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Eukaryon

TRAP my Soul: An Archival Account

Chisomo Mwale
Lake Forest College
Lake Forest, Illinois 60045

TRAP, or Tropical Respiratory Antigenic Pneumonia is a simple infection that, today, can be treated with a course of antivirals and be vaccinated against. But the TRAP we know today was once a disease of destruction. To truly understand the nature of this disease, and to actually get a taste of the environment during the time of the TRAP epidemic, we need to look to the history of some of the very first documented accounts of TRAP.

Account #1: Trap Inspection

I suppose my passion for epidemiology and pathology was as innate as it was acquired.  You see, I believe science, and disease especially, is like a mystery awaiting solution. The more information one gathers about something, the stronger the thirst for information becomes. I, Warner von Braun, am that type of person: fuelled by the strong desire to quench my thirst for information. Not to toot my own horn, but this thirst is the predominant reason for my success in the research epidemiology field. Because I had never doubted the potential others saw in me, I was hardly surprised when my detective skills were called upon by her majesty, the Queen herself, to be utilized on the island of Nam, a former (and rather wealthy) British colony. Alas, I digress. This story is not about me and my achievements. You see the following is not a “Warner von Braun came in and saved the day” type of account, nor is it an “and they all lived happily ever after” type of account. In fact, this is more of a “how the hell does the story end” kind of account. So, proceed with caution. The following account gives a true epidemiological research perspective of investigating disease, whereby the majority of the information is second or third-hand, and insight into the disease is not extremely clear.

In the year 1872, I was tasked with determining the possible origin and path of this disease, TRAP, which led to a cascade of devastation. My investigation into the origin of TRAP started with one person. Daniel Grosse, a native of Nam and a cabinet maker who specialised  in making cabinets from a unique series of oak tree that grew only on a nearby island because of the tropical atmosphere it had. This island had no human inhabitants because of the diverse and largely unknown wildlife that claimed the island as their own. Nevertheless, it was not unusual for people to make the odd trip or two about once every five years for natural supplies. A middle-aged man of 45, Grosse was in great shape for his age. He had been married for 20 years and his wife, Mika, was the primary source of information for the following account.

One summer day in July, Grosse had embarked on a journey to the island. This journey had taken longer than usual; his wife reports that he took 24 hours longer than normal to come back. She had not been surprised though, when he provided a reasonable explanation. He had had to go deeper into the island forest to procure oak - because the oak trees at the periphery were now non-existent. At the time, Mika was just grateful they would be able to put food on the table.

About fourteen days after his trip, Mika noticed a change in her husband. His body seemed unusually hot, and days later he developed an incessant cough, and an abnormally runny nose. “Honey, I just have a bad case of the flu,” he assured his wife when she told him to go to the hospital. Her mind was momentarily eased because he presented flu-like symptoms. But then a rash inside his mouth appeared alongside his other symptoms. She took a closer look at him, saw that his eyes were stained lava red, making him look freakishly demonic, and were perpetually teary. In a moment entwined with fear and panic, she called the local doctor.

“Mika. Your husband is very ill,” the doctor said after he finished his examination. “I do not have the resources with me right now to determine what is wrong with him. We need to get him to the hospital quickly,” is the last thing she remembered the doctor saying from that conversation. The moment those words left the doctor’s lips, Grosse’s condition deteriorated. His coughing transitioned into severe hacking, as though his lungs were fighting to rid themselves of his diseased and dying body.

Shortly after, the blood which, up until then, had only stained his eyes, began to find its way out of his body, also seeking to find refuge. Before either the doctor or Mika could adjust to the change in Grosse’s status, the horse-drawn carriage had arrived to take him to the hospital. His body, gushing with blood, was loaded into the carriage and rushed to the hospital. Grosse’s blood was no longer clotting. He bled out on the way.

Two weeks later, the doctor began to feel strange. Soon after, children began to fall ill. And so began the next steps in trying to contain this outbreak.

 

 

Account #2: Doctor and Patient confidentiality

Ann & Robert H. Lurie Children’s Hospital

225 E Chicago Ave

Chicago, USA 60611

 

Patient Name: Isabelle Dune

Date: July 19th, 1990

Preoperative Diagnosis: Pleural effusion due to pneumonia

Postoperative Diagnosis: Pleural effusion due to pneumonia

Procedure: Pleurectomy

Surgeon: Linda Adams, M.D.

Assistant: N/A

NAME:

Anaesthesia: Lidocaine with I:100, 000 epinephrine

Anaesthesiologist: Sebastian Sandler, M.D.

Dictated by: Linda Adams, M.D.

