Ep. 77 | The Sliver/Killer Style
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Hey Prime members! You can binge episodes 73 through 80 right now and ad-free on Amazon Music. Download the app today. In the spring of 2021, a man in his mid-50s crouched beside a raised bed of cherry tomatoes pulling out weeds. Gardening was one of his greatest pleasures, but he'd been away from it for a few days due to a recent surgery. He could feel a subtle pain creeping up his chest and up into his jaw, but he thought a little gardening wouldn't make it any worse.

Suddenly, the man felt like someone had stabbed him in the chest. He took a seat on the ground and began breathing slowly to calm himself down and he put his hand over his heart. The beat was steady, but so was the pain now washing over him in waves. With difficulty, he pulled himself to his feet, staggered over to the patio, slumped in a chair, and took a sip of water. But it didn't help. The pain only got more and more intense until he realized he might be having a heart attack.

Just as his vision began to cloud, he reached across the table, grabbed his phone, and dialed 911. From Ballin Studios and Wondery, I'm Mr. Ballin, and this is Mr. Ballin's Medical Mysteries, where every week we will explore a new baffling mystery originating from the one place we all can't escape, our own bodies. So, if you liked today's story, please take the Follow Button's prized collection of very expensive comic books and sell them for pennies on a dollar at a yard sale.

When it comes to medicine, some problems are very easy to fix. Doctors have seen them so many times that they know exactly what to do and how everything will play out. But in today's two stories, everything is not as it seems. And by the time doctors realize what's actually happening, they might be too late.

Our first story is about a man whose routine surgery results in a life-threatening complication that his doctors never saw coming. And our second story is about a young man in Turkey whose breathing problems come from a source nobody ever suspected. And now here's our first story called The Sliver. 56-year-old Greg Wolf backed his dusty old Jeep down the driveway and headed towards one of his favorite places, the garden center.

Ever since the COVID pandemic started, his work had slowed down, so he had a lot more time on his hands for hobbies like gardening. As he cruised along the winding road, he thought about what he might want to plant. Every year, he liked to mix it up and try a few new fruits, flowers, or vegetables. Greg stopped at a red light and let his mind wander, picturing different layouts for his garden. When the light turned green, Greg put his foot on the gas pedal, but just as he entered the intersection, a black truck came barreling toward him.

There was an explosion of crunching metal and shattered glass. Greg felt a blinding pain rip through his spine as his car spun across the road. And then everything went black. Three days later, Greg lay on his stomach in an operating room under fluorescent lights. Just minutes earlier, an anesthesiologist had shot him full of lidocaine to numb his spine for surgery. And as he began to feel the medicine kicking in, it occurred to him that this was actually the first time he had not been in pain since the car accident.

Even though Greg had been wearing a seatbelt at the time of the crash, the impact of the crash had broken a vertebrae in his back. He'd been in the hospital for days while doctors did everything they could to try to stabilize his injury. Once he'd regained consciousness following the crash, doctors told Greg that he was very lucky. The accident could have been much worse. Greg had suffered what's known as a "stable fracture." This meant that when his vertebrae cracked, it stayed in the same place, rather than being knocked out of alignment.

So the nerve endings in Greg's spinal column were not affected. If they had been, Greg could have been paralyzed. To relieve his pain, Greg's doctors had decided to perform a surgery called kyphoplasty, which corrects small fractures like the one in his vertebrae. This was the surgery he was being prepped for right now. A few minutes later, the doctor arrived and greeted Greg and walked him through what was going to happen. Greg was going to remain conscious during the procedure.

Then, after Greg acknowledged that he was ready to go, Greg felt the doctor's hands on his back, followed by a dull pressure as a large, hollow needle entered his spine.

After the needle was in place, the doctor inserted a balloon-like device into Greg's vertebrae through the needle and gently inflated it until it opened up a small space in the bone. Into this space, the doctor then injected a special type of liquid cement. As the cement settled in the cracked vertebrae, it hardened and bonded against the bone. This would stabilize Greg's spine while staying flexible enough to allow him a full range of motion.

And, critically, it would also help reduce Greg's pain. Within a week, the doctor said he'd be feeling like his old self. Greg felt the pressure in his back start to fade as the doctor withdrew the needle from his spine. A few minutes later, a nurse came in and wheeled Greg down the hall to a recovery room to rest. As the anesthesia began to wear off, Greg did feel soreness in his spine, but the pain was mild. And after what he'd been through, this felt like a gift.

