Vivian Shaw

Radiotherapy can take many forms: teletherapy (now known as external beam radiotherapy), where the source of radiation is outside but focused on the body; brachytherapy, where sealed radioactive sources are placed inside or next to the part of the body needing treatment; and systemic or unsealed source radiotherapy, where a soluble radionuclide is injected or ingested into the body. Mostly when people think of radiotherapy they think of external-beam machines with the rotating gantry and patient couch.

These days EBRT is mostly performed using linear accelerators, which produce a powerful beam of either electrons or X-rays with the push of a button and do not require dangerous radioactive source capsules, but in the early days of teletherapy you had your gamma emitters and you damn well liked it. The two most common radioactive isotopes used in teletherapy sources are cobalt-60 and caesium-137, contained in sealed steel source capsules that sit inside heavy lead shielding when not in use. The caesium-137 source in the Goiânia accident was filled with highly soluble, highly dispersible caesium chloride powder. If it had been a cobalt source, it would probably have been full of lots of little individual pellets, like the one involved in the Juarez orphaned-source accident in 1983. The fact that the caesium was in the form of a crumbly powder that could be daubed onto the skin, like carnival glitter, would turn out to be important.

The unit involved in the accident was a Cesapan F-3000, a 1950s Italian design containing a source capsule thought to have been manufactured at Oak Ridge in the seventies.

It would have looked a little something like this (images from IAEA report).

The rather ominous-looking head was capable of moving up and down on its support pillar and rotating round a horizontal axis, and contained the stainless-steel source capsule in a rotating assembly that could move to line up the window in the capsule with the radiation aperture in the head, as illustrated here.

According to the International Atomic Energy Agency (IAEA) report, the source capsule itself was of standard international dimensions and potency. It was tiny. It was less than two inches tall and just about two inches in diameter. You know those adorable little one-ounce mini jam jars? It was about that size. It killed four people and forever altered the lives of a whole bunch of others, required seven houses to be demolished (and the bits disposed of as radioactive waste), and cost millions and millions of dollars in damage.

Some accounts of this mess state that the source capsule’s 1mm-thick “window” was made of iridium, but on further research I have not been able to track down any supporting documentation for this claim: it was most likely just a thinner bit of the stainless-steel capsule itself without the shielding that covered the rest of the source. Definitely not made of glass: you would not have been able to see the source material through any such window, no matter what Reddit creepypasta authors would like you to believe.

The source capsule, as illustrated by IAEA.

This machine was left in the derelict premises of a private radiotherapy clinic in Goiânia, capital of Goiâs State, Brazil, after the partnership that owned it dissolved toward the end of 1985; a cobalt teletherapy unit from the same clinic premises was removed and transferred to a new facility, but the caesium unit stayed where it was, presumably because nobody was sure who was actually responsible for dealing with it, or notifying the authorities that any of this had happened. At the time of the IAEA report nothing was 100% clear and legal action was being pursued, so they covered their collective ass and left this part of the narrative somewhat vague.  

Most of the building was knocked down, but the treatment rooms were left derelict and totally unsecured. Vagrants used the gutted building to shelter in; wildlife came and went, and the Cesapan F-3000 stood there hiding its deadly little heart in plain sight. I’m honestly a bit surprised that it took as long as it did before somebody considered its potential scrap value.

On September 10, 1987, two men, A and B, began to try to dismantle the machine. It took a while and several attempts, but by September 13 they’d managed to extract the rotating source assembly from the massive shielding of the radiation head. Outside this shielding, the unprotected source in its assembly was giving off 465 rads an hour, or 4.65 gray if you want to be modern about it. For comparison, the accepted annual radiation dose for non-nuclear-workers in the USA is between 1 and 5 millisieverts, or ~ 0.001 to 0.005 gray.

They put the assembly in a wheelbarrow and took it to A’s house, as A had suggested salvaging the machine for scrap in the first place. Both of them were feeling sick and had started to vomit by the end of the day, but they figured hey, it must’ve been something they ate.

