Love is a Frond
with Bull fiddle head
crushed still curled
by a hiker’s boot
to spring up again
from the very same root
Love is a tadpole
a fat black drop,
a squiggly tailed thing
squirming to apogee
to be bleeping king
of the green algae
Too small and foul
for the grand and the wise,
love’s found all over
in slimy disguise
by fortified mosses
and amused eyes
-Sebastian L. Domenico 1978
Weather’s heavy hand has shaped the course of history. It facilitated the fall of Rome, sunk the Titanic, and was Hitler’s demise in Russia. It has leveled entire civilizations, left millions homeless, and dashed all hope in its senseless fury.
Global warming only made things worse. Extreme weather was setting new records, especially in the Northeast. It wasn’t quite even Summer, and the heat was unbearable. The grid was stressed beyond capacity, leaving millions without power and desperate for relief. Just a few months earlier, Long Island was in the grips of a bitter cold, which was all now an afterthought.
Meanwhile, a far more menacing danger was at foot. Something dark and deadly was making its way around Brookstone Hospital, Long Island’s premier medical center. Some of the most exotic and dangerous diseases were studied at Brookstone. Today it would create one of its own.
In the incessant heat, a soldier of death descended upon the hospital. It started in the neonatal intensive care unit (NICU), among the most defenseless. Without mature immune defenses, these kids were sitting ducks. Something ungodly was spreading through the nursery, leaving no baby safe. The scene went chaotic as nurses and doctors flitted about, administering meds. Surrounded by expensive, useless equipment and helpless attendants, the incubated preemies lay deep in the shadow of death.
A crowd of anxious parents looked on in horror through the glass enclosures. An acclaimed pediatric staff was now beside itself. Even the head nurse foundered while resuscitating a boy no bigger than her outspread hands. Antibiotics were ineffective. All treatments proved useless, as the mysterious disease cut rapidly through the living. Unfortunately, it was just getting started.
“Chief! What’s up?”
“Can you to join us on rounds today? Some wild epidemic is winding its way through the hospital. We’d like your expertise.”
Buried deep in study at the lab, Dr. Evo Lucio was unaware of the dark cloud hovering over Brookstone. Rarely was he called in to the clinic. His usual patient contact was with body secretions and tissue specimens, so this was out of the norm.
“Which ward is having problems?”
“All of them,” Dr. Nigel Wally blurted. The NICU’s a graveyard, there’s a plague in the Burn Ward, and a necrotic pneumonia struck the VA hospital; not to mention a surge of nasty urinary tract infections in Geriatrics.”
Evo’s thoughts went out to the good nurses who ran those wards. Brookstone boasted a Burn Unit second to none. The NICU was also highly regarded. There was no better place to have a baby than at Brookstone…but not today.
The University also took pride in its Infectious Disease Division, headed by Dr. Wally. Dr. Lucio ran the ID Research Lab.
“Have they determined the cause?”
“Not yet,” Wally answered. “That’s why we called you.”
“I gathered so,” Evo responded. His tall stature, graying temples and conspicuous good looks added to his credibility. He could have played a doctor on T.V., if so inclined. Rather, he was merely a scientist, who knew his place, as well as his deadly pathogens.
“So? What are we waiting for? Let’s do it!”
“I’ll be there shortly!” Evo slipped his phone into his back pocket, closed down his office computer system, and hurried toward the exit. His path took him through the lab, where he and his students studied germs and parasites. He had spent decades there, focused on solving medicine’s most urgent needs. Evo’s expertise was in biofilm–or biological film–a fancy name for slime.
According to the NIH, slime is a factor in nearly 80% of all bacterial infections. Bacteria thrive in nature as biofilms, hunkered together in large masses on surfaces, protected from noxious elements in their milieu, and working together to meet their needs.
Once a slime forms, it is largely impenetrable to antibiotics and immune defenses. It accretes on catheters, hip replacements and other indwelling medical devices. It gloms onto heart valves, urinary tracts, sinuses, and in the lungs. It causes pneumonia and keeps wounds from healing. Biofilms dominated medicine and Dr. Lucio’s world.
On the way out, Evo summoned his new students–Ayden Fry and Katey Cairn–to join him on rounds with Dr. Wally. Eagerly, they jumped from their adjacent stools, ready for adventure. Neither ever entered the hospital wards. Each scientist grabbed their cleanest, whitest lab coat from behind the main door and headed toward the hospital, a few blocks down the main campus road.
Dr. Wally greeted the winded scientists as they entered the ER’s double doors. Wally was escorted by a posse of medical interns and residents, with stethoscopes dangling from their necks and the pockets of their white coats stuffed with notes and things. The entire ER was looking a little tattered.
“The famous Dr. Lucio!” Wally announced, gesturing proudly toward Evo. Wally was known for embarrassing folks with praise. Not normally on their radar, the young physicians were suddenly attuned to Dr. Lucio. If anyone could solve this riddle, it was he. Katey and Ayden headed up the rear, as all followed the portly Dr. Wally around the hospital.