A few hours later, as Greg got dressed and ready to go home, the surgeon came by to check on him. He recommended that Greg only take showers, not baths, for a few days to allow the wound on his back to heal, and he should avoid any heavy lifting for at least a week. But otherwise, his life would be just like before the surgery. Riding home from the hospital with his wife, Greg felt like he had miraculously avoided a tragedy. Now he could get back to enjoying his life. But only seven days later, Greg was back in the emergency room.

Everything hurt, his chest, his neck, his jaw. Even turning his head sent shivers of pain rippling through his body. The first few days back at home had been fine. He was able to take walks and cook, even do a little gardening. But on the fifth day, he began to feel this new kind of pain in his chest. Following the doctor's advice, Greg checked his wound from the surgery to see if it was infected. But the wound looked fine, so he decided to turn in early that night and hope he would feel better in the morning.

However, over the next two days, Greg's pain only spread. Greg tried to relax and avoided doing anything strenuous. But almost any movement, even just turning his head, hurt like crazy. He thought he felt well enough to weed his garden, and that's when the pain suddenly became almost blinding. It was so intense that Greg thought he was having a heart attack.

And so now he was lying on a bed in an emergency room, trying not to move a muscle. The pain still flickered through his chest and neck. He could barely breathe. Greg had never felt anything like this. It felt even worse than what he imagined a heart attack was like. Greg just hoped that whatever was happening, it was not too late to fix it. ER doctor Miranda Gibbs was just coming back from lunch when an x-ray technician stopped her in the hallway with an update. There was something seriously wrong with her new patient, Greg Wolfe.

She followed the technician to his office and looked at Greg's x-rays displayed on his computer. Greg's spine looked fine. His recent kyphoplasty surgery had clearly repaired his cracked vertebrae. But something else she saw in Greg's x-ray disturbed her. Dr. Gibbs pulled out her phone and called the medical imaging department. She told them she needed to book a CT scan for her patient immediately. Two hours later, the images had been processed and were ready for her inspection.

Sitting in her office, Dr. Gibbs struggled to comprehend what she was even looking at. She grabbed the phone and called the ER. She hoped there was a trauma surgeon on duty or somewhere nearby, because Greg Wolfe was a pinprick away from disaster. An hour later, Greg was on his back, unconscious. His chest had been surgically opened. A surgeon leaned over him, looking in at Greg's heart. The surgeon maneuvered until he found what he was looking for.

A long, thin, four-inch object. It had pierced through the upper right chamber of Greg's heart and also cut into his right lung. This is what Dr. Gibbs had seen in the images of Greg's chest. Now, the strange object was just sitting there, simultaneously poking Greg in the heart and lung. The surgeon steadied himself and carefully gripped the object with his tool. Any abrupt movement could cause a tear in Greg's heart or lung. The damage could be fatal.

As he began to pull the object out, the surgeon was surprised at how hard the object was. It was like a stone, pale, pointed, and slightly curved. Little by little, the surgeon pulled the hard little dagger out from Greg's organs until finally it was free. Examining it in the light, it looked a bit like one of those heavy-duty needles used to repair upholstery or carpet, except it was made of medical-grade cement.

It would turn out, during Greg's back surgery, a small splash of the liquid cement had leaked out of his vertebrae into his body. Once there, it hardened into a sliver and basically followed through Greg's bloodstream, eventually reaching his heart. Greg's sudden stabs of pain he was feeling were from the tip of the cement needle piercing his heart. His trouble breathing was the needle literally poking his lung.

If he had waited even 24 more hours to go to the ER, the needle could have stabbed him even more deeply and potentially killed him. Fortunately, doctors were able to repair the tear in Greg's heart and his lung, and after being sewn back up, he made a quick recovery. Only one month later, Greg Wolf was back in his garden in full health. He had dodged two near-death experiences in two weeks, and he had no intention of trying for a third. And now here's our second story called Killer Fashion.

