With Teresa Barker
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Everybody knows that pestilences have a way of recurring in the world; yet somehow we find it hard to believe in ones that crash down on our heads from a blue sky. There have been as many plagues as wars in history; yet always plagues and wars take people equally by surprise.
—Albert Camus, The Plague
A Deadly Hitchhiker
We stopped looking for monsters under our bed
when we realized that they were inside us.
—Attributed to Charles Darwin
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 US 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 a hundred 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…
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 seem 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 were 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?”
A MENACING AIR
12 weeks earlier
November 23–27, 2015
It had all started out so ordinary. Well, ordinary for a couple of globetrotting scientists who go looking for trouble in the world of infectious diseases.
Egypt hadn’t seemed like a dangerous place to go when we’d started planning our dream vacation, but a month before we left, a plane was blown up near Sharm El Sheikh, Egypt’s famous beach community. A few weeks later, a series of orchestrated terrorist attacks in France shook Europe to its core, with blame cast on extremists in the Middle East and Northern Africa. The tourist industry in Egypt took a nosedive. By Tom’s logic, it was the perfect time to go.
Given the circumstances, I had suggested to Tom a few times that we cancel, but we’d both just launched several new research projects and were desperate for some downtime. Admittedly, our threshold for risk is a little higher than the average Joe. Our research on risk factors for HIV, sex work, and drug use routinely takes us to places where disease and street violence are everyday facts of life—and death—for many people. For thirty years before that, Tom’s field work in evolutionary biology had taken him to some of the most remote places on earth, where humans weren’t the favored species for survival.
As a “second time around” couple now married eleven years, our kids were grown. We were empty nesters with a passion for travel. We’d been to more than fifty countries between the two of us, frequently presenting our research at an international conference and then tacking on a few personal days for a getaway. Our adventures often included unexpected challenges. We’d fended off a rogue hippo from a dugout canoe on the Zambezi, and in India, glistening ribbons of leeches in Kerala and giant jumping spiders in Orissa. We’d narrowly missed a terrorist attack in Mumbai and a violent coup in Timbuktu, and encountered drug cartel henchmen and police on the take in our field research. We’d long since accepted that our work came with risks, and travel did, too. That was the fun part.
Tom, in particular, had a deep interest in ancient Egyptian history, art, and culture. He had wanted to do this trip so badly for so long, and we’d had to scuttle plans before. So our excitement at finally getting to go eclipsed any other considerations. But after the attacks on Sharm El Sheikh and Paris, even well-traveled friends had raised their eyebrows when we told them we were passing up their invitations of Thanksgiving dinner for the pyramids. My parents, who had flown in from Toronto to house-sit, were a tad more outspoken.
“Bad things come in threes,” my mother cautioned, as she finished chopping a fennel bulb for our dinner salad, paused to play Candy Crush Saga on her iPad, then resumed chef’s duty. “Hope number three doesn’t happen in Egypt,” she said ominously, motioning with the point of her knife to the CNN footage of the Paris attacks.
Spontaneity had always been a common denominator for us in our travels, and we liked to meet nature on its own terms. Eleven years earlier, Tom had proposed to me as we walked along the beach in Del Mar during the bioluminescent tide, when a particular species of phytoplankton glows blue-green as it’s roughed up in the surf. The shimmering ripple kissed the beach and made our footprints glow, a nice romantic touch. The thing is, this kind of bioluminescence is also a marker, a warning of sorts, of the bacteria that lurks invisibly below it, causing a toxic algae bloom known as the red tide. That pretty much summed up our life view as a couple: bask in the glow, and deal with what lurks below when the time comes. Work hard, play hard.
We were married later that year by our children in an offbeat civil ceremony at a beach house in Hawaii. At the time, Tom’s daughters, Carly and Frances, were twenty-one and seventeen, respectively. My son Cameron was twelve. I bought leis, grass skirts, and coconut shell bra tops for the girls. When Cameron pouted that he didn’t have a wedding outfit, I bought him a set, too. Back then, he’d sulked about his dad and me divorcing, and he seemed noncommittal about my plans to marry again. Thankfully, when we overheard his side of a phone conversation with a schoolmate, he’d said, “Yeah, I am going to have two sisters, but they’re cool; one even has dreadlocks!” Carly, who had yet to shear her shoulder-length dreadlocks, had become a mail-order minister through the Universal Life Church. When I teased her about it, I learned that Tom had been similarly ordained decades before in one of his repeated attempts to dodge the Vietnam War. As Carly presided over our wedding ceremony with Cameron and Frances standing solemnly on either side of us, hands clasped and grass skirts swaying, Tom and I clinked Champagne glasses. For a couple who, as individuals, had grown from humble origins and through hard times in a number of other ways, we felt we’d led a charmed life ever since.
