Agent 69 - Top Secret Dodo

I was all resigned to the fact that I had to work at Trader Joe's while waiting for Residency to start when I get an email from the infectious disease people at the CDC. I had been accepted to do an Epidimeology elective in Atlanta.

Epiwhatology? Most people in my school can't even pronounce it. I never really got epidimeology. In med school, we had such crappy epi professors that all we did was memorize formulas without actually knowing what they all meant. Attack rates, and, what one epi professor called, The 'Barkers', ARR, CAR, and ORR. I have no clue what they all stand for expcept for a vague idea that they are some sort of calculated risk. So what the hell was I doing applying to an elective in something I only had a vague understanding of that is limited to calculating the sensitivity and specitivity of things? Well, I came across a book in New York while in Colombus Circle, browsing betweeen the shelves of the Borders bookstore, by the name of "The Medical Detectives", written by an author named Berton Roueche. Roueche had worked for The New Yorker and wrote a column detailing the work of epidimeologists who investigated outbreaks. This book is a compilation of his stories.

He started out with a story, set after WWI, about an 88-year old man, who collapses in the street and is sent to the local ER. At the ER, he is noted by the physician to be blue. That is, the color blue. Not more than an hour later, another man comes into the hospital and is also noted to be of the same hue. All in all, the physician saw 12 blue men that night. An investigation was launched and the authorities called in, trying to piece together the common denominator that linked these 12 blue men. It was determined that these men all shared their mornings in a warehouse that served breakfast. In this breakfast hall, there were 15-20 benches, each with the capacity of seating about 12 men. However, these 12 men didn't share breakfast at the same table. What they shared was the breakfast. Each had a bowl of oatmeal. So the oatmeal was analyzed. Inevstigators observed how it was prepared. They even tested the industrial sized pot it was made in and found nothing amiss. Then one of the investigators decided to be present while breakfast was served and noticed a trickling of a dozen or more men into the warehouse. Of all who ordered the oatmeal, he noticed that the majority had added salt to their oatmeal. There was 1 salt shaker for every bench. Now the investigator was curious. He wanted to know where the salt was kept. He went into the kitchen and asked the cook who showed him a large bottle of salt she kept above the stove. On top of the salt that was added to the pot of oatmeal, the men were adding more with their salt shakers at the benches. The investigator found nothing unusual with the bottle of salt the cook had above the stove. Then he asked the cook where the main salt bin was stored that these bottles were being refilled from. And in the back storage room, he found sacks of salt. All the sacks had a preservative in it, a nitrate derivative. This nitrate derivative was mandated by the government to preserve salt during the war and some of it was still circulating in the population in the post war era. Nitrates given in large enough quantities to rats causes methhemoglobin. Essentially, it deforms the red blood cell and red blood cells carry the life giving element, oxygen. So when the RBC becomes deformed, it has diminished its capacity to carry oxygen and under duress, these men turned blue! Only these 12 men were affected because they were the only ones who had added more salt on top of the salt already added by the cook.

I was hooked from then on. Using science and logical deduction, crimes of this nature were solved. I couldn't wait to participate in something like that!

This is the caveat that most authors like Roueche forget to mention: nothing written about stuff is always as accurate as what it is. Somehow, people fail to mention the unglamorous sides to things.

Fast foward till today. I am pretty excited. After a grueling month in a neurology rotation during which I pretended to know what I was doing, I fly the red-eye into Atlanta and suffer through screaming children and overweight people with body smells. I rent a car and make it to my final destination after having 0-3 hours of sleep.

I am at the CDC.

Imagine that.

I sign in (which is the begining of my nightmare) and am greeted by my supervisor who takes me up to the office. I get introduced to my cubicle, which has my name on it (rock on!) and she proceeds to tell me this:

"Welcome to the branch of Respiratory Health and Indoor Pollution. We are the Asthma people."
She is whispering and barely audible.
I feel like a secret agent on an undercover sting.
"I am sure you have heard about the Katrina victims and the FEMA trailer incident that has been all over the news lately."
I nodd my head, even though I had no inkling of what she was refering to.
"Well recently, there have been complaints among the residents who are still living in FEMA trailers and we have been mandated by congress to get to the bottom of these health complaints."
Uh-huh. I nodd again, feeling more espionagy then I ever have in all my 33 years of existence.
"This matter is political in nature. In fact the other day, we were on a field trip to Louisiana and the White House Representative was there and he was on his Black Berry, aparently on the phone with the President, and he said: the President wants an answer in three months."
Gulp. The President?
Then she proceeds to say: "Do you have friends?"
I said I have few, feeling this was the best answer amidst the circumstance.
"Well, it would be good if you just remained very general when you talk to or email them about Katrina FEMA trailers. We don't want to have to subpoena you and all your electronic communications when there is a congressional hearing on this matter." She smiles with a-matter-of-fact look on her face.
Double gulp gulp. Congressional hearing?
"Ok, that having said, we can get down to work."
But we all know better. It's wanting me to keep quiet about something and then telling me I can't tell anyone that prompts me to do the total opposite.

I was half expecting getting all suited up like Bond, with a cell phone that doubles up as a satellite receiver, a shoe that has a hidden camera, a BMW that talks and has a digitalis remedy in the glove compartment. I'm part of the CDC now, Secret Agent, sworn to absolute secrecy.

