Two years after the first major bioterrorism attack in U.S. history nearly killed them, most of the inhalation anthrax survivors are still suffering severe physical and psychological aftereffects that have left them unable to work.
"Some days I get up, and after an hour and a half I have to lie back down," says David R. Hose, 61, who was infected on his job at a State Department mail-handling facility.
FOR THE RECORD - An article in Thursday's editions gave an incorrect number of cutaneous, or skin, anthrax cases resulting from the mail attacks of 2001. There were 11 cutaneous cases resulting from exposure to mail, plus one additional case in a Texas lab worker exposed while conducting tests.
The Sun regrets the error.
Before he breathed in the microscopic spores, Hose says in an exhausted voice from his home in Winchester, Va., he was a healthy man who routinely put in 12-hour days handling heavy diplomatic mail pouches. Today, after the anthrax and a near-fatal bout of pneumonia, "I'm on three heart medications. I have asthma. I'm extremely weak."
Whoever dropped letters loaded with anthrax spores into a blue mailbox in the Princeton, N.J., business district Sept. 18 and Oct. 9, 2001, gave the nation a taste of the devastation that bioterrorism can cause.
The government rushed to spend billions of dollars stockpiling vaccines for smallpox and anthrax and bulking up defenses against the chance that al-Qaida might try germ warfare. Universities battled for biodefense grants and built high-security labs.
But on the human scale where the postal attacks found their random targets, some victims of the mailings feel lost in the shuffle. They struggle to get by on worker's compensation, fight over medical bills and feel as though they have borne the brunt of the mail attacks alone. Their anxiety is not eased by the fact that nearly two years into the FBI's costly, much-criticized hunt for the anthrax mailer, the culprit is still at large.
"These guys are also victims of terrorism," says Ramesh Patel, whose wife, Jyotsna Patel, 45, a New Jersey postal worker, survived inhalation anthrax and is still tormented by weakness, nightmares and crying bouts.
"I would say they should be treated like anyone who was at the World Trade Center or the Pentagon. But they've been completely forgotten."
The billions of spores that spewed from the anthrax letters infected 11 people with inhalation anthrax; six survived. That surprised experts, who had expected a death rate even with treatment above 75 percent. An additional 17 people developed the blackened skin sores of cutaneous anthrax; all recovered.
But though they are grateful to be alive, the inhalation anthrax victims still feel the effects of the anthrax toxin every day.
Fatigue, says New Jersey postal worker Norma J. Wallace, 58, "is a given at this point. The shortness of breath still comes. I still have joint pain."
By memorizing Bible verses and working through books of brain-teasers, Wallace says, she believes she has nearly overcome the memory problems that trouble the survivors.
Still, "I have to consciously focus on what I'm doing, or I lose my train of thought."
That's typical, says Dr. Tyler C. Cymet, who heads family medicine at Sinai Hospital and is assistant professor of internal medicine at the Johns Hopkins University School of Medicine. He has conducted telephone interviews with all but one of the six anthrax survivors every three months since late 2001.
His colleague, Dr. Gary J. Kerkvliet, an internist at Sinai with a Hopkins faculty appointment, continues to care for William R. Paliscak Jr., a criminal investigator for the U.S. Postal Inspection Service who has been severely ill since shortly after he was showered with anthrax-laden dust while removing an overhead filter at the Brentwood postal center in Washington.
Paliscak never tested positive for the Bacillus anthracis bacteria or its toxin, but Kerkvliet and Cymet are convinced that his debilitating illness resulted from his exposure.
They say they understand the bitterness of the survivors, who have gotten no special financial help or medical care from the U.S. government. Only one has been able to return to work - the oldest, Florida mailroom worker Ernesto Blanco, 75.
Cymet contrasts the lack of federal outreach with the Israeli government's rapid and sustained support for victims of terrorism, which he witnessed after responding to a bombing during a recent trip to Israel.
"It's not medicine's finest moment," Cymet says of the haphazard follow-up with the survivors. "We need leadership."
In his periodic 20-question telephone survey of the inhalation anthrax survivors, Cymet has found that five still report similar symptoms: weakness, memory problems, cold sweats, low-grade fever and headaches.
"It's tough to ferret out what's psychological, what's physiological and what's post-traumatic stress disorder," he says.
Cymet's informal survey appears to have reached more of the inhalation anthrax survivors than any other study, but he admits that his phone interviews are a poor substitute for a full-scale study. As a hospital doctor with a busy practice, it is all he can manage, he says.