C-I-H or C-I-A: The Woz puzzles!

CHAPTER 8 POISON CENTER VISITORS April 1979

Racer watched a young physician from the university hospital carry an unlikely entry for the K-L-W hit parade, an Atala Pro bicycle frame, one separated from its wheels. K-L-W’s newest customer recognized him as a lab assistant, making Racer’s bicycle store role a surprise.

Addressing Kern, he initiated a dialogue. Good morning, my name’s Brian Wozniak. I couldn’t help but notice how comfortable you were with wheelchair-fitting. Moving toward bicycle repair matters, the newlyintroduced Brian Wozniak switched to cycling-specific language. Since moving here I haven’t ridden it.

Could you check out its brakes, tires and derailleurs, shifters, too?

Kern motioned for Racer to join, believing he might like to meet the Atala’s owner. The enforcer of clarity, Kern time-estimated a repair. We’re working on a seven-ten-day repair schedule. Given we may need to order some Campagnolo bits, how would a week from Wednesday work?

That’ll be fine. To simplify spelling, why don’t you print the repair tag as Woz, my nickname? Instead, Racer lettered the claim check as overhaul -complete, for Brian Wozniak, MD, University Hospital. A New York transplant, the Woz was more of a bikie than they might have appreciated.

On Sunday mornings an adolescent Woz had joined Central Park pace lines, packs of below-the-waist identically attired cyclists, black chamois-lined shorts, white socks and polished bike cleats contrasting with bright jerseys representative of New Jersey delis, the Police Athletic League and Brooklyn bubble gum.

Woz’ parents insisted Brian, their only child wear a cycling helmet, one constructed using threefront-to-back rubbery strips sewn into a thick leather hat band. As devotees of TE Lawrence, they had been saddened by news of Lawrence of Arabia’s tragic end, one resulting from a motorcycle-related brain injury.

Woz watched Racer climb a ceiling-mounted ladder, placing his soon-to-be-repaired Atala alongside a F-U-J-I race bike. Viewing him working a second job, the Woz reviewed his obligations, recalling how the previous Wednesday his assistant handed him a questionnaire originating with the American Association of Poison Control. Scanning across fourteen block response fields, he puzzled over new requirements for consulting resources in fields identified as botany and industrial hygiene, specifying the association would need to review resumes from candidate subject matter experts.

Although relatively young by physician standards, Dr. Wozniak had already witnessed a stream of changes creating a strikingly different environment. Scheduled charges of $875 for gall bladder removals and $350 for labor and delivery were extinct.

Lyndon Johnson’s Great Society ushered in a new era, one of contracted fees. A key legislative development for poison control centers was passage of the 1973 Emergency Medical Systems Act, also

known as E-M-S-A - Public Law 93-154, providing funding for both burn and poison control units. More locally, hospital administrators regarded these units as financial loss producers.

The Kansas City Fire Department and its local 42 championed burn unit contributions.

Firefighters waving empty mount-out boots at Wornall and Ward Parkway intersections, encouraged small change donations. While the telephone directories included a listing for poison control, its number followed those for police and fire, sometimes appearing after the listing for time and temperature updates. Oddly, 911-call reimbursement for police and fire services did not extend to poison control.

Prior to 1957, Kansas City’s hospital care split between care offered at its general hospital number one, whites, and its number two, non-whites. Dr. J. Edward Perry’s Provident-Wheatley Hospital augmented services provided by number two. Subtly, legislation like E-M-S-A pushed health care toward common care.

Poison control protocols partially resembled those of other emergency call centers. Its telephones were hosted by assistants, mainly senior pharmacy students, capable of managing easier calls by relying upon a Poisondex database linked to a microfiche reader. An observer might have likened the work to serving as a theater usher, matching microfiche lettered and numbered positions against narratives and references.

Management of drug-related poisonings was more straightforward than for industrial chemicals.

Industrial substance categories were quite broad, generic entries for hydrocarbons - volatile or metals – heavy, chemicals shoehorned into broad categories. Similar terms could designate radically different substances; Dioxane, a common solvent differed by only two letters from dioxin, possibly the world’s most toxic chemical. While benzine was a synonym for petrol in the UK only a single letter distinguished it from benzene, a potent leukemia-causer.

Woz wondered if these new requirements for botany and industrial hygiene resources suggested these skill sets had proven useful. The toxic plant part suggested to the Woz he should enlist a botanical expert but he wasn’t sure what an industrial hygienist either was or did. Fanning the form’s pages, he encountered a section entitled locating subject matter experts, hinting the botanical expert would distinguish toxic from edible mushrooms.

