When Lucinda Marker heard of the suspected death from ‘plague’ of 28-year-old laboratory technician Darya Shipilova in Russia last week, she was overcome by a harrowing sense of recognition.
‘This disease changes your life. When I saw the news, I thought it could be bioterrorism. This is such a rare disease: there has to be something else going on.’
Though Russia has refused to confirm the cause of Shipilova’s death, reports claim that she became ill after dropping a test tube containing a sample of the pneumonic plague pathogen at her laboratory. The hospital in which Shipilova was treated was placed under strict lockdown but only days later, another plague death was reported in the region, sparking fears about a resurgence of one of history’s most feared diseases.
Shipilova contracted the deadliest form of the disease. Unlike bubonic plague, known as the Black Death, which laid waste to Europe in the 14th century and is usually transmitted through the bite of an infected flea, pneumonic plague attacks the lungs and can spread directly between people through infectious respiratory droplets. Without prompt treatment, it is almost 100 per cent fatal.
Both infections are caused by the same bacterium, Yersinia pestis.
And as Lucinda knows all too well, even the more common bubonic plague can have devastating consequences. In November 2002, she and her husband, John Tull, became the first people diagnosed with bubonic plague in New York City in more than 100 years.
The couple, who had three children from John’s previous relationship, lived outside Santa Fe, New Mexico, on desert scrubland where the disease still circulates among wild rodents and their fleas. They were aware of it: two dead animals on their land, a rabbit and a rat, had tested positive for plague.
‘We were so cautious,’ says Lucinda. ‘When we stacked wood, we’d cover up head to toe, wear masks and use bleach. We were careful with our two dogs. We used flea treatments. We hadn’t done anything risky.’
In 2002, Lucinda Marker and her husband John Tull became the first people diagnosed with bubonic plague in New York City for 100 years
But when they flew to New York in November 2002 to celebrate the launch of their business together, financial adviser Lucinda, then 47, and lawyer John, 53, had unknowingly been bitten by infected fleas. Bubonic plague takes up to six days to show itself, so they were already infected when they arrived in New York on November 1. They both fell seriously ill two days later.
‘It was terrifying,’ says Lucinda. ‘We were both very healthy. Neither of us had ever had the flu, so we thought it must be that. We were feverish, writhing around in bed on soaked sheets.’
Bubonic plague strikes suddenly, causing a high fever, pounding headache, chills that set the whole body shaking, aching muscles and exhaustion. Then come the terrifying buboes – the swellings that give the disease its name.
Lucinda and John developed agonising swellings in their groins. Caused by inflamed lymph glands, the swellings can grow to the size of a hen’s egg and are excruciatingly painful. Initially, they put the swellings down to walking so much around New York.
But, too weak to leave their beds for any length of time, they spent two nights feverish and dehydrated in their hotel room.
‘We were so dehydrated, and our sheets were drenched with sweat,’ says Lucinda. ‘I kept limping to the bathroom to get a cold flannel to put on John’s head.
‘I remember getting sicker and sicker, with this feeling of impending doom and darkness.’
John called his doctor in Santa Fe, who urged them to seek medical attention immediately.
Both of John’s feet had to be amputated and he needed further surgery to reshape his legs for prosthetics
The hotel called them a cab to visit a travel doctor on Fifth Avenue. John was so weak that he had to lie on the surgery floor – not that he remembers. By then, he later discovered, his organs had already started shutting down.
Their doctor had never seen a case of bubonic plague before, but recognised the symptoms immediately.
‘I think he was quite excited,’ says Lucinda. ‘He pulled a book off his shelf and showed us a photograph of a bubo.
‘I didn’t believe it. I didn’t believe we were that sick. The doctor wanted to call an ambulance, but we took a cab to the hospital. John was hardly able to walk. It was insanity.’ At Beth Israel Medical Centre, John’s temperature was 40.2C (104.3F) and his blood pressure had crashed to 78/50 – (a healthy reading might be 120/80). Lucinda’s temperature was 39C (102.2F).
Doctors suspected that while Lucinda’s infection was largely contained in her lymph nodes, John’s had reached his bloodstream.
Within a day, tests on John’s blood confirmed they were suffering from bubonic plague.
Their cases were particularly alarming as they came barely a year after 9/11 and the anthrax letters – where mail laced with the bacteria that causes the anthrax disease were sent through the US postal system, killing five people. Fears of biological terrorism were running high and plague was among the diseases experts feared could be used as a weapon.
The couple were isolated and questioned by health officials and the FBI.
John died in 2014, aged 65, from spindle cell sarcoma, a rare cancer. Lucinda suspects the trauma of his plague may have played a part
‘They thought we were possibly terrorists, or victims of bioterrorism,’ says Lucinda.
‘I was questioned over and over in my hospital room,’ she says. ‘They wanted to know what we were doing in New York, why John was so much sicker, where we had been before.
‘In the meantime, the FBI ran background checks on us, and I was told they had worked to confirm that there wasn’t a lab set up at our house.’
