CARIBOU – There was a steady flow of patients with minor ailments, but it was generally a routine Sunday afternoon at Cary Medical Center.

That changed quickly with the arrival in the emergency room of a man with severe flu-like symptoms. Then there were a few more. Soon, the doctor and three nurses knew they were dealing with a crisis.

Little did they know their 65-bed hospital was dealing with one of the most severe arsenic poisonings in modern history.

That night, a dozen churchgoers streamed into the emergency room. Three more sought help the next day. By the time it was over, one was dead and several more were in critical condition.

“They just kept coming, one after the other,” said Rob MacKinnon, one of the emergency room nurses.

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The first patient arrived in the ER at 3:30 p.m., hours after members of the Gustaf Adolph Lutheran Church in New Sweden gathered for coffee and treats following their worship service on April 27.

The next, an elderly man who later died, came in an hour later. He was followed by a 30-year-old man.

Pretty soon, the emergency room’s nine beds were filling up with people who attended the reception.

All said the same thing: The coffee didn’t taste right and they felt it was the cause of their illnesses. Some had begun throwing up 10 minutes after drinking it. Others fell ill within an hour. The common complaint: nausea. Some were throwing up repeatedly, and others had diarrhea.

Most of them had been sick for hours before being ordered to the hospital by spouses. Several were so ill that they brought buckets on the 12-mile drive to the hospital.

By the time they arrived, they were dehydrated and their blood pressures had dropped precipitously. One kept shivering, even after being covered with 17 blankets. Some of their arms, legs and faces turned blue. One had to be carried in.

Dr. Dan Harrigan, an emergency room physician, arrived at work at 6:30 p.m. to find a patient outside on his knees.

It was the man who made the coffee.

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Fortunately, the parishioners at the Gustaf Adolph Lutheran Church keep good records. They were able to report that 46 people attended the Sunday service and that 27 stayed for the social hour.

People attending the after-service reception had snacked on treats left over from a bake sale the day before. They also had coffee, a favorite drink among Swedes who settled in the area in 1870.

Emergency room workers began thoroughly questioning the patients about what they ate and drank. Initially, they didn’t believe it could be the coffee, even though parishioners had little doubt.

Patty Carson, who’s in charge of infection control at Cary, questioned the patients thoroughly on what they’d eaten and drunk, pausing when necessary to let them retch, then continuing the questioning.

“We said, ‘Coffee? People don’t get sick from coffee,”‘ said Kathleen Parent, an emergency room nurse.

By 7:30 p.m., seven patients had arrived in a four-hour span. Four more arrived in a little more than an hour. “I said, ‘There’s something horrible going on here. Something is not right,”‘ Parent said.

The nurses were attaching IV drips to the patients, but even after four liters’ worth the blood pressure of some wasn’t responding.

“No matter how much fluid we attempted to give those people, we couldn’t catch up,” Parent said.

All the while, patients continued to suffer from nausea, and the countertops and the floors in the rooms were covered with vomit-filled basins, buckets and garbage cans.

“We had to basically stop cleaning and start working on the more serious patients,” said Chrissy Miller, a nurse who was called from another part of the hospital to assist.

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There were already about 30 patients at Cary Medical Center and only two of the six beds in the Intensive Care Unit were available that night.

The staff improvised. Husbands and wives were doubled up in rooms in the ER. Some of the parishioners who were less sick than the others were put in the pediatric ward. But the shortage of ICU beds meant three people had to be airlifted to the Eastern Maine Medical Center in Bangor. More would be sent to Bangor the next day.

Unsure of what they were dealing with, the staff worked through the night under the assumption that it was either food poisoning or ingestion of some sort of toxic substance.

By midnight, things were coming under control. Some patients had improved and were sent home. But others were still ill.

One of them, Walter Morrill, 78, continued to go downhill. Doctors and nurses did everything they could but his blood pressure continued to drop until he was pronounced dead, Harrigan said.

At 3 a.m., Harrigan consulted on the phone with Dr. Anthony Tomassoni, director of the Northern New England Poison Center. Brainstorming aloud, Tomassoni decided it had to be some sort of heavy metal, Harrigan said.

Food poisoning typically hits an hour later, but the churchgoers were sick right away. And the low blood pressure fit with metal poisoning.

It wasn’t until that Tuesday that the state health lab in Augusta confirmed Tomassoni’s suspicion by reporting that a heavy metal, arsenic, had poisoned the group. The state immediately began shipping out antidotes stockpiled after the Sept. 11 terrorist attacks.

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The antidote for arsenic poisoning doesn’t make patients feel better in a snap. Instead, patients received two painful injections of a chelation agent called DMSA, which brought on another wave of nausea and headaches, said Dr. Carl Flynn, chief of medical staff at the hospital.

Chelation agents bond with arsenic in the bloodstream and they’re flushed out with along with urine.

Nearly two weeks later, the patients continue to recover. As of Friday, one remained at Cary and seven at Eastern Maine Medical Center, officials said.

What doctors learn from the patients will be used to rewrite guidelines for treating arsenic poisonings, Flynn said.

“The next chapter on arsenic poisoning in the toxicology textbooks will be written based on our data and patient outcomes,” he said.

AP-ES-05-09-03 1458EDT

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