Episode 4: The Curious Case of Sergeant Bill Brooks

Description

In 1979, a young man's persistent pain and fatigue defy every test until pathologist Eve Reiner, MD, uses emerging tools to reveal what’s been hidden all along.

Cast:

Narrator / Sage Whitlock: Elizabeth V. McLeod, MD, MS, FCAP
Dr. Robert Cochrane: Charles T. Beavers, MD, FCAP
Dr. Eve Reiner: Dana Martin, MD, FCAP
Dr. Henry Coe: Adam Cloe, MD, PhD, BA, FCAP
Bill Brooks: Daniel E. Sabath, MD, PhD
Voiceover Intro/Outro: Robert Frick, MD, FCAP
Technical advisors: Jason V. Scapa, MD, FCAP, and Bobbi S. Pritt, MD, MSc, FCAP, with contributions from Elizabeth V. McLeod, MD, MS, FCAP; Thomas J. Cooper Jr., MD, FCAP; Xiaoyin "Sara" Jiang, MD, FCAP; and Feifan Fred Chen, MD, FCAP

This episode of Case Encounters is inspired by a real-life pathology case submitted by Diana Olguta Treaba, MD, FCAP, member of The College of American Pathologists.

To learn more about the work a pathologist does on your lab test, visit yourpathologist.org.

Case Encounters is a production of The College of American Pathologists, with creative direction from StudioNorth.

Executive Producer: Robert Johnson

Creative direction by StudioNorth

Produced and directed by Natalie Gregory

Editing, sound design, and original music by Jake Sorgen

Written by Paige Freeborn for StudioNorth

Special thanks to Justin Charlton-Perrin and Clemmie Lozano

Additional production support from Nefsi Williams, Isabelle Ritz, and Anabella Torres

Hosted on Ausha. See ausha.co/privacy-policy for more information.

