From the UK we heard that Woody had contracted leish, as had Sully, despite bundling themselves up so scrupulously every evening. Sully was going to be treated at the Royal Centre for Defence Medicine at Birmingham Heartlands Hospital, while Woody was starting treatment at the Hospital for Tropical Diseases in London. Both would get a new drug, miltefosine. Word soon came back from Honduras that many Honduran members of the expedition had also fallen ill with leishmaniasis. These included Oscar Neil, the archaeologist; the commanding officer of the military contingent, Lt. Col. Oseguera; and nine soldiers.
When the news of our mini-epidemic began to spread among members of the expedition, accompanied by gruesome photos of weeping ulcers, it was hard not to think about the centuries-old legend and its oft-cited “curse of the monkey god.” All those flowers we chopped down! Gallows humor aside, though, many of us were privately aghast at having walked so blithely into that hot zone, and then having congratulated ourselves, prematurely, for emerging from the jungle unscathed. The jokes petered out quickly in the face of this dramatic disease, which had the potential to alter the course of each of our lives. This was deadly serious.
Because amphotericin is expensive and not available in Honduras, the Honduran members of the expedition were being treated with an older drug, a pentavalent antimonial compound. Antimony, a heavy metal, is directly below arsenic in the periodic table of elements and is similarly poisonous. This drug kills the parasite while sparing (one hopes) the patient. As bad as ampho B is, this one is worse: Even in the best scenarios it has dreadful side effects. We heard from Virgilio that Oscar, who had been bitten on the right side of his face, had almost died of the treatment and was recovering in seclusion in Mexico. He would have a nasty scar for life; he later grew a beard to cover it up and declined to speak of his experience or do any further work at T1.
After Dave was diagnosed with mucosal leish, I finally understood that I had to stop procrastinating and get treated. As bad as the treatment sounded, I wasn’t willing to take a chance with the disease itself, or with my face.
So finally, at the end of May, I called the NIH and set up an appointment for early June to get a biopsy and diagnosis. By this time my bug bite had turned into an oozing crater the size of a quarter, fiery red and disgusting to look at. It didn’t bother me; I’d had no more fevers and I felt fine. Dr. Nash said he doubted my fevers had been caused by the leish anyway; they were, he thought, coincidental viral infections, perhaps opportunistic because my immune system had been shaken up by leish, which hijacks white blood cells.
As my date approached, I heard that Dave’s treatment with liposomal amphotericin had gone very badly. He had suffered serious kidney damage and Dr. Nash had halted it after only two infusions. He remained hospitalized at the NIH under observation while the doctors debated what to do next.
CHAPTER 24
My head felt like it was in flames.
The National Institutes of Health occupies a verdant campus of several hundred acres in Bethesda, Maryland. I arrived alone on June 1, a gorgeous summer day, the smell of freshly cut grass drifting in the air, birdsong pouring from the trees. Sandals and jeans seemed to outnumber lab coats, and the place had the relaxed air of a college. As I walked up the drive toward the clinical center complex, I could hear from faraway a lone bugler playing taps.
I entered the center, and after wandering around more lost than I’d ever been in the jungle, I managed to find the patient processing area. There I signed paperwork agreeing to be studied, and a kindly nurse took thirteen vials of my blood. I met Dr. Ted Nash and my second doctor, Elise O’Connell, and was reassured by their warmth and professionalism.
In the dermatology lab, a photographer arrived with a Canon digital camera. He affixed a little ruler just below the ulcer on my arm and took dozens of photographs. I was ushered into an examination room where the lesion was inspected by a gaggle of earnest medical students, who took turns peering, palpating, and asking questions. Next, in the biopsy lab, a nurse cut two wormlike plugs of flesh out of the lesion, and the holes were stitched up.
When the biopsy came back it would offer no surprise: Like Dave and everyone else, I had Leishmania braziliensis. Or at least that’s what the doctors initially believed.
Our primary doctor, Theodore Nash, was seventy-one years old. He did his rounds in a white lab coat with a roll of papers precariously shoved into a side pocket. He had curly salt-and-pepper hair brushed back from a domed forehead, steel-rimmed spectacles, and the kindly, distracted air of a professor. Even though, like most doctors, he was fantastically busy, his manner was unhurried and relaxed, and he was gregarious and happy to answer questions at length. I said I wanted to hear the straight story without any window dressing. He said that was how he preferred to work with all his patients. He was refreshingly, even alarmingly, direct.
The National Institutes of Health has been conducting clinical studies on leishmaniasis since the early 1970s, treating recent immigrants and people who had picked up the disease while traveling. Many of the patients were Peace Corps volunteers. Dr. Nash participated in the treatment of most of them. He had written the upgraded leishmaniasis treatment protocol for the NIH in 2001, and it is still in use today. He shifted treatment away from the antimonial drug, which he thought was too toxic, to amphotericin and other drugs, depending on the parasite species and the geographic variety. Nash knew as much about leish treatment as any doctor in the United States. This is not a simple disease, and treatment is more an art than a science. The clinical data aren’t deep enough to give doctors a precise formula, and there are too many forms of leish and many unknowns.