People there are welcoming and enthusiastic — a byproduct of working at a museum. But there is one topic no one will discuss. In 2001 Joe Slowinski — a much-beloved, cheerful Midwesterner — was one of herpetology’s rising stars, wrangling the world’s most dangerous snakes with superhuman ease. That September, he took an academy expedition to the farthest reaches of the Burmese jungle, cataloging new species of reptiles and amphibians. Reaching into the wrong collection bag one morning, he pulled his hand out with a banded krait — one of the world’s most lethal snakes — attached. The venom quickly blocked communication between Slowinski’s neurons and the muscles they controlled, causing progressive paralysis that made his diaphragm limp, preventing him from breathing. His lungs stopped working, and a little over a day later, he died.
Seven years later, Lewin became a go-to guy for scientists preparing to go into the field. He put together first-aid kits, advised safety measures and planned for emergencies. He helped retool the academy’s safety standards, running drills to test and fine-tune protocols for responding to emergencies such as venomous fish bites. He helped design a new system of checks, complete with color-coded labels, to safeguard his colleagues in real life. And in 2010, he created the Center for Exploration and Travel Health, a clearinghouse that academy scientists working in remote sites can turn to for referrals to expedition doctors; it even includes Lewin’s home number — which they can call at all hours — in case disaster strikes.
With the center now running, Lewin has turned his attention back to Slowinski and what he calls “the biggest gap in field treatments for 10 things that can kill you quickly.” Namely, snakebites.
Snakebites kill nearly 100,000 people worldwide each year, mostly in the developing world. Those who get to a hospital in time receive antivenom and are put on life support, which keeps them breathing until the venom clears their system. But in the field, the only effective treatment is to give a patient mouth-to-mouth for hours or even days. What bite victims in the wilderness need most, therefore, is time. And Lewin thinks he has found a solution. Two common drugs — neostigmine and glycopyrrolate — could buy a victim some time. As the venom snips the lines of communication between the neurons and muscle, the drugs work to enhance the signal — like sending a surge of electricity down an increasingly fraying wire.
Lewin has come up with a travel-friendly nasal spray incorporating the two drugs that could be used in dozens of snake-riddled countries. Last year, after tinkering with the doses on himself, he tested the treatment in the lab. Sure enough, it worked. Now he is searching for funding to build a pilot project to put the spray through clinical trials and eventually distribute a refined product in countries like India, where snakebites cause thousands of deaths before victims can reach the hospital.
Could this nasal spray have saved Slowinski? Maybe. Rais Vohra, a Fresno colleague who advised Lewin in the early stages of his research into the antidote combination, says, “This is not going to be a definitive treatment. It may not do much but buy a few hours. But that much might count.”
The Killer List Revisited
Today Lewin has forged the alternate path he first imagined a decade ago while sitting among museum fossils, lamenting the death of a woman from an ER procedure gone wrong. He still works part time in ERs, and when he sees patients, he runs through his list of killers (updated these days with all manner of clauses and addenda). If the problem is not on the list, he takes a step back. The litany “is my daily prayer. It’s my calisthenics,” he says.
Whether in the ER or the Gobi, the list of quick killers dictates how Lewin thinks about treatment and evacuation. Expeditionary medicine is about good decisions coupled with preparation. Over the next year, he’ll fly to Papua New Guinea, India, Australia and Argentina. Before his plane touches down in each, he will be able to recite all the local diseases, venomous snakes, frogs, bugs, and fish, and poisonous plants. He will know where the medical facilities are, what equipment they have and what’s broken. He also keeps a list of classically Lewin-esque research questions to explore: How well does honey treat wounds? Can raw eggs make a suitable field dressing? Does hot water actually release a Gila monster’s jaws?
We’ve reached the end of our New Mexico road trip, and we have scoured the side of the road for long-dead sea creatures, found a shark tooth in an ancient seafloor and tracked long-dead worms across fossilized mud. Today, Lewin has managed to pull a few strings to get us a backstage look at the legendary Ghost Ranch. In addition to being the stunning backdrop for countless movies, for 125 years this sandstone formation has yielded a continuous line of important Triassic dinosaurs, like Coelophysis and Dromomeron.
Kneeling next to an active dig of an ancient crocodilian creature, Lewin admits that he is not a paleontologist, but he can pore over a find like this for hours. This quality may seem incongruous with the adrenaline-infused ER, but Lewin disagrees and points to the fossil. “It has a story. Same thing as when you are seeing patients. You are trying to figure out the story,” he says. The story of a 200-million-year-old animal or a single disease — the only difference is the pace.