Transcription

Speaker #0
This is Case Encounters, a journey to the true medical mysteries solved by pathologists, like Bill Brooks, an everyday man who had a secret even he didn't. Sorry.
Speaker #1
The year is 1979, Jimmy Carter's in his third year, Rocky II is on the big screen, gas is 86 cents a gallon, and Sony has just introduced the Walkman. MASH and Happy Days dominate the airwaves, and disco is peaking, but fading fast. DNA sequencing and CT scans are a luxury. Papered charts rule the hospital floor. and the electron microscope is in its glory days. It's a warm May morning when a man walks into the VA hospital. It's been weeks since Bill Brooks started noticing weight loss, abdominal pain, the skin on his hands peeling, and pain in his legs that made it difficult for him to get up out of a chair.
Speaker #2
Mr. Brooks, I'm Dr. Cochran. What brings you in today?
Speaker #3
Morning, Dr. Cochran. I'm not sure, but something's just not right. I don't usually come into the city, but I've been pretty sick. My legs feel like dead weight. Hurts to stand, hurts worse to walk.
Speaker #2
So, when did this start?
Speaker #3
About a month or so ago. I thought it was just the heat or some kind of bug, but it won't let go and it seems to be getting worse.
Speaker #2
Any numbness or tingling? Any pain anywhere else?
Speaker #3
Yeah, my hands and feet. Feels like they're asleep all the time. Sometimes they burn. Sometimes I can't even tell if I'm holding my coffee.
Speaker #2
Have you noticed any other changes? How's your appetite?
Speaker #3
I'm barely eating. Lost about 10 pounds. And look, my palms are peeling like I got sunburned. My feet, too.
Speaker #2
Okay, I'd like to run some labs. Might be something metabolic. Could be a deficiency. We'll have a look and see what's happening.
Speaker #1
The skin on his palms is cracked and flaking. His grip is weak. His usually rigid posture is slumped. This isn't just fatigue or the heat. Something else was happening to Bill Brooks. Later the next day, the initial lab results were back, and Cochran didn't like what he saw. He ordered additional blood work to get a clearer picture. And when those results came back a few days later, his concern escalated. And he called in hematologist Dr. Henry Ko to help him decipher what he was seeing.
Speaker #2
His initial blood work showed his hemoglobin at 8.4. And his red blood cells are macrocytic. They're huge. His MCV is over 100.
Speaker #4
That's classic megaloblastic anemia. How are his B12 and folate?
Speaker #2
His B12's fine. The folate's low normal. But look here at the smear.
Speaker #4
Hmm. Basophilic stippling and howl jolly bodies.
Speaker #1
Basophilic stippling. Leftover bits of RNA like static in the signal. And howl jolly bodies. An absurdly joyful name for such a grim discovery. Fragments of DNA that should have been cleared before the cells left the bone marrow.
Speaker #4
This isn't about his nutrition. His bone marrow is under stress. Something's disrupting the red blood cell development. Maybe a toxin. Heavy metal exposure comes to mind.
Speaker #2
Lead? Arsenic? Where does he work? No word that would explain this.
Speaker #1
In 1979, there were no molecular tests, no genetic panels. When all three bloodlines were down, red, white, and platelets, there was only one next step.
Speaker #2
I'm going to have him admitted for observation and order a bone marrow biopsy. I'll have Dr. Reiner look at it.
Speaker #1
The biopsy results arrived in the pathology lab a few days later, where we find Dr. Eve Reiner, who, in 1979, Stood out simply by being there She was methodical unassuming one of the few women in a field dominated by man. She wasn't looking for recognition. She was looking for truth. The air was cooler here than the rest of the hospital. Still, quiet, just the low hum of machines. Sometimes, Dr. Reiner could barely tell if another human was on the floor. She was already at the microscope when Dr. Cochran arrived. She didn't look up. She didn't need to.
Speaker #2
Didn't mean to interrupt, Dr. Reiner. Just curious. This case, something feels off.
Speaker #5
And with good cause this time.
Speaker #2
I had a feeling that you'd have something interesting for me. What's happening under there?
Speaker #5
The marrow's hypercellular. Way more crowded than it should be. I'm seeing erythroid hyperplasia, too many immature red cell precursors, all clustered together. But... Here's the thing. They're not maturing properly.
Speaker #2
So, megaloblastosis?
Speaker #5
Exactly. And the cells are oversized. The nuclei look off. Some with fragments, others trying to divide, but like they're stuck mid-process. It's really disorganized. Like they started building and then lost the blueprint halfway through.
Speaker #2
Really? What is happening to Mr. Brooks?
Speaker #5
I'm also seeing abnormal DNA stuck between two nuclei and a nucleus that's literally breaking apart. They look damaged, rushed, like chaos. These cells are supposed to be more uniform, predictable, designed to carry oxygen through the body.
Speaker #2
Toxic?
Speaker #5
That's where I'm leaning. The nuclear envelope looks disrupted. Like something's interfering with the DNA synthesis itself. I want to take a closer look with some deeper resolution. I'll prep it for the SEM.
Speaker #1
SEM, the scanning electron microscope. One of the latest breakthroughs in medical technology. A hulking machine the size of a refrigerator, weighing over a thousand pounds. The SEM used electrons, not light, to create high-resolution images of the cell's surface. Paired with X-ray analysis, it revealed not just what the cells looked like, but what they were made of. It couldn't give her the answer, but it showed her where to look. The rest was up to her sharp eye and near total recall of cellular behavior. The challenge? Where this analysis would take hours today, in 1979, results would add days to the already lengthy process of reaching a diagnosis for Mr. Brooks. When it was finally ready, Dr. Reiner called Dr. Cochran, and they met in the lab to review the elemental profile. She read the report twice.
Speaker #5
Holy moly.
Speaker #1
One single offending element. It shouldn't have been there, but it was. And in that moment, she knew.
Speaker #5
Wow. Element 33.
Speaker #2
Arsenic? Are you sure?
Speaker #1
It wasn't just cell damage anymore. It was evidence. And with it, a dozen new questions.
Speaker #5
Yes, it's in the cytoplasm. Multiple cells, consistent across the sample. It's not a contaminant.
Speaker #1
There it was, the pattern behind the chaos. And it wasn't just traces. Arsenic had infiltrated Bill Brooks' bone marrow,
Speaker #5
soaked into the very cells that carried oxygen through the body.
Speaker #2
The nerve pain, the marrow failure, even the peeling skin. It all makes sense now.
Speaker #5
This is textbook arsenic exposure. Where has this guy been? And who has he been with?
Speaker #1
Cochran and Reiner weren't just looking at a diagnosis. They were looking at a crime scene. Bill Brooks hadn't fallen ill by accident. Something. or someone had poisoned him. Later that day, Dr. Cochran returned to Bill Brooks' room. The treatment plan wouldn't be nearly as difficult to swallow as his diagnosis.
Speaker #2
How are you feeling, Bill?
Speaker #3
Still the same, Dr. Cochran. Maybe a bit better. I've mostly been sleeping when I can get comfortable.
Speaker #2
Okay, Bill. Have you been around anything out of the ordinary in the past few months? Pesticides? Contaminated water? Old medications? Has anyone given you anything?
Speaker #3
Not that I know of. I've been working at the Social Security office for the past few years now, so I wouldn't have been around anything like that.
Speaker #2
I see. Well, we got the results of your bone marrow biopsy. I even went down to the lab myself to see the pathologist. It seems you've been exposed to arsenic, and a pretty significant amount. Arsenic? Arsenic. Do you have any idea how that might have happened, Bill? Not that I can think of.
Speaker #1
There was a silence, not just in the room. But in his response, Maybe he truly didn't know, or maybe he did, and wasn't ready or willing to say. Bill Brooks was treated with chelation therapy to help remove the arsenic from his system. That meant painful injections every few hours. No IV, no pill, just a thick needle and time. Today, Mr. Brooks would have been treated with a course of oral medication, and the poisoning would have been more easily and quickly detected in toxicology panels using urine, hair, or blood samples.
Speaker #5
Hey there, Daniel. I've been thinking about your arsenic patient. Did we ever find out what happened?
Speaker #2
Nope. We discharged him a while back. He was supposed to come back in for a follow-up, but I haven't seen him since.
Speaker #1
Bill Brooks returned to his daily life at the Social Security office. He never visited the VA hospital again. Sometimes, the body tells a story the patient can't or won't. It may have taken longer to unearth these kinds of stories decades ago, but the results remain. Dr. Reiner identified the what in this case. The why and the who remain unknown. And those remaining details still haunt her.
Speaker #0
You've been listening to Case Encounters. This story is inspired by a true medical mystery solved through collaboration, curiosity, and a pathologist. Names and locations are fictitious. Until next time, stay curious. The voices you just heard are those real pathologists, the people who work long days and longer weeks to solve medical mysteries big and small. To learn more about the work pathologists do for patients, visit yourpathologist.org. For a full list of the pathologists featured in this episode, and those who advised the creation of this story, please visit the show notes. Case Encounters is a production of the College of American Pathologists. Creative support from Studio North. Produced and directed by Natalie Gregory. Sound design, editing, and original music by Jake Sorgan. Written by Paige Freeborn for Studio North.

