From resource to rescues
Toxicologist puts expertise to work

By Caroline Sheen

Last year, Chechen rebels seized a Moscow theater and took the playgoers as hostages, leading to a standoff of several days. Eventually, Russian authorities released an unknown chemical inside the building to quickly incapacitate the occupants, then stormed the theater.

The chemical, which Russian law-enforcement authorities refused to identify, caused illness among many of the hostages, some of whom died. Analysts initially suspected the chemical to be 3-quinuclidinyl benzilate, also known as QNB or BZ, a chemical warfare agent used as a hallucinogen.

They sought confirmation from U.Va. medical toxicologist Dr. Christopher Holstege, the only person in the world who had written a chapter solely on the chemical.

Holstege reviewed photos from the event, analyzed the patients’ symptoms and determined that QNB was not the released toxin. “We knew it wasn’t QNB, because people fell down immediately. QNB’s effects are slow,” said Holstege, an assistant professor of emergency medicine and medical director of the Blue Ridge Poison Center.

Holstege and Mark Kirk, director of the medical toxicology fellowship program and associate medical director of the Blue Ridge Poison Center, are the only full-time, practicing medical toxicologists in Virginia. Last summer, the U.Va. Health System took advantage of their talents by opening the state’s only Center for Clinical Toxicology, housing clinical, research and educational programs related to toxicological emergencies and occupational poisons.

Not surprisingly, Holstege has played a major part in the development of local homeland security plans. Since the Sept. 11, 2001, attacks, Holstege has worked to educate the public, increase communication between the 50 hospitals across the region which he regularly consults, and become more knowledgeable of the inventory of antidotes available regionally to combat chemical warfare agents.
Most of Holstege’s day-to-day work, however, does not involve international consulting or national security.

He was called in this winter when an overworked boiler at the U.Va. heating plant belched large quantities of soot that soon settled on the Venable neighborhood. Holstege considered the settled soot medically harmless. “The only concern,” he said, “was the aesthetic damage.”

More gratifying, he said, is his work with individual patients. When a 16-year-old girl overdosed on her mother’s hypertension medicine, leaving her near death, Holstege led a team focused intensely on salvaging what seemed a grim situation. He remained bedside, fighting for the girl’s survival, for eight hours. “She was finally able to stabilize,” he said. “That was the most rewarding experience. It’s pases like that that make a difference.”

Asked to describe a typical day in his life, Holstege laughed at the impossibility. He is on call to respond to poisoning cases from 62 neighboring counties with a population of 2.8 million people, in addition to his teaching duties and his role as a husband and father of six young children.

Normalcy is not the norm.

He’s not complaining. Holstege finds his position as head of the Blue Ridge Poison Center thrilling, diverse and unparalleled. “I love my job because it is a unique specialty. I get the opportunity to teach, and it’s my job to ensure that all the patients are taken care of.”

The Blue Ridge Poison Center has four focused areas, including the center of clinical toxicology comprising the clinical service, the educational service, research and the Blue Ridge Poison Center.

Holstege emphasizes the educational side of toxicology and has implemented a rotation for residents in training and medical/pharmacy students.

Teaching, he says, is the most rewarding role in his career. “As a medical toxicologist, if we are able to impact young clinicians early in their career in reference to their knowledge of drugs, then we, as teachers, are doing our jobs,” he said. “Health care providers should know what the medications do.”