On a cold, clear afternoon in February of 2000, after a long, bumpy ride through snow-capped mountains, 15-year-old Ahmet Balik stepped off a bus into the city center of Erzurum, Turkey. The urban bustle was a culture shock for a country kid like him. He had spent his whole life in the small Turkish village where he was born, helping his family tend land and herd livestock. But two weeks earlier, Ahmet's uncle had found him a job in a textile factory in Erzurum.

So, here he was, surrounded by cars and buses and people, with businesses and cafes stretching down every block. It was a lot for Ahmet to process, but he was thrilled to be in this new environment and to start this exciting new chapter. He grabbed his bag from the bus's luggage compartment and headed straight for his new job. As he walked through the city, Ahmet had to stop every few blocks to catch his breath. Erzurum was a high, mountainous city, and so the air was thinner up there. He could feel the difference in his lungs.

Eventually, Ahmet found the factory, walked inside, and introduced himself. His boss gave him a quick tour of the facility. As they walked around, Ahmet saw long rows of industrial looms and conveyor belts loaded with fabric, and he also saw another part of the building that was filled with workers hunched over sewing machines. Then, Ahmet followed his boss to a back area of the factory where narrow pallets were clustered in a corner.

The man told him that that was actually where many of the workers without families would sleep, since the hours were long and the factory was a good distance from most residential areas. Now, Ahmet really needed this job to work, and he would do whatever it took. So he smiled and tossed his bag on one of the pallets and followed his boss to begin his training. Four and a half years later, in July of 2004, Ahmet wiped the sweat from his face as he paced the crowded waiting room of a government hospital. He was 19 years old, but he felt much older.

His life at the factory had been a whirlwind, getting up at dawn, shuffling to the assembly line, then sewing and finishing garments until dark. He and a couple other workers shared an apartment near the city center, but some nights he was too tired to make the walk back. So on those nights, he just curled up on the floor of the factory until it was time to get up and start the next day's shift. And before long, the late nights and early mornings began to take their toll.

His sleep got worse, which only made the days feel longer. Ahmet also developed a bad cough, and gradually it got so severe that he began waking up in the middle of the night gasping for breath. The exhaustion also affected his appetite, and he started losing weight. And this only made Ahmet feel weaker and more fatigued. It was a vicious cycle. A year earlier, in the fall of 2003, his condition had gotten so bad that he began making mistakes at work.

He confused the measurements of seams and hems. He skipped entire steps of the production process. In November of that year, some shops complained about the quality of their orders, and the errors were traced back to Ahmet. When Ahmet's boss confronted him about the problem, Ahmet tried to pass it off as an accident, but Ahmet's boss could tell something deeper was wrong. So he removed Ahmet from the work schedule until his health improved. Without a job, Ahmet felt lost. His small amount of savings quickly dwindled.

Ahmet tried to find other work, but Erzurum was full of young men who were hungry for similar jobs. And since Ahmet looked visibly ill, most employers turned him away. Ahmet had been able to scrape by on savings through the winter, but by the spring of 2004, Ahmet was broke. His roommates tried to be understanding, but told Ahmet that he would have to move out if he couldn't keep up with his share of the rent. And so, if Ahmet couldn't find a job soon, he would soon have no choice but to move back to his family's home in the country.

Unfortunately, Ahmet's time away from the factory did not improve his health. He was still sleeping poorly, he felt run down, dizzy and exhausted. And then one scorching summer morning in July, Ahmet woke up so out of breath that he couldn't even make it to a job interview he had booked. He realized something serious might be wrong with him. So Ahmet took a cold shower, threw on clothes and dragged himself to the government hospital across town. Now here he was, weak and lightheaded, pacing a waiting room full of sick people.

An hour later, a nurse called Ahmet's name. He was taken to a treatment room where a tired-looking doctor listened while Ahmet described his symptoms. When he was done, the doctor told Ahmet he most likely had tuberculosis, commonly called TB, a contagious bacterial disease of the lungs. For hundreds of years, TB had been one of the world's deadliest diseases. But thanks to the development of antibiotics in the 20th century, it was now a very treatable illness.

The doctor guessed that Ahmet had caught TB in the factory, since the disease spreads easily in confined spaces. All it takes is being near the wrong cough or sneeze. The doctor said that most likely the disease had lingered in his lungs ever since. Ahmet was surprised by the diagnosis, especially considering the doctor didn't actually run any tests. But it seemed like an obvious enough explanation, and he was honestly just relieved to have an explanation at all for his trouble breathing and fatigue.