Next day, B was feeling dizzy and having diarrhea as well as vomiting. One of his hands was swollen, and he would subsequently develop a burn on his hand and wrist corresponding to the size and shape of the beam aperture in the rotating assembly. He had been holding it with that hand over the aperture. The next day, September 15, he went to the doctor – and was told that his symptoms were due to a food allergy and he was to take it easy for a week.

Over the days between September 13 and September 18, A had been tinkering with the rotating source assembly, which he’d dumped under a mango tree in his yard. He was trying to get the source capsule free of the assembly. At some point he managed to poke a hole through the thin steel window of the source with a screwdriver.

He thought that perhaps the intensely radioactive caesium chloride thus exposed might be gunpowder, and tried to light it.

On the 18th he managed to get the broken-open source free of the rotating assembly, and sold the whole mess to a third man, C, who owned a junkyard nearby. That night, C went into the garage where the bits were stored and noticed that the stuff in the opened capsule was emitting* a blue glow, and brought the capsule into his house to show it to his wife. Because it was so pretty and so strange, they thought it might be valuable, or have supernatural powers, and invited their friends over to have a look. On the 21st one of these friends dug out some of the powder with a screwdriver and took it away with him to give to his family and friends. Quite a few of them rubbed it on their skin like body glitter. C received a total dose of 7Gy and survived. His wife (5.7 Gy) would not.

I know this reads like a horror novel. It gets worse.

More people were (unsurprisingly) suffering the symptoms of acute radiation sickness: C’s vomiting wife was examined at a local hospital, diagnosed with food poisoning, and sent home to rest. Her mother came over to take care of her, and took home a dose of 4.3 Gy.

Two of C’s employees were tasked with removing lead from the remnants of the assembly, and worked on it from September 22 to 24. Directly exposed to the breached source capsule, they would be among the four victims who did not survive.

The last of the four fatalities was C’s six-year-old niece, whose father had visited C and taken away some of the glowing powder. This was left on the table and handled by the family during meals. The little girl had played with the powder, rubbed it on her skin, and then eaten a sandwich with glowing dust still clinging to her hands. According to one source, when international medical teams arrived to treat the victims, they found her in an isolated room in the hospital because she was so contaminated the staff were afraid to go near her.

On the 23rd, B was admitted to hospital: his skin lesions were diagnosed as related to some exotic disease, and on the 27th he was transferred to the Tropical Diseases Hospital.

After doing its damage to C’s friends and family, the remains of the source and rotating assembly were sold to a second junkyard. The sudden epidemic of vomiting and diarrhea among their acquaintances was not lost on C’s wife, who became convinced that the glowing powder from the capsule was responsible for all the sickness. On the 28th, ten days after the source was transferred to C’s ownership, she and one of C’s employees went to collect the remains of the source and rotating assembly from the second junkyard, put it in a plastic bag, and took it by bus to the local Agência Nacional de Vigilância Sanitária (Health Surveillance Agency, similar to the American FDA) office, spreading contamination as they went. At the Vigilância Sanitária, the employee and C’s wife presented a doctor, P, with the source in its bag, and she told him that it was “killing her family.”

By now the employee who had carried the bag was developing a skin lesion on his shoulder, where it had rested, and he and C’s wife were sent to the Tropical Diseases Hospital, where B and several other contamination victims had also been sent for treatment. One of the doctors at the TDH was beginning to suspect that in fact the nearly identical symptoms of this whole cohort of patients could have been caused by radiation, and he contacted a TDH colleague who also served as the superintendent of the Toxicology Information Center. It turned out that this colleague had also been contacted by Dr. P from the Vigilância Sanitária regarding the “killer” bag C’s wife had brought to him. Dr. P had initially thought that the bag contained bits from X-ray apparatus, and became wary of it, moving it outside the facility (and thus probably saving his own life).

The doctors at the TDH had another look at the patients, with the mysterious bag’s contents in mind, and agreed that it would be a good idea to contact the state department of the environment; when they did, it was recommended that a medical physicist examine the package.

On the 29th they found a medical physicist, W. That morning, he borrowed a radiation monitor used for uranium prospecting, which had a range of 0.03–30 microgray/hour, and set off for the facility to which C’s wife had brought the source: quite some distance away he noticed that the monitor was pegged no matter where he pointed it. He assumed it was malfunctioning and went back to fetch a different one, which showed exactly the same thing as soon as he turned it on.

