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Imagine loving your husband so much that you had billions of viruses injected into his body.
You heard me right. Viruses.
No, I’m not talking about HIV, Ebola, or influenza. Or viruses that cause measles or the common cold. I’m talking about bacteriophages, also known as phages, which are viruses that prey upon bacteria and destroy them. These microscopic viruses were my last hope to wipe out the bacterial infection that was eating my husband alive.
If a cure for Tom’s infection wasn’t to be found in modern medicine’s arsenal, it was time to look elsewhere.
Tom and I had been fighting viruses for decades, first as individual scientists and then as a married couple. As AIDS researchers, we both considered viruses the enemy. But now that Tom was comatose — fighting a superbug called Acinetobacter baumannii that had struck him down three months earlier while we were on vacation — viruses emerged as our lone allies in this fight to the death.
I stumbled across the idea of phage therapy soon after the doctors told me there was nothing more they could do for Tom. I’d gone home to feed the cats and planted myself on the sofa with a bottle of wine and my laptop. As an old friend once said, “If you can’t find something where it’s supposed to be, you have to look where it’s not supposed to be.” If a cure for Tom’s infection wasn’t to be found in modern medicine’s arsenal, it was time to look elsewhere.
With Sir Isaac Newton, our Maine coon cat, curled up at my side, I turned on the Apple TV and watched a screensaver of photos of Tom and me traveling through the years. A “second time around” couple, now married 11 years, with grown kids and an empty nest, we’d traveled to more than 50 countries to present our research at scientific conferences and then abscond for personal time to our preferred habitat: nature.
Our shared devotion to science and exploring the natural world on its own terms made for some dicey itineraries. At the Zambezi River, a rogue hippo nearly capsized our dugout canoe. In Borneo, I pried tiger leeches off Tom’s back after a day of tracking orangutans. In Orissa, giant jumping spiders the size of my hand beckoned to us.
In the infinite universe of possibilities, as romantic origin stories go, we’d found each other through the wormhole of science. Tom, the evolutionary biologist and experimental psychologist, and me, the epidemiologist, had been on parallel paths in HIV research for years. One day, those paths magically converged. We would laugh later about what attracted us to one another. I took my cue from an ex-girlfriend of Tom’s, who happened to be a gorilla. Over a glass of wine on our first date, Tom told me that in the late 1970s, he was a graduate student studying Dolly, a lowland gorilla who lived at the San Diego Zoo. He was a bona fide hippie back then, with a full beard and long hair. Each day, he would sit in an examination room adjacent to Dolly’s pen and slide plastic shapes through a slot in the bulletproof glass that separated them. He was supposed to record how fast Dolly could push the shapes through matching holes, but soon, she was the one testing him.
One day, when Tom entered the exam room, he realized that Dolly had pressed her bottom against the exam-room glass, presenting herself to him because she was in estrus. As she continued to gaze lovingly over her shoulder at Tom, her mate, a silverback gorilla in the pen, named Trib, went ape. A zookeeper finally intervened before Trib could break through; gorilla testing was definitely over for the day.
When Tom returned several days later, he saw that Dolly had pushed raisins and nuts through the slot in the glass as token gifts, willing him to return. Trib, increasingly frustrated and furious, caused so much of a commotion that the zookeeper finally told Tom to leave and never come back.
When I heard the story for the first time, I wondered, could I love a man who came recommended by a gorilla? My heart said maybe.
Tom’s sense of humor had also won me over, perhaps because I didn’t have one. Seriously. Today I’d be described as a little “on the spectrum” — a euphemism for Asperger’s syndrome, though I’ve never had a formal diagnosis. It had always been hard for me to decode humor — my brain tends to process everything literally. In a group, when someone told a story that would make people chuckle, I wouldn’t get it. I once read a book by Temple Grandin, a famous professor of animal science who has autism. She confided that she was always considered a boring speaker until she learned to take a joke out of a box inside her brain and integrate it into her lecture. I realized I wasn’t the only one! Since Tom was a notorious prankster, I made him my study subject. Tom claimed to have manually trained the junipers in the garden to twist, for instance. The day I found out they grew that way naturally was the day I finally began to develop a sense of humor.
The last three months at Tom’s bedside in the intensive care unit had taught me that humor can also be an intimate language. Before Tom had lapsed into his coma, he was delusional and often didn’t recognize me. Out of desperation, I drew the curtains and took a cue from the gorilla Dolly’s playbook. I flashed him.
“If I wasn’t your wife, would I be doing this?!” I yelled, baring my chest at him. The shocked look on Tom’s face told me that whoever I was, I was stark raving mad.
If necessity is the mother of invention, I was about to become even more of a mad scientist. So with Newt by my side and PubMed on my browser (the scientist’s version of Google), I stepped into the more familiar role of researcher and epidemiologist. I was a disease detective looking for an unconventional way to fight the superbug that was killing Tom.
Eventually I found data on bacteriophages, viruses that evolved as natural predators of bacteria. Phages are the oldest and most ubiquitous organism on the planet. The estimated 1 million trillion trillion phages are found just about anywhere: soil, water, and in our bodies. Since phages are very finicky and only attack the bacteria they “match” to, the trick is finding the phages that are the perfect predator for the bacteria you’re trying to kill. It sounds crazy, but sewage treatment facilities are some of the best places to go on a phage hunt, because they’re teeming with bacteria and phages. The internet revealed a network of phage researchers, some of whom volunteered to turn an experimental mash of phages derived from sewage into a microbial cocktail to be administered intravenously, where it would hopefully attack Tom’s systemic bacterial infection in time to save his life. The downside was that phage therapy was considered experimental in North America. The Food and Drug Administration allowed it to be used only in emergency situations where the patient was dying. But that was our situation.
In calmer, healthier days, Tom and I often seriously pondered whether we’d risk our lives for a scientific gain that could help others. The details in those what-if scenarios changed over the years, but the answer was always the same. Science always won. Suddenly the what-if was when: That day was upon us.
The morning of Tom’s therapy, I awoke to see a pair of Bullock’s orioles on the blood orange tree that Tom had planted eight years ago. They migrate each winter, and Tom and I always looked forward to their return each spring, when they would nest in the palm trees behind our back yard. They were back — it felt like a hopeful sign. So was the fact that no one had called from the hospital during the night to say Tom had died.
Later that morning, Tom’s doctor handed me papers to sign, authorizing him to administer the phages, acknowledging that it was an experiment and agreeing that if Tom died, I wouldn’t hold anyone liable. Of course I wouldn’t. But that wasn’t the question that was terrifying me now.
If Tom died of septic shock, would it be because this was an unconventional treatment I had sought out and initiated? What if I killed him? How could his daughters — my stepdaughters — forgive me? Would I ever be able to forgive myself? I was confident that he’d rather try and fail than die without trying. But over the past several months, as Tom descended into delirium and then coma, we weren’t sharing the same reality anymore. The jarring change from living as a carefree and loving couple to living in a frightening Twilight Zone had left us both very much alone.
Could I risk killing Tom in an effort to save him?
Science spoke. My heart said yes. And he survived to tell the tale.
Steffanie Strathdee, PhD, is associate dean of global health sciences and co-director of the Center for Innovative Phage Applications and Therapeutics at the University of California, San Diego. Together with her husband, Thomas Patterson, she co-authored The Perfect Predator: A Scientist’s Race to Save Her Husband From a Deadly Superbug, published by Hachette Books.