Ashley

Hi, Doctor Gee!

Dr. Gee

Hi, Ashley.

Ashley

It's so great to speak with you and take this opportunity to talk about my experience. It feels a little funny because you — and my experience — are obviously very memorable for me. I don't know how memorable, if at all, I was, for you. This was almost 13 years ago… and, you know, at the end of the day, I have to say — you saved my life. And I'm here to be able to have this conversation 13 years later, which is a crazy thing to begin with. And so I kind of want to start by hearing a little bit about your background. You have a background in toxicology and I wonder if you could tell me a bit about that?

Dr. Gee

Sure. It's great, and I was delighted and pleased that you reached out to me. And it's great to hear you're doing such a worthy project. I can't take sole credit for saving your life — there was a joint effort from a lot of people and, in many ways, I was kind of in the background.

But in answer to your question, I started out life as an emergency doctor. I've been at that for 25 years. And, midcareer, I had an epiphany and decided to do some toxicology training. So I do that, but since toxicology doesn't pay the bills, I'm primarily an emergency doctor.

Ashley

It's so funny hearing your voice, because I'm thinking you sound more kiwi than I remember! (laughs)

Dr. Gee

Oh, yeah. I hope your listeners can understand the southern accent. (both laugh)

Ashley

No, it's great, I can hear you very well. I know this is asking you to remember a long way back, but when I was admitted to Christchurch back in end of August, 2011… What do you remember? If anything?

Dr. Gee

I do remember quite a bit, because you were such an unusual patient — both from a medical point of view and also personality wise. (Ashley laughs)

13 years ago… Yeah, I remember that you came into the emergency department in the afternoon. There were a few doctors who had already seen you, and we were gathered in a huddle because you were a bit of a diagnostic conundrum, so we were trying to work out what was going on with you. You're an unusual story of a young person who's come in with sudden loss of vision, which isn't common at all. So you didn't pattern for any of the things that we normally see, o we had to had to think carefully about how we're going to work out what was going on.

Ashley

I remember it being a Friday… and I remember, you know, from my point of view, my experience coming into the hospital. But what did you think that it was, right off the bat, me being admitted? Because I do recall and remember it being chaotic, in the way that folks weren't totally aware with what was going on, and I could tell that.

Dr. Gee

Sure. So, it starts off with the symptoms, obviously, and that creates a list of things that would normally be considered. And as I said, you weren't the obvious causes of blindness that we see in older people. I think you're we were 18 or 19 at the time?

Ashley

I just turned 19. I was 19 for about, like, 12 days.

Dr. Gee

Yeah. So, the normal things that that we would think about for blindness would be stroke, hemorrhage into the eyes… neurological things like multiple sclerosis, even brain tumors. But all of those happen in much older people. So we had to sort of go back to square one and think through. When we have a bit of a conundrum like that, we go through lists and we just work through a process of deduction.

We didn't think poisoning was high on the list, but then some of your blood tests came back. And one of the things that really stood out to us was that you had a condition called acidosis, which is when your blood essentially starts to turn slightly acid. And that was actually quite severe in your case.

And only a limited number of things cause that — a number of poisons. So poisons wasn't on our radar initially, but definitely came to the front because of that. I think because you were young, your body had done such a good job in compensating. I think if you were much older, you would have you would have been much, much sicker than you were.

Not that you could get much sicker than you were, but you were tolerating it very well. You were talking to us. So that was a little bit dissonant from your presentation. So once we had a list of poisons that we could work through, it was obvious. You mean you may remember getting asked had you used any TB drugs, had you been exposed to cyanide? All those kind of funny questions. But the only thing that came out of your story was that you'd gotten off the plane, and I think you'd been in Bali 30 hours prior, and had a few drinks at a bar, and that was the thing that we finally settled on as the cause of what was going on.

Ashley

Could you explain to me what methanol is and how it affects the body? For me, it's hard to remember how much time took place from when I was admitted to when my blood results came back, and when you guys realized it was methanol. But, can you explain how methanol affects the body — or in my case, how it was affecting my body that day?

