Neuroscientist Rebecca Brachman is working late one night alone in the lab when she accidentally sticks herself with a needle full of deadly toxin.

Rebecca Brachman is a neuroscientist, playwright, and screenwriter. She obtained her PhD at Columbia University, where she recently discovered the first drug that might prevent psychiatric disorders such as post-traumatic stress disorder (PTSD) and depression. Prior to that, she was a fellow at the National Institutes of Health, where she did pioneering work on how the immune system influences cognition by showing that white blood cells can act as antidepressants. She has also served as the director of NeuWrite, a national network of science-writing groups that fosters ongoing collaboration between scientists, writers, and artists.

STORY TRANSCRIPT

It’s about 11:00 p.m. on Friday night. I am alone in lab, cleaning up after an experiment and I accidentally stick myself with the needle full of diphtheria toxin. 

You guys will all know diphtheria as that thing that Mr. T always gets on the Oregon Trail. So think back to fourth grade, right, everyone. You're playing the Oregon Trail. Everyone puts their friends on their team. Really? These are ten-year-olds. So Mr. T, Doc Brown, Robocop, this is my team. And Mr. T always got diphtheria.

So diphtheria is an infectious bacterial disease that killed a lot of people during the time of the Oregon Trail. It’s usually respiratory. So the bacteria grows in your throat and your lungs and it secretes this toxin that essentially melts the top layer of cells and forms this grayish, greenish‑white film, this pseudomembrane. And it’s blood and it’s bacteria and it’s dead cells and patients would die from inhaling this and not being able to breathe. Or from heart failure as the toxin circulated through their blood. Or they would just end up paralyzed from nerve damage or a coma. 

We use the toxin in the lab to kill cells and I have just stuck myself with a needle full of it. 

I strip off the two pairs of gloves that I am wearing and I run to the sink. I am running water over my hand where I've stuck myself. I’m not scrubbing it. I’m just sort of squeezing it and trying to encourage bleeding, which means you'll get the blood to come out, the toxin come out. 

This is when you've seen movies and someone’s bitten by a snake and they're trying to suck out the venom. I’m doing this and the water is running, but I also know that water does not inactivate diphtheria toxin so I am seriously considering pouring bleach in this open wound. 

I am alone. I am the only person in the lab. I am the only person on the floor. This is like those really tense two minutes in the movie where the hero has to decide whether to pull out their own shrapnel or suture themselves with the hotel bathroom sewing kit or cauterize themselves with a curling iron that their cheating ex-girlfriend left behind and I decide, yes. 

Pouring bleach on your skin is not a good idea. Pouring bleach into an open wound is a worse idea. But between diphtheria toxin and bleach, I will take bleach. 

So I’m doing about three things simultaneously. I am washing my hand almost automatically, I am on the phone with my mom and, in my head, I am running the calculations. Because I wasn’t exposed to diphtheria. I was exposed to diphtheria toxin, which is not what Mr. T gets on the Oregon Trail. 

The toxin is what makes the disease deadly. Toxin is basically synonymous with poison and the lethal dose is one microgram per kilogram. So I’m about 45 kilograms. That means that it would take something like the amount of one-five-hundredth of a grain of salt. So take a grain of salt and divide it into five hundreds of pieces and one of those is what it would take to kill me. 

The powder form of this, the way it’s sold is in a vial. It’s about one milligram. It looks like a thimble-full of indelible snowflakes. And it is also two hundred times the lethal dose, more than enough to kill everyone here. So if I’m stuck with that, I’m basically dead. 

I had sent an email earlier that quoted the directions that came with this stockpile which say to reconstitute the powder with one milliliter of water using a needle and syringe. And the only other thing I have written in this email is this seems like a bad idea to me. 

Accordingly, I have diluted the stock to only two times the lethal dose. So now the question is how much is in a drop?

I’m off the phone with my mom so I make one other call to the guy that I had been out to dinner with earlier, Tim. I don't know in New York what the protocol is for what date you go shopping together or you meet the parents or what date you go to the ER together. But in this case this is date number two basically. You know, date number one being dinner earlier. 

And I’m like oh, “Hey, Tim. You know, will you take me to the ER?” And he said yes. He said yes. Great. 

So we walk. Fortunately, the hospital is only down the street. We walk. We make the usual small talk. We step in to the Columbia Presbyterian emergency room around midnight, in Harlem on a Friday night. To say this hospital gets busy on the weekends is not quite right. It’s more like it gets farcical. Being shot, a gunshot wound does not get you to the front of line unless you are bleeding out. 

So I go in, armed with the material safety data sheet which explains how dangerous diphtheria toxin is and I really urgently press the triage nurse about how quickly we need to get for me to see a doctor and the Center for Disease Control the CDC on the phone. 

And she says, “All right. Take a seat.” So I do. 

Where I've been stuck, the ring finger where I've been stuck and then also subsequently poured bleach over, and my middle finger they're both turning red. They're starting to swell. The skin is uncomfortably taut and the joints are getting really stiff. 

And I know. I know that every minute I am sitting there this toxin is coursing through my body irrevocably and moving into my cells, and possibly, probably killing me. So I call Environmental Health and Safety Office and get their answering machine. 

There are some people that are good at being patient in most reasonably trying situations, and I am usually one of those people. This is not one of those situations. So I go back to the nurse, who is thrilled to see me, and I explain to her that I am poisoned, because that’s straightforward enough. That if diphtheria is like being bitten by a snake I have been bitten by a thousand snakes. 

She looks at me and she looks me up and down and she says, “You look fine.”