At this point W realized that something was desperately wrong. At the Vigilância Sanitária, Dr. P had become sufficiently concerned about the source in its bag that he had called the fire department, which had arrived and was preparing to chuck the whole thing into a handy river. W arrived on the scene mid-morning, just in time to prevent this. He convinced them to evacuate the building and make sure no one else got near it, and after talking with Dr. P they set off together to C’s junkyard–where the monitor again read off the scale. It was now midday.

W, among others, managed after some effort to notify the secretary of health, which took up much of the afternoon. Once the authorities had been convinced that yes, in fact, this was a huge deal and would require evacuation of a large number of people, steps began to be taken with considerably greater speed. The physicist and physician at the radiotherapy clinic’s new location were notified, and the source was tentatively traced to the abandoned clinic and the caesium unit.

Throughout the evening and into the night, the scope of the emergency became clearer. Civil defense forces were notified; the TDH was informed that a number of patients were contaminated; the known sites of contamination were resurveyed with equipment from the radiotherapy clinic; an emergency receiving and decontamination facility was set up in a local stadium. W, the physicist who had initially discovered the contamination, was contacted by an individual who had intended to cut up the source for C with an oxyacetylene torch (but had luckily forgotten to do so), who explained several useful details to the investigation including the locations where the source assembly had been broken up and where the parts had been taken.

The remains of the source capsule, still sitting in the courtyard of the Vigilância Sanitária where Dr. P had put them, were still putting out astonishing amounts of radiation, and the nuclear emergency coordinator who had arrived from Rio de Janeiro around midnight arranged for a crane to hoist a section of sewer pipe over the wall of the courtyard and lower it down over the chair on which the bag of source bits lay. The section of pipe surrounding the chair was then filled with concrete pumped over the wall, entombing the source and cutting down the amount of radiation it was emitting.

That’s one way to do it.

~

International teams were sent in to decontaminate and treat the victims of the disaster. There isn’t a hell of a lot you can do about radiation sickness: you can’t undo the damage, all you can hope to do is try and manage the acute effects and do everything you can to prevent infection. In this case, therapy consisted of managing the acute-radiation-syndrome hematological crisis and subsequent immune deficiency, treating the burns, removing contamination from the body (decorporation), and general support.

I think Goiânia still represents the worst caesium-137 contamination accident of all time. External decontamination was relatively simple to achieve, but a lot of the patients recontaminated their skin repeatedly by sweating; the caesium in their bodies found its way out in everything. Chelation with Prussian blue helped a significant number of the victims, a point which recalls the hopeless suggestion of treating Louis Slotin with methylene blue after his deadly exposure to plutonium criticality.

The final count of people with significant contamination, out of the many screened, was two hundred and forty-four. Most of those were lucky and received fractionated doses–spread over a long time period, giving the body’s tissues a chance to attempt to recover from the damage. Some were not. The dead of Goiânia–two men, one woman, and one six-year-old girl–had to be buried in lead coffins surrounded by concrete.

Caesium didn’t just destroy people in Goiânia, it destroyed property and livelihoods. Seven houses had to be demolished, so badly contaminated they could not be made safe. Topsoil was removed by the ton. In total 85 houses had to be decontaminated.

Of the orphaned-source accidents known to the internet, Goiânia is probably the most horrific because of the tragic fascination the source inspired in those who saw it and had no idea of its actual nature. It shares some aspects with the Radium Girls tragedy–they didn’t just ingest the stuff when they pointed their dial-painting brush-tips with their mouths, they painted themselves with it. Who wouldn’t want to be the only girl in the nightclub with eerily beautiful glowing fingernails or teeth? In Goiânia, the glittering, glowing blue substance was just as irresistible. One man took a piece of it to set in a ring for his wife. Others, as previously mentioned, rubbed it on their skin like body glitter. 