Description

In 1979, a young man's persistent pain and fatigue defy every test until pathologist Eve Reiner, MD, uses emerging tools to reveal what’s been hidden all along.

Cast:

Narrator / Sage Whitlock: Elizabeth V. McLeod, MD, MS, FCAP
Dr. Robert Cochrane: Charles T. Beavers, MD, FCAP
Dr. Eve Reiner: Dana Martin, MD, FCAP
Dr. Henry Coe: Adam Cloe, MD, PhD, BA, FCAP
Bill Brooks: Daniel E. Sabath, MD, PhD
Voiceover Intro/Outro: Robert Frick, MD, FCAP
Technical advisors: Jason V. Scapa, MD, FCAP, and Bobbi S. Pritt, MD, MSc, FCAP, with contributions from Elizabeth V. McLeod, MD, MS, FCAP; Thomas J. Cooper Jr., MD, FCAP; Xiaoyin "Sara" Jiang, MD, FCAP; and Feifan Fred Chen, MD, FCAP

This episode of Case Encounters is inspired by a real-life pathology case submitted by Diana Olguta Treaba, MD, FCAP, member of The College of American Pathologists.

To learn more about the work a pathologist does on your lab test, visit yourpathologist.org.

Case Encounters is a production of The College of American Pathologists, with creative direction from StudioNorth.

Executive Producer: Robert Johnson

Creative direction by StudioNorth

Produced and directed by Natalie Gregory

Editing, sound design, and original music by Jake Sorgen

Written by Paige Freeborn for StudioNorth

Special thanks to Justin Charlton-Perrin and Clemmie Lozano

Additional production support from Nefsi Williams, Isabelle Ritz, and Anabella Torres

Hosted on Ausha. See ausha.co/privacy-policy for more information.

