The Hackman Coincidence

Rachel:
February twenty sixth, twenty twenty-five. One forty-five in the afternoon. Hyde Park, on the eastern edge of Santa Fe, New Mexico.

Maintenance and security workers arrive at a house off Old Sunset Trail. Through a window, they can see one of the bodies. They call the Santa Fe County Sheriff.

When deputies arrive, they find two people and one dog dead inside the house. The other two dogs are alive. One is in the house. The other has let itself out a doggy door.

The man is ninety-five years old. The woman is sixty-five. They have been married for thirty-three years.

The woman has been dead for about two weeks. The man, about eight days.

A national news story is about to break, because the man's name is Gene Hackman.

But that is not the part of the story we are here to tell. We are here to tell you what his wife was doing in the days before she died.

From Armbrust USA, this is Vector. Season one. Hantavirus. Episode three.

The Hackman coincidence.

I'm Rachel Marin. With me is Seth Avery.

Seth:
Betsy Arakawa died of hantavirus pulmonary syndrome on or around February twelfth. She was the first hantavirus death reported in New Mexico in twenty twenty-five.

Rachel:
She died alone, in the house she had lived in for forty years, because her husband had advanced Alzheimer's and may not have understood what was happening.

This is that story.

Rachel:
Gene Hackman is what you think he is. Two Academy Awards. Sixty years of credits. The French Connection. Unforgiven. The Royal Tenenbaums. He retired in two thousand four after a movie called Welcome to Mooseport. He moved to Santa Fe. He painted. He wrote historical novels. He did not do interviews.

Seth:
Betsy Arakawa is the part of the story most people did not know. She was born in Honolulu in December of nineteen fifty-nine. Trained as a classical pianist. She performed at age eleven for nine thousand children at the Honolulu International Center Concert Hall. She attended USC. She met Gene Hackman in the eighties at a Los Angeles fitness center, when she refused to let him in because he had forgotten his membership card.

Rachel:
They married in nineteen ninety-one. She gave up performing after the wedding. She moved with him to Santa Fe. She co-founded a linens and home furnishings store. She edited his historical novels.

Seth:
And as he got older, she did what a lot of spouses of much older men with advancing Alzheimer's do. She kept his medications straight. She drove him to appointments. She protected him. One of his daughters said it plainly. Quote, "I give credit to his wife, Betsy, for keeping him alive."

Rachel:
That is the shape of the household. Two people in their seventies and eighties, alone on a fifty-three-acre property on the edge of a small American city. The husband disappearing into Alzheimer's. The wife keeping the lights on.

Seth:
And then she got sick.

Seth:
Hantavirus pulmonary syndrome has three phases. The first one is called the prodrome.

Rachel:
For one to five days, the prodrome looks like the flu. Fever. Muscle aches. Headache. Fatigue. Sometimes dizziness. Sometimes nausea. There is nothing on the outside of the patient that tells anyone this is unusual.

Seth:
At the end of the prodromal phase, the lungs fill with fluid. That is phase two. The cardiopulmonary phase. The heart races. Breathing becomes shallow and rapid. Without aggressive ICU support, most patients die within twenty-four to forty-eight hours of that point.

Rachel:
There is no proven antiviral for hantavirus pulmonary syndrome. Care in the cardiopulmonary phase is supportive, in an ICU, and the odds are better the earlier the patient gets there. The honest version of the diagnostic threshold is that somebody has to ask a careful exposure-history question while the patient still looks like they have the flu.

Seth:
Case fatality is somewhere between thirty and thirty-eight percent. Even with the best supportive care.

Rachel:
For the patient, the prodrome is the part where you might wonder if you have a cold. Or COVID. Or something else minor. And then it is too late.

Rachel:
On February eighth, twenty twenty-five, Betsy Arakawa started searching the internet for medical information.

Seth:
Her search history, recovered by investigators, shows what she was looking for between February eighth and the morning of February twelfth. Most of the searches were about COVID. Could COVID cause dizziness. Could COVID cause nosebleeds. What were the early symptoms of COVID. What were the early symptoms of the flu.

Rachel:
These are exactly the searches a thoughtful caretaker would make. She was looking for a category for what she was feeling, and what her husband was feeling. And the category she was reaching for was reasonable. They had just come through several years where every respiratory illness in America was treated, by default, as possibly COVID.

Seth:
On February eleventh, she emailed her massage therapist. She wrote that Hackman had woken up that morning with flu-like or cold-like symptoms. She added that he had tested negative for COVID. She wrote that she would have to reschedule her own appointment for the next day, quote, "out of an abundance of caution."

Rachel:
Out of an abundance of caution. A woman in her sixties, taking care of a husband with advanced Alzheimer's, who is herself in the prodromal phase of a disease with a thirty percent case fatality rate, is canceling a massage to protect her massage therapist from what she thinks is a cold.

Seth:
The next morning, February twelfth, she searched for a concierge medical service in Santa Fe. She called them. The call lasted less than two minutes. They called her back later that afternoon. She missed it.

Rachel:
And then she was gone.

Seth:
The autopsy showed fluid in her lungs and in her chest. No trauma. No carbon monoxide. Negative for COVID, influenza, and other common respiratory viruses. The microscopic findings were consistent with hantavirus pulmonary syndrome.

Rachel:
She did not know what she had. The disease had moved out of the prodromal phase and into her lungs while she was still searching for symptoms of the wrong illness.