This 8-year-old female demonstrated the conditions described above, of excess fluid in the pleural cavity, and severe damage to the pleural lining. Removal of the pleural lining is crucial to the patient’s survival. The procedure, alternatives, risks and limitations in this individual case have been carefully discussed with the patient’s legal guardians because the patient is not a consenting adult. All questions have been thoroughly answered, and the guardians understand the surgery indicated. Parental consent was signed.

The patient was brought into the operating room and placed in the supine position on the operating table. An intravenous line was started, and sedation anaesthesia was administered intravenously after preoperative P.O. sedation. The patient was monitored for cardiac rate, blood pressure, and oxygen saturation continuously.

The surgical callipers were used to measure the supratarsal incisions so that the incisions were symmetrical from the sternum and scapula. The pleura was stripped from the lateral interior of the left rib cage. Dense adhesions between the apex of the lung, were produced. Some bullae formed and were stapled down. Shortly after, more bullae appeared. The surgical nurse attended to these bullae while the remainder of the procedure was continued. Approximately 2 minutes later, the patient began to crash and code. Viscous, blood-tinged fluid leaked out of the bullae. Steps were taken to drain the fluid and to keep the bleeding under control. The pleurectomy was momentarily halted while the coding was addressed. The patient had lost significant blood, so more was ordered. Oxygen stats dropped, and the patient was at risk of hypoxia. All the fluid was drained and the operating team waited sixty seconds for improvement. Twenty seconds later, the patient’s heart rate was back to baseline, and oxygen stats were moving toward normal levels. The pleurectomy resumed with cautious haste. Great care was taken to ensure near-perfect removal of the pleura.

The procedure was completed without further complications and tolerated well after that crash. The patient left the operating room in satisfactory condition despite the quick turn of events. A follow-up appointment was scheduled, routine post-op medications were prescribed, and post-op instructions were given to the responsible party.

The patient would be scheduled for release to return home after thorough post-op examination to ensure prevention of sepsis.  

 

Account #3: Poem for my love

By your side I stand.

Brave. Watching, as

The sands of time flow through an hour glass,

So are the days of our lives.

Your life.

 

Once full, and lively.

Now filled with IVs.

I watch and stare. As the

Rash consumes you,

And your lungs abuse you.

 

You no longer speak,

Speak to me, speak to yourself, SPEAK FOR YOURSELF!

I watch as infection invades your brain,

unlike the summer rain, so sweet and lovely,

it proceeds to take you away from me.

 

You see they never tell you this when you fall,

But love is a trap, and conveniently

It is TRAP which consumes you

So all I do, is I watch you,

As you lay trapped in a dying man’s body.

 

Account #4: The Secret Life of a Dying Person

 I was never one for goodbyes. They always made me feel uncomfortable because they almost always leave a heavy, awkward silence, that can only be rectified by someone physically turning their back toward the other person. My life two months ago was not where it is now. Had you asked what I was looking forward to most, my response would’ve been “I am so excited to have my life begin.” Part of that beginning was me embarking on a journey far, far away from my otherwise suburban life. After working tirelessly, for ten years, in an infectious disease laboratory, I realised that besides my work, I had no idea where my life had gone. One would not be able to take a look at me and conclude that I had lived a full life, filled with adventure, spontaneity, and experience. So, I decided to go out into the world and find my own.

Continuing with the theme of spontaneity, I took out my globe, closed my eyes, spun it around and placed my finger on a random spot. Whichever country (aside from the one I was currently in) my finger landed on would be the destination location. And from here on, my life would only reflect the experiences I had. Now of course I did not quit my job, but I simply cashed ten years-worth of vacation time. The chosen destination was an island in the Caribbean. My life had officially begun.

Or so I thought. Two weeks after I had gotten back from the trip of a lifetime, I felt a slight itch in my throat. A tingling sensation I was sure would be soothed with a glass of water. When it didn’t go away, I figured I had a cold, and I proceeded to take the appropriate medication for it. Days later, it had not gone away. My nose was now constantly runny. I took one look in the mirror and was horrified to see a devil with red eyes staring back at me. What the fuck is going on with my body? I thought to myself, as I coughed my lungs out.

Not wanting others to see me in this state, I went to the emergency room, hoping someone there would be able to rectify the situation. I went through the standard hospital procedure: the doctor asked what was wrong, my response was “can’t you see?”, and he stayed silent and continued with the examination. Then with no warning whatsoever he ran out of the room. I would definitely be asking to see a different doctor next time!