Dr. Gee

So, one of the things that we suspected was that methanol was in your drinks in Bali. And that's not an unusual — well, it's not frequent but — it's a dangerous thing that happen, in some countries where bootleg alcohol is used. Methanol is generated when you make bootleg or moonshine alcohol. and normally it's taken out. But if you're not careful about how it's done, then methanol stays in the drink.

And the way you described the drinks that were given to you that evening, I think you said a lot of people early in the evening were offered cocktails out of a jug. One of the local cocktails is Arak, which is a coconut-brewed alcohol. And it comes along with alcohol as well, so you normally just feel like you've had a few drinks… but then, problems are caused later down the track.

In answer to your question about what is methanol — Methanol is actually a very simple and common industrial chemical. It's very useful. It's called wood alcohol because you can make it from wood. And for many centuries it's been used as a cleaner, can be used as a fuel. You can power race cars with it, and it's also used in lots of industrial processes. It's one of the closest members of the alcohol family, that's close to the alcohol that we drink down at the bars and other places, which is usually quite safe in moderation.

The problem with methanol when you drink it, though, is, not so much with the methanol itself but what happens to methanol in your body. In our body, with alcohol, we have an enzyme called alcohol dehydrogenase and alcohol aldehyde dehydrogenase. And both of those chemicals just break down normal alcohol into things that the body can handle and get rid of. But in the case of methanol, which is a different chemical, instead of making nontoxic things we can get rid of, it actually makes toxic chemicals, in particular formaldehyde and formic acid. And that's where the acid comes from, from the acidosis I mentioned.

Now, that's a very dangerous process that will occur in your body. And as a person who's drank methanol, normally, as I said, you wouldn't notice anything different initially — but when those toxic chemicals, metabolites that accumulating, that's when you'd start to feel unwell. And — do you remember much of those symptoms?

Ashley

I do. And obviously I've thought about this day for the last 13 years — and what I remember in my travels to New Zealand, from Bali, and once I got to New Zealand, I did feel very unwell. I felt quite nauseous. I felt quite sick. But, because I was traveling on my own and lots of things were kind of going wrong on my travels, I really chalked up my feeling to just anxiety or nerves rather than something was actually wrong with my body.

It wasn't until I woke up in my hostel the Friday morning and I was unable to breathe, and I was noticing that something was wrong with my eyes, that were the symptoms that I actually realized I needed medical attention. Or I needed help from somebody, at least. But I do remember feeling sick and I don't think I thought anything bad about it at first. I think because methanol poisoning wasn't on my radar, it wasn't something that I was aware of, or knew. And so, yeah, I do recall feeling quite sick, but especially the Friday morning when I came into the hospital and I was unable to breathe. And I recall by the time being in the hospital, in Emerg, I wasn't able to see anything. I remember being in-the-dark blind.

So, I guess that that kind of leads me to my next question. You know, I've, over the years, looked up lots of other folks who have been poisoned by methanol — a lot who have died, and a lot who survived — but a majority of folks who are, who unfortunately didn't make it. Based on my symptoms that you saw, how close was I to death, or how bad was I that day? I would love to hear from your perspective.

Dr. Gee

Yeah, I think you got about as close to dying as you can get. I think you were very lucky that you were young and fit and healthy. And that, you got to us quickly enough for us to work out what was going on and start treatment. There are a number of measures that we use to predict the outcome of prognosis, and one of them was the amount of acid in your blood. And, that if had been a little bit higher, it could have ended quite differently. As I said, the methanol and the metabolites that were accumulating — they shut down every cell in your body. And that's why nothing was working. That was why you were feeling short of breath. That was your body… Your anxiety was your body telling you that things were very, very wrong.

Ashley

Yeah. Um, I do remember not thinking that anything bad was going to happen to me. And I know you folks did a really good job at keeping me calm and making me feel like everything was going to be okay, whether or not you believed that or not. But I know, for my mom who got the phone call from you guys, that wasn’t — you know, she had a little bit more of the reality of how severe my condition was.