Rachel:
If you live in, or care for an older relative on, a rural-adjacent property with outbuildings, the kind of environment where hantavirus shows up is more common than people realize.

Seth:
The minimum respiratory protection for cleaning out a closed shed or garage is an N95 or KN95.

Rachel:
We wear Armbrust KN95s on this show. Vector dot armbrust U S A... dot com. Thirty percent off anything Armbrust makes if you sign up for the newsletter.

Seth:
Back to Santa Fe. And the week that nobody knew Gene Hackman was alone.

Seth:
Gene Hackman had an implanted pacemaker. After his death, investigators downloaded its logs.

Rachel:
The pacemaker shows him alive through February seventeenth. On February eighteenth, the log records an episode of atrial fibrillation. That is the last entry. Authorities concluded he most likely died that day.

Seth:
He had advanced Alzheimer's. He had a history of multiple heart surgeries and prior heart attacks. The chief medical investigator for New Mexico determined his cause of death as hypertensive and atherosclerotic cardiovascular disease, with Alzheimer's as a significant contributory factor.

Rachel:
A separate detail from the autopsy. He had no food in his stomach at the time of death. He had not been eating.

Seth:
The dog that died in the crate was an Australian kelpie mix named Zinna. She had been at the vet four days before Betsy's death. The crate was likely part of her recovery. With her caretaker gone, she had no way out. She most likely died of dehydration and starvation.

Rachel:
The two surviving dogs had access to a doggy door. One stayed near Betsy's body. The other ranged the property.

Seth:
Nobody called. Nobody came to the door. The man with Alzheimer's was alone in the house with his wife's body for six days. He may not have understood that she was gone.

Rachel:
One week after the bodies were found, the environmental assessment of the property came back.

Seth:
The primary residence, where they had lived for forty years, was clean. No signs of rodent activity. None of the things you look for.

Rachel:
But on the rest of the fifty-three-acre property, the picture was different. Rodent feces in three detached garages. Rodent feces in three sheds. Rodent feces in two casitas. Dead rodents and nests in eight separate outbuildings. Two vehicles with rodent activity inside them. Live traps already set, which means somebody on the property had known about the problem.

Seth:
That is the textbook exposure environment. A house that's clean. A rural-adjacent property with multiple outbuildings that are not.

Rachel:
Two weeks after Betsy Arakawa died, Mono County, California, announced the first of three hantavirus deaths in Mammoth Lakes. Two of the three Mammoth Lakes victims had no mice in their homes. We covered that last week.

Seth:
Different state. Different exposure environment. Same disease.

Rachel:
What changed in the United States between February of twenty twenty-five and now is that a famous man's wife died of hantavirus. And for the first time since the nineties, the disease became a household word. Search traffic on the internet went up by orders of magnitude. State public health departments updated their guidance. New Mexico ended up recording seven confirmed hantavirus cases in twenty twenty-five. Three of them were fatal.

Seth:
Before Betsy Arakawa died, hantavirus was, for most Americans, a regional curiosity. After she died, it was a household word again for the first time since the nineties.

Rachel:
And here is the uncomfortable question that emerged. How often does someone in this country die of what gets written up as, quote, "respiratory failure of unknown cause," and the actual cause was hantavirus pulmonary syndrome that nobody thought to test for.

Seth:
The honest answer is that nobody knows. Hantavirus has only been a nationally notifiable disease since nineteen ninety-five. The reporting lag is real. The diagnostic threshold is whether somebody with the right clinical suspicion is in the room with the patient. And the right clinical suspicion is almost always set by exposure history.

Rachel:
Betsy Arakawa was searching the internet because nobody had connected the dots. She had been in and out of a property with rodent problems in the outbuildings for years. So had her husband. The clinical suspicion for hantavirus comes from someone asking the right question about that exposure. Nobody was asking.

Seth:
That is the coincidence. A famous death surfaced a rare disease, and the surfacing may be what helps the next cases get caught earlier.

Rachel:
Betsy Arakawa was not famous. She was Gene Hackman's wife. After her death the obituaries focused on him, because that is how it works. But the actual story is hers. She was a classical pianist who became a private person who spent the last twenty years of her life keeping her husband alive. She was the first hantavirus death reported in New Mexico in twenty twenty-five, and the circumstances that led to that recognition were not ordinary.

A famous American man, in his nineties, with advanced Alzheimer's, who had not been outside his fifty-three-acre property in years, may not have understood what had happened. His pacemaker did the timekeeping. The household sat for fourteen days. The recognition came after.

Three months after Betsy Arakawa died, a cruise ship in the Atlantic reported that eleven of its passengers and crew were sick. Three of them died. The strain on board was something new. The only hantavirus on earth known to spread from person to person.

That is episode four.

Seth:
I'm Seth Avery. Vector publishes new podcasts each week as the story develops. Subscribe so that you don't miss important updates.

Rachel:
And I'm Rachel Marin. If anything we covered today made you think differently about how rare diseases get caught, or about the relatives in your life who clean out other people's outbuildings, go to vector dot armbrust U S A... dot com, sign up for the newsletter, and get thirty percent off anything Armbrust makes.

Seth:
Vector is a Vector Media production for Armbrust USA. The information in this episode is journalism, not medical advice. If you think you may have been exposed to hantavirus, contact your local public health department or a medical provider. We are not a substitute for either.