Prime Slime

“Dr. Lucian?”

“Chief, what’s up?”

“Can you to join us on rounds today. A contagion is winding its way through the hospital.”

Evan Lucian was buried deep in study at the lab, unaware of the dark cloud hovering over Burrstone. 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. Wally’s funereal tone matched the gravity of the situation. “The NICU is a graveyard, wound infections plague the Burn Ward, and a necrotic pneumonia struck the VA hospital; not to mention today’s surge of urinary tract infections in Geriatrics.”

Evan’s thoughts went out to the nurses who ran those wards. Burrstone boasted a Burn Unit second to none. The NICU was also highly regarded. There was no better place to have a baby than on North Brother Island, but not today; not now.

The University was also known for its Infectious Disease Division, headed by Dr. Wally, under whom Dr. Lucian directed the Infectious Disease Research Laboratory.

“Have they determined the cause?”

“Not yet,” Wally answered. “That’s why you’re being called in.”

“I gathered that,” Evan responded. The tall and lanky, but rather handsome scientist was familiar with deadly pathogens. He already had a good hunch about this one, but needed more info to make a positive identification.

“So? What are we waiting for? Let’s do it!”

“I’ll be there shortly!” Evan slipped the cell phone into his back pocket, closed down the computer system in his office, and hastened toward the exit. His path took him through the lab, where he and his graduate students studied nasty germs. He had spent the larger part of two decades there, focused on solving an important riddle in medicine: how to stop bacterial slime. Evan’s expertise was in slime, or biofilm, which is short for biological film.

According to the National Institutes of Health, up to 80% of all bacterial infections have a slime component. Slime is how bacteria thrive in nature, hunkered together in large masses, immobilized on surfaces, protected from noxious elements in its surroundings, and working together to get what they need. Once a slime forms, it is impenetrable to antibiotics and immune mechanisms. If it forms on a catheter, a hip replacement, or some other indwelling medical device, that part has to be remove quickly. It also forms on heart valves, urinary tracts, ears, noses, throats and lungs, to name a few. It is likely the reason why Lyme disease is so hard to eradicate, or why people get pneumonia, or need colostomy bags, or why wound infections won’t heal. This was the world Dr. Evan Lucian lived and breathed in.

On his way out, Dr. Lucian summoned his students–Dexter and Terri–to join him on rounds with Dr. Wally. They jumped in tandem from their neighboring stools, ready for adventure. Neither had ever been in the hospital wards, especially during an emergency. They grabbed their cleanest lab coats from behind the main door (reserved for such occasions), and made a beeline for the hospital, a few blocks down the main campus road.

Dr. Wally greeted the winded scientists as they entered the ER’s sliding double doors. Wally was escorted by a posse of young medical interns and residents. With stethoscopes dangling from their necks, stuff hanging out of their white coats, and lack of sleep, they looked a bit unkempt.

“The famous Dr. Lucian!” Wally announced, gesturing proudly toward Evan and crew. He was famous for embarrassing Evan with praise. Usually paying Evan no mind, the young physicians were suddenly attuned to him. If anyone could solve this riddle, it was the anti-slime, Evan Lucian. Terri and Dexter trailed behind, as all followed the portly Dr. Wally around the hospital like baby ducks.

This was not a typical Grand Rounds by any means. Burrstone was jammed with stricken patients, and no place to put them. Many were on makeshift beds, and in tight spaces. The slimy disease had already caused considerable destruction and heartbreak, and was likely to get worse. Scarier still, this plague was totally antibiotic resistant, and they were helpless to stop it.

Needless to say, hospital personnel were working overtime. Nurses and doctors made their way helplessly among the cases, washing their hands thoroughly between each successive patient. Bright red, hazardous waste bags overflowed with masks, gowns, gloves and other disposable stuff. Cases of disinfectant were thrown at the problem, to little avail. The place was a sickening mess.

“Is it all the same germ?” asked one resident.

“Who knows for sure?” Evan replied with furrowed brow. “Many pathogens could be involved. It could be a bacteria, fungus, or virus, for all we know. We’ll do the tests, and compare results from the various wards to see if they concur.” Evan knew more than he led on.

“What’s the source? Where did this nastiness stem from?” Wally asked.