That night, as we finished packing to leave for Egypt in the morning, I set out keys to the house and car; directions for tending the cat, the garden, the bird feeders, and the worm composter; and instructions to the remote controls for the TV. Then I did something I had never done before. At the last minute, I penned a single page of notes that began with the words “In the event of our death…” Tom rolled his eyes skyward, but he scribbled his signature on the bottom beside mine. I read it again once through and placed it neatly on the kitchen island alongside the car keys.
Taking the advice of friends, we’d found a respected Egyptologist to be our guide, trading our improvisational habit for a more intentional learning experience. An uneventful flight left us eager to start the day’s itinerary when we met Khalid the next morning. A lithe, petite man who looked to be around forty, Khalid wore khakis, a button-down plaid shirt, and worn but very well polished shoes. He approached us with an outstretched hand and a warm smile to welcome us to Cairo. Khalid had been a guide for several documentary crews and scholarly expeditions, and he would be ours for the next week through an ambitious itinerary of pyramids, temples, tombs, and other ancient sites.
Each morning Khalid picked us up and, as we drove into the desert or hiked through ruins, spoon-fed us a condensed version of thousands of years of Egyptology, archeology, and mythology. In his stories, he wove together tales of the kings and pharaohs, their tombs, and the pyramids in a lively narrative that merged bricks and mortar with ancient mysticism. So it was that each day we were immersed in a realm where the grand and ancient architecture and liturgy of death came alive for us, from mummies frozen in time to the fantastical hieroglyphics that told their tales—the graphic novels of their time.
On what was Thanksgiving Day back home, we toured several ancient ruins within a few hours from Cairo, Egypt’s modern-day capital and vibrant metropolis home to more than seven million people. Virtually all of these sites were what Egyptologists call a necropolis. In other words, mass burial graves.
Inside one museum, Khalid showed us hieroglyphics painted on a sarcophagus that outlined the process of mummification. They included multiple depictions of Anubis, who had the body of a man and the head of a jackal. Anubis was the Egyptian god of the dead, responsible for presiding over embalming and mummifying bodies, ushering souls to the afterlife, and protecting their graves from robbers and demons. Also depicted were intricate, oddly shaped tools for the task of preparing bodies for the next realm. Tom shuddered at the sight of them, never one for gruesome clinical detail, even when it’s five thousand years old. I found them fascinating.
“What’s that one for?” I asked Khalid, pointing to a strange little hook that a thousand-year-old dentist might wield to pull an errant tooth. Khalid looked up at us with a hint of a grin.
“That one’s for removing people’s brains,” he replied. “Through their nose. To preserve the skull. Without a preserved body, the ancient Egyptians believed there would be no home for the soul in the afterlife, and its ghost would be forced to haunt its family members.”
If the ancient Egyptians seemed to have been overly preoccupied with death and funeral preparation, it was because they believed the spirit faced a perilous journey to reach the afterlife and settle in for eternity. I could appreciate their desire for a smooth journey and their abundance of caution to ensure it. Tom might scoff at my thorough notes for house sitters, but as an evolutionary biologist he had to appreciate that it’s only human.
About an hour south of Cairo, we made our way to the royal desert necropolis of Dahshur and the Red Pyramid, the largest of three pyramids neighboring a military base. Because of its proximity to the base, the pyramid had been closed to tourists for many years, and even now was not always open. But we’d lucked out; it was open today and there was no one else in sight. Khalid said it was possible to crawl inside the tunnels for a close-up view. Ignoring the heat and swirling red dust, Tom and I raced to see who would be first to explore the pyramid. To reach the entrance we first had to climb several steep staircases that zigzagged up the face of the pyramid to a makeshift door, several hundred feet above the ground. Tom is nineteen years my senior, but you wouldn’t know that from looking at him. Tall, with broad shoulders and a natural athleticism, he’d always been fit—a diehard surfer undaunted by the risk of “going over the falls” in “wave architecture” with dubious descriptors like “gnarly” and “walled up.” From lanky youth to a sturdier middle age, Tom was always among the first to get into the water when storms or wild waves made retreat a reasonable option. He rarely considered retreat a reasonable option, period.