And so the doctor prescribed Ahmet medication that would stop the TB from being contagious within two weeks. And then two weeks after that, all of Ahmet's symptoms would be gone. Ahmet was thrilled. If the doctor was right, he could be back in the factory within a month, making his full wages again. He wouldn't have to move back home after all. Even better, he would finally stop coughing and be able to sleep through the entire night.

One month later, in August of 2004, a pulmonologist named Dr. Yusuf Kaya went to meet a new patient at the Ataturk University Clinic in Erzurum. The patient was a 19-year-old factory worker named Ahmet. He reported having trouble breathing, a painful cough, and intense fatigue. As soon as Dr. Kaya stepped into the treatment room, he could tell from the teenager's face alone that something was deeply wrong. Ahmet's skin looked waxy and sickly. It looked like he'd barely slept in days.

Ahmed explained to Dr. Kaya that he had been taking TB antibiotics for a full month, but hadn't seen any sign of improvement. He felt weak and run down, and no matter how deeply he tried to breathe, he just couldn't get enough air. Dr. Kaya found this very worrying. If Ahmed had TB, then the antibiotics definitely should have helped him by now.

But since his body was not responding, Dr. Kaya wondered what else might be causing Ahmet's symptoms. The doctor placed a stethoscope on Ahmet's chest. The teenager's heartbeat was normal. However, his breathing sounded shallow. Dr. Kaya told Ahmet that he wanted to run some tests to figure out why the TB medication was not working. He proposed starting with an x-ray of Ahmet's chest, followed by a full-body CT scan to provide a more detailed 3D rendering of Ahmet's organs.

After that, Dr. Kaya suggested doing a bronchoscopy, which uses a thin, illuminated tube to examine the lungs and airways. Separately, he also wanted to test Ahmet's blood, mucus, and saliva for disease or infection. Ahmet told Dr. Kaya that his number one goal was getting back to his job at the factory. So, whatever was necessary to make that happen, Dr. Kaya should do it.

A few days later, after all the tests had been performed, Dr. Kaya opened a link on his computer to inspect Ahmet's results. And what he saw made him very concerned. Ahmet's chest X-ray looked speckled, particularly in his lungs. This indicated the presence of small foreign objects in Ahmet's lungs that shouldn't be there. His CT scan was more detailed. In addition to the foreign objects, it showed small growths in his lungs known as micronodules, which are often caused by respiratory illnesses or infections.

and a culture test of his phlegm confirmed that Ahmet did not have TB. Dr. Kaya had suspected this when Ahmet's TB treatment didn't have any effect, but it was a relief to see it medically proven.

But even so, ruling out TB didn't get Dr. Kaya any closer to figuring out what was causing Ahmet's symptoms. The cumulative picture provided by Ahmet's tests indicated that there was some sort of serious infection in his lungs. It just wasn't clear what that might be. So Dr. Kaya canceled Ahmet's TB medication and replaced it with a more general antibiotic.

Dr. Kai hoped this would ease Ahmet's symptoms, but he knew antibiotics wouldn't fix anything. Until he identified the infection in Ahmet's lungs, it wouldn't go away, and it very well might get worse. He just didn't know how much worse. Ahmet was already struggling to breathe, and less oxygen in his lungs meant less oxygen to his brain. And if that trend continued, things could get very bad very quickly.

A few weeks later, Dr. Kaya was scanning the paperwork of the clinic's latest patients when something caught his eye. It was the intake form of a young man named Ali. He was 18, only a year younger than Ahmet, and suffering from very similar symptoms. Struggling to breathe, dry mouth, bad cough, unusual fatigue. Dr. Kaya decided to pay him a visit at the clinic. Maybe Ali could provide a clue as to what was making Ahmet so sick. After introducing himself, Dr. Kaya asked Ali to describe the history of his symptoms.

And right away, one detail surprised him. Ali worked at the same garment factory as Ahmet. Dr. Kaya wondered why two otherwise healthy young men would have breathing issues or lung infections at their age. Neither of them smoked, and they spent their days doing physical labor, which in theory should have made them stronger, not weaker. Taking a seat by Ali's bed, Dr. Kaya asked Ali to walk him through a regular day at the factory. The jobs he did, the machines he used, what he ate, all of it.

