Science presents particular challenges for narrative writers, like deciphering the often arcane language of scientific studies, or coaxing pithy quotes from scientists accustomed to speaking in academicese, and wary of having their work misinterpreted. Then there’s the usual daunting exercise of taking reams of material and turning them into an engaging, coherent piece of narrative journalism.
But with patience and luck, the result can be an immensely satisfying read that takes us inside how scientists figure out how to solve complex problems. Freelance science writer Sarah Scoles’ recent Slate feature about doctor Matt Lewin’s quest for a universal snake venom antidote is a lesson in how to find drama — and humor — in the lab.
Storyboard: How did you come up with the idea to write about Lewin’s obsession with finding a snakebite antidote?
Scoles: My background is in astronomy — I don’t have a background in health. But I was talking to an astronomer affiliated with the California Academy of Sciences who said, “There’s this guy who’s trying to come up with a snake venom antidote.” And she mentioned a volunteer had taken the antidote. And I just got really curious about that. I didn’t know until I went to the interview that [the volunteer] was him [Lewin]. As soon as I found out he had paralyzed himself I thought, this has got to be an interesting dude. And, how did someone ever think that was a good idea?
It actually took me a little while to talk to him. He kept putting it off, and I thought he just wasn’t interested in this article. But then I found out he was working on all the patents and was caught up in a lot of paperwork and actually wanted to have that squared away before our talk. He’s smart about media, which is helpful and not helpful, because you can’t necessarily trust what he’s saying but on the other hand you don’t have to pry to get information.
Did you have a narrative approach in mind from beginning or did that come later?
I did think of this as a narrative story from the beginning. He’s gotten quite a bit of coverage before, but what was interesting to me is that those stories didn’t go into the results. He has two antidotes. The first is neostigmine, that goes through the nose, which was at first lauded as this universal thing. And I thought that was the whole story — that he paralyzed himself and now no more snake bites. I didn’t know the second half of the story, the search for a truly universal antidote, until I interviewed him.
Slate seems like an especially good home for this story. Did you have Slate in mind from the beginning, or did you consider pitching the story to other publications?
I was actually struggling with where I should try to place it. I think at some point, when I was thinking of where, with this whole paralyze-someone-to-try-the-antidote thing, I could see a Slate headline for that. And I knew Laura Helmuth [then Slate’s science and health editor] was someone who might be invested in this narrative treatment. And I knew it was time-sensitive and soon it would be news again, when he found the antidote. I wanted to have it out there after the old news and before the new news. And I knew it could be long, and I knew it could be narrative, and I knew it had that, “Really? What the Hell?” element that Slate goes for.
I sent the pitch, and Laura sent back an email saying essentially, “Holy board of subjects approval, how was that ever allowed to happen?”
My questions are in red, her responses in blue. To read the story without annotations first, click the ‘Hide all annotations’ button below the byline, up and to the right.
How to Save People from Snakebites
Originally published on Slate on Jan. 11, 2016
Matt Lewin waited for the paralysis to set in. Two anesthesiologists and an emergency-room doctor monitored his vitals while the mivacurium moved through him. Mivacurium paralyzes skeletal muscles the same way a cobra bite does, with the venom’s most deadly effect: It causes the diaphragm to stop contracting, and the victim suffocates. The doctors had chemically immobilized Lewin, like a snake would, to see if they could reanimate him with a new snake-venom antidote. This is such an arresting, dramatic lede — there’s no way you’re not going to keep reading to find out what happens. What was your thinking in using this scene as the opener? I knew the scene existed before I went into the interview. I knew I wanted to use it, and I knew I wanted to use it in a narrative way, so I knew I needed to get him to tell me about his feelings. Lucky for me, he is just a really forthcoming, dynamic, intense guy. So when I asked, ‘Who did you paralyze?’ he said, “It was me!”
It was an antidote Lewin himself had developed: a nasal spray of the compound neostigmine. Doctors first described neostigmine’s ability to undo snake-induced paralysis in 1972, but it is usually injected, and administered by doctors in a hospital. Lewin wanted to create a first-aid-style, no-supervision-required version that a person could stick up her nose after a cobra bit her. But his Afrin-like version had never been tested against snakebites—not even in mice, rats, chimps, or the other lab-test favorites that usually precede humans. Here you’re slipping key context into the narrative. Was it challenging to know where to stop the action to work in this important information? That was the hardest part, figuring out which facts to weave in. It was a challenge to figure out how to include as few facts as possible and examine why he’s doing it, but also to help set up the rest of the story — why he’s paralyzed, what is the antidote. So my tactic was to mention a fact whenever it was warranted, do it as briefly as possible and then get back to the scene. I didn’t want to break away form the narrative, but the narrative wouldn’t have made sense if you didn’t know what it was about.