Transcription

Speaker #0
This is Case Encounters, a journey to the true medical mysteries solved by pathologists, like Bill Brooks, an everyday man who had a secret even he didn't. Sorry.
Speaker #1
The year is 1979, Jimmy Carter's in his third year, Rocky II is on the big screen, gas is 86 cents a gallon, and Sony has just introduced the Walkman. MASH and Happy Days dominate the airwaves, and disco is peaking, but fading fast. DNA sequencing and CT scans are a luxury. Papered charts rule the hospital floor. and the electron microscope is in its glory days. It's a warm May morning when a man walks into the VA hospital. It's been weeks since Bill Brooks started noticing weight loss, abdominal pain, the skin on his hands peeling, and pain in his legs that made it difficult for him to get up out of a chair.
Speaker #2
Mr. Brooks, I'm Dr. Cochran. What brings you in today?
Speaker #3
Morning, Dr. Cochran. I'm not sure, but something's just not right. I don't usually come into the city, but I've been pretty sick. My legs feel like dead weight. Hurts to stand, hurts worse to walk.
Speaker #2
So, when did this start?
Speaker #3
About a month or so ago. I thought it was just the heat or some kind of bug, but it won't let go and it seems to be getting worse.
Speaker #2
Any numbness or tingling? Any pain anywhere else?
Speaker #3
Yeah, my hands and feet. Feels like they're asleep all the time. Sometimes they burn. Sometimes I can't even tell if I'm holding my coffee.
Speaker #2
Have you noticed any other changes? How's your appetite?
Speaker #3
I'm barely eating. Lost about 10 pounds. And look, my palms are peeling like I got sunburned. My feet, too.
Speaker #2
Okay, I'd like to run some labs. Might be something metabolic. Could be a deficiency. We'll have a look and see what's happening.
Speaker #1
The skin on his palms is cracked and flaking. His grip is weak. His usually rigid posture is slumped. This isn't just fatigue or the heat. Something else was happening to Bill Brooks. Later the next day, the initial lab results were back, and Cochran didn't like what he saw. He ordered additional blood work to get a clearer picture. And when those results came back a few days later, his concern escalated. And he called in hematologist Dr. Henry Ko to help him decipher what he was seeing.
Speaker #2
His initial blood work showed his hemoglobin at 8.4. And his red blood cells are macrocytic. They're huge. His MCV is over 100.
Speaker #4
That's classic megaloblastic anemia. How are his B12 and folate?
Speaker #2
His B12's fine. The folate's low normal. But look here at the smear.
Speaker #4
Hmm. Basophilic stippling and howl jolly bodies.
Speaker #1
Basophilic stippling. Leftover bits of RNA like static in the signal. And howl jolly bodies. An absurdly joyful name for such a grim discovery. Fragments of DNA that should have been cleared before the cells left the bone marrow.
Speaker #4
This isn't about his nutrition. His bone marrow is under stress. Something's disrupting the red blood cell development. Maybe a toxin. Heavy metal exposure comes to mind.
Speaker #2
Lead? Arsenic? Where does he work? No word that would explain this.
Speaker #1
In 1979, there were no molecular tests, no genetic panels. When all three bloodlines were down, red, white, and platelets, there was only one next step.
Speaker #2
I'm going to have him admitted for observation and order a bone marrow biopsy. I'll have Dr. Reiner look at it.
Speaker #1
The biopsy results arrived in the pathology lab a few days later, where we find Dr. Eve Reiner, who, in 1979, Stood out simply by being there She was methodical unassuming one of the few women in a field dominated by man. She wasn't looking for recognition. She was looking for truth. The air was cooler here than the rest of the hospital. Still, quiet, just the low hum of machines. Sometimes, Dr. Reiner could barely tell if another human was on the floor. She was already at the microscope when Dr. Cochran arrived. She didn't look up. She didn't need to.
Speaker #2
Didn't mean to interrupt, Dr. Reiner. Just curious. This case, something feels off.
Speaker #5
And with good cause this time.
Speaker #2
I had a feeling that you'd have something interesting for me. What's happening under there?
Speaker #5
The marrow's hypercellular. Way more crowded than it should be. I'm seeing erythroid hyperplasia, too many immature red cell precursors, all clustered together. But... Here's the thing. They're not maturing properly.
Speaker #2
So, megaloblastosis?
Speaker #5
Exactly. And the cells are oversized. The nuclei look off. Some with fragments, others trying to divide, but like they're stuck mid-process. It's really disorganized. Like they started building and then lost the blueprint halfway through.
Speaker #2
Really? What is happening to Mr. Brooks?
Speaker #5
I'm also seeing abnormal DNA stuck between two nuclei and a nucleus that's literally breaking apart. They look damaged, rushed, like chaos. These cells are supposed to be more uniform, predictable, designed to carry oxygen through the body.
