Making the right sick call

My eyes popped open sometime after midnight and I knew I was in trouble.

This was not a typical bellyache. It radiated from my gut. Whatever it was, I could feel it in my toes. I tossed about, trying helplessly to fall back asleep.

Beads of sweat rose suddenly on my forehead. A sharp chill hit me. My teeth clattered, my body shuddered.

Then things got bad.

I bolted for the bathroom.

I couldn’t have known it at the time, but in those early Monday morning hours, dozens of other people across Los Angeles were suffering just like I was. By sunrise, some of us would wind up in hospital emergency rooms. We were men and women, old and young, linked only by our unfortunate decision to eat a certain meal at a certain place at a certain time.

An outbreak had begun.

Each year, food-borne bugs sicken an estimated 75 million people in the United States. In Los Angeles County, a small army of inspectors, doctors, specialized nurses and epidemiologists in the Department of Public Health watch over our 38,000 restaurants, markets and bakeries, hoping to catch problems with cleanliness and food handling before a meal gets contaminated.

When two or more people get sick from the same food -- an outbreak -- these are the experts who try to figure out where and when and how things went sideways. It happens 40 or so times a year in the county, sometimes at restaurants you would never expect.

I, of course, learned all this the hard way.

When a friend half-dragged me into Cedars-Sinai hospital about 3 a.m., I was a mess. The unrelenting bursts of diarrhea and vomiting dehydrated me to the point that I was having trouble walking and keeping my head upright.

After a half-hour wait, a nurse led me to a bed. With my frequent sprints for the bathroom, a fever that was hovering around 103.5 degrees and the knife fight going on in my gut, I was presenting the classic signs of food poisoning, but the doctor sent off vials of my blood to rule out anything more serious.

By the time I shuffled out seven hours later, I had had three liters of saline water (nearly 7 pounds) and some top-shelf antibiotics pumped into me. The doctor discharged me with a vague diagnosis of an infected intestinal tract and told me to call in a few days to see what the lab tests revealed, if anything.

But I was convinced I already knew.

The night before, three friends and I had eaten at a sushi restaurant in Venice. They were feeling fine, but I had hogged the only two pieces of shrimp on the plate. That must have been my undoing. Too tired to muster any anger in my voice, I had a friend call to yell at the restaurant’s manager. I drifted off to sleep thinking the dirty place should be stripped of the “A” health-inspection report card hanging on the wall.

Two days later, about noon, my cellphone rang. A woman introduced herself as a nurse with the county health department. Cedars, she said, had reported my case. The tests had come back showing I had contracted salmonella.

Salmonella?

This complicated my tidy theory.

In the dirty world of food-borne bacteria, salmonella looms large. First identified in the late 1800s by a veterinarian named Salmon, it commonly resides in the intestines and droppings of chickens, pigs and other animals. The bacteria can contaminate meat if the animal slaughtering process is sloppy. It can also infect chicken eggs. Food handlers at a processing plant or restaurant can also contaminate food if they are carrying the bacteria and do not wash their hands thoroughly after using the restroom.

About 1.2 million people in the United States are thought to get salmonella poisoning each year. That number would be exponentially higher if not for the fact that the bacteria are killed in cooking. All bets are off, however, if you eat a raw or undercooked dish.

Sometime between nine hours and four days after a tainted meal, the horrible symptoms begin as your body mounts its defense, trying to expel the bacteria however it can, releasing a fever-inducing onslaught of white blood cells. People in good enough health typically recover in a few days or weeks, although salmonella sometimes can be fatal in young children, the elderly or someone with a weakened immune system.

It is nearly unheard of to get salmonella from fish, so the diagnosis threw me. The sushi chef, I quickly decided, must have used the same knife to cut raw chicken and my sushi.

I offered up the filthy-knife theory to the nurse. She listened politely and took down the name of the restaurant, saying they would follow up. She was more concerned, however, about making sure I wasn’t a high risk to transmit the bacterial infection to others. She seemed satisfied to hear that I didn’t work around food or small children. We hung up.

By the next morning, I felt human again. And so, armed with anti-diarrhea medicine and antibiotics, I decided to go on a long-planned camping trip deep in the Nevada desert. When I returned on Sunday, my cellphone flashed to life with messages. Several were from the county health department, urgently asking me to call.

I reached Rita Bagby, a program specialist. I started to rail once again against the Japanese restaurant, but Bagby cut me off. She didn’t want to hear about fish.