“That’s the key,” Evan responded. “Once that’s determined, we’ll find a way to stop it.”

“We are blessed to have the world’s top biofilm expert among us,” Dr. Wally exclaimed, with a hand on Evan’s shoulder. Wally blew smoke like a politician, but Evan deserved the praise. His breakout paper on biofilms–the technical word for slime–was recently published in a top-notch medical journal. Slime was a topic few others could touch, or wanted to for that matter.

It took a crisis of immense proportions for Evan to get a tour of the hospital, after a long career at Burrstone. In that time, the medical complex had grown into a prestigious academic institution, thanks to professionals like Lucian and Wally. Evan had been publishing on biofilms for decades, but knew nothing about life and death in the wards. He was strictly a lab guy. Labs are reserved for doctors who love to solve medical problems, but have 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.

In one patient’s room, a morbidly obese female lay face down, encircled by monitors and other life-support devices. Dr. Wally positioned himself on one side of the bed, with his entourage on the other side looking on. He lifted the patient’s gown and exposed a large burn area on her back. As he removed the gauze, strings of slime stayed attached to it, like melted cheese on a pizza box. Yellow-green pus bubbled from the charred skin surface, to a room full of queasy stomachs, fighting to keep breakfast down.

Never had Evan seen or smelled such infection close up. It proved far more grotesque in person than on Petri dishes. 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, who labeled it properly and stuffed it in her lab coat pocket. It would eventually be brought to the lab for identification.

Evan’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. There they identified the causative organisms and determined their sensitivity to antibiotics. This had to be performed quickly, since a patient’s life often depended on it.

In his ivory tower, Evan was twice removed from the clinic, seeing neither patients nor body parts. He was spared the human tragedy and foulness in the hospital wards. The dirty work was relegated mostly to nurses and orderlies. Still, working with slime was not exactly appetizing.

Evan’s job was to study isolated bacteria, well after the lab report went out. Scientists like Dr. Lucian studied how germs caused disease, and developed new methods to combat them. These lofty projects took years–often entire careers–and provided no immediate service to clinicians. New drugs required decades of testing before they reached the clinic.

Evan 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 crime.

With mounting trepidation, the entourage made its way to the NICU. So many babies had died, and so many more were on the edge. Hospital personnel worked tirelessly to save these children and console their parents, who were understandably angry and demanded explanations. So did a reporter from the local press, who badgered the hospital staff with questions. The Grand Round physicians were already apprized of the disaster, and prepared to engage the grieving parents.

“My baby! What have you done to my baby!” a devastated parent screamed. So many nests would be emptied before this disaster ceased. In the mayhem, Evan reflected on life’s unfairness.

“Excuse me, doc. I’m from the Burrstone Gazette. Can you tell us what’s going on here?” The diminutive reporter, in gray suit and fedora, was right out of an old black and white thriller. He stood uncomfortably close to Dr. Wally, with his cell phone recorder in Wally’s face.

“Ah-hem, yes, we are currently trying to determine causation,” Wally answered, backing away. “The good news is it’s under control.” Evan and the physicians tried to conceal their 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 told him how dire it was.

From the NICU, they crossed over a walkway to the VA hospital. Old veteran alcoholics–with advanced liver problems–were perfect incubators for slime. Two old duffs had already died from pneumonia. Three others were deathly ill in the ICU, 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 equally ineffective. This plague was impervious to their outdated drugs.

“These old farts don’t have a prayer,” Wally confessed. “Either the slime or the drugs may be their undoing. It’s a shame we can’t use MUFF, your anti-slime agent, Evan.”

“It’s MIFF, sir.”

Evan’s biofilm research led to the discovery of a novel and potentially groundbreaking drug. MIFF wasn’t meant to kill anything. Rather, it stopped germs from sticking to themselves and to surfaces. By stopping slime, MIFF took away the glue that keeps germ gangs together. It also took away the shield that protects bacteria from noxious elements, like toxins, antibiotics and antibodies. Evan’s anti-slime agent stripped bacteria of their armor, which forced them to disperse, and made them susceptible to drugs and immune defenses. MIFF rendered germs naked and easily killed. Without slime, bacteria can’t stick to anything. They can’t hunker down and wait for opportunities to cause problems. Basically, they become harmless.