However, before that, I had to clear security. Since the Secret Agent was not a citizen, I was treated to 10 layers of government scrutiny before I was even allowed on the premises. Since no one knew I wasn't a citizen, by some glitch in the communication process, and the guy that processes the paperwork was not familiar with processing paperwork of individuals who weren't citizens, my approval to enter Government buildings, where sensitive data (on Asthma surveillance) were stored, was pending. I spent one week living in the terror of being sent home for the crime of being a Resident Alien instead of a citizen. When they finally got their heads out of their asses, I was supposed to be entered into the mainframe, except that the person who usually does it is on vacation and the person hired to replace this person was a government contractor with no higher up security clearance. Someone else had to do it, someone that has yet to be identified, whose job was not to enter people into databases. By the time they had it sorted out, another 1/2 week had lasped and I was rearing to go. There you have it for government efficiency. Your government hard at work.

Secret Agent needed to feel purposeful.

When I finally get to Secret Agent status with full security clearance, I spend the better part of two weeks researching literature articles on everything and anything there is to do with formaldehyde and the mobile home, which isn't very much. I spent the better part of my waking hours in a tiny cubicle with no natural sunlight, freezing my ass off because some woman in menopause is in control of the temperature. So when the opportunity came up to do an outbreak investigation in Mississippi and I was asked if I wanted to, I said: "are you kidding me?" At that point I was willing to go anywhere just to be able to see the sun for a couple of days.

And so I went, to Philadelphia, MS, where in 1964, three civil rights activists were murdered by the KKK and their bodies dumped into the Mississippi (remember Mississippi Burning?) river. Just the place for a Pertussis outbreak, right? Right.
My dream of finding the cause for 12 men to be blue is finally becoming a reality.
The outbreak happened on an Indian reservation and has since spread to the neighboring counties. People are getting wary and are casting sidelong glances at the native indian populations, as if they had set a plague on the community. The CDC is called in because the local news media of sleepy hollow have finally found some ants in their pants and are starting to report mostly erroneous facts. The state needed a federal body to cover their ass to make sure everything is running accordingly.

The lead field investigator is a young, skinny asian who had just recently sat for his boards in Internal Medicine. He looked to me like someone who had invested a lifetime in cultivating his gray matter and somehow forgot he had a body, much like a Conehead with a big head and a small body. In fact, he did have a big head, metophorically and literally. He is a newly inaugurated EIS (Epidemic INTELLIGENCE Service) officer, commisoned in the Uniformed Services of America. These are civilian doctors and PhDs who like to dress up and order people around so they can justify their over compensated benefits packages. Of course, there is an upside to being called "Sir" or "M'am" and have someone salute you, unless you consider someone like me, who joined the Navy Reserves secondary to purely mercenary intentions.

There were four of us in the investigation team; a french Belgian, a redneck PhD from Pennsylvania, skinny man, and me. There was a senior EIS investigator who traveled with us for about 3 days. We arrived on the reservation in two groups. I was picked up by the Belgian and the senior EIS officer and we took the 1 1/2 hour trip from Jackson to Philadelphia. This town was apparently named after Philadelphia, PA. However, unlike Philadelphia, PA, this imitation was in the middle of sleepy hollow. It was sleepy hollow central, with not much else in between except dense Mississippi forrests with miles and miles of trees. I can't help but think of the picture I had seen when I visited the MLK Historical Society of a lynched black man hanging from a tree with a sign dangling off his great toe that said: "Sleeping. Do not disturb", surrounded by smiling white men posing for the picture. It is unsettling to visit a place that is so haunted, with trees that know too much.

So when we came upon the gargantuan silver ball in the sky, it was a juxtaposition I could not wrap my mind around. On this tiny highway, the very same one on which the three civil rights workers made their last travels on earth, there stood Las Vegas, glittering and neoned-up, like a harlot but in the middle of the Bible Belt. This was the invention of the 20th century, a native indian creation that sidesteps centuries of ill treatment, to level the playing field. This was the reservation's own Pearl River Resort Casino and Spa.

We checked in. I proudly displayed my "government" issued, hot of the press, Department of Health, ID and got ushered into my fantastically dim room, air-freshened with the scent of the day: stale cigarette smoke de jour, with the sound of a thousand slot machines muted in the distance to lull me to sleep. I lower the temperature to a chilly 61 degrees. Smells are not so apparent in this temperature range. While I chilled in my room, watching CNN, someone knocks on my door. At the door were two ladies from room service.

"I didn't order any room service," I said.
"It's ok. This plate of fruit has been paid for and it's yours."
"But I'm not who it says on this card. I'm part of his party but he isn't even checked in yet."
"Really, it's yours, enjoy it."
Ok, I said to myself. Must be some nice Secret Agent welcoming gift from the Reservation thanking the CDC for coming to the rescue. I let the ladies in and started to unwrap the fruit. Pineapple, honeydew, canteloup and grapes. I was hungry! There was also this fantastic to-die-for strawberry mousse.

At this time, the Belgian calls and I ask if she had a fruit platter brought up to her room. She said she had to switch rooms and that maybe, the platter was brought up to the room she'd just vacated and hadn't gotten to her yet.
"Well," I said "there's more than plenty for me and you are welcome to share some of it with me."
"Maybe after dinner," she says in her inspector Clouseau accent.

We finally meet up with the rest of the party. Skniny man and redneck PhD came in a separate vehicle. I am partially satiated with the fruit platter as we walk to dinner, an all-you-can-eat-buffet, Vegas style but with southern food (everything deep fried to death).

I ask everyone whether or not each had received a fruit platter. To my dismay, I was the only one. Hmmm. Mighty strange. At this time, skinny man gets a call from his fiance who asks him how he liked his fruit platter. And flowers.

Oh-oh. Why does this not sound good?

Needless to say, I was the butt of many fruit jokes to come. Apparently, since skinny man had reserved all four rooms, the hotel had automatically assumed he had checked-in and then promptly assigned me the wrong room. Either that or they had assumed skinny man and I were related, which grosses me out just to think about it.

For the most part, the first night passed uneventfully.
I stopped eating fruit that belonged to my boss.