“We don’t think you got sick from sushi,” she said firmly. “Why don’t you tell me everything else you ate that day.”

I thought back. The only other meal I had that Sunday was brunch. But it couldn’t have been that, I told her.

“What’s the name of the place?” Bagby demanded.

“BLD, but . . . “

“Bingo.”

Opened to gushing reviews a year ago by star chef Neal Fraser, his wife, Amy Knoll Fraser, and a business partner, the restaurant on Beverly Boulevard quickly earned a devoted following in my neighborhood. Laid-back, open late and staffed by a friendly crew, it offered delicious food, as the name suggests, for breakfast, lunch and dinner.

I loved the place.

The righteous anger I had so easily summoned toward an anonymous sushi restaurant drained away. In its place, something more confusing set it.

On Tuesday, Aug. 28, the day before the nurse contacted me with word of my salmonella diagnosis, a person called county health officials to report that they and two friends had eaten at BLD on Sunday. All three at the table had shared dishes of blueberry pancakes and eggs, the caller said, and all had become ill around 11 that night with the same unpleasant symptoms.

The county health department receives about 2,000 food-poisoning calls each year. If a claim sounds plausible -- about half the time -- an inspector with the department’s food and milk team visits the restaurant.

But this call raised the stakes. The prospect of several people being sickened by the same food at the same place can mean an outbreak. And an outbreak means the six-member food team in the department’s Acute Communicable Disease Control Program gets involved.

The report triggered an e-mail alert in the ACDC office and, shortly after 9:15 that morning, an epidemiologist on the food team took a quick look. The small number of possible victims and their generic symptoms, however, were too little to go on.

At BLD, meanwhile, Amy Knoll Fraser was realizing a restaurant owner’s worst nightmare. The day before had brought two other calls from customers saying they had fallen sick after brunch. Knoll Fraser had been troubled.

Then, on Tuesday, “it was just call after call,” she said.

As the numbers mounted, the Frasers tried to pinpoint what had gone wrong. Had someone neglected to wash his hands after handling raw meat or going to the restroom? Had juice from uncooked chicken dripped? Had a pan not been cleaned properly?

They found nothing that their kitchen crew had done wrong. But suspicion was turning quickly toward eggs . It appeared to be the only common link between those who had called to complain.

By early afternoon, with the tally of sick customers over 20, Knoll Fraser picked up the phone. She wondered if the call would lead to her restaurant’s being closed down or the destruction of its reputation.

On the other end, a health inspector answered.

At 7:45 Wednesday morning, a fax machine in the health department’s regional Burbank office spit out a “Suspect Establishment” form. Someone had written “RUSH!!!” across the top.

Dave Margosian picked it up later that morning.

If you own a restaurant, you don’t ever want to meet Dave Margosian. As an inspector on the food and milk team, he is a first-responder on suspected outbreaks of food-borne illness. And he is, to put it gently, very thorough.

Margosian arrived unannounced at BLD about 11 a.m. He spent five hours checking everything from the temperature of the dishwashing water to the cleanliness of the cooks’ fingernails. All in all, things were in order, although he found some problems: A bowl of beaten eggs had been left out on the counter, allowing them to warm up several degrees to an unsafe temperature; a prep cook was wearing a bandage on a cut finger but no protective glove; menus didn’t have the required warning about how eating undercooked meats or eggs can be dangerous.

At some point during the inspection, Margosian got word from the ACDC that it had received hospital test results confirming salmonella as the cause of the outbreak.

Now knowing the culprit, and that everyone involved had eaten the eggs , Margosian zeroed in. He asked Neal Fraser how he makes his hollandaise sauce.

Cooking well and cooking safely are not always the same thing. And there is perhaps no better example of the resulting friction than hollandaise sauce, the delicious concoction that tops eggs Benedict. It is traditionally made by mixing raw egg yolks with butter, lemon juice and spices, and heating the yolks until they are thickened but not fully cooked.

Fraser, who has a reputation for using only fresh, natural ingredients, made a traditional sauce. He knew that hollandaise heated to the 145 degrees Fahrenheit needed to kill salmonella would be rendered a clumpy mess. And pre-made “yolk products” that are pasteurized to wipe out bacteria are often artificially sweetened and made from “breakers” -- the cracked, deformed or otherwise imperfect eggs that don’t make it past quality-control standards and are sold in bulk at half price.