This was not a typical Grand Rounds by any means. Brookstone was suddenly jammed with sickness. Patients were on makeshift beds in tight spaces. The epidemic had already caused considerable destruction, and was growing exponentially. Plus, it was totally antibiotic resistant, so they were helpless against it.
Hospital personnel were working overtime. Nurses and doctors made their way among the sick, washing their hands thoroughly in between cases. Hazardous waste bags overflowed with masks, gowns, gloves and other disposables. Cases of disinfectant were being thrown at the problem. The place was an absolute mess.
“Is it all the same germ?” asked one resident.
“Who knows?” Evo replied, with furrowed brow. “Many pathogens could be involved. It could be bacterial, fungal, or viral, for all we know. We’ll do the tests and compare results from various wards to see if they concur.”
“What’s the source? Where did it come from?” Wally asked.
“That’s usually the key,” Evo responded. “Once that’s determined, we may be able to nip it in the bud.”
“We’re blessed to have the world’s top biofilm expert among us,” Dr. Wally exclaimed, with a hand on Evo’s shoulder. Wally blew smoke like a pro, but Evo deserved the praise. His recent breakout article on biofilms was published in a top-notch medical journal. Slime was a topic few others could touch, or cared to.
It took a major crisis for Evo to get a tour of the hospital, after decades at Brookstone. In that time, it had grown into a prestigious academic institution, thanks to professionals like Lucio and Wally. Evo had been publishing on biofilms for decades, but knew little about life and death in the wards. That’s where Wally shined. Evo was strictly a lab guy, with no bedside manner.
Dr. Wally led the entourage through the corridors of the sick and dying, pointing out the most compelling cases. They ventured first into the Burn Ward, which was as hard hit as the NICU. All patients with extensive burns were heavily infected. The sickest among them passed quickly, adding to the rising death toll.
They entered one room, where a morbidly obese female lay face down, encircled by monitors and other life-support machines. Dr. Wally positioned himself on one side of the bed, with his entourage circled around looking on. He lifted the patient’s gown and exposed a large burn on her back. Strings of slime stayed attached to the gauze as he removed it, like melted cheese on a pizza box. Yellow pus gurgled from the charred skin surface, creating a room full of queasiness.
Evo had never seen or smelled such infection close up. It proved far more grotesque in person than on Petri plates. With a cotton swab, Wally extracted slime from an infected area, placed it in a sterile vial, and handed it off to one of the residents. She labeled it and stuffed it in her lab coat pocket to be brought to the microbiology lab for identification.
Evo’s lab did not receive body samples or secretions directly. Nor did he process the initial specimens. That was a task for the Clinical Microbiology Lab, located inside the hospital, where they routinely identified causative organisms and determined their sensitivity to antibiotics. This had to be performed quickly, since a patient’s survival often depended on the diagnosis.
In his ivory tower, Evo was twice removed from the clinic, seeing neither patients nor body parts. He was spared the human tragedy and foulness of the hospital wards. The dirty work was relegated mostly to nurses, orderlies and lab techs. Though working with slime and disease in any capacity was unappetizing.
Evo’s job was to study isolated bacteria, well after the lab report went out. Scientists like Dr. Lucio studied how germs caused disease, and developed new methods to combat them. These projects took years–often entire careers–and provided no immediate service to clinicians. New drugs required decades of testing before reaching the clinic.
Evo was also an epidemiologist–a private investigator of germs–who could trace epidemics back to their origins. Getting to the source of an outbreak often solved the problem.
With mounting trepidation, the entourage made its way to the NICU. Many babies had succumbed to the raging infection, and many more were on the edge. Hospital personnel worked tirelessly to save these children and console their grieving parents. A reporter from the local press was there, badgering the hospital staff. The Grand Round physicians had been apprized of the disaster, and were prepared to engage the press and the anxious parents.
“What have you done to my baby!” a devastated mother screamed. So many nests would be emptied before the dust settled. In the mayhem, Evo reflected on life’s unfairness.
“Excuse me, doc. I’m from the Brookstone Gazette. What’s going on here?” The diminutive reporter, in gray suit and fedora, seemed right out of an old black and white thriller. He jammed his cell phone recorder in Wally’s face.
“Ah-hem, yes, we are doing everything possible to determine causation,” Wally answered, backing away. “The good news is it’s under control.” Evo tried to conceal his disbelief.
“How far did it spread?”
“There will be a full report forthcoming. For now we ask you to be patient and let our staff do its work. Thank you.”
But the reporter was persistent: “What’s the death toll so far?”
Dr. Wally smiled politely as he distanced himself from the gathering. One look at the head nurse revealed how dire it was.
