University of California–San Diego
Thornton Hospital, La Jolla
February 15, 2016
I never dreamed I’d be outwitted by a wimpy bacterium. I’d tracked a killer virus across multiple continents to wage the war against AIDS, through the trenches and at the table with policymakers at a global level. Viruses were to be feared. Bacteria? Not so much. At least not this one. I’m an infectious disease epidemiologist, director of a global health institute at a major United States university, and, of all people, I should have been able to protect my husband from a bacterium I’d last seen in my undergrad days, when we’d handled it without concern in basic lab experiments. If someone had told me that one day this microbial mutant would have us on death watch and I’d soon be injecting my husband with a legion of killer viruses to try to save him, I would have thought they’d lost their marbles. And yet, here we are.
The holidays — Thanksgiving, Christmas, New Year’s, and Valentine’s Day — have passed in a blur. Tom is hardly recognizable beneath the web of IVs, monitor cables, drains, tubes, and other medical paraphernalia. His once thick silver hair, which stylists swooned over, has fallen out in clumps, and the skin on his feet and hands is peeling off in layers. He has lost more than 100 pounds from his six-foot-five-inch frame. We have not lost hope, and, on this day, like every day, we are strategizing how to beat this thing. But at this moment I am doing it on my own. Tom is lapsing in and out of consciousness, an improvement over the coma, but still ...
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The tone of the clinical conversation among the specialists and other medical staff around Tom has changed in some subtle way. It’s hard to nail down. His labs and vital signs fluctuate as they have for three months now, so it’s not that. It’s something between the lines, something they’re not saying, that I’m unable to decipher. Since our lives went from bliss to hell in a handbasket, it’s been all I could do to learn enough about anatomy and medicine just to keep up with their conversation. I’m a researcher, not a doctor, but even I know something about bedside manner. And theirs has shifted.
Now, the doctors and nurses speak in hushed tones and some seem afraid to look at me. In short snippets, between running exchanges with doctors and hospital staff, I turn to the internet, where I enter phrases like “alternate treatments” and “multi-drug-resistant bacteria” into PubMed, a search engine beloved by scientists. Ordinarily, my online searches are specific and hyperfocused because I usually know what I am looking for — like “prevention” and “HIV transmission” and “injection drug use.” But right now, I’m not so much an epidemiologist as I am the wife of a very sick man. I’m not sure what the operative questions should be or what a useful answer might look like. And what’s freaking me out is that none of the docs treating Tom seems to know either.
What’s obvious at first glance in the scientific literature just confirms what we already know: Tom is up against, as one study says, “a difficult‑to‑treat pathogen whose antibiotic resistance patterns result in significant challenges for the clinician.” No shit, Sherlock. What we’ve got here is one of the most lethal bacteria known to humankind, a “superbug,” that has mutated to resist all existing antibiotics. Recent advances in exploratory research on how to fight this superbug have all been experimental, meaning that there was insufficient data to prove that they worked, so none was approved for general use, leaving Tom’s docs at a dead end in their hunt for approved treatment options. Among novel ideas out there was an approach I vaguely remember studying briefly as an undergrad — the use of viruses that prey on bacteria — but that idea appears to be nothing more than a footnote in the margins of modern medicine.
Tom lies motionless, the steady hum and beeps of monitors the only sign of life, and I try to distract myself, emailing our graduate students about their latest papers from the corner of his room. In my busy mode, trying to keep at least a nominal tether to the real world, I dial in to a conference call to join my senior colleagues on a university retreat in San Francisco. I was supposed to be there, too. But in the months since the war against pandemics took a personal turn, everyone we know has heard what Tom and I are up against and where we’re holed up. Several of my colleagues ask how Tom is doing. I give them the latest rundown before telling them that I have to ring off. We say our goodbyes, and, as I get ready to hang up, the chair of the meeting, a retired surgeon and former university chancellor, asks a question quietly to my colleagues, thinking I’m no longer on the phone.
“Has anyone told Steff that her husband is going to die?”
Excerpted from The Perfect Predator by Steffanie Strathdee and Thomas Patterson, published on February 26, 2019 by Hachette Books, a division of Hachette Book Group. Copyright 2019 Steffanie Strathdee and Thomas Patterson. Visit theperfectpredator.com.