On June 22 I returned to the National Institutes of Health. In the interim, Chris Fisher had also been through the treatment, while most of the others were scheduled after me. His initial reaction to the drug had been as bad as Dave’s—sudden pain, a feeling of pressure and suffocation, and a panicked feeling that he might be dying. But luckily those side effects went away in less than ten minutes. Chris’s body had tolerated the amphotericin better than Dave’s, and he managed to get the full, seven-day course. Even so, he had a rough time. The treatment left him feeling nauseated, exhausted, beaten up, and “totally without ambition.” After he returned to Colorado he got a rash on his body so terrible that the NIH doctors wanted to hospitalize him (he refused). He was sick all summer and unable to work into the fall semester, which caused him professional difficulties with his university department. The leish ulcer then started to come back, and only went away after Chris applied heat treatments to it. Over a year later, Chris’s rash still hadn’t completely healed.
Dave’s and Chris’s experiences were in the forefront of my thoughts as I filled out the usual paperwork at the NIH. My wife, Christine, had come with me, and we were escorted into one of the hospital rooms used for infusions. It was a very pleasant space, although the furniture was bizarrely oversized. I felt like I’d landed in Swift’s imaginary kingdom of Brobdingnag. The nurse explained that the NIH was researching morbid obesity, and we were in one of the rooms specially built for those patients.
I took my seat in the infusion chair, stressed and anxious. Since the infusions took a total of six to eight hours a day for seven days, I had brought a backpack stuffed with twenty pounds of my favorite comfort books, far more than I could ever read—Edgar Allan Poe, Arthur Conan Doyle, Wilkie Collins. I imagined being trapped for hours with a terrifying Nurse Ratched hovering about. But a perverse part of me was also curious about the effects of the drug. What would it be like to believe I was dying? Maybe I’d see the face of God, or the light at the end of the tunnel, or the Flying Spaghetti Monster.
An agreeable, totally un-Ratched nurse arrived, inserted the IV, and drew blood; then she started me on the saline drip. My actual ulcer would not be messed with, although they would examine it every day to see if it began to heal.
The bloodwork came back an hour later and all was good: I had strong kidney function. With both Drs. Nash and O’Connell in watchful attendance, the evil brown bag of amphotericin B was hung on the IV rack next to a bag of Benadryl. Fifteen minutes of a Benadryl infusion left me feeling groggy, and then the stopcock was turned and the ampho started down the tubes.
Dave, our honorary Italian, had compared it to limoncello. To me it looked like the color of urine. Watching it creep down the tube toward my vein only raised my anxiety levels, so I forced myself to avert my eyes. I chatted with the doctors and my wife, pretending nothing was happening, but all the while bracing myself for the sudden pain, the pressure, my head erupting in flames, God, or Baal. I could see my two doctors were also chatting about nothing with excessive cheer, trying to cover up their own nervousness.
The yellow liquid went in and then—nothing happened. I experienced none of the side effects that Dave and Chris did. It was a total anticlimax. Everyone was relieved, but I was also slightly disappointed.
From there, my treatment proceeded uneventfully. I arrived at the clinical center every morning around eight, got stuck with an IV, was subjected to a battery of blood tests, and then infused. After the third day, I asked my doctors to stop the Benadryl (aimed at blocking an allergic reaction to the drug) because it made me sleepy. They did so with no problems. After a few days the inevitable nasty side effects of the ampho did begin to creep in: I got a persistent headache and started to feel nauseated. Beyond that, I had a vague mental uneasiness that something was going badly wrong inside me, but I couldn’t put my finger on what. The side effects worsened until the sixth day, when I felt I was dragging around the world’s worst hangover—headache, nausea, lethargy, and muddled thinking. Toward the end of my treatment, Mark Adams, the sound engineer, started his. Mark had been on both expeditions, the 2012 lidar search and the 2015 jungle foray. He had been one of my favorite people, soft-spoken and cheerful even while hauling forty pounds of sound equipment and a long boom mic through dense jungle in the pouring rain. We asked to be together in the same room, where we passed the time chatting and reminiscing about our adventures. Mark also tolerated the ampho well, experiencing none of the scary side effects.
Awful as I felt, the nausea and apathy were among the most common and mildest side effects of amphotericin. I was extremely lucky. My doctors gave me anti-nausea drugs, ibuprofen, and a vile-tasting drink to restore my electrolyte balance. But on the sixth day, Nash and O’Connell told me my kidney function had dropped into the danger zone and they were going to discontinue the infusions. They wanted me to wait and have the final infusion after my kidneys had recovered. I received that infusion a few weeks later, closer to home, arranged by the NIH and my brother David, who is a doctor.
The hangover went away after about a week of the initial round, and in the following months the lesion dried up, flattened out, and turned into a shiny scar. At one point I asked Dr. Nash about the risks of going back into the jungle, which, despite everything, part of me remained eager to do if I could. He said that research indicated that 75 to 85 percent of people who got leish were thereafter immune; he felt I should be much more concerned about other diseases rife in the area for which there are no preventatives—dengue fever, chikungunya, and Chagas’ disease. (At this point Zika had not yet arrived in Honduras.)