Lewin, prone in the research room, was the first test subject. (A known antidote to mivacurium waited right next to him, just in case.) At first, the effects of mivacurium felt relaxing, the ultimate shavasana. This is an unusual word, at least to those who aren’t yoga practitioners. Did you use it to foreshadow the Indian component to this story? “Shavasana” is also called corpse pose. I used it not so much to foreshadow the trip to India but to bring up the danger and stakes again without having to say, “This is dangerous!” For the record, I don’t do very much yoga, but I do live in the Bay Area, so it seeps into consciousness. Then, Lewin couldn’t see. His breathing got shallower. He had trouble swallowing, couldn’t lift his head. Speech departed.
He felt impatient and dependent, like a child whose well-being depends on others. “Even though I knew I was being monitored intensely, they appeared to me very casual,” he says, “because they couldn’t experience what I was experiencing.” And what he was experiencing was a slow, staggering walk toward death (metaphorically, since he couldn’t even wiggle a toe). He could only hope that his antidote would grab his hand and lead him back.
“Everything that was going on was just in my head,” he says, “which was, give me the drug. Stop talking about Hank Williams, Jr.”
Underneath his anxiety, though, he knew that the doctors were confident and focused, playing out the scenario they had dress-rehearsed and planned for months. When he heard them approach his nose with the antidote, he got so excited that his heart monitor began beeping like crazy before the mist even entered his nasal cavity.
The effects were almost instantaneous. The muscles under his face jerked awake and reordered themselves. It felt cartoony, like CGI of a human morphing into an animal. Minutes later, the rest of his body worked. He rose from the bed like Lazarus.
“It worked!” he said.
His words came out slurry and garbled. He cried. This scene is so vivid, but as we learn later, he took the antidote in 2013, and you wrote this story in 2015. How did you go about recreating the scene in such detail? Anything about how it felt just came from his storytelling. I can’t really take any credit for that. What was more difficult was some of the details, like how many anesthesiologists were there, and the order of things. Some of that came from the paper they published. It gave the protocol they went though and what went on with him biologically minute by minute. The other thing that was very helpful was there was a PBS segment that included the end of this scene, where he gets up and says, “It worked.” So I could see what the room looked like and I could see how he looked. But most of it came from him being such an open interview subject. Did you think about talking to the anesthesiologists at all, or did you think they would distract from the narrative’s focus? I wanted to ground the initial scene in a single perspective–Lewin’s perspective–and not have it rove around. I wanted the narrative to stay inside his head (and paralyzed body) so a person reading could go through the experience with him, without being pulled out of it. So, beyond their ability to verify the details of how the experiment went down, I knew I wouldn’t be using the anesthesiologists’ thoughts or experiences, so I didn’t focus on them.
* * *
Lewin, a wilderness physician, first began thinking about snakebite treatments after he became a fellow at the California Academy of Sciences. As part of his duties preparing for the 2011 Hearst Philippines Biodiversity Expedition—which sent 94 people in search of new land and sea species in the Coral Triangle, which is full of venomous snakes—he created a snakebite treatment kit. Here, after the opening scene, you go back and tell the story of how Lewin got here from the beginning. From here through the end, the story unfolds in chronological order. Was the overall structure obvious to you when you sat down to write, or did you play around with different structures? Before I sit down to write, I think, ‘I have so much material, how am I going to organize it? What am I going to do?’ Then I go for a run, and I don’t actively think about it. Then I sit down to write the lede, and it kind of feels like black magic, but really my brain has been working on the problem in the background the whole time. I knew I wanted to start with the paralysis scene, because it was the most gripping event and provided a way into the more detailed explanation of how he got to that point. And after I finished that, I went into the next part with the thought that I wanted to tell the narrative of how he came to be interested in this. I wanted to tell it straight chronologically. I know it’s fun narrative structure to go out of order, but it’s good for the reader, if you’re writing about complicated things, to go with a chronological structure. He started reading about treatments and discovered how big a problem snakebites are worldwide—and how many problems the solutions have. Scientists make antivenom by injecting an animal—like a horse or a sheep—with venom, harvesting the antibodies they produce to fight it, and then packaging those antibodies for injection into humans. It works well, but it is fairly snake-specific. The bitten person must know what bit him and get to the hospital, where the antivenom must be kept refrigerated. The right serum must be on hand, as well as personnel who know how to administer it and how to monitor the sometimes deadly side effects. But, on the plus side, the technology to produce antivenoms exists already.
