media. The woman threw the letter into a wastebasket and called the Capitol Police.
Odorless, invisible, buffeted in currents of air, the particles from the letter were pulled into the building’s high-volume air-circulation system. For forty minutes, fans cycled the air throughout the Hart Senate Office Building, until someone finally thought to shut them down. In the end, the building was evacuated for a period of six months, and the cleanup cost twenty-six million dollars.
THE HAZARDOUS MATERIALS RESPONSE UNIT of the Federal Bureau of Investigation—the HMRU—is stationed in two buildings at the FBI Academy in Quantico, Virginia. When there is a serious or credible threat of bioterrorism, an HMRU team will be dispatched to assess the hazard, collect potentially dangerous evidence, and transport it to a laboratory for analysis.