Using his long legs now to his advantage, Tom took the stairs two at a time and, despite having added a bit more heft to “sturdy” in recent years, was first to reach the small platform at the pyramid door. He gloated over me when I arrived a few minutes later, huffing and puffing. A lone watchman, an aging militiaman in worn army fatigues, crouched by the low entrance door, observing our arrival with cool interest. His head wrapped in a turban, with one hand he absently stroked his long white beard. In the other he clutched a battered AK-47, which lay lazily across his lap. I peered past him. Khalid hadn’t exaggerated when he’d said you can crawl inside. More precisely, you had to crawl to get inside. I took a deep breath, lowered my head, and stepped down the first few rungs, but that was enough. I scrambled up, and Tom gave a smug smile as he started a backward crawl downward into the pyramid.
“Do not breathe the air!” the watchman called down to Tom. Local lore had it that noxious gases lingered in the chambers. Tom scoffed. Poisonous gases? It sounded like a line fed to gullible tourists.
“Famous last words,” Tom hollered back. He quickly disappeared from view into the bowels of the Red Pyramid, the top of his silver-haired head no longer visible. I swallowed hard, and tried to shake a growing feeling of dread. Despite the heat, I shivered. The guard’s leering presence made me uncomfortable. I turned to face the desert, scanning the dunes for Khalid. He was a black dot on the horizon. I bellowed down the chute at Tom. “Hurry up!”
Tom finally emerged, panting, covered with sweat and red dust, his face a little ashen. I handed him a bottle of water from my pack.
“Let’s get out of here,” I said, tugging his shirtsleeve. Another tomb awaited.
A short drive from Dahshur was Saqqara, the main necropolis for the ancient Egyptian capital of Memphis and onward for over three thousand years, well into the Roman Empire. Tom was still looking a little bushed from our last hike when we arrived at the Step Pyramid. He wandered out among the alabaster benches that lined a catacomb of tombs, closed his eyes, and took a deep breath. I could see that his brow was now coated in sweat and he was breathing more heavily, as if we were climbing a mountain.
He waved off my concern.
“There’s just something about this place,” he murmured absently. “It’s strangely familiar.” We both knew he had never been to Egypt before, and Tom was skeptical about reincarnation.
“Maybe just creepy,” I said.
Khalid caught up with us and resumed his informative lecture as we walked through the ruins of the necropolis; below us were the catacombs, the subterranean crypts, with mummies and the king’s chambers. During the king’s rule, no effort was spared to keep his larder and spirit stoked, to protect his ka, or his energy, his inner power. If his ka weakened, Khalid explained, he could be deposed by enemies. Saqqara had also been an important destination for Egyptian pilgrims who belonged to several different sects. Recent excavation had uncovered almost eight million animal mummies, including dogs, cats, baboons, falcons, and ibis.
A glimmer of interest broke the pall on Tom’s face.
“Hey, Dr. Doolittle,” I quipped, using one of my favorite nicknames for him. “Maybe you wrapped animal mummies in another life.”
From the time Tom was young, he’d shown a special affinity for animals. He considered this a natural inheritance from his great-grandfather, who was supposedly Cherokee. In Tom, it developed into a passionate vocation, and later a scholarly one, as he first pursued research and training as a primatologist, publishing studies on the psychology and memory of lowland gorillas. Later, he became an ornithologist, studying how the dialects of white-crowned sparrows had evolved differently from one part of San Francisco to another, publishing his dissertation paper in one of the world’s top journals, Science. He liked to tell people that he later worked his way down the evolutionary ladder to study humans. When we went on our usual walk at the local lagoon, Tom was more likely to say hello to other people’s dogs than their owners.