Dr. Gee

Yeah. I think we also went once we realized what was going on, we actually had concerns for your friend as well, who you had been at the bars in Bali and, we started off another the process of trying to track her down because I think you parted ways in Sydney. (Ashley agrees)

And we were trying to find her at a backpacker in Sydney to check whether she was okay — and luckily she was.

Ashley

Yeah… it’s… so much happened that day. It kind of, like, makes me at a loss of words a little bit, just to know how close I was to dying that day. (pauses)

Dr. Gee

Yeah. I could see you were very anxious and scared, but you were doing a very good job of keeping it together and putting on a brave face. And you were actually able to help us find your friend, which is great.

Ashley

Yeah, thank you for saying that. Yeah… It was… whenever I tell folks this story, the thing that I often mention was how you treated me. And I have such a vivid memory of the drinks you guys gave me, which I believe you referred to as a screwdriver. I wonder if you could go into details about how you guys then did go forward to save my life?

Dr. Gee

So, methanol is metabolized by these enzymes into those toxic poisons, but we can actually get those enzymes occupied doing something else by metabolizing ethanol. So that's the first aid for methanol poisoning, is to give normal alcohol, and then those enzymes switch over — instead of producing toxic metabolites, it actually switches over to working on the ethanol in your body. So we wanted to get some alcohol into your system pretty quickly. We had medical grade — sorry, it wasn't anything nice like general vodka — but we did have to make it palatable by putting in some orange juice. We have some more expensive antidotes now, but that was what we used on the day.

Ashley

Medical grade alcohol — like what you would use to clean stuff with?!

Dr. Gee

No, no, no, it's safe for injection and ingestion.

Ashley

Okay! Yeah... When people ask if I was scared in the hospital, I often tell them I wasn't, because I was getting drunk! (laughs, and Dr. Gee agrees) And you don't have as many worries when you're intoxicated… and I remember, as quickly as I'd finish the drink, my cup would be refilled to keep on drinking.

And I remember feeling quite, like, jovial and kind of having fun in the hospital with my bartender doctors giving me screwdrivers. So, I really didn't realize how serious the situation was. And it's interesting because the drunker I became, the more I could breathe and the more I could see.

Dr. Gee

Wow, that's amazing. You remember that?

Ashley

Yeah. Which in my play, I kind of go into what it was like to be drunk in a hospital.

Dr. Gee

Yeah, and it's great that you were a happy drunk, because we often get the other side of it as well. (both laugh)

Ashley

So could you explain how… so after you prescribed that drink and I proceeded to be intoxicated, what you guys then did after?

Dr. Gee

Okay, so that's… the alcohol, the screwdrivers, the first aid —that buys us time while we're sitting up the next thing. Which, I don't know if you remember, but you had at least 24 hours of dialysis, and that's the definitive treatment to remove the methanol and most of the toxic stuff from your body. It will take it out of your body fairly quickly, but it doesn't reverse the damage that had already been done, unfortunately.

Ashley

Mhmm. And are there any other ways to treat methanol poisoning, or is this the standard?

Dr. Gee

Yeah, dialysis is the standard. We do have new forms of enzyme inhibitor, which have been around for probably about 18 years now, but we're only just getting those now in New Zealand. But again, they are temporizing measure, until we can get somebody hooked up onto a dialysis machine to clean the blood, literally.

Ashley

Yeah. I remember being in ICU and waking up — probably not with a hangover because I had new blood? I'm not sure?! — but yeah, I remember waking up in ICU, and hearing that my mom was on her way over to New Zealand. And again, I thought I was going to go backpacking the next day. I really didn't think… I didn't understand the gravity of what had happened to me quite just yet. Yeah. All in, I remember being treated at the hospital for about a month. And I remember, when I was finally out of ICU and in a ward, I had all these doctors and nurses come and visit me in my ward just to see that I had made it. And I think that was kind of a another sign for me to realize how severe my situation was, because folks were just so impressed to see that I had made it.