Ali explained that he started at the factory doing heavy labor, like loading and unloading fabric from the trucks to the machines and back. But over time, he was trained to do more skilled work, putting the finishing touches on garments before they were shipped to shops around the world. Ali and Ahmet's factory produced contemporary clothing for the latest fashion trends of the 2000s. Some of their factory's techniques were extremely new to the industry, and they sounded pretty strange to the doctor.

But as Ali described his responsibilities, Dr. Kaya began to get an idea. And by the end of their chat, Dr. Kaya felt confident that he actually knew what was happening to both Ali and Ahmet. However, to be certain, he would need to examine samples of Ali and Ahmet's lung tissue under a microscope. And so he ordered lung biopsies for both men. Days later, the lung tissue samples confirmed Dr. Kaya's hunch.

Both men were suffering from silicosis, a disease more commonly found in miners than garment factory workers. It's a lung disease caused by breathing silica, which is a common mineral in sand, gravel, clay, granite, and other rocks. Dr. Kaya had diagnosed cases of silicosis before, but only in workers who spent their days in tunnels or moving heavy stone materials and breathing in all kinds of rock dust.

He would never have thought textile factory workers would have silicosis since their product was fabric, not rock. But fashion tastes had changed in Europe and America in the early 2000s. One of the most popular and profitable items that Ahmet and Ali's factory produced was something called distressed jeans, and making them involved a lot of rock dust.

To create the hip, faded denim look, workers used a high-pressure air compressor to blast sand up and down the legs of a pair of jeans. The silica particles in the sand gradually shredded the denim, giving the jeans a worn-in, weathered look.

Like a lot of factories in Turkey at the time, Ahmet and Ali's workplace was crowded and lacked proper ventilation. This meant the silica particles stayed in the air long after the jeans were sandblasted. And so Ahmet and Ali breathed these particles in all day. And then at night, if they slept on the factory floor, they would continue to breathe in the silica during their sleep. Over time, the tiny crystals of silica scar and harden the delicate tissues in the lungs, making them less effective at processing oxygen.

That's why the men's breathing became increasingly shallow. Sadly, silicosis damage is permanent, and it often leads to other respiratory illnesses. Lung cancer is a common outcome, and there is no cure. Even after Dr. Kaya identified Ahmet and Ali's condition, their health steadily worsened, and in 2008, both young men died from silicosis complications. And they were not alone either. Four other workers at the same factory died as well,

and 16 others suffered debilitating lung damage. In March of the following year, Turkey's Ministry of Health banned denim sandblasting, and thankfully, sandblasted jeans quickly fell out of fashion. From Ballin Studios and Wondery, this is Mr. Ballin's Medical Mysteries, hosted by me, Mr. Ballin.

A quick note about our stories. They are all inspired by true events, but we do sometimes use pseudonyms to protect the people involved, and also some details are fictionalized for dramatic purposes. And a reminder, the content in this episode is not intended to be a substitute for professional medical advice, diagnosis, or treatment. This episode was written by Britt Brown. Our editor is Heather Dundas.

Sound design is by Matthew Cilelli. Our senior managing producer is Nick Ryan. And our coordinating producer is Taylor Sniffen. Our senior producer is Alex Benidon. Our associate producers and researchers are Sarah Bytack and Tasia Palaconda. Fact-checking was done by Sheila Patterson.

For Ballin Studios, our head of production is Zach Levitt. Script editing by Scott Allen and Evan Allen. Our coordinating producer is Samantha Collins. Production support by Avery Siegel. Executive producers are myself, Mr. Ballin, and also Nick Witters. For Wondery, our head of sound is Marcelino Villapando. Senior producers are Laura Donna Palavoda and Dave Schilling. Senior managing producer is Ryan Lohr. Our executive producers are Aaron O'Flaherty and Marshall Louis for Wondery.

Hey, Prime members, you can listen to new episodes of Mr. Ballin's Medical Mysteries early and ad-free on Amazon Music. Download the app today. And also, Wondery Plus subscribers can listen to Mr. Ballin's Medical Mysteries ad-free. Join Wondery Plus today. Before you go, tell us about yourself by completing a short survey at listenersurvey.com.