From the NICU, they crossed over a walkway to the VA hospital. Alcoholics–with advanced liver problems–were perfect incubators for slime. Two old duffs had already succumbed to pneumonia. Three others in the ICU were deathly ill, and hooked up to life support. Patients were treated with high-dose antibiotic cocktails in hopes of finding an effective drug combination. Antibiotics of last resort were also unveiled, but proved largely ineffective. The slimy plague scoffed at their outdated medicines.
“These old farts don’t have a prayer,” Wally confessed. “Either the slime or the drugs will be their undoing. It’s a shame we can’t use MUFF, your anti-slime agent, Evo.”
“It’s MIFF, sir.”
Evo’s research led to the discovery of a novel and potentially groundbreaking drug. MIFF was not really an antibiotic: it didn’t kill anything. Rather, it stopped germs from sticking to things. MIFF took away the glue that kept germ gangs together. If bacteria can’t stick to things, they can’t cause decay. MIFF also removed the shield bacteria use to ward off toxins, antibiotics, and antibodies. Evo’s anti-slime agent stripped bacteria of their armor, making them susceptible to drugs and immune defenses. It rendered them naked and easily killed. Indeed, its potential seemed unlimited.
MIFF was also a natural product, extracted from a poisonous mushroom. Evo dubbed it “mushroom infectious film fighter”, or MIFF for short. Its exact composition and method of extraction and purification were proprietary, especially while patents were pending. Ultimately, MIFF’s safety and effectiveness would need to be verified by clinical trials. Numerous studies were required before it could be approved for commercial use.
Creatures on land, air and sea make slime to protect themselves, and have been doing so for billions of years. Other living things produce anti-slime (anti-biofilm) compounds to counteract these slimy critters. A prime example is coral, which stays remarkably pristine, despite all the slime in the ocean. Humans have natural anti-biofilm agents in their blood and tissues that keep slime at bay. So do most plants. Evo happened to stumble upon an inexpensive, safe, and broadly effective one from mushrooms, which seemed destined for success.
MIFF’s potential went far beyond medicine. Biofilms are also problematic in dentistry, agriculture and industry. Slime causes tooth decay, fouls toilet bowls, rots shower curtains, and forms drags on the bottom of boats. Biofilms cause metal to rust, concrete to crumble, flowers to droop, and food to go bad. Amazingly, all these biofilms were sensitive to MIFF.
But MIFF had a double edge, since it could also destroy good biofilms. Enough of it could wipe out friendly bacteria in the gut or vagina. If enough got into the soil, it could stop microbial activity important for plant growth and breakdown. Like any antiseptic, too much could backfire.
Another drawback for MIFF was its lack of purity, made evident by its funky odor. A rotten egg smell rocked Brookstone each time a new batch of drug was made. MIFF was still a diamond in the rough.
“We have a lot of work to do,” Evo admitted. “MIFF is not yet approved for use.”
“It should at least be available for terminally ill patients,” Wally insisted.
“They won’t care if it stinks.” Wally looked more rotund than usual, standing next to the tall lanky scientist.
“The terminally ill are often beyond repair,” Evo declared. “MIFF is better for preventing disease.” Prevention was an idea whose time had come.
Lucio was intent on advancing MIFF despite all the obstacles, and lack of funding. To get the ball rolling, he had to promote awareness. He talked about biofilms in the classroom, at conferences, in his writing, and to anyone who listened. The deadly slime running amok through Brookstone was a sobering reminder of the unmet need.
Dr. Wally’s troops finally reached the morgue, where the dead were piling up. The pathologist was asked to present a victim from the Burn Ward. They followed her through a clutter of corpses on stretchers, and finally to their destination.
Oddly, the covering over the corpse was difficult to remove. It seemed glued to the slimy carcass. When finally lifted, the group retreated in unified shock. What was once human was now unidentifiable. It looked like a cocoon of translucent jelly.
“Good God!” Wally exclaimed, “That corpse is one day old! I’ve seen nothing like it in 40 years of practice!” The slime glistened in the eyes of all onlookers.
“That’s not normal,” Evo blurted, as he shuffled through the medical images in his head.
The pathologist then brought out an expired pneumonia patient, who died the night before. The edematous head appeared ready to explode. Slime oozed from every orifice. The doctors kept their distance. This was an eye-opener, especially for Katey and Ayden.
“Much more aggressive than I’ve ever seen.” Wally sampled more slime for testing.
Evo was anxious to get back to the lab. He and his graduate students bowed out as the physicians headed to Geriatrics. En route, Evo visited the clinical microbiology lab to view their findings. He examined a number of Petri plates containing the offending organism. The plates were dotted with shiny, gooey grey blobs. Bacteria normally grew on these plates in discreet mounds the size of pinheads. But, these colonies were more like large runny pearls. From dish to dish, the slimy mess looked identical, suggesting that a single germ caused all the outbreaks. Evo selected bacterial samples isolated from different wards to take back to his lab.