Dr. Gee

We were so, so pleased that you made it. And I think, once we stabilized you, I think the focus really was on trying to preserve as much vision as you had. So the eye doctors and the eye specialty was focused on that.

Ashley

Could you explain a little bit about how the methanol would have affected my eyesight and why it damages your optic nerves?

Dr. Gee

Yeah, it's a cellular poison, so it poisons so many different cells, and it works on the mechanism of the cell that enables it to survive and generate energy. And one of the most vulnerable tissues is nervous tissue, and particularly eyes, because they've got such a high metabolic rate. So it's the retina and the optic nerve — it attacks those cells in particular.

Ashley

I don't know if you have it in front of you from my medical documents but are you able to speak to how bad my eyesight is as a result of the poisoning?

Dr. Gee

No, I don't. I didn't get the last breakdown, but I recall 1%.

Ashley

Yeah, that's pretty much it. (laughs) I will say that it's still pretty much the same. It hasn't deteriorated or gotten any worse that I've been able to notice. But yeah, there's no functional use of my central vision. I don't see colour, I don't read, I can't see depth. I've got quite a few blind spots, but I do take in light still. So I have that function, of use for my eyes, which is really, really helpful, but for the most part, it's been learning to adapt to what my eyesight is now.

I wanted to bring up the case that you published about what happened to me in the hospital, and I would love to know what the biggest findings were for you, in that case?

Dr. Gee

A few of us really wanted to highlight your case. We felt really bad for you, and we didn't want it to happen to anybody else. You'd come so close to death, and it wasn't something that we see usually. We see it very rarely now in New Zealand and in Australia, but there are a lot of Australians and New Zealanders who go over to Bali and I think the risk is still ongoing, unfortunately.

There are people every couple of years who die or become blind from methanol poisoning in that location and many other locations around the world — in African countries, Eastern Europe, are common places where this happens as well. And we wanted to highlight the issue just so that it would be in doctors’ thoughts, should they ever come across somebody who's been unwell in traveling and in those countries. Because it is a bit of a trick to make the connection because you had left the country, that was about 30, 35 hours, and so we're going — why would a poisoning take so long to sort of, become symptomatic? And it was obvious just from a number of factors that it was just the amount of time it took for those poisonous metabolites to accumulate. So we wanted to make sure that doctors would know about it so that they could get on to the diagnosis and treatment promptly.

Ashley

Are you aware if the medical journal that you wrote has helped any other doctors or any other victims of methanol poisoning?

Dr. Gee

I’m not sure. It's a big journal. It's the English Emergency Medicine Journal, which is an international journal. But I think there are quite a few other outlets and people who are onto the same sort of issue. There’s an Australian guy I'm aware of, who runs a Facebook [group] and actually helps out a lot of people who are worried if they get unwell in countries where they think they've been methanol poisoned. Have you heard of this guy?

Ashley

Yes, Colin! I know exactly who you're speaking about, he's really, really lovely. And I've chatted with him over the years, him hearing about what happened to me. And, yeah, the work that he's doing with that Facebook group is so fantastic. I don't know if that Facebook group would have necessarily helped me 13 years ago, but maybe it would have helped with the awareness so that I would have been aware that it happens.

You know, I do remember you saying to me — you or one of the doctors saying to me — that if I would have had one more beer, I could have been okay. And maybe that's why my friend wasn't poisoned, and some of the other people we were with that night. I don't remember if you said it or not, but could you speak to that?

Dr. Gee

I don't think one more beer would have made a difference. It would have just pushed out at the time from when you first started feeling unwell. But obviously there was some bad luck in that you probably got the concentrated amount of methanol in your friend didn't. (Ashley agrees)

But one of the other things that was good to get the story out was not only for doctors to sort of be aware and make the diagnosis ormake the connection quicker, but also for the general public to be aware that this happens. And I know Colin puts out a consistent message that if you're in countries where methanol poisoning is a concern, just stick to duty-free bottled alcohol, beers. And nothing from an open container.