Until this year, there was nothing in the law that prevented California chefs from making hollandaise sauce the old-fashioned way. But in July, about a month before the outbreak, a new California Retail Food Code took effect, banning restaurants from using raw, unpasteurized eggs in dishes. The code is unusually detailed, specifically mentioning hollandaise sauce, as well as the dressing for Caesar salad.

Knoll Fraser said that she and her husband had been unaware of the new law. But after the outbreak, they switched to a pasteurized yolk product in their hollandaise. To their credit, they made the decision on their own, a day before the first county health official showed up.

But the hollandaise is not nearly as good now, Knoll Fraser said. “And where are we supposed to draw the line?” she asked. “Should we not serve sunny-side-up eggs? Should we not serve meat that isn’t well-done? Should we not serve spinach? Bacteria can be in food anytime, anywhere. You can’t see it. All we can do is our best to get rid of it.”

Iprobably should have just let it go. I knew what had gotten me ill. But no one had yet explained to me how the hollandaise sauce had become contaminated. If no one at BLD had made a mistake, was an egg already laden with salmonella the culprit?

I drove for two hours into the Inland Empire in search of the hens that had laid the eggs from which my sauce was made.

Chino Valley Ranchers is one of the country’s largest producers of organic eggs. It owns more than a million birds, all roaming around in cage-free houses. In the days before I got sick, 45 dozen of their medium-size, AA-grade eggs, laid by hens raised on organic feed, had been delivered to BLD

After finding the purchase order for the eggs in the restaurant’s records, Margosian had called Chino Valley to make sure none of its other customers were reporting outbreaks. Another outbreak elsewhere would have sent inspectors to the company’s facilities.

As I pulled off the freeway in Beaumont to meet Steven Nichols, the owner of Chino Valley Ranchers, I knew there had been no such reports. Regardless, I secretly hoped I would find dirty, Third World conditions. What I found, instead, was an impressive-looking operation where chicks are vaccinated, hens screened for infection and eggs put through a mind-bogglingly thorough washing and quality-control process.

Nichols said that he had traced BLD’s egg order and determined that the hens in one house possibly were the ones who had filled it. He took me inside. Standing there, among 3,200 cooing, clucking birds, I ran a theory by Dr. Gregg Cutler, the veterinarian who oversees Nichols’ flocks. Could a hen have somehow avoided vaccination or been resistant to it, and now was producing contaminated eggs?

“It would be a freak of nature,” Cutler said. During his six years of randomly screening Chino Valley’s birds, he had never seen evidence of hens laying bad eggs. The company’s eggs have never been linked to a salmonella outbreak.

He must have seen the disappointment in my face. “I’d love to hand you a smoking gun. But the only thing I know for sure,” he said, chuckling, “is that you’ll never know for sure.”

I guess it was then that I understood why I wanted an answer so badly. If I knew what had gone wrong, I could have at least dismissed it as bad luck. Instead, I was left with a reality that is much more unsettling.

At least 40 people are suspected to have been sickened from the hollandaise sauce at BLD that Sunday, making it one of the largest outbreaks of food-borne illness in Los Angeles this year. The Frasers, by all accounts, have tried their best to make a horrible situation better, cooperating with health officials and sending all customers’ medical costs and other expenses to their insurance company. (I declined the offer.)

Amy Knoll Fraser seems genuinely shaken by the experience. It has, she said, made her think seriously about quitting the business.

“It’s been a bitter pill. We spend so much time and work so hard to make people feel good when they are here. For this to happen, it’s been devastating.

“Quite frankly, I wouldn’t blame you if you never wanted to come back.”

Indeed, I thought about it.

But I missed the place. So on a recent Sunday I walked back in, smiled at the hostess and sat down at the bar. It was early, and the brunch rush had not yet begun.

“What can I get you?” the waiter asked.

“I’ll have the eggs Benedict.”

I ordered the eggs well-done. When they arrived, two dollops of hollandaise topped them, instead of the drenching they used to receive. I suspected Fraser was not happy with the artificial ingredients and ordered his cooks to use as little as possible.

I took a bite. It tasted, well, bland.

But it was nice to be back in that sun-lit room; the coffee tasted excellent, and that night I slept fearlessly.

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joel.rubin@latimes.com

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If you suspect you have been sickened by something you ate, contact your local department of public health. In L.A. County, call (888) 397-3993 or visit www.lapublichealth.org/acd/ FoodReporting.htm