More general than antivenoms and less explored, antidotes (sometimes called biotherapeutics) are small molecules that treat the symptoms of snakebite—the paralysis itself, for instance, rather than the specific poison that caused it. That’s how neostigmine works. Most antidotes don’t need to be refrigerated, but these, too, usually require professionals to inject a victim. And while antivenoms will help reverse most if not all the symptoms of snake venom, a given antidote usually works on just one symptom. In the case of neostigmine, that’s paralysis. This is a very clear explanation of what I would guess is some pretty complex science.How did you go about breaking it down into easy-to-understand terms without oversimplifying things? He and I had quite a bit of back-and-forth after the interview so I could be sure I understood it. He’s a research scientist, but he’s also a practicing doctor, and works with lay people a lot. So I think he naturally was able to tone it down, which helped me too because I knew nothing about this topic going into the story. I had to understand it myself before I could convey it casually to everyone else. I also talked to a few other snakebite people. The difference between antivenom and antidote sounds pretty simple in the text, but I had a hard time understanding it — for example, how someone could be clotting while bleeding profusely and how the venoms work. Lewin was super concerned I was going to get something wrong, and he made me promise I would do thorough fact checking before he agreed to talk to me at all, because he said a lot of people get a lot of the story wrong.
Snakes bite about 5 million people per year, and 2 million people end up with venom in their bloodstream. Of these, hundreds of thousands are injured, and between 94,000 and 125,000 die. For the most part, these “envenomations” happen in poor, remote areas. It’s often hard for victims to reach a hospital, let alone get to one quickly.
Based on his reading, Lewin included injectable neostigmine—a standard treatment recommended by the World Health Organization—in the explorers’ snakebite kits, but he wanted to do better. By keeping the story about him and his experiences, even when getting into the history and background, you maintain the storyline and make what could have been dry material relatable and interesting. They already like him, the guy who paralyzed himself, so it makes sense to associate it with him, rather than have it come from me.
He soon became obsessed with the idea of creating an inexpensive, foolproof, snake-agnostic antidote. He continued to work with neostigmine, came up with the idea of nasal spray, and tried to get development money. But potential funders didn’t think his plans felt solid enough.
Lewin was flailing at that time, dissatisfied with his life personally and professionally. A friend dragged him to a house party in Marin County, California, just across the Golden Gate Bridge from San Francisco, where people like George Lucas live. Lewin made himself a wallflower. But the wall of this house was more interesting than most. Stuck to it was a newspaper clipping with the headline “Jerry Harrison Makes People’s Visions Happen.” Harrison is a founding member of the Talking Heads and now a music producer, and a friend of the party’s hosts. As if in some kind of belief-straining movie orchestration, Harrison happened to be at the party, and Lewin heard him ask, “Does anybody have any crazy ideas that are lying fallow?”
Lewin blurted out, “Nasal spray for snakebite!” This is such a fun and totally unexpected turn in the story. All of a sudden, Jerry Harrison of the Talking Heads shows up to help save the day. How did you find out about this encounter? Were you lucky enough to be at this party? I wasn’t there for the party, unfortunately. But Jerry Harrison was actually there for the interview. After I met with Matt at his office, he was meeting with Jerry there — he’s really involved in the planning and execution of the antidote. He was in and out of the room when I was there at Matt’s office, and Lewin was talking about this house party, in part because it’s part of the story but also partly because Jerry Harrison was in his office. I didn’t recognize him. I didn’t know what he looks like. So when he went outside to get something, Matt said, “Do you know who that was?” As soon as I got out of the interview I emailed my editor and said, ‘You won’t believe what just happened.’
Harrison was intrigued. He hooked Lewin up with a patent lawyer and has been involved with the project planning ever since. His enthusiasm gave Lewin a boost, and Lewin plunged into the work. But Harrison didn’t provide funding, and no one else wanted to invest the big money necessary for biomedical research and development. Without it, Lewin couldn’t run the trials necessary to test the new antidote formulation. He felt frustrated that his vision for a world safe from venomous snakes had stalled. He describes his mindset as “very nihilistic.”