Ashley

How do you know Colin, then? (laughs)

Dr. Gee

Oh, I followed your story to a bit. And his story as well. Because I was just — after we looked into your case and I saw how many people are affected, both locals and tourists, by this. I think, in one year, there was over 20 people who died in one outbreak caused by a bad batch of methanol poisoning.

Ashley

Yeah, it’s… every time I look it up online, the victims that I continuously see and folks who have died from it, I'm very fortunate that I was poisoned on my last night and that I was hospitalized in New Zealand because I don't think I would be sitting here today if it happened halfway through my trip and I had to be hospitalized in Bali.

Dr. Gee

Yeah, that could have been the case. Yeah.

Ashley

I'm guessing just from your answers, but you haven't had any other methanol patients in the past, other than me, have you?

Dr. Gee

No it's the last — No, you were the last one. We used to have it more commonly, back in the — and I'm showing my age here — back in the 80s. Methanol, as I said, was quite a common cleaning agent in painting, paint brushes and things like that. And so, people might know it by this other name, methylated spirits. It's very commonly sold in hardware stores.

But, as it was realized that people were drinking it a substitute for alcohol and causing problems, it was gradually phased out. So we did see quite a steady flow of cases up to about 2000, even the occasional death. But, 2010, it had become a rarity by then.

Ashley

I'm happy to hear that I'm your last patient, because it's nothing that I would wish upon anyone, and certainly not where I anticipated my life going 13 years ago. As we've been speaking about the seriousness of methanol poisoning — but how much of a concern do you think this still is today?

Dr. Gee

It's very much concern in many countries. We're lucky in high income countries that public health has made it very rare. As I said, they removed methanol from public sale in many, many countries. But, as I said, the main danger is in some of the poorer countries, where moonshine bootleg alcohol is prevalent and where the standards of manufacture or brewing are very poor, those are the countries where it's very profitable to make bootleg alcohol. And they're the countries, unfortunately, that you still hear about cases of mass poisoning.

Ashley

Has this made you rethink any drinks that you've had on vacation?

Dr. Gee

Yeah. Only light beers! (both laugh)

Ashley

Yeah, I feel the same way. I feel the same way. I really just want to thank you so much for — alongside the folks who assisted you, but — in saving my life. Because I've wondered about that day, for the last 13 years, and maybe if I'd done things differently, I wouldn't be here. And hearing how close I was to death is really a surreal thing for me.

But I'll have you know that I'm doing okay,13 years later. Like, I may be legally blind now, and my life is vastly different than what I anticipated, but I've still — you know, I went back to university, I am pursuing, you know, acting and theatre and working as an artist, and more than anything, advocating and spreading the word about methanol poisoning and sharing my story. Because I do think that's the only way people are going to know about it and hopefully learn from it.

Dr. Gee

I’m so pleased you reached out to me. It's great to hear from patients that I’ve had in the past. It doesn't happen very often, and it's good to hear how you've gotten on. Because you never know — I mean, in my line of work, you see people having their worst days in their life… and you never know what life's going to throw at you. I'm glad you've made something good out of that, arising from that bad day.

Ashley

Yeah. I don't mean to, like, be a little bit emotional about it, but, yeah… It's definitely had its hard moments. (pauses)

Sorry. Yeah, I think at the end of the day, I'm quite fortunate to be alive. And I'm just really, really grateful. For you.

Dr. Gee

Not only alive — you're doing well!

Ashley

Thank you. Yeah, but thank you so much for chatting with me and giving me a little bit of insight from your point of view, about what treating me was like. And really happy to hear that you've followed along, and I'm really glad that you wrote a medical journal, and I've seen it cited in other journals, and so I hope that it is helping people. And that you hopefully never have another patient with methanol poisoning.

Dr. Gee

Thanks, Ashley. Keep on fighting the good fight.

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