Another section indicated a subset of Certified Industrial Hygienists - CIH’s were employed by government agencies causing him to speculate that the C-I-H requirement originated with the C-I-A or its Dulles creators. Similar to the three-letter C-I-H designation, Dulles issues favored three names or letters, brothers John Foster Dulles and Allen Welsh Dulles and the agency they devised, the Central Intelligence Agency. Woz wondered if the new C-I-H requirement connoted a C-I-A super spy.

Regardless, he needed two consultants and a plan to pay for their services.

The last time he had engaged in a serious science exercise occurred when he lettered W-O-Z-N-IA-K on an exam paper. Since then he had adapted himself to medicine’s narrow corridor in which the inter- of -disciplinary could be as subtle as an internist consulting with a surgeon. The dimensions of this requirement leap-frogged from medicine over nursing and allied health all the way to basic science and beyond.

Its requirement for consultant resumes was particularly troubling. Less the resume requirement, he reasoned he might turn a pleasant faculty club lunch into permissions to forward two subject matter experts’ phone numbers. So on a Saturday that would have otherwise been a day off, Woz applied a popular decision-making approach, one of stewing, embracing indecision until late afternoon sun produced lengthened shadows.

He then shut his office door and drove home. Reaching his Forest avenue flat, a converted No.-2 hospital room converted into a studio apartment, he chuckled. For Saturday night he would be KO-W0Z, all shortwave, no title.

Monday morning necessitated case follow-ups accompanied by a numbing cascade of meetings.

With each interruption came a reminder of the unaddressed form, its fields still blank. Lacking further

stewing or driving options the Woz phoned the science department. Good morning, this is Dr. Wozniak.

Could you tell me who might advise me regarding botany and chemical exposures?

While her first instinct was to take a number, OfficeLady pursued a more aggressive solution.

It’s true she heard the doctor part; it’s true she heard the term botany, but past those conversational elements, the remainder of his inquiry generated an alternative, bizarre meaning.

A big fan of Dick Van Dyke and Danny Thomas reruns, she persisted through credits announcing Dick Van Dyke wears BOTANY 500 suits and Mr. Thomas’ wardrobe furnished by BOTANY 500. Her fondness for those suave entertainers possibly explains the conversational detour that ensued. Did I hear you right?

You need a professor to remove a chemical stain from your BOTANY 500 suit?

Skilled in clinical calming and clarification, Dr. Wozniak redirected. No thank you, my suit is fine but I need to find someone to identify mushrooms, toxic plants and poisonous berries. Her shortfalls did not extend to call forwarding. Please hold for Dr. Mel. Woz and Mel’s conversation was brief.

Two days later Mel walked to Woz’ office. Mel’s prior contact with medical personnel involved Navy Corpsmen during the battle for Okinawa. Beyond inter-service teasing, Marines like Mel generally held Corpsmen in high regard. Mel also wondered if this new relationship could further his interest in botanicals as medicinal chemicals.

Woz was somewhat nervous about soliciting an older professional for a mostly unpaid assignment, perhaps accounting for the thoughtfulness he applied to Mel’s medicinal plant inquiries, rather surprised actually the largely unpaid nature of the consultancy did not deter Professor Mel. Mel on the other hand was pleased Dr. Wozniak took his questions seriously, making their sole unresolved issue one of a contact telephone number. Mel handed Woz a business card onto which he had scrawled his home number, adding his wife could always reach him.

Brooklyn was well through a box of chalk-sticks when OfficeLady squeezed into his lecture space, signaling an important telephone call. He had agreed to bonus her with Coke money any time she rescued him from a lecture. I have Dr. Wozniak from poison control on hold.

As if the twenty-year-olds hadn’t heard, Brooklyn loudly re-phonated the Dr. Wozniak feature.

Sans an apology, he abandoned them in favor of monopolizing her handset, baritone-ing Dr. Brooklyn, as if interrupted midway through a Nobel-deserving synthesis.

Woz first complimented Brooklyn on unspecified good things he had heard about the latter’s industrial experience. Indicating he would prefer to explain an important project in person, he invited him for a coffee later the same day. Commencing their meeting, Woz pursued the certified industrial feature without clarifying the form’s requirement, mainly because he didn’t understand it well himself.

Favoring the first two of the three certified – industrial - hygienist terms, Brooklyn neglected the hygiene piece, expounding on pollution challenges facing Bossier City, Louisiana.

