Reliving Nightmare of Plague, 10 Years On

http://www.nytimes.com/2013/01/08/health/when-the-plague-came-to-new-york.html

Version 0 of 1.

It was November 2002, little more than a year after planes had been flown into the World Trade Center and anthrax mailings had killed five Americans. New York City was still on edge, in a state of high alert for suspected terrorists.

Suddenly all eyes were on a middle-aged married couple from Santa Fe, N.M., on a brief vacation to New York, who had the remarkably ill luck to come down with the city’s first case of bubonic plague in more than a century. Television news trucks surrounded Beth Israel Medical Center North, where they had dragged themselves after being stricken in their hotel room with rampaging fevers, headaches, extreme exhaustion and mysterious balloonlike swellings.

It took just over a day for public health officials to dispel fears about bioterrorism; there had been no unusual rise in the number of very high fevers that could have suggested an attack.

It turned out that the couple, Lucinda Marker and John Tull, had been bitten by fleas infected with Yersinia pestis, the bacterium that causes plague. Their home state, New Mexico, accounts for more than half of the average seven cases of plague in the country every year. (In 2012, just one case was reported in the state.)

“It was an absolute fluke,” Ms. Marker, now 57, said during a recent visit to New York. “Just rotten luck.”

Like most people who contract the disease and are quickly treated with antibiotics, she recovered in a few days. But 10 years later, her husband is still badly scarred.

In the days after they were bitten, Mr. Tull, a burly, athletic lawyer — a former prosecutor who volunteered with search-and-rescue teams — developed septicemic plague, as the infection spread throughout his body.

His temperature rose to 104.4, his blood pressure plummeted to 78/50. His kidneys were failing, and so much clotted blood collected in his hands and feet that they turned black.

Mr. Tull was put into a medically induced coma. When he was brought out of it, nearly three months later, he found out that both his legs had been amputated below the knee to drain the deadly infection. The surgery that saved his life radically changed it, but did not dampen his resilient spirit.

Even before he was released from the hospital to begin a long rehabilitation, he vowed he would once again be hiking on the rustic trails above his home.

Today Mr. Tull, 63, drives his own car, sometimes takes over the controls of a private plane, and goes on an annual trout-fishing trip to Colorado with friends. But he has not been able to hike that trail.

“That is one of the things I miss most,” Mr. Tull, now retired and receiving a disability pension, said in a telephone interview from his home. “Every single hour of every single day, the plague affects our lives, but about the only time I really get angry these days is when, because of my physical condition, there is something I want to do but can’t.”

He has appeared in several television documentaries, speaking to medical researchers around the world and dealing with a posse of journalists as his very private ordeal has been played out in public.

“Basically Lucinda and I surrendered our privacy to the press and the people who make documentaries,” Mr. Tull said. “But you know what? That didn’t bother us a bit. Lucinda had been an actress and I had been a trial lawyer. We were used to it.”

Ms. Marker, who has started to write about their ordeal, says that after 10 years she is coming to terms with it emotionally and psychologically. Yet many aspects of their case still puzzle medical experts.

In particular, no one knows why she was so easily cured while he nearly died.

Bubonic plague is transmitted by fleas that feed off pack rats, ground squirrels and prairie dogs in the mountains of New Mexico and several other states. According to the Centers for Disease Control and Prevention, the disease probably came to the United States around 1900, in Asian rats that escaped from ships in the port of San Francisco.

Initially, plague was restricted to cities. The worst outbreak came in 1907, after the San Francisco earthquake. Vermin control programs prevented further outbreaks, but fleas hitched onto other animals in the wild.

Dr. Paul Ettestad, public health veterinarian for the New Mexico Department of Health, said prairie dogs became an “amplification host,” carrying the disease to their burrows and spreading it throughout their territory. Today, the easternmost limit of the plague roughly corresponds to the 100th meridian, which passes through central Texas. Known as the plague line, is it also the extent of the prairie dog population.

When doctors from New York called Dr. Ettestad in 2002 asking about bubonic plague, he thought it was some kind of joke. The height of plague season is summer, not November, and there had not been a single instance of human plague that year in New Mexico.

“Imagine my skepticism when the New York doctor said there were two people with plague at the same time,” Dr. Ettestad said. An investigator on his team heard the names of Ms. Marker and Mr. Tull and remembered that an infected pack rat had been found on their property that July.

“I thought, ‘Oh my God,’ ” Dr. Ettestad recalled.

Samples of Mr. Tull’s blood were sent to the New York City Public Health Laboratory, which had received training for diagnosis of plague after Sept. 11.

Within hours, plague was confirmed. Dr. Thomas R. Frieden, then commissioner of New York City’s Department of Health and now director of the C.D.C., said in an interview that the city’s emergency room surveillance system enabled officials to rule out bioterrorism.

“That showed us the importance of having information systems that could not only show trends but also show when trends were not there,” Dr. Frieden said.

Mr. Tull was deteriorating rapidly. “At one point, I was on a respirator, I had a tracheotomy and a feeding tube, I was unconscious, I was on a dialysis machine,” he recalled. “Hell, I was hooked up to every damn machine in the hospital except the vacuum.”

Early in 2002, Mr. Tull had learned he had Type 2 diabetes, which might have affected the progression of the plague. The bubo that Ms. Marker developed — a swelling that is the telltale marker of plague — was more pronounced than anything Mr. Tull had, suggesting that her lymph nodes were combating the bacteria more effectively than his. Another theory held that if both were bitten by the same flea, Mr. Tull might have received more of the bacteria than his wife.

But there are no clear answers. “You can speculate all you want,” said Dr. Donald A. Romig, a retired infectious disease specialist in New Mexico who has seen or been consulted on dozens of plague cases, “but as far as I’m concerned, you’ll never know.”

The couple still live in the house on five acres outside Santa Fe that was their home when they were infected. The most important lesson, Mr. Tull said, is that to get through an ordeal like this, you need someone to lean on.

“With true understanding and love,” he said, abandoning his usual mountain toughness, “two people can get through anything.”