He came back, with his supervisor and a few other people. He had a grim look on his face. His supervisor dealt with me from then on. “Miss Beckman. Do you have any family or close friends you could call to come be with you?” was what he began with. I was confused. Family? Close friends? Why I only had a bad case of the flu, why on Earth would I need emotional support? He saw the look of confusion on my face and finally explained what was happening. “Miss Beckman, we believe you have contracted the Tropical Respiratory Antigenic Pneumonia, which you may know as TRAP. We still have further tests to run, but the symptoms you’ve presented with are strong indicators of TRAP. In fact, we have reason to believe you are in the severe stage of the disease now. If we are right, there is no treatment, and patients typically die within ten days. We believe you should contact your next of kin and any friends you may want to say goodbye to. Now, I know you are scared, but we will try and make this process as comfortable as possible.”

There was a point when the words the doctor was saying stopped penetrating through my brain, and a numbing feeling took over. The room began to fade and, momentarily, I was transported back to that island, back to paradise, back to where my life began and ended at the same damn time.

***

 I woke up to a room full of people. My mother, father, aunts, uncles, cousins, second cousins, and people I had not seen in years were all there for emotional support. Why were they all here? I scanned the faces around me and saw looks of grief, pity, and fake encouraging, hopeful smiles. And then I didn’t care. Plus, the morphine they had given me had been doing a great job of sedating me and helping me not feel.

“How are you doing honey?” they asked. I wanted to tell them to fuck off because they knew how I was doing. No dying person wants to be asked about their health because they are literally on the brink of death – what does it matter how they’re doing?

Lying there with them watching me, and me not watching them, I began to reflect on the past 32 years of my life. Ten of which were spent working in an infectious disease laboratory. My situation was quite ironic, comic even; that the very thing I spent a good portion of my adult life researching was the very thing that led to my demise. I would never escape it. I was to be consumed by it.

“Goodbye,” I whispered to no one and everyone. “What was that honey?” my mother asked. “I said goodbye. Leave. All of you. I don’t want any of you to be here. Just leave me alone to die in peace without your eyes on me,” I shouted. Because I couldn’t take it anymore. No one told me I would be saying goodbye to my family and friends at the age of 32. So, I chased them away, to get rid of that awkward heavily silence. To spare them, and myself, the pain, tears, and uncontrollable wails drama. The last thing I needed was to feel bad about causing all this pain.

 

TRAP my Soul: An Archival Account Summary

TRAP was a slightly modified version of measles. I referred to many of the symptoms of measles, and in some cases, I dramatized them. Symptoms: after about 2 weeks of incubation, measles presents itself with symptoms of fever, coughing, runny nose (corzya), and red and watery eyes. Three days after the symptoms begin, tiny white spots called Koplik spots may appear inside the mouth. In addition, patients present with a rash on their body.

My first account was a witness account from a research epidemiologist’s perspective. The second was a doctor’s surgical notes, the third was a witness account in the form of a slam poem, and the last was an autobiographical account from the patient’s perspective. For my first account, I channelled Richard Preston’s The Hot Zone, and used Peter Ludwig Panum’s Observations Made During the Epidemic of Measles on the Faroe Islands in the Year 1846. The second account was partially inspired by Henry Marsh’s Do No Harm, in order emphasize the sometimes-dramatic environment. The poem was influenced, ever so slightly, by Auden’s Surgical Ward. The autobiography was inspired by Paul Kalanithi’s When Breath Becomes Air and by Leo Tolstoy’s The Death of Ivan Ilyich.

With the whole archive, I wanted each piece to touch on at least one major theme. I tried to have the first account explore the diseases: public and private theme, particularly, pinpointing the origin of disease. For the second account, I tried to explore the healing the sick theme, focussing in on the sometimes-stressful work environment doctors face. With the third account, I chose to explore the isolated sick theme, but from a loved one’s perspective because they too get isolated. Lastly, I wanted to combine the finding communities and meaning through suffering and the isolated sick theme through the fourth account.

I enjoyed writing these accounts because they allowed me to think about life, death, and meaning in different ways. I realised that these three things will change with perspective. Some people may have careers based on life and death, and some lives and deaths have more meaning than others. Other people are forced to face death, reflect on their lives, and think of all the meaningful things, and others have to stand by and watch the people they love die. I believe the meaning of each account comes when you place yourself in the shoes of the person writing that account. The meaning is in the story you are being told.

Disclaimer

Eukaryon is published by students at Lake Forest College, who are solely responsible for its content. The views expressed in Eukaryon do not necessarily reflect those of the College.

Articles published within Eukaryon should not be cited in bibliographies. Material contained herein should be treated as personal communication and should be cited as such only with the consent of the author.