Eventually his career evolved to focus on long-form history—the evolutionary origins of behavior. He took the very, very long view of the natural world and how we—and all creatures great and small—evolve to adapt to a changing environment. Or perish. It’s our ability to adapt in response to the stressors around us that helps us cope and survive. With that long view as his preferred one, Tom considered the world not in terms of days, months, or even years, but in millennia. He’d point to the topknot of some obscure bird species in Africa relative to a comparable one in Asia, musing aloud how they reflected “convergent evolution,” the way different species develop analogous traits as they adapt to similar environments. Rather than feel sorry for himself if he got the flu or even when he was infected with a voracious parasite he picked up in the Colombian rainforest, he’d marvel at the biological brilliance that enables an organism to outwit challenges to its survival, and the adaptive value of surviving it. He was annoyingly quick to remind me of the evolutionary bright side: “What doesn’t kill you, actually does make you stronger.”
That afternoon at Saqqara, Tom was evolving right before my eyes. Within seconds, he seemed a thousand years older, his face pale and drawn. His ka was definitely weak. Even so, he remained intent on exploring the underworld of the ancient necropolis. Khalid and I had to tear him away.
“Just the heat,” he said. By morning he seemed rested and ready to go again. We forged ahead by car, camel, and air and on foot, with Khalid in the lead, to see the temples of Ramesses II and Nefertari, and the Aswan Dam. Finally, we boarded the MS Mayfair, a cruise ship that would take us to Luxor for the grand finale: the Valley of the Kings. The ship accommodated 155 people and ordinarily would have been fully booked this time of year. But the recent terrorist scares and drop in tourism had left it eerily vacant. We didn’t mind. We’d looked forward to some special downtime together, and an empty cruise ship certainly promised that.
As we’d learned from Khalid, Egyptian mythology held that at the end of each day, Ra, the sun god, descended into the underworld on his solar boat, where he encountered demons and gods who opposed him, such as Apep, often called Apophys, the god of chaos. Apophys would partially swallow Ra, leading to the setting of the sun each night, and would spit him back out at dawn. We’d had it easier, returning to our cozy accommodations each evening and updating our friends and family on Facebook before calling it quits.
When our ship anchored in Luxor the next day, there were several other ships but not enough docks. Our crew tied the Mayfair to a ship that had already moored, which in turn had tied itself to another, and so on. Hand in hand, Tom and I traversed three ships to get to shore so that Khalid could take us to visit the Luxor and Karnak temples. We returned to the ship at dusk for a romantic dinner on the top deck under the stars—a towering platter of seafood paella and a bottle of wine that I had saved for the occasion. In the days and weeks ahead, I would come to refer to our feast under the night sky as the Last Supper.
THE LAST SUPPER
November 28, 2015
We hadn’t planned on having the ship to ourselves, nor could we have known the evening would be so spectacularly beautiful on that upper deck, under the blanket of stars and the warm, velvet breeze. But we had planned on a special dinner, and I’d packed the special bottle of Chardonnay from home and asked the ship’s chef if they could chill it to go with our meal. We were celebrating the last night of this dream vacation, after all. Plus, it was the anniversary of our first date fourteen years before, and, as is my habit, I rarely left anything to chance. Organization, focus, and follow-through are the Day-Glo genes in my DNA. Tom was an amused but graceful beneficiary. If his “never retreat” ethos was a signature trait, then mine was “never give up.” It had steeled me through a childhood as a brainy, bullied kid, and earned me the nickname Pit Bull in my early academic career.
Tom sometimes chafed at my dogged persistence and attention to detail over things that he might have preferred to put off for another day. But he also mused, affectionately at times like this, how the forces of nature and nurture that were so different for each of us could have forged the likes of us as a couple. Tom had grown up something of an Oliver Twist in 1950s Southern California. I’d grown up in the seventies white-bread middle-class Toronto suburb of Scarborough, with two sisters and a mother and father who provided for us in all the ordinary ways a kid can take for granted. Our job was to study hard and get good grades.
My dad was a high school science teacher who later took on mentoring gifted kids, and I guess he’d practiced on me from the start. I was the nerdy girl who took even that a step beyond the norm. 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. With a high-octane brain for academics but low-res skills for connecting with kids my own age, I was forever on the fringes socially, but had a couple of girlfriends who shared similar interests. Meanwhile, my dad tutored me painstakingly in physics and math, showing me techniques for testing a hypothesis to determine the “knowns” from the “unknowns”—the analytical heart of scientific enquiry. I was required to study two hours after dinner, and my sisters and I were only allowed one hour of TV per week. When I told my dad that I’d decided I wanted to be a scientist, he thought it was because I was trying to follow in his footsteps, but the truth was I wanted to prove to myself that I could do something really challenging. Once I discovered a passion for problem-solving science puzzles, I’d found my path.