Then one day, Lewin was driving across the Golden Gate Bridge (a historically bad place to be when in a nihilistic state of mind) with anesthesiologist Philip Bickler. Lewin lamented the lack of money for proper studies. He couldn’t just hide behind a bush, wait for someone to be bitten by a snake, and then spring out and stick his concoction up the poor guy’s nose.
Bickler, the cables of the bridge whizzing past his window, said, “We could just paralyze you.”
Lewin didn’t say yes right away. But he did say yes. This is a serious story at its heart — the whole reason Lewin is testing antidotes on himself is because people around the world are dying horrible deaths from snakebites — but you manage to bring levity to the storytelling, through tone and scenes like this one. My natural writing mode is pretty casual and funny, so my natural tone fits well with Slate, which is kind of nice. And I think in science writing, that’s helpful in making it sound more accessible, so that it doesn’t sound like a scary thing but something that people will enjoy. Did you initially write more about the decision process? It seems like a big decision. It was a big decision. But it was always a short part of the written scene, from the beginning. I wanted to take something that sounds crazy — “Yes, I decided to paralyze myself”— and say it in a calm way, while indicating that a thought process had gone on behind that. I hoped the contrast between what he was agreeing to and the no-big-deal presentation of that agreement would highlight the finality of his decision. Because he did go think about it for a while, as I wrote — but as soon as he decided to go for it, there was no going back for him. It was a done deal, and he staked a lot of his time and resources on making it happen. Going into the details of his mental back-and-forth in the text took away from his ultimate sense of certainty, I thought.
* * *
They worked for six months to get approval for their experiment from the Committee on Human Research at the University of California–San Francisco (UCSF), where Bickler works. “We never mentioned the word snake or the word paralysis in the application,” says Lewin. “We said nasal spray and muscle relaxation” (which the committee understood as code words). They used as precedent two studies from UCSF anesthesiologists John Feiner and Tim Heier, who had previously paralyzed people with mivacurium to find out how residual muscle relaxation affects patients’ breathing after they leave the operating room. It was the procedure Bickler was thinking of when he brought up the idea, and the procedure they later followed.
And that is how, in April 2013, Lewin came to be on the anesthesiology table, unable to move or speak or breathe or do anything but exist and hope that his antidote would be the thing to save his life, and the lives of others around the world.
Later that month, Lewin gave a talk to the American Physician Scientists Association in Chicago. He hadn’t planned to talk about the nasal spray, but he gushed about it anyway. This yanked awake a young scientist named Stephen Samuel, who worked at Trinity College Dublin and was fighting jetlag. Samuel had grown up in India and knew the magnitude of the snakebite problem. He caught Lewin after his lecture to talk about a collaboration. Was it challenging in this history section to figure out how to get past 2013, past the scene you already explained in the lede, to what he’s working on now? It was a little bit of a challenge, because I needed to get from the nasal spray to today. I needed a bridge. In some ways I could have ended it there. But I wanted to show the evolution of his thought and his growing ambition for expanding the studies, from testing on him to move into something closer to this universal antidote, which is what he’s working on today. I tried to set that next section up as, this is what led him to the second part of the story. This section used to be longer, by the way. Laura [Helmuth] cut a chunk of it, which I think was a very good decision. It used to have a full scene in India inside of it, instead of this pretty straight, fast-paced chronology. It was a scene where they met a fortune teller. I felt like it really wanted to be in the story, but it didn’t fit.
With just a few emails to their relationship history, Samuel became totally committed to the project, like a novice Internet-dater. In what Lewin calls a “clinical leap of faith,” Samuel traveled to India to prepare the stage. He spent two months working with hospitals in Krishnagiri to figure out how to do a clinical trial in this real-world setting, on real people with real snakebites who staggered into real emergency rooms. They hope to eventually use what they learned in a trial of an antidote.
While Samuel was there, Lewin traveled to India to meet him and do a mouse study. Typically, researchers would drug mice long before they drugged a human. If a treatment works in mice, it might work in humans. Smiling, Lewin says of their backward method, “The fact that it worked in me suggested it would work in mice.”
