# Bob Stevens # Bio-terrorism ##### [Atlanta Journal-Constitution](http://www.ph.ucla.edu/epi/bioter/floridadoctorfirstclue.html): The morning of Oct. 2 (Tuesday, [2.15am](https://www.sun-sentinel.com/news/fl-xpm-2001-10-19-0110190228-story.html), 2001), anthrax was not on the radar of doctors... [Annals of Internal Medicin](https://www.acpjournals.org/doi/10.7326/0003-4819-155-12-201112200-00373)e: ...(when) a confused and febrile Robert Stevens walked into the emergency department of JFK Medical Center, Palm Beach County, Florida. [Drs. Larry M. Bush/Maria T. Perez:](https://www.acpjournals.org/doi/10.7326/0003-4819-155-12-201112200-00373) What transpired .. including how public health and federal government agencies performed, has been both praised and criticized. An intertwined epidemiologic and criminal investigation of such magnitude was unprecedented in U.S. history... ([Scientific American:](https://www.scientificamerican.com/article/postal-anthrax-aftermath/)) ...and sparked a massive infusion of research funds ($41 billion) to counter .. bioterrorism. # 5 Days Earlier #### [New York Times:](https://www.nytimes.com/2002/11/10/books/chapters/the-demon-in-the-freezer.html) (On) Thursday, September 27th, Robert Stevens and his wife drove to Charlotte, North Carolina, to visit their daughter Casey. [Dr. Barry Abrams/Dr Larry M. Bush, co-authors of *Index Case of Fatal Inhalation of Anthrax due to Bioterrorism*):](https://www.nejm.org/doi/full/10.1056/nejmoa012948) Immediately on his arrival in North Carolina, the first symptoms developed; (including) muscle aches, nausea, and fever. The symptoms waxed and waned for the duration of the three-day trip. [Esquire](https://www.esquire.com/news-politics/a1501/esq0303-mar-anthrax/): (T)hey hiked a trail to the bottom of Hickory Nut Falls .. Bob .. scooped a handful of water , and drank it. He told Casey, "Tastes minerally." [C. A Mimms:](https://images.macmillan.com/folio-assets/book-excerpts/9780805091045EX.pdf) They (then took) a side trip to Durham to meet her boyfriend who was in school there. On the Sunday drive to Durham, flu-like symptoms of weakness, fever, and chills hit. [Palm Beach Post](http://www.ph.ucla.edu/epi/bioter/widowwantsanswers.html) (interview with Maureen Stevens): They thought it was flu. On the way home (to Florida) .. Stevens .. drove .. [for ten hours](https://www.esquire.com/news-politics/a1501/esq0303-mar-anthrax/) .. pulling himself together long enough to make it home. They turned in early because they both felt like they were coming down with something. [Esquire](https://www.esquire.com/news-politics/a1501/esq0303-mar-anthrax/): Home by 5, in bed by 8, with a temperature of 101. [https://www.sun-sentinel.com/news/fl-xpm-2001-10-19-0110190228-story.html](https://www.sun-sentinel.com/news/fl-xpm-2001-10-19-0110190228-story.html) # The Middle of the Night [Palm Beach Post](http://www.ph.ucla.edu/epi/bioter/widowwantsanswers.html): Maureen Stevens awoke in the middle of the night [(about 2am)](http://www.ph.ucla.edu/epi/bioter/floridadoctorfirstclue.html) and found (her husband) wandering the house. He was stumbling, speaking in gibberish, barely lucid. [Atlanta Journal-Constitution](http://www.ph.ucla.edu/epi/bioter/floridadoctorfirstclue.html): (H)e tried to dress to go to work .. was running a high fever. His frightened wife got him into the car and quickly drove the short distance up Congress Avenue to JFK Memorial in Atlantis. Maureen took him to the emergency room of the John F. Kennedy Medical Center in Palm Beach County. [Palm Beach Post](http://www.ph.ucla.edu/epi/bioter/widowwantsanswers.html): (S)he found a wheelchair and sat him in it. It was .. the last interaction between them. The next 48 hours elapsed in that kind of slow-motion surreal blur that happens when personal disaster strikes. She began to gather the kids, one of whom was overseas at the time. # JFK Memorial Hospital [Seattle Times:](https://archive.seattletimes.com/archive/?date=20011021&slug=detect20) (T)he leading players on Stevens' team of doctors (were) **Dr. Larry Bush and Dr. Barry Abrams**, infectious-disease specialists, and **Dr. Randall Wolff**, director of JFK Medical Center's emergency department. [Dr. Barry Abrams/Dr Larry M. Bush,](https://www.nejm.org/doi/full/10.1056/nejmoa012948) co-authors *Index Case of Fatal Inhalation of Anthrax due to Bioterrorism*[:](https://www.nejm.org/doi/full/10.1056/nejmoa012948) Because (Robert Stevens) was disoriented at the time of his presentation, he was unable to provide further relevant information .. On physical examination (by rostered doctors), he was found to be **lethargic and disoriented**. His temperature was **39°C** (102.5°F), blood pressure was 150/80 mm Hg, pulse 110, respirations 18. Treatment with intravenous cefotaxime and vancomycin was initiated for presumed bacterial meningitis while the patient awaited lumbar puncture. No respiratory distress was noted. [Seattle Times: ](https://archive.seattletimes.com/archive/?date=20011021&slug=detect20) (At 7am) Wolff walked into the ER to start his shift. He found Stevens convulsing just before he slipped into a coma. [*Index Case of Fatal Inhalation of Anthrax due to Bioterrorism*](https://www.nejm.org/doi/full/10.1056/nejmoa012948): Within hours after admission, the patient had a generalized grand mal seizure and was intubated to protect his airway and so that ventilatory assistance could be provided. [Orlando Sentinel:](https://www.orlandosentinel.com/news/os-xpm-2001-10-19-0110190110-story.html) (same writer, dif version) Wolff performed a spinal tap, looking for hints in the spinal fluid that bathes the brain. [New York Times:](https://www.nytimes.com/2001/10/14/us/nation-challenged-disease-anthrax-threats-points-limits-health-systems.html) Healthy spinal fluid is clear, but Mr. Stevens's was cloudy and cluttered with infection-fighting white blood cells. [Dr. Randall Wolff:](https://archive.seattletimes.com/archive/?date=20011021&slug=detect20) That was the start of some sort of sign that something wasn't right. #  Dr. Larry M. Bush  - Bug Hunter [Atlanta Journal-Constitution](http://www.ph.ucla.edu/epi/bioter/floridadoctorfirstclue.html): About **6:30 a.m.** Oct. 2, Dr. Larry Bush, an infectious disease specialist at JFK Memorial Hospital in Atlantis, received a call saying his help was needed with a gravely ill patient. [Esquire:](https://www.esquire.com/news-politics/a1501/esq0303-mar-anthrax/) Larry pads into the hospital shortly before eight o'clock. a slender man with an unruly fringe of wiry hair .. (Dr. Bush is) (a) **bug doctor ..** a **hunter**, .. tracking **microscopic trophies** .. figuring out how to kill them. [Abrams/Bush: ](https://www.nejm.org/doi/full/10.1056/nejmoa012948)Dr. Bush examined a by-then comatose man, interviewed his wife standing at the bedside, and hastened to the laboratory to inspect a Gram-stained sample of his cerebrospinal fluid. [Atlanta Journal-Constitution](http://www.ph.ucla.edu/epi/bioter/floridadoctorfirstclue.html): When Bush saw the fluid, he found it "grossly cloudy" -- a sign of something other than meningitis. [Dr. Larry M. Bush:](https://www.esquire.com/news-politics/a1501/esq0303-mar-anthrax/) I realized then that we might have something very unusual here. [Dr Bush](https://www.nytimes.com/2001/10/14/us/nation-challenged-disease-anthrax-threats-points-limits-health-systems.html) (thought) I've got to make sure this isn't anthrax. **Diagnosis** [Dr. Larry M. Bush](https://www.nytimes.com/2001/10/14/us/nation-challenged-disease-anthrax-threats-points-limits-health-systems.html): When you see rod-shaped bacteria in the spinal fluid, you become particularly concerned. I was .. trying by the process of elimination to determine what they could *not *be. I was thinking they could be listeria, but they didn't fit the pattern. [NY Times Oct 14 2001:](https://www.nytimes.com/2001/10/14/us/nation-challenged-disease-anthrax-threats-points-limits-health-systems.html) (H)e realized only a handful of rod-shaped bacteria fit the .. shape he was peering at under the microscope. That handful included anthrax. [Dr Larry M. Bush](https://www.ph.ucla.edu/epi/bioter/criticaldoctorfirstFLcase.html): I thought, '**Why not anthrax? Right here. Right now.'