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September 20 - October 5, 2023
It’s something between the lines, something they’re not saying, that I’m unable to decipher.
Tom is up against, as one study says, “a difficult-to-treat pathogen whose antibiotic resistance patterns result in significant challenges for the clinician.”
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.
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?”
We’d long since accepted that our work came with risks, and travel did, too. That was the fun part.
He was annoyingly quick to remind me of the evolutionary bright side: “What doesn’t kill you, actually does make you stronger.”
In the days and weeks ahead, I would come to refer to our feast under the night sky as the Last Supper.
I rarely left anything to chance. Organization, focus, and follow-through are the Day-Glo genes in my DNA.
He was one of the first people in the field to develop a risk-reduction program for people who were already HIV-positive—recognizing that people needed skills to help prevent them from passing the infection on to others.
But having a PhD without an MD meant that sometimes I knew just enough about medicine to get me into trouble.
Epidemiology was the big-picture, bird’s-eye lens needed to develop strategic action to help people.
During that same period, I learned how, even as scientists, our intuitions can help us.
My finding became part of a budding body of research that showed that social determinants—including the driving forces in our economics, politics, and laws—helped explain the marginalization and stigma in these key populations, increasing their vulnerability to HIV.
Beyond that recognition was the power of the lesson I’d learned as a young scientist and practiced ever since: listen to your intuitive hunches, don’t let the unknowns limit your search, and approach all possibilities with an open mind and rigorous research.
The chorus in my head was always: By this time tomorrow, he’ll be laughing at me for being a worrywart.
Who knew that there are 100 million times as many bacteria in the oceans as there are stars in the universe?
By my thinking, once you know what a problem is, you can figure out how to solve it, right?
The biomarker CRP—C-reactive protein—which is a sign of inflammation, was much higher than normal. In this crash course in medicalese, the vocabulary was spelling trouble.
It happened to be one of my favorite stories in the history of science: how Fleming made the landmark discovery that would transform how bacterial infections would be treated in the twentieth century and forever, the world over.
Moving through the food chain from livestock to farm workers, meat, and then consumers, antibiotic-resistant bacteria shared their resistance genes with other bacteria everywhere along the way.
Tom had often described how the mind works to make sense of sensory input—what we see or hear, for instance—but may also filter our perceptions through implicit biases of our own making.
It’s surprising how much stuff you realize you don’t need when the only carry-on you really care about is the irreplaceable man on the gurney.
Every obstacle or inconvenience reminded me how resourceful the local people had to be, day in and day out.
The world can collapse around you, but you can survive, they tell me. Resilience is the sad, strong legacy you carry in your bones, they say.
Where does it reside, exactly, in my DNA? I need to ask Steff. I can feel the world collapsing now, from the inside out.
“Dr. Patterson, you have acute pancreatitis with the complication of a pseudocyst in your abdomen. The cyst is an abscess approximately fifteen centimeters in diameter, which is about the size of a football.
“We suspect that you may have a gallstone, which created the cyst. You also have a good deal of ascites in your abdomen—fluid caused by inflammation.
The pseudocyst size and contents suggested that it had been there for at least a month.
The pseudocyst was “super-infected” with at least one kind of microbe, he told us. They couldn’t be sure what it was until the lab results were back in a few days.
“Steff, the only reason Tom is still alive is because you got him medevacked out of Egypt.
Tom is in great hands, but he needs you to be his advocate. That’s your job now. That’s what anyone in his situation needs.
“We are hoping Dr. Patterson will recover from septic shock. He also has metabolic acidosis, due to an excess of carbon dioxide in his blood, which is why he is receiving oxygen. As for the mortality rate—it is much higher than that, I’m afraid.”
“Your husband’s condition is grave. With these sorts of complications, mortality is at least 80 percent.
“You are fighting for your life,” I told him. “Robert says it isn’t your time, but if you want to live, you are going to need to give it all you’ve got.”
Tom threw up projectile vomit halfway across the room. It was black and viscous matter like nothing I’d ever seen. And it was everywhere.
“I regret to tell you that our microbiology lab has now cultured the sample from the pseudocyst that was collected during the procedure the other day,” Dr. Zeuzem told us.
“The pseudocyst is infected with the worst bacteria on the planet. Acinetobacter baumannii. This microbe has been responsible for the closure of several ICUs across Europe in recent months. It is the worst news we could have had.”
A few months later, it would achieve the number one ranking on the World Health Organization’s list of the world’s twelve most deadly superbugs. The dirty dozen.
Given that you were in Egypt, it is likely that you acquired this pathogen there, which is worrisome. Egyptian strains tend to be highly resistant.”
A. baumannii is nicknamed Iraqibacter, because more than three thousand wounded American and European soldiers and military contractors were diagnosed with it upon their return from fighting in the Middle East between 2003,
when the bacteria was first identified, and 2009, the last time the Department of Defense made statistics public.
Of a list of fifteen antibiotics, all but three were marked R, which meant that Tom’s isolate was resistant to them.
“Didn’t Dr. Zeuzem explain to you that this is the worst bacteria on the planet?”
“Please, don’t come any closer. Just—just turn around and go back.
If these bacteria spread, it will ki...
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In sepsis, the immune system overreacts to an infection by launching inflammatory responses throughout the body.
Then it throws the whole system into reverse with an extreme anti-inflammatory response, which creates the chaos that can trigger organ failure, tissue damage, and a steep drop in blood pressure that can kill you.
I was to watch for fever, intense shivering called rigors, clammy or mottled skin, a spike in the heart rate, shortness of breath, a sharp drop in blood pressure, mental confusion, or sudden changes in urine output.
“If Candida escapes and enters Tom’s bloodstream, it, too, can be fatal.”