In the mouse trial, the rodents received actual Naja naja venom, from the mouths of cobras. Then scientists shot atomized neostigmine up their tiny, twitching noses. It saved 67 percent of the mice that had received 2.5 times the lethal dose of venom. The rodents who received 5 times the lethal dose survived 196 minutes compared to 45 minutes in untreated mice, and those that got 10 times the fatal dose lived 175, as opposed to 30, minutes. It wasn’t a panacea, but it was a start. With these initial successes, Lewin’s ambition grew.
* * *
Neostigmine probably only works against snakes that paralyze their victims like cobras do, although no one has funded a proper study on even that since the 1970s. What if a kind of snake that kills in a different way—like a krait—bites you? And, as David John Williams of the University of Melbourne and the CEO of the Global Snakebite Initiative points out, “snakes very rarely have venoms that contain only one type of toxin.” Their fangs deliver cocktails of deadly components. An antidote like neostigmine helps against a major one and buys the victim time, but it’s not going to help every snakebite victim. Williams says that Lewin’s nasal-spray neostigmine could save the lives of people bitten by snakes whose venom it works against and “should be promoted specifically for species that meet this definition,” after full clinical trials, but it’s not universal.
Lewin steered his next project toward finding a more widely applicable treatment. Now he thinks he’s found a biochemical pathway that many venoms’ deadliest effects have in common. More importantly, he also claims he’s found a way to shut that pathway down.
When I met him in November at his medical practice—in a Marin office building that also houses a law firm and a beauty salon—the weather was uncharacteristically rainy. He showed up on a bicycle, his cargo shorts drenched. He unlocked his office door, slipped his soaking shoes off, and set them by the furnace. Soon after he sat down, a FedEx deliverer arrived with a round Styrofoam container.
“Flu vaccines! Do you want a flu vaccine?” he asked me, and then told me that journalists aren’t allowed to accept gifts and ferried the container to a back room. He glanced at the print that hangs behind his office chair: A fire blooms from the painting’s upper right edge; a rabbit, an armadillo, a rat, a turtle, and a snake all huddle together at the lower left. This description of the art on his office wall is a nice detail. What’s your strategy for collecting observations while also asking questions and making good eye contact? Yeah, when I saw there was a snake in the picture, I thought I should write it down. I record interviews, but I have a notebook and a pen, so no one thinks twice about me writing in a notebook. But I’m just writing observations. So it doesn’t feel strange and they don’t know that I’m spying on them.
“What’s a snake’s objective?” he asked, then paused for just long enough that I wondered if I was mistaken in thinking he would answer his own question. “To eat,” he continued. “How is it going to eat when it can’t chew and has no legs?” In this scene, where you’re with him in his office, you show up in the story for the first time. Why did you decide to insert yourself into the story? I go back and forth on that, in general. In this case, he was such a dynamic person to interact with — I needed to show him in the presence of someone to show the action, and here that someone was me. Like when someone brings in the vaccine, and he asks if I want one. It shows how he talks in conversation. So I thought there was a benefit for me being in the story. But I do think about it being in the last section of the story, and there hasn’t been an “I” so far. Generally, I’d try to have an “I” before this, just so it doesn’t come out of nowhere. But there wasn’t a good spot, because everything happened in the past. I figured it might be too jarring.
While any given venom has hundreds of components, only three or four of them are usually responsible for quickly killing the victim. (Some of the others are digestive agents, which eat away at the victim from within to make it easier for the snake to digest, but they work more slowly than the other killers.) The paralyzing agents work fast. These keep victims from running away and also stop their breathing. Many venoms’ enzymes also affect the body’s ability to regulate bleeding and clotting, and they work fast, too. The same mechanisms that clog crucial blood vessels and the kidneys can also cause uncontrollable bleeding elsewhere in the body. “This [is] why you can die of complications of clotting while bleeding out your gums, bladder, and brain,” says Lewin. Combatting venoms that kill this way won’t be as “simple” as fighting those that kill by paralysis, says Robert Norris, a professor of emergency medicine at Stanford University in Palo Alto, California. “That will be an even tougher nut to crack, as the toxins of those snakes are very complex,” he says.
Lewin thinks he has found a common biochemical cause of paralysis and bleeding: He believes enzymes in a family called phospholipase A2 (PLA2), which cause paralysis, interact with proteins called Factors V and X, which help regulate blood clotting. He compiled a list of thousands of medical compounds that are either FDA-approved or have been tested by others but didn’t work well for their original purpose. Maybe, he thought, one of them could block PLA2.