So the reason it takes so little diphtheria toxin to kill you is there are so many different ways it can. It can kill skin cells. It can kill liver tissue, kidneys, lungs, brain, pretty much any organ in the body. As a result, it’s anyone’s guess whether you're going to die from your lungs giving out or a heart attack or a liver failure.

And confusingly, for the nurse, these effects are delayed. You do not see them for a while. So the long and the hard, you don’t see that effect for about one to two weeks. And nerve damage can take up to eight weeks for you to see. But it is happening right now in the first 24 hours. Once the toxin is in your cells there's nothing to do. It’s too late. 

So I might look fine but I’m probably not, and I am definitely not going to be if I sit in this waiting room for the next few hours. So after some tasteful yelling I’m admitted into the ER. 

Tim comes with me when we walk down the hall. And we pass this guy who’s strapped to a gurney who is yelling hysterically that the Gatorade he's been given is the wrong flavor. We all know what that’s like. 

I go in and the doctors come over and they have no idea what to say or do, because they've never seen this before. 

I mentioned that I had called my mom and that wasn’t just because something happened. I called my mom because my mom is also a doctor with a specialty in toxicology and she knows the head of poison control in New Jersey. So on her end, through this sort of carpool, snow day‑style phone tree, we are working our way up to the CDC, because diphtheria, even though it has mostly been eradicated in the United States, it occasionally comes up. As a result there is an anti-toxin. 

There is an anti-toxin, but it is not available commercially anymore, well, because no one gets diphtheria anymore. But the CDC has it stockpiled. CDC is in Atlanta. Not only do we need to get them to release the anti-toxin, we need to wait the time it takes to put it in a helicopter and send it up to New York. 

So the CDC is calling. Initially, the way this works is the doctors will be on the phone and I feed them the information. So CDC on the phone, doctor, CDC asks a question, doctor asks me the question, I give the answer, they feed it back to the CDC. And we keep getting these calls because we’re working our way slowly up the hierarchy. Eventually, this evolves into them just handing me the phone when the CDC calls. And this goes on for hours. 

There is a pretty obvious logic to what should be happening here. You have the science. You have the material safety data sheet. There is an anti-toxin. There is a pretty irrefutable logic to what should be happening here. 

The medicine is very bureaucratic and most doctors part ways with science and theory somewhere in between first and second year of med school. 

I don't know Tim well enough to have any idea what he is thinking at the moment. He looks bored. But having him there is actually unexpectedly calming because it’s preventing me from falling to pieces because I would be too embarrassed. 

I’m a scientist now but I used to be a poet. And it would be really easy for me to spend this time romanticizing my inevitable death. And Tim, Tim is all science. And having him there makes the whole thing so much more mundane. 

The doctors come over and they ask me to take a urine test, which is surprising because this is the first thing they've done other than take my vitals. It’s a pregnancy test. 

Finally, around 3:00 in the morning, the CDC calls back and they let us know that someone with the authority to release the anti-toxin will be reaching out to us in the next 24 to 48 hours, which is too late to make any difference. 

I am not happy about this, not surprisingly. This is that scene in the movie where the shipwrecked survivors realize that the rescue party isn’t coming. This is also where it’s worth mentioning that this is not the first time that I have been exposed to diphtheria toxin and not just virtually on the Oregon Trail. I have been exposed before. Actually, we all have. When I was two months old and four months old and six months and a year-and-a-half and four years, because diphtheria is part of the routine vaccination series we give children in the U.S. It’s actually part of the same vaccine that includes tetanus. So also every time I had gotten scraped with something rusty, I had gotten this vaccine. 

And it’s unique in that it’s not just the bacteria but they also put in dead pieces of the toxin because that’s what kills you, so I have some immunity to diphtheria toxin. But this type of immunity is very slow to come online. It only revs up in proportion to the amount of toxin it comes in contact with. 

So the only thing I can think of at this point is give me a booster. Give me another injection of this vaccine so there's more toxin in my blood, but dummy toxin so I can start making more proteins, these antibodies against the toxin. 

And the doctors are like, “Okay,” because that’s as logical as anything else.

So they give me an injection of the vaccine and they send me home, because there's nothing else to do. 

I don't know how but I must have slept because I wake up the next day so stiff. So stiff that it hurts to lift my arms and everything is really, really hazy. 

But on the plus side I’m not dead. But on the realistic side that doesn’t mean anything, because I would probably be perfectly fine for days until some organ failed, and it could be any organ. 

Over the next two weeks they monitor my vitals. I see a bunch of specialists, mostly because they're curious. The CDC calls and they tell me I am the first reported case of diphtheria toxin exposure and say, “You know, the vaccine strategy was not a bad one.”

Oh, also the anti-toxin was at JFK, 30 minutes away from us by cab. 

I once flew 5,000 miles and drove what ended up being about eight hours through these really treacherous, pitch black, Grecian winding hills, so winding that I bet they were the inspiration for the labyrinth for the minotaur just to see Delphi. 

When I got there it was closed, so I hopped the fence. At a national landmark at a UNESCO world heritage site in the post 9/11 era I hopped the fence. And I can’t remember now why. I can’t remember how any place or object or event could possibly have been that important. 

Somehow in the face of death, all the things that I aspired to in life: getting a PhD, owning a peacock, anything to do with the word ‘career’ all seem arbitrary, trivial. Because, yeah, we all know that we’re going to die. But we don’t. Not really, until we do. 

It occurs to me that if I’m going to die in my sleep I should probably clean my room. 

And about two weeks later, where I was initially stuck this little dot, about the size of a period in a Word document, it turns white and it dies and it falls off. And that’s it. I’m fine. Maybe.