Woz formed some thoughts about poorly treated thyrotoxicosis, twice interrupting Brooklyn to confirm the professor was comfortable regarding sampling air for benzene and analyzing blood for lead.

Their back-and-forth progressed until Woz seriously over-invested in his chemical knowledge, inquiring if Brooklyn possessed something similar to Star Trek’s Tricorder, taking Brooklyn’s silence as a Tricorderno.

Brooklyn then asked Woz if he had encountered physicist Richard Feynman’s writings, ones suggesting heart surgery might be accomplished by a patient swallowed a tiny surgeon machine.

Professing his ignorance of tiny surgeons, they both laughed, realizing neither understood much of what the other either knew or did.

The pharmacy assistant patched an urgent call to Woz’ speaker phone, one originating from the Wabash hospital in rural Missouri. The caller indicated an 80-year-old suicidal gentleman in Moberly had laced a glass of orange juice with three tablespoons of weed poison. Brooklyn listened as Dr. Wozniak described a bicarbonate treatment protocol for correction of the poisoned man’s acidosis.

Listening to Woz’ disease-laden words, made Brooklyn anxious, shortly miming his way toward a departure. Outside of Woz’ office, he was relieved to return to molecules of his choosing, ones far removed from Glyphosate cocktailed into orange juice. Mainly, though, he needed a nap.

Only a few days passed before the newly-created Brooklyn-Racer team, received a call from the poison center requesting some industrial hygiene help. The pharmacy caller shared with Brooklyn that Wanda Swearengin had called enough that they recognized her by voice.

Her house was located in an older Kansas City neighborhood, one labeled Harlem just east of the downtown airport. The assistant shared that apparently that Wanda Swearengin had become convinced vapors from nearby Cook Paint Company were making her ill.

Racer recognized Cook paint as a sponsor of a semi-pro basketball team, the Painters. Semi- applied to talented players formulating paint ahead of four o’clock whistles and night-only home games. While Kansas City noses could locate Cook Paint, as far as Brooklyn knew, Cook’s emissions did not constitute a threat to public health.

Electing to send Racer, Brooklyn outlined the tasks. Would you ride there to monitor paint chemicals, toluene and xylene? Depending on what you find, we’ll compare your results with references for comparable entries in the 1974 Threshold Limit Value list, my old Big River TLV booklet.

Since reaching there meant passing over a Missouri river bridge, Racer requisitioned the Econoline. Stuffing Brooklyn’s TLV booklet into his jersey pocket, he first bicycled to K-L-W where Kern handed him a trip clipboard and two dimes that would satisfy the Paseo bridge tolls.

Studying the case file, he noted Mrs. Swearengin’s address placed her east of the Richards air field. Converted from commercial to general aviation use, Richards’ runways accommodated planes that used aviation fuel, also termed Avgas, causing Racer to question if her chemical issues originated there.

Upon arrival Racer quickly learned from her that her health conditions were exceeded only by medication entries, multiple prescriptions ordered by five unacquainted physicians. As she explained, her struggles gave rise to crank status but further clarified, a nice lady crank.

While she went inside to quiet a ringing phone, he opened a small leather case, Draeger-lettering announcing German origins, shortly notching two different detector tubes, for toluene and xylene, respectively, anticipating color changes proportionate to chemical concentrations. Neither registered a measurable concentration.

Although disappointed with Racer’s negative findings, Wanda resigned herself the fumes weren’t too bad, requesting he return. She then presented Racer with one of two nearly identical and also unused inhalers, noting she had been unsuccessful in coordinating their activating triggers. While reading aloud from an unfolded insert, Racer circled a black-and-white cartooned depiction of a young male robustly inhaling with a similar device clamped between his teeth.

Following goodbyes, he retraced his path over the Paseo Bridge, returning the Econoline to K-LW before riding back to the lab. The same day Wanda shared with her neighbor some news that poison control had sent a doctor to Harlem, feeling so much better now that someone was finally taking her seriously.

Before stuffing the Heartland center’s response in an envelope, the Woz re-read and edited its consultant section, 4-C. Restricting himself to fewer than three corrections, he zigged-and-zagged across it using an IBM Selectric spacebar. Chuckling, the Woz wondered if he could spoof Brooklyn about completing the form courtesy of that non-NASA-inspired spacebar.

Dr. Wozniak also corrected an important typo, one in which his assistant had listed Brooklyn as C-I-A eligible; overtyping C-I-H as corrected by BWMD. While the Dulles’ might have been limited to threeletter abbreviations, the Woz could handle four.