Speaker #2
Toxic?
Speaker #5
That's where I'm leaning. The nuclear envelope looks disrupted. Like something's interfering with the DNA synthesis itself. I want to take a closer look with some deeper resolution. I'll prep it for the SEM.
Speaker #1
SEM, the scanning electron microscope. One of the latest breakthroughs in medical technology. A hulking machine the size of a refrigerator, weighing over a thousand pounds. The SEM used electrons, not light, to create high-resolution images of the cell's surface. Paired with X-ray analysis, it revealed not just what the cells looked like, but what they were made of. It couldn't give her the answer, but it showed her where to look. The rest was up to her sharp eye and near total recall of cellular behavior. The challenge? Where this analysis would take hours today, in 1979, results would add days to the already lengthy process of reaching a diagnosis for Mr. Brooks. When it was finally ready, Dr. Reiner called Dr. Cochran, and they met in the lab to review the elemental profile. She read the report twice.
Speaker #5
Holy moly.
Speaker #1
One single offending element. It shouldn't have been there, but it was. And in that moment, she knew.
Speaker #5
Wow. Element 33.
Speaker #2
Arsenic? Are you sure?
Speaker #1
It wasn't just cell damage anymore. It was evidence. And with it, a dozen new questions.
Speaker #5
Yes, it's in the cytoplasm. Multiple cells, consistent across the sample. It's not a contaminant.
Speaker #1
There it was, the pattern behind the chaos. And it wasn't just traces. Arsenic had infiltrated Bill Brooks' bone marrow,
Speaker #5
soaked into the very cells that carried oxygen through the body.
Speaker #2
The nerve pain, the marrow failure, even the peeling skin. It all makes sense now.
Speaker #5
This is textbook arsenic exposure. Where has this guy been? And who has he been with?
Speaker #1
Cochran and Reiner weren't just looking at a diagnosis. They were looking at a crime scene. Bill Brooks hadn't fallen ill by accident. Something. or someone had poisoned him. Later that day, Dr. Cochran returned to Bill Brooks' room. The treatment plan wouldn't be nearly as difficult to swallow as his diagnosis.
Speaker #2
How are you feeling, Bill?
Speaker #3
Still the same, Dr. Cochran. Maybe a bit better. I've mostly been sleeping when I can get comfortable.
Speaker #2
Okay, Bill. Have you been around anything out of the ordinary in the past few months? Pesticides? Contaminated water? Old medications? Has anyone given you anything?
Speaker #3
Not that I know of. I've been working at the Social Security office for the past few years now, so I wouldn't have been around anything like that.
Speaker #2
I see. Well, we got the results of your bone marrow biopsy. I even went down to the lab myself to see the pathologist. It seems you've been exposed to arsenic, and a pretty significant amount. Arsenic? Arsenic. Do you have any idea how that might have happened, Bill? Not that I can think of.
Speaker #1
There was a silence, not just in the room. But in his response, Maybe he truly didn't know, or maybe he did, and wasn't ready or willing to say. Bill Brooks was treated with chelation therapy to help remove the arsenic from his system. That meant painful injections every few hours. No IV, no pill, just a thick needle and time. Today, Mr. Brooks would have been treated with a course of oral medication, and the poisoning would have been more easily and quickly detected in toxicology panels using urine, hair, or blood samples.
Speaker #5
Hey there, Daniel. I've been thinking about your arsenic patient. Did we ever find out what happened?
Speaker #2
Nope. We discharged him a while back. He was supposed to come back in for a follow-up, but I haven't seen him since.
Speaker #1
Bill Brooks returned to his daily life at the Social Security office. He never visited the VA hospital again. Sometimes, the body tells a story the patient can't or won't. It may have taken longer to unearth these kinds of stories decades ago, but the results remain. Dr. Reiner identified the what in this case. The why and the who remain unknown. And those remaining details still haunt her.
Speaker #0
You've been listening to Case Encounters. This story is inspired by a true medical mystery solved through collaboration, curiosity, and a pathologist. Names and locations are fictitious. Until next time, stay curious. The voices you just heard are those real pathologists, the people who work long days and longer weeks to solve medical mysteries big and small. To learn more about the work pathologists do for patients, visit yourpathologist.org. For a full list of the pathologists featured in this episode, and those who advised the creation of this story, please visit the show notes. Case Encounters is a production of the College of American Pathologists. Creative support from Studio North. Produced and directed by Natalie Gregory. Sound design, editing, and original music by Jake Sorgan. Written by Paige Freeborn for Studio North.

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