A Life-Saving Medical Treatment, Both Cutting-Edge and Historical, Succeeds Where All Else Failed

Book review: The Perfect Predator, by Steffanie Strathdee and Thomas Patterson (Amazon / Book Depository)

In November 2015, globetrotting epidemiologist Steffanie Strathdee was on vacation with her husband, psychologist and psychiatry professor Tom Patterson, exploring pyramids in Egypt when Tom fell suddenly and violently ill. They initially suspected food poisoning, but it quickly became clear that something more sinister was at work.

In a Luxor clinic, Tom’s situation worsened, eventually leading to a Medevac flight to Frankfurt’s Uniklinik. There, doctors diagnosed a dreaded antibiotic-resistant superbug, Acinetobacter baumannii, nicknamed Iraqibacter for its prevalence in military clinics during the Iraq War. His condition included gallstone pancreatitis and a football-sized pseudocyst filled with Iraqibacter. In one of several instances of the worst case scenario happening in this terrifying story, a drain later spilled, leaving Tom’s body completely colonized with the lethal, resistant bacteria.

What followed were nine months of hospitalization and a “Russian roulette” of choices as doctors in California struggled unsuccessfully to treat the bacteria, constantly fighting against the ensuing medical complications. Strathdee, panicked and overwhelmed, managed to go into scientist-mode and began poring through medical publication databases looking for alternatives as every option failed and Tom got sicker.

We’ve put people on the moon and developed technology that can take your gall bladder out through your mouth. How could the best doctors and the best medicine at one of the top medical centers in the world be coming up short?

This led her to bacteriophage therapy, a branch of medicine popular in Eastern Europe but not widely accepted beyond a few major clinics in Georgia (that of Stalin, not of peaches) and Poland. Phages are viruses that prey on bacteria but are harmless to human hosts. Their use has been hindered over the years by various blocks – political, social, medical – but some dedicated researchers have been pushing for their comeback in our current alarming age of growing antibiotic resistance. As Strathdee and Patterson learned the hard way, when antibiotics fail and a person’s body is succumbing to untreatable infection, alternatives are limited or nonexistent.

Under these conditions, Strathdee and a team of supportive medical colleagues and global phage researchers, including from the Navy’s own labs, were able to attain compassionate approval from the FDA to try a last resort of setting loose the “perfect predator” in Tom’s system. It was a race against the clock as his body systematically shut down and major organ failure occurred. The position Strathdee found herself in, as Patterson was comatose by this point, is harrowing. She had hope for this final measure, but the effects and outcome were difficult to ascertain without enough research dedicated to phage therapy. Either way, Tom was dying, so there was nothing to lose by taking the chance.

He survived, certainly against the odds, and this amazing story of a medical marvel ends up fairly tear-jerking. In addition to being a fantastic story of science and medicine at work, the workings of a therapy strangely both cutting-edge and historical, and a push for willingness to innovate as antibiotic therapy becomes increasingly problematic, it’s also a powerful love story. Strathdee describes how these long months felt to her, the decisions she was forced to make with no right answer and the overwhelming fear that entailed, and it’s crushing.

But it’s also touching to see two people so connected and well matched, and the dedication with which she threw herself into researching and advocating for Tom. It’s likewise inspiring that so many people, total strangers from around the US and the world, were willing to offer their research and phages. An additional complication is that not all phages are effective for every type of bacteria, so even finding and preparing the correct ones is a complex, multifaceted process.

Strathdee’s voice is the primary one here, but interspersed throughout are interludes from Tom, as he recalls hallucinations and memories. It creates a full, if chilling, picture of what their experience with A. baumannii and the final-hour, life-saving treatment were like.

Strathdee, despite being a scientist, has a clear and readable writing style that makes the science and medicine of this completely accessible for the layperson. But she doesn’t talk down to her reader or cut corners on the science and medical topics, filling it with the history of phages and why their use never became widespread, with detailed contextual data and background to explain Tom’s case and its historical role. Even in describing their hospital experiences, it’s always enlightening and easy to follow while still informative. You may not always like what you learn (sometimes I was squirming), but Strathdee is intelligent and thorough in her telling, creating unputdownable reading.

Despite the stress of these events, the uncertainties, and the mountains of red tape in multiple countries, there’s also something admirable in Strathdee’s conduct. She includes the small kindnesses or moments that reassured her and gave her tiny pushes to keep going, and even in the most fraught of circumstances she kept this remarkably positive, persevering attitude.

As she struggled to navigate the bureaucracy of their travel health insurance from a makeshift clinic in Egypt, spending hours looking for a hotel with scanner and fax machines, instead of griping (as I would) she observes, “Every obstacle or inconvenience reminded me how resourceful the local people had to be, day in and day out.” I felt humbled by this book in a lot of ways.

She writes that they’re giving back to the world health community who helped them and to future patients who could benefit, among their methods by writing the book to spread information about the possibilities offered by phage therapy and by starting a new bacteriophage therapy center at UC San Diego, the first of its kind in North America.

There is no new family of antibiotics on the horizon that promises to rescue us as penicillin once did. However, there is precedent for innovative breakthroughs in science and medicine when disasters strike and our backs are up against the wall. The urgency of war led to a number of medical advances in World War II, penicillin topping the list. If not for the mounting pressure to find a cure for battlefield wounds, would penicillin have been tested and scaled up at the time? When the pressure is on and conventional methods fail, alternatives get more serious attention, and that is often how old ideas get recycled, new discoveries are made, and new cures are developed.

Scary but illuminating and fascinating page-turner of a medical mystery turned miracle, shedding light on the revival of promising options in medical treatment.

The Perfect Predator:
A Scientist’s Race to Save Her Husband from a Deadly Superbug
by Steffanie Strathdee and Thomas Patterson
published February 26, 2019 by Hachette

I received an advance copy courtesy of the publisher for unbiased review.

Amazon / Book Depository