He thinks he has found one that can. He just filed the patent application to lock down the snake-specific use and the therapeutic composition. The research is still in its early stages: It hasn’t yet been peer reviewed or published, and the recipe remains secret. But he says experiments in test tubes and with mice and rats seem to bear it out.
Lewin is, quite rightly, suspicious of his own potential biases. “All the experiments were done by me, a person who has a lot at stake,” he says. “And the experiments all seem to work.” For a year during development, he woke up spontaneously at 3:28 a.m. every day with the bolt-upright fear that he had screwed something up, unwittingly pushed the data in the direction he wanted. Am I being a little nicer, playing soft music to the mice I want to live? he wondered. It’s unusual in science stories to see the scientist struggle with self-doubt like this. By including this detail about Lewin’s late-night second-guessing, you’re not only revealing his integrity and obsession with getting the science right, and a deeper glimpse into who he is, you’re also introducing important caveats about the potential limitations of his research. I think it’s dangerous and irresponsible to overhype things, especially things that are medical. I had some caveats and Laura encouraged me to put in more, which I think is good. I left most of them at the end of the story, most of the outside comment, because I wanted them to be in there but I didn’t want them to break the flow of the narrative.
His father, a chemist, has long lectured Lewin about reproducibility, and Lewin’s body never cleared itself of the warnings. “Your experiments don’t mean anything,” his father has always told him. “It only matters when somebody else can do it.”
And so Lewin sent the protocol to outside labs for replication. The test-tube data came back—with better results. And the week before we spoke, outsiders had reproduced the animal results, too.
“One hundred percent survival over 24 hours,” Lewin says, grinning, describing the outcome of the limited test. He says his perpetually doubtful father smiled, too, “for the first time in this entire torture.”
Williams, of the Global Snakebite Initiative, still has doubts. If Lewin is right about PLA2 enzymes being a common cause of clotting and bleeding, Williams wonders how Lewin will be able to block the enzymes in snake venom without interfering with the chemically similar PLA2 enzymes the human body uses for its normal functions. “Notwithstanding this, the inhibition of venom PLA2 activity is an area in which a number of researchers have been active,” Williams says, so Lewin isn’t alone in thinking this is a good path to pursue. Time, and tests, will tell. How did you go about finding outside perspective for this story? It was actually hard, because there aren’t a ton of people doing work like this. And some people were less willing to comment on what Lewin was doing. I didn’t have much luck getting one of the competing research groups to comment. I asked Lewin if he could recommend someone who knew a lot about this topic generally. Again, he’s a savvy guy. He said, “I know you want an outside perspective from someone who’s critical of my work, so here’s this guy [Williams].”
Lewin has started a company called Ophirex—ophi- meaning snake, and -rex meaning king—to develop and distribute the drug after clinical trials. While he says he began the project as a purely philanthropic venture, his seed investors would like to make some profit (presumably that money won’t hurt Lewin, either). His company has trademarked the word Unidote, meaning an antidote with one ingredient.
The drug has many more obstacles to overcome before it can be proven, approved for human use, and distributed to the remote areas where people are most at risk of snakebite. And while this antidote is a step closer to a universal solution it, like neostigmine, is a cure-some and not a cure-all.
“This is a field of research that is going to take many years, many millions of dollars in funding, and a great many false starts and dead ends, before it yields a therapeutic agent with sufficient potential to be put through as a candidate drug,” says Williams. But he is hopeful that within his lifetime, we will have a suite of options that, in combination, can combat snakebites around the world.
Lewin, too, is optimistic. He envisions a world where people don’t have to be afraid of what slithers through the grass, and where if they don’t watch where they step, they don’t have to die. In the end, we return to Lewin’s ultimate goal — the reason he’s doing of all of this. There’s a satisfying ring of hopefulness in this ending. But endings can be so hard to write. How did this one come about? I wanted to end on a hopeful note. But the original ending was different. It was the fortune teller in India, which was pretty lofty, but it didn’t work. So I decided I wanted to have it end on a thought from him, and not a thought from me. Since it started with him, I wanted to have it end with him. He had this vision, he’s very concerned about people in countries without a lot of medical infrastructure, and they tend to have venomous snakes. I feel like in the story I didn’t talk about how it’s a big sociological, global problem as much as anything else. So I was going for something that had him but also had the larger picture than just the details of some guy in San Francisco making a drug.