Mr. Yuk has had his day.
You remember Mr. Yuk: the sickly green, unsmiley face with his tongue sticking out, who adorned many a household telephone, refrigerator and bleach bottle.
Mr. Yuk was the face of your local poison control center, whose hot line phone number was printed around his collar. His pukey look was designed both to discourage kids from drinking or eating the contents of containers bearing the sticker and to give parents quick access to the phone number in case they did. For 22 years Yuk and his human surrogates answered many a panicked mother's pleas for what to do after her toddler ingested an unknown quantity of daddy's Aqua Velva.
But last year, Mr. Yuk was sidelined when the nation's 64 poison control centers consolidated their phone numbers into one -- 800-222-1222; in the process, two-thirds of them changed the "recognition symbol" from Mr. Yuk to the less cartoonish "Poison Help" logo that features the letter L in "help" as an open red bottle with a skull and crossbones.
The face of the poison control centers may have changed, but their mission has not. Besides answering urgent calls from moms and dads about household hazard "exposures" (one of many terms of art in the poison control business) the centers' professional toxicologists field calls from emergency rooms and hospitals at a rate of more than 2.2 million a year -- one every 14 seconds -- according to last year's American Association of Poison Control Centers (AAPCC) annual report. (The figures are for 2001.)
The centers also make recommendations to manufacturers and regulators about changes in formulas and packaging, perform "post-marketing surveillance" of newly released products and distribute information at schools and health fairs.
And thank heaven for it: It's a dangerous world out there. Poison control centers take calls involving "cleaning substances, personal care products, medications, plants, pesticides, hydrocarbons [gasoline, lighter fluid], automotive products -- those are the major categories," says Rose Ann G. Soloway, clinical toxicologist for the National Capital Poison Center (NCPC). The NCPC handles poison queries for all of the District, adjacent Maryland counties and Northern Virginia.
Most real and suspected poisonings involve children from infants to age 5, and nearly 90 percent of the exposures take place at home. In 2001, according to National Center for Health Statistics, 12,030 deaths by poison occurred in the United States. Of this total, more than 1,000 involved cases where a poison control center had been called to help the victim. Nineteen of these fatalities occurred in the Washington area. (In 2002, that number was 10).
While 26 of the fatalities for 2001 -- 2.4 percent -- were children under 6, that demographic makes up 51.6 percent of the total calls. The bulk of the fatalities, 517, were classified as suicides among those over 19 and over; the next biggest category were deaths among those over 19 that were due to "abuse," accounting for another 123.
"The kind of calls over the years don't vary," says Jane Elshami, a registered nurse and a certified specialist in poison information. "Except the drugs people abuse; those vary."
Elshami has been at the NCPC since it was founded in a windowless room in the back of Georgetown University Hospital's emergency room in 1980, when Mr. Yuk went national. These days the center is in much more comfortable offices above a Sutton Place Gourmet on New Mexico Avenue NW. There are windows now, including a large one by the front door that gives the room a radio studio feel. Today, three women -- Nancy Camp, Mary Gray and Elshami -- handle the phones at sleek, blond wood computer stations.
"Ninety to 95 percent of [the poison information] we need is in the computers," says Soloway. Dozens of books -- such as "All About Weeds," "Medical Management of Radiation Accidents," "Pharmacokinetics," "Clinical and Experimental Toxicology of Organophosphates and Carbmates" -- and a tidy bank of file cabinets filled with journal abstracts about poisons and treatments cover what isn't in the computers' databases and patient management programs.
It's quiet in the room, quiet like a library, as the three women take calls and talk in hushed tones into their phones.
"We take 50,000 calls a year from the Washington metro region," says Soloway, keeping her voice low. "Between 37,000 and 38,000 of those 50,000 calls are poison emergencies. The others are poison-related requests for information. But the call volume is steady, from 8 or 10 in the morning to 10 or 11 at night. It peaks at dinner time." For 2002, the center averaged 136.9 calls a day.
The round-the-clock NCPC professional staff includes 14 full- and part-time poison information specialists, with three toxicologists and one part-time office worker. The center operates on an annual budget of about $1.5 million; half of that comes from state governments and federal block grant funding from the District, with the other half coming from donations from the public. The service is a United Way and Combined Federal Campaigns participant.
Soloway also serves as associate director of the AAPCC, whose offices are just down the hall. Toby L. Litovitz, the founder and executive director of the NCPC, is the current executive director of the national group.
