医生House试图给王晓业找解药的故事 ZT

Doctors, scientists searched for antidote for Monroe man dying from thallium poisoning
Star-Ledger Staff

MONROE — Dressed in green jail garb and with her hands cuffed in front of her, 40-year-old chemist Tianle Li stood before a judge in New Brunswick on Wednesday and listened with quiet composure as she was charged with murdering her husband by dosing him with a rare lethal drug.

Li’s lawyer, Steven Altman, entered a plea of not guilty, and a few minutes later, the hearing was over.

But while the legal part of this story was sorting itself out, startling details were emerging about a frantic, heroic attempt by doctors, scientists, and federal and state agencies to save the dying husband as he lay in a hospital, slipping away from thallium poisoning.

The scramble to save 39-year-old Xiaoye Wang began around 9 p.m. on Jan. 25, when Steven Marcus, the medical and executive director of New Jersey Poison Control, received a call from University Medical Center in Princeton. A doctor was on the other end of the line telling him about Wang and that thallium had been discovered in his system.

Marcus couldn’t believe what he was hearing. This was only the second time in his 43-year medical career that he’d come across a case of thallium poisoning. The physician at the Princeton hospital knew little about the deadly chemical and even less about how to treat it.

It’s either attempted suicide, Marcus told the doctor, or homicide.

There was silence on the other end of the phone, Marcus said.

Then he told the physician there was only one way to save Wang’s life — an antidote called Prussian Blue — and only one company in the United States manufactured it.

Thallium is tasteless and odorless and was used in rat poisoning and insecticides until it was banned in the United States in the 1980s because of its toxicity. It is still used in small doses in glass-making, mirror circuits and certain medical tests.

Marcus, who says his nickname is House, a reference to the television character because he’s often called about perplexing medical cases, said his first thought was to contact everyone he could think of who might be able to help.

One of the first he reached out to was a former colleague at the U.S. Department of Energy’s Oak Ridge National Laboratory in Tennessee. Marcus had taken a course there 10 or 15 years earlier and remembered asking at the time if the lab kept antidotes on hand for thallium.

A year or so prior to that he had been contacted by doctors treating a New Jersey schoolteacher for thallium poisoning. The woman eventually recovered and no one was ever arrested, but the unusual case had stayed with him.

At 5 a.m. on Jan. 26, as scientists at Oak Ridge tried to figure out how to get Prussian Blue to New Jersey in the middle of a snowstorm, Marcus shoveled his driveway in North Jersey, then headed to Princeton, continuing to make calls the entire way — to the state Health Department, to New York City poison control, to anyone who might have Prussian Blue in stock and was closer than Tennessee.

No one did, but Christopher Rinn, the assistant commissioner of New Jersey’s Department of Health and Senior Services, told Marcus the agency was at his disposal.

He said, ‘Whatever you need. Let’s cut through this bureaucracy,’ Marcus recalled.

By this time, however, Wang was unconscious. He had come to the hospital in Princeton on his own on Jan. 14, the same day he and Li were due in court to finalize their divorce, said Middlesex County Assistant Prosecutor Nicholas Sewitch, who confirmed after Li’s arraignment Wednesday that Wang was administered a lethal, massive dose of thallium.

A neighbor living near the couple’s home in Monroe Township, who identified herself only by her last name, Patel, said the two were not friendly. We didn’t talk ... We knew they were having problems. We saw the cops there all the time.

Sewitch was unable to say how the thallium was administered or whether it was given in several small doses over time, or in one dose. All he would confirm is that the drug was ingested in December or January. He also would not comment on where Li allegedly obtained the thallium, but did say it would have been available to her at Bristol-Myers Squibb in Lawrenceville, where she’s worked since 2001 as a research chemist.

When Wang first arrived at the hospital on Jan. 14, Wang was experiencing flu-like symptoms, Sewitch said.

Thallium poisoning typically includes loss of hair, thickened skin, severe gastrointestinal pain and loss of feeling in the extremities. Wang didn’t present many of those symptoms until a few days after his arrival, Marcus said.

At that point a nurse recalled cases of thallium poisoning in China in the 1990s and suggested Wang’s urine be tested, Sewitch said. No lab in New Jersey was capable of performing the test, so Wang’s urine sample was sent out of state.

Twenty-four hours later, the diagnosis of thallium poisoning was confirmed and Marcus was notified.

If someone at the hospital had not guessed it might be thallium and tested for it, it might have gone undetected, Marcus said.

With time running out, Marcus suggested to a pharmacist at the Princeton hospital that she contact chemical supply companies in the area to try and obtain a less pure dose of Prussian Blue, which is also used to dye clothes as well as microscopic specimens in biological research.

A dose of the non-medical grade was found in a matter of hours and rushed to Princeton the medical center, but Marcus and the other doctors realized they had no idea how much of it to administer.

Still traveling through snow and ice, Marcus suggested diluting the bright blue powder in water and simply doubling the recommended dose.

Nearly two hours after leaving his home, Marcus arrived in Princeton. The non-medical grade Prussian Blue had been administered through a gastric tube, but Wang had showed no response.

In the meantime, Marcus had contacted a federal facility near Albany, N.Y., that had the purer form of the antidote, and an SUV was dispatched to Princeton. When it finally arrived five hours later, Wang was near death.

The antidote would be useless. Marcus, along with a number of doctors and nurses, stood beside Wang’s bed, unable to do anything more.

Sometime around 3 p.m. on Jan. 26, as several detectives stood nearby, Wang’s heart monitor flatlined.

There was remarkable cooperation between the hospital, poison control, the police, the state health department, the Centers for Disease Control and the nuclear energy department in Tennessee — all to get this antidote to the hospital in snow in a matter of a few hours, Marcus said. Unfortunately it was too late.

By Amy Ellis Nutt and Sue Epstein/The Star-Ledger

Staff writer Amy Brittain contributed to this report.