MIFF was also a natural product, which has its commercial advantages. It was extracted from a poisonous mushroom. (Even mushrooms need to keep slime at bay.) Evan dubbed it “mushroom infectious film fighter” (MIFF for short). The exact composition and methods were proprietary, especially while patents were pending. Otherwise, some rogue Chinese company would be selling it online in no time. Meanwhile, numerous studies needed to be performed, in both animals and humans, to show MIFF’s safety and effectiveness, before it could be approved and commercialized. As a natural substance, both consumers and government regulators would give it the benefit of the doubt.

Many creatures on land, air and sea make slime for many purposes, and have been doing so for billions of years. Conversely, living things have long produced anti-slime compounds to counteract these pesky critters. A prime example is coral, which stays remarkably pristine, despite all the slime in the ocean. Humans also have natural anti-biofilm agents in their blood and tissues that keep slimy critters at bay. Evan happened to stumble upon an abundant, inexpensive, safe, and broadly effective one from mushrooms, which seemed destined for success.

The great potential of MIFF went far beyond medicine. Biofilms are also problematic in agriculture and industry. Starting with slimy toilet bowls, fouled shower curtains and boat-bottom drag, biofilms also cause the rusting of metal, the breakdown of concrete, the wilting of flowers, and food poisoning. Fortunately, all these biofilms were sensitive to MIFF.

Unfortunately, MIFF also destroyed “good” biofilms. That includes the friendly bacteria in our intestines, which are lined with slime, to the tune of tens of trillions of organisms. These critters have been with humans since the dawn of time. Indeed, we’re like a big vessel for them to get around in. In turn, they help us with digestion and detoxification, and an assortment of other bodily functions. We couldn’t exist without them. But MIFF could not distinguish between good and bad slime; between helpful and harmful microbes. Only humans could do that.

At this juncture, MIFF was still a diamond in the rough. The biggest drawback was its funky sulfur odor. Burrstone was made aware of MIFF’s drawbacks, every time a new batch was made, as the smell would permeate the entire campus. “We have a lot of work to do,” Evan 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.” Standing next to his tall, handsome scientist, Wally looked like the ball to Evan’s stick.

“Perhaps, but the terminally ill are often beyond repair. MIFF will fair much better in preventing, rather than treating, disease. Unfortunately medicine is profit driven, and largely ignores preventive measures. There’s no money in it.”

“That’s good for business,” Wally assured his interns and residents.

Biofilm prevention was a radical idea whose time had not yet come. And market forces would keep it buried, since vast treasures were being made on people’s illness. Despite the obstacles, Lucian was intent on advancing MIFF. The project would require considerable funding, countless man-hours and multiple collaborations to reach maturity. But, first, Evan’s job was to promote awareness. The deadly slime running amok through Burrstone was a sobering reminder of the unmet need.

Dr. Wally’s medical troop 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 to the case at hand.

Oddly, the covering over the corpse was difficult to remove. It was basically glued to the slimy carcass. When the covering was finally lifted, the group retreated in uniform shock. What was once human was now unidentifiable. Wrapped in a slime casing, it looked like a cocoon of translucent jelly.

“Good God!” Wally exclaimed, “That corpse is only one day old! I’ve seen nothing like it in my 40 years of practice!” The slime’s reflection glistened in the eyes of all onlookers.

“That’s not normal,” Evan concurred, 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. For Terri and Dexter, this was an eye-opener like no other.

“Much more aggressive than I’ve ever seen.” Wally took another sample of slime for testing.

Evan was anxious to get back to the lab to begin his analysis. He and the graduate students bowed out as the others headed to Geriatrics. On the way, Evan visited the clinical microbiology lab to drop off specimens, and see what they uncovered. He examined a number of Petri dishes containing the offending organism. The gooey blobs dotting the plates were larger than usual. Bacteria normally grew on these dishes in discreet mounds called colonies, the size of pinheads. Each colony originated from one single microorganism that grew into millions overnight, eventually to become visible to humans. But, these were more like large runny pearls than pinheads. From dish to dish, the slimy colonies looked identical, suggesting that a single germ caused all the outbreaks. Evan selected samples from different wards to take back to his lab.