It's What You Know
Mary Gray, a registered nurse, came to the NCPC in June. "What surprises me the most is how the other people working here know all the incredible amount of stuff there is to know," she says. "I don't think I'll ever get to that point. My first day here, Toby Litovitz put this on my desk and said, 'Can you memorize this?' "
It was a phone-book-sized, 1,589-page tome called "Goldfrank's Toxicological Emergencies."
Gray's nursing experience has proven essential not just in understanding the jargon of poison but also in communicating with those calling from hospital emergency rooms.
Not long ago Gray took a call from an ER in which "the patient was unresponsive, comatose, and they thought it was some kind of overdose. They said, 'We gathered all the medications in the house and no bottles were empty, but they had this, this and this' and none of that sounded particularly exciting."
After considering, Gray asked, "Does the patient happen to have an anionic gap?" They shot back, "Yes, the patient has a big anionic gap."
The solution became clear: "That's toxic alcohol," Gray concluded. "Ethenene glycol [antifreeze] or methanol [windshield washer solution]. You need to get the patient Antizol and dialysis."
Gray was right: The patient had consumed antifreeze. The big clue was the anionic gap, which is an imbalance in positive and negative charges of electrolytes and other substances in the bloodstream. Toxic alcohol poisoning creates such a gap.
Suddenly there is an event that passes for high drama at the NCPC. Camp, on staff since June, has taken a call from an emergency room and once again it involves ethylene glycol. Apparently, a lot of it gets swallowed, either accidentally -- it's the color of Gatorade and tastes sweet -- or deliberately. In this case, the consumption was intentional.
"The patient is obviously dangerously poisoned," says Soloway, who observes Camp's hushed dialogue with the veteran Elshami. While Camp works with the ER on the phone, Elshami consults on-site resources for possible treatments; the two women communicate from across the room, in a medical language that is virtually foreign to the layman.
"The episode involves patient management in conjunction with the treating staff at the hospital, but you're also seeing some staff training here," Soloway says.
Their voices are calm but deliberate, and Camp eventually comes over to look over Elshami's shoulder at the computer screen . As in Gray's case, they are recommending Antizol, a relatively new antidote, one for which there isn't a wealth of experience, as well as kidney dialysis. Another toxicologist is called for a consult.
"The question we will always have is, 'How aggressive should we be?' " says Soloway. "We'll always be as aggressive as necessary."
In the end, the patient survives. The call to the NCPC linked the ER to not one but three toxicologists who recommended the most up-to-date antidote for saving a comatose patient. Without the NCPC professionals who stay abreast of poison developments, the ER personnel might have been flummoxed long enough for the patient to suffer the consequences.
Just about every call is followed up with a phone call (and, later, a solicitation by mail for a donation) "except the really non-toxic," says Camp, an RN who decided to seek out work "that was more mentally challenging" than more traditional nursing assignments. Follow-ups are crucial because the poison centers need to be sure they gave the right information.
Toxins in the news -- ricin, ephedra, smallpox, nerve agents -- are familiar topics at the poison center, since the staff stays ahead of the toxicological curve. Dextromethorphan isn't heard about much in the media, but poison control centers have been dealing with it with more frequency. The active ingredient in many cough syrups, it can lead to hospitalization or death when abused or consumed with other drugs. "It gives a little euphoric sensation," says Elshami.
Elshami says the staff keeps a "Can You Top This?" book of anecdotes about the outrageous things people ingest, "but you can't publish it," she says with a laugh. "There isn't anything people won't try [to swallow]." While most are stories of inexplicable ingestions, some are amazing stories of a different sort. One, Soloway says, involved a boy who flipped off his skateboard and onto a copperhead snake, which bit him. Talk about a nasty wipeout! (The boy recovered.)
The staff has to be ready for anything. Years ago, Elshami says, she took a panicked call in the middle of the night from the U.S. Embassy in Russia. It seems the chef there had mistakenly used flower bulbs instead of onions in the turkey stuffing. Were the guests going to be poisoned if they ate the turkey?
"All [they] really needed to do was throw out the stuffing and they could eat the turkey," she recalls. "That's the kind of calls we get."
Buzz McClain last wrote for Health about body piercing.
Mr. Yuk, though replaced by a new logo, remains a presence at the center.
Poison control staffer Tina Harrington checks on outcomes of recent cases. Follow-up is crucial in confirming that information given out was correct. Mary Gray's nursing exprience has been invaluable in her work at the poison control center.