** [NY Times Oct 14 2001:](https://www.nytimes.com/2001/10/14/us/nation-challenged-disease-anthrax-threats-points-limits-health-systems.html) **(W)ithin six hours** of examining Mr. Stevens, (1-2pm, Oct 2) Dr. Bush says he was convinced the man had anthrax. [Dr. Randall Wolff:](https://archive.seattletimes.com/archive/?date=20011021&slug=detect20) We were hesitant to mention the word because of all the implications. **I mentioned at the time that**, considering the World Trade Center bombing, this bacillus is more likely to be anthrax than two weeks ago. [Bush to Abrams:](https://www.esquire.com/news-politics/a1501/esq0303-mar-anthrax/) I've got a guy in the ER and I think he has anthrax. No. I'm pretty sure he has anthrax. Do you know what that means? [Bush/Abrams](https://www.esquire.com/news-politics/a1501/esq0303-mar-anthrax/): Bioterror. [New York Times:](https://www.nytimes.com/2002/11/10/books/chapters/the-demon-in-the-freezer.html) At two o'clock on Tuesday morning, Maureen took him to the emergency room of the John F. Kennedy Medical Center in Palm Beach County. A doctor there thought he might have meningitis. Five hours later, Stevens started having convulsions. The fact that anthrax popped into Dr. Bush's mind had not a little to do with recent news reports about two of the September 11th hijackers casing airports around south Florida and inquiring about renting crop-dusting aircraft. Anthrax could be distributed from a small airplane. At around four o'clock in the afternoon of Friday, October 5th, he (Stevens) suffered a fatal breathing arrest. On Saturday, October 6th, Sherif Zaki and his team of CDC pathologists arrived in West Palm Beach in a chartered jet. # Maureen Stevens [Palm Beach Post](http://www.ph.ucla.edu/epi/bioter/widowwantsanswers.html): [Palm Beach Post](http://www.ph.ucla.edu/epi/bioter/widowwantsanswers.html): On Thursday (Oct 4, 2 days later), Dr. Jean Malecki - the county health department director .. - called (Maureen Stevens) at the house in suburban Lantana. (She) had gone home for a short rest. We think it's anthrax, Malecki told her. [Maureen Stevens:](https://www.youtube.com/watch?v=exwpHPDw_NA) (1:59) I’d been at the hospital all morning - and we were constantly asking what it was - the timing - this still just really upsets me. They called me and said they had the diagnosis - they knew what was wrong with Robert and she said it’s Anthrax - which just floored me. I didn’t know a lot about it but I knew it wasn’t good. Then she said ‘Unfortunately’ she said, ‘the media knows about it - somebody informed the media - that they knew before I did. So this - for some reason - has always irritated me. * * The nurses were very nice - they seemed to pick up how serious it was before the ... I ... I spoke to Dr Bush - I said is this you know .. ahr can ca-can he .. I was trying to find out whether he could get better or was it so dire? (He) said ‘Well, there’s always a possibility.’ 250 But he .. at that moment I needed it .. I mean he must have known that I needed because I'm sure he knew very well what that disease did. **Home** [Palm Beach Post](http://www.ph.ucla.edu/epi/bioter/widowwantsanswers.html): Newspaper photographers took pictures of the handwritten note (Maureen Stevens) taped to the front door telling the kids where she was. There were top-level officials everywhere: deputies, FBI .. CDC. [Atlanta Journal-Constitution:](http://www.ph.ucla.edu/epi/bioter/floridadoctorfirstclue.html) Stevens' home on quiet Massachusetts Avenue in Lantana, a neighborhood of modest bungalows .. was cordoned off by yellow tape as investigators descended on the house to take hundreds of samples of soil, household items and anything else that might harbor anthrax. [Maureen Stevens:](http://www.ph.ucla.edu/epi/bioter/widowwantsanswers.html) We couldn't go home. [Palm Beach Post](http://www.ph.ucla.edu/epi/bioter/widowwantsanswers.html): (T)hen the family got the hospital page..: Hurry. (They) were ushered to the private room [Maureen Stevens:](http://www.ph.ucla.edu/epi/bioter/widowwantsanswers.html) Water and tissues, I should have known. [Dr Larry M. Bush](https://www.nejm.org/doi/full/10.1056/nejmoa012948): On the third hospital day, (sic?) despite aggressive medical treatment .. the patient had an asystolic cardiac arrest and died. [Maureen Stevens (recalling, Feb 26, 2003)](https://www.ph.ucla.edu/epi/bioter/scientistsanthraxbogus.html): *We were getting near the retirement years. We were planning to do things. We wanted to go back to Paris. We wanted to do so much, and that's all been taken away, and his children have had so much taken away. You know, no walking down the aisle with their father...*