A week after an attack on the subways here killed 10 people, only a handful of the more than 5,000 commuters afflicted by sarin nerve gas are still in serious condition. Quick treatment--and a stroke of luck--helped keep the number of badly ill low, doctors say.
The early morning attack on March 20 happened just after hospitals normally conduct staff meetings, meaning lots of personnel were on hand and doctors had not yet busied themselves with surgeries.
Also, a quick-thinking physician in the city of Matsumoto--who had treated nerve gas poisoning before--saw the crisis on television and alerted his puzzled colleagues in Tokyo, allowing them to administer the right antidote to patients before permanent damage set in.
At St. Luke's International Hospital in the Tsukiji neighborhood, near where some of the deadly gas was released, only two of 110 victims initially hospitalized are still undergoing treatment. One is about to be discharged; the other is comatose without brain function. "He's not likely to recover," said an attending doctor.
Several dozen other patients around Tokyo remain under treatment; a few are in comas. One woman in Matsumoto has been on life support since a poison gas attack there last June killed seven people.
Police are especially interested in one mysterious patient: a man whom witnesses saw kick a newspaper-wrapped bundle containing sarin across a subway platform. He allegedly tried to flee when passengers questioned him, but passed out when the nerve gas hit. Two bystanders died. The man, who is suspected of being a member of the Aum Supreme Truth cult, is under guard in a Tokyo hospital, and doctors say he is nearly well enough to be questioned.
Kiyo Shibata, a nurse who was hospitalized herself after being contaminated while tending victims, said she didn't know if the suspect was among those she treated in the attack's chaotic aftermath. "I am a nurse and a patient is a patient, no matter who they might be," she observed. "But if he was there in the emergency room, surrounded by people suffering and dying because of his actions, I am sure he suffered too."
But one physician said privately that if the patient had indeed played a role in the mass murder attempt, he had not suffered enough. "They should make him face the people of Tokyo," he said, pounding his triangular reflex hammer against the desk for emphasis.
Sarin, a colorless nerve gas developed in Nazi Germany, works by putting a roadblock in the nervous system, cutting off electrical signals from the brain that tell the body how to function. Many afflicted commuters experienced the first symptoms of exposure: dimmed eyesight, as the pupils involuntarily contract, along with spasms and vomiting. Those who came in direct contact with the chemical solution--such as a subway official who dutifully carried a leaky, foul-smelling package off a train--died almost instantly.
When ambulances first arrived at St. Luke's with ailing passengers, doctors didn't recognize the symptoms. "Some of the older doctors who lived through World War II might know sarin, but few of the younger doctors had ever even heard of nerve gas," said hospital official Toshiaki Saito.
But in Matsumoto, a city northwest of Tokyo, Dr. Nobuo Yanagisawa of Shinshu University Hospital had treated patients for exposure to sarin nine months earlier and called to explain the treatment. St. Luke's staff quickly began administering atropine sulfate--a sarin antidote--to hundreds of victims who filled the hallways, waiting room floors and even the hospital's chapel.
By day's end, exhausted doctors, nurses and medical students at St. Luke's had treated 1,410 people.
"We were very lucky that everyone had the same symptoms," said Dr. Kenji Sakurai, the hospital's vice president. "If it had been an explosion or an earthquake, demanding different treatment for each person, we wouldn't have been able to cope."
Most people were able to go home that day despite "pinhole vision" and headaches. Based on Matsumoto's cases, doctors assured patients that they would fully regain their eyesight and feel normal within a week to a month.
A little more than a week later, some report lingering effects.
"I still feel numb at times. My stomach is not functioning well either," Mitsuru Yoshiaki, 55, told the Mainichi Shimbun after being taken off a respirator. Kazuyuki Takahashi, 31, also in intensive care, was feeling well enough to receive a visit from his son. "I feel a little faint when I walk, but I'm much better now," he said. "I just want to know who did this and why."
Patients also worry about long-term effects, especially four pregnant women treated at the hospital. Experiments with fish exposed to sarin caused birth defects, but scientists think that those results may not be applicable to humans.