Amazon, "Best Books of 2019 (Science)"Goodreads Choice Awards, Semifinalist (Science & Technology)STAT News, "Best Health and Science Books to Read This Summer"
- "A fascinating and terrifying peek into the devastating outcomes of antibiotic misuse -- and what happens when standard health care falls short."—Scientific American
- "[A] gripping and intriguing medical thriller...This page-turner of a couple's determination to survive also serves as a dire warning regarding the consequences of the overuse of antibiotics."—Publishers Weekly (starred review)
- "A thriller, a detective story, and at its core a profound romance, The Perfect Predator is [a] breathtaking story.... It's a warning of the havoc that awaits us as antibiotics lose their power, and a glimpse of the science that could hold that dark future at bay - if we can summon the funding and the political will to create it."—Maryn McKenna, Senior Fellow of the Schuster Institute for Investigative Journalism at Brandeis University and author of Big Chicken and Superbug
- "At once terrifying and inspiring, The Perfect Predator is a brilliant race-against-the-clock medical thriller that is also a celebration of love, commitment, and the power of scientific collaboration."—Steven Johnson, New York Times bestselling author of Where Good Ideas Come From and The Ghost Map
- "A remarkable story of love, resilience, the science of discovery, and quite possibly the future of medicine."—Richard Horton, FRCP, FMedSci, Editor-in-Chief, The Lancet
- "One of the single most compelling personal stories we've ever heard."—Arielle Eckstut and David Henry Sterry, authors of The Essential Guide to Getting yourBook Published
- "A real-life medical thriller...fast paced [and] the writing is always infused with humor, hope, and intelligence, and the couple's remarkable story is grounded in real-life details that bring readers directly into their world. Dark, surreal poetic."—Kirkus Reviews
- "The Perfect Predator is a compelling and heart-wrenching medical drama that would be completely unbelievable - if it weren't 100% true! Strathdee and Patterson masterfully weave together the personal, medical, and scientific strands of their battle against one of the world's worst superbugs, bringing not just Patterson, but a century-old medical technology back from the brink of death. This first-hand account of the front lines of the battle against the scourge of antimicrobial resistance underscores the human cost underlying the bland statistics."—Rob Knight, PhD, Director, Center for Microbiome Innovation, University of California San Diego and author of Follow Your Gut and Dirt Is Good
- "[A] riveting tale...The saga reads like a thriller....Remarkable passages from Patterson [describe] how he interpreted events through veils of feverish delirium, pain-killer fog, and coma."—Laurie Garrett, The Lancet
- "The story of a woman fighting for her husband's life is interesting in and of itself, but this book is so much more than that. It was written by a scientist who used her public health training to discover a solution to a problem; it just so happens that the solution she found may be an answer to one of the most urgent health problems in the world."—American Journal of Public Health
- "[A] real page-turner."—Science News
- "I simply could not put down the book. It reads like a fast-paced, detective thriller."—Madhukar Pai, MD, PhD, Professor and Canada Research Chair in Epidemiology & Global Health, McGill University, Montreal
- "[A] medical thriller for the antibiotic-resistant age."—Smithsonian
- "[Tom's case is a] case that may mark a turning point in medicine."—American Association of Medical Colleges Newsletter
- "A riveting, pulse-pounding medical thriller that just happens to be true. Steffanie Strathdee is expert at weaving science into compulsively readable prose."—Tess Gerritsen, New York Times bestselling author of THE SHAPE OFNIGHT
- "...A memoir that reads like a thriller."—New York Times Book Review
- "If you're looking for a gift for a young person currently considering a career in science or medicine, this is the book to buy."—AJTMH journal
- "The Perfect Predator may be the best and most important book I've ever read... [A] personal and moving odyssey."—Louis R. Franzini, The Florida-Times Union
- On Sale
- Feb 26, 2019
- Page Count
- 352 pages
- Hachette Books