IAEA: It is relevant to note that the interest aroused by the blue glow that emanated from the radioactive caesium chloride significantly affected the course of the accident. Also, caesium chloride’s high solubility contributed to the extensive contamination of persons, property and the environment. But for these factors, the accident might have developed similarly to the accident with cobalt-60 that occurred in Ciudad Juarez, Mexico, in 1983, which resulted in little contamination and no deaths.

But the real lesson to learn here is do not fucking leave radioactive sources lying around. Of course it wasn’t learned; there have been a bunch more predictably tragic orphaned-source accidents since Goiânia. Like the industrial irradiator accidents, they all have basically the same plot, with varying levels of awfulness; and like the industrial irradiator accidents, I don’t really see how they can be completely prevented in the future, except by increased attention to correct record-keeping and proper custody of dangerous materials, and people are always going to be fallible and fuck things up. It’s a cautionary tale.

I’ve always been That Person, which I think is twin-born with my profound and possibly pathological need to do the research -- Those People’s worst nightmare is having somebody else be That Person regarding their own work. If I’m going to write about something, I need to know I know it well enough to confidently defend it. Because I research things compulsively I know a lot of fairly esoteric information, and therefore I can’t not notice, while reading or watching or listening to work in which this information is mentioned, when somebody gets it wrong. 

Being That Person is something that can’t really be switched off, although good manners and self-control step in to prevent expressing it. That’s not how that works invariably comes across as I Don’t Like Thing, despite the fact that I might Like Thing very much in all other respects and really, really wish that [factual error] did not throw me right out of Thing. 

Fig. 1: Okay.  (Image by tumblr user wealldraw, 2013.)

(But it itches. God, does it itch. It’s the same failure mode I experience when I can’t for any number of reasons correct typos: can’t unsee them, can’t squash the visceral need to fix the goddamn thing. I’m one of those slightly-spooky proofreaders capable of catching more and tinier errors than the majority of people, and the best way I can explain what it feels like to read a text containing errors is that they stand proud of the surface: they stick out at me like little thorns, impossible to ignore.)

The argument against being That Person in the world of fiction is of course things don’t work like that, it’s pretendy-made-up-story-time, and to a great extent this is true -- but there is a world of difference, to me, between “it’s fiction, you don’t have to get it right” and “within this fictitious universe, with these specific and internally consistent rules, things can and should be made to make sense and adhere to this universe’s framework.” (Most recently this has arisen in the time-honored format of Arguing About Star Wars: the fact that lightsabers can’t and don’t actually exist, for example, is often held up to render any questions regarding verisimilitude or accuracy in the SW universe moot, without taking internal consistency into consideration.)  

If you are inventing an entire universe of your own, you absolutely get to make up all the rules. The problem is that you then need to adhere to those rules, or give the reader a good reason why you aren’t doing so. If you’re writing about a real thing, or things, and certain aspects of that thing or things possess or affect key plot elements for your story, you really do need to do the research first and then decide how much of that you are going to use, why, and why not.

The example I always keep going back to, because it is such a shining and classic instance, is Mr. Dan Brown’s decision in The Da Vinci Code to have a character with severe oculocutaneous albinism, a character described multiple times as having white hair and red eyes, be an assassin. 

The aspect of oculocutaneous albinism that is of particular significance here is the fact that people with this condition who possess the phenotype Brown describes almost universally have major vision impairment. The absence of melanin results in abnormal development of the eyes, causing anything from optic-nerve misrouting to foveal hypoplasia to strabismus, nystagmus, photophobia, and so on. The level of visual impairment varies, but it is practically impossible, without magic, for “Silas” to possess the level of visual acuity required to drive a car without corrective lenses, or, you know, shoot people accurately from more than a few feet away. I know anime is full of instances of albino-appearing characters who lack any notable visual impairment, but The Da Vinci Code is -- as far as I am able to make out -- set in the real world, where real-world rules apply.

Most instances of Did Not Do The Research that set off my That Person response are less extreme -- but nonetheless it is very difficult to ignore. Sometimes I do wish I could turn it off, like the proofreading, and simply enjoy books and movies and television without the involuntary limbic-system nngh that’s not how that woooooorks reaction. It’s particularly annoying when in all other respects I really love the thing I’m watching or reading.