The pair were making headlines, with news cameras gathered outside the hospital.
‘I was in hospital with the plague, watching the doctor who had diagnosed us being interviewed on Good Morning America,’ she says. ‘It felt like a movie.’
They were both put on a drip to flood their bodies with powerful antibiotics, including gentamicin and doxycycline. Untreated, bubonic plague kills between a third and two-thirds of its victims, but early treatment saves most patients. Thankfully, Lucinda’s condition improved almost immediately. But John was worsening by the hour.
The bacteria were flooding his bloodstream, causing septic shock. His blood pressure collapsed further and his kidneys and lungs began to fail.
He developed disseminated intravascular coagulation – a condition in which tiny blood clots form throughout the body, disrupting circulation and causing bleeding elsewhere. Starved of blood, his hands and feet turned black as he developed gangrene.
Lucinda is now finishing the book about their ordeal that she and John started together
Doctors put him on a ventilator and dialysis, administered four different antibiotics and placed him in an induced coma.
‘He looked horrific,’ says Lucinda. ‘His body and face swelled up.’
Lucinda spent ten days in hospital herself, during which staff wheeled her to intensive care to visit John.
‘I’d never seen anyone on advanced life support,’ she says. ‘He was surrounded by machines – a huge amount of technology and kit.’ Lucinda was repeatedly asked to consent to emergency procedures. One night, surgeons operated on John’s feet to assess whether any tissue could be saved.
The following morning, they told Lucinda that both of John’s feet would have to be amputated.
‘I couldn’t deny it,’ she says. ‘He would never walk on those feet again, and this might save his life. I refused to think he would die.’
Only later did doctors inform her that they had given John less than a one per cent chance of survival. ‘I’m very glad they didn’t tell me that at the time,’ she says.
Her own treatment, she says, didn’t hurt, though the swelling in her groin stayed painful for a long time, and she was only able to walk slowly. ‘I was so focused on John that I didn’t notice whether I felt sick or not,’ she says.
After she was discharged, Lucinda moved into an apartment near the hospital and visited John every day.
His family travelled from across America to see him, while a friend flew from London. His three children, the youngest just 16, were distraught.
‘They thought they had come to say goodbye to their father,’ Lucinda says. John’s eldest son and his wife were expecting their first baby and John later said the thought of meeting his grandchild kept him alive.
He spent six weeks in intensive care, finally coming round in the third week of January, almost three months after falling ill.
With no doctors present when he regained consciousness, Lucinda and John’s sister, Janie, had to explain that his feet had been amputated.
He mouthed the words: ‘What? My feet? That’s unbelievable.’
John needed surgery to reshape his legs for prosthetics. The night before one operation, heavily medicated and exhausted, John became desperately distressed.
‘He was moving his head back and forth and he asked me to throw him out of the window,’ says Lucinda. ‘He’d been through so much. I don’t know how anyone could handle that.’
In February 2003, John was flown by air ambulance to a hospital in Albuquerque, New Mexico.
‘His body had wasted away,’ says Lucinda. ‘The most he could do was lift one arm a little bit. He couldn’t even swallow. He had to start from zero.’
Back at home in Santa Fe, it took months for John to learn to walk again. In total, he spent around eight months in hospital and rehabilitation. Remarkably, returning to the property where they had contracted plague sparked no fear for Lucinda.
‘It wasn’t frightening,’ she says. ‘But the CDC cleaned the whole house and grounds.’
Investigators trapped 41 rodents and collected 88 fleas around the property and nearby hiking trail. Genetic tests showed the bacteria were indistinguishable from the strain that had almost killed John.
With Lucinda’s support, John rebuilt his life. A former prosecutor who had volunteered with search-and-rescue teams, he learned to drive again, fly planes and went fishing every year. But he never stopped missing the hiking trails near their home.
‘To some, it might seem as if John got the raw deal,’ says Lucinda. ‘But he was given less than a one per cent chance of survival and he made it. That’s pretty lucky. We survived the bubonic plague. That’s a big deal.’
John died in 2014, having just turned 65, from spindle cell sarcoma, a rare cancer. He and Lucinda had been together for 21 years, and married for 16.
Lucinda suspects the trauma of his plague ordeal may have played a part, although no direct connection was established. ‘He’d done amazingly well for someone who’d had both feet amputated, both in spirit and physically.’
Now she is finishing the book about their ordeal that she and John started together, Love in the Time of Bubonic Plague: One Couple’s Journey to Hell and Back. It is due to be published next year.
She says British readers are particularly fascinated by their story.
‘In Great Britain, people know about the plague,’ she says. ‘They’ve got the history. Hundreds of thousands of people over there were killed by it [the Black Death]. Here in the US, so many people just don’t have a clue.’
But after those two mysterious deaths in Russia, is the world about to have a vivid reminder of one of history’s most terrifying pathogens?
Visit johnandlucinda.com for more about their story