The Antibiotic Crisis Scares Me So Much I Wrote A Novel About It / By Rachael Sparks

When I decided to write a novel, I believed the adage that you should write what you know. For me, that topic was clear: the fact that we are running out of antibiotics faster than we can develop new ones. Gonorrhea, Staph, CRE, and tuberculosis are all displaying an ability to adapt and survive most of the medicines we’ve developed for them. 700,000 annual deaths are attributed to resistant bacteria worldwide; the accurate count is probably more since our systems for tracking this are faulty.

But weaving my experiences into my novel didn’t come easy. Instead, I found myself summoning old ghosts I didn’t necessarily want to unpack. I had to treat these memories as a research project: which ones would make an impact in my story if I only wanted the feelings to be recreated in the reader? Our impending antibiotic crisis first began to scare me in the early 2000s as a young tissue transplant coordinator in Austin, Texas. A daily job responsibility was to visit the medical examiner’s office. In most cases, medical records gave me enough info to screen; however, for certain deaths, especially those outside the hospital, coordinators sometimes need to perform a quick physical check of the injuries or donation exclusion indicators.

That day, a young woman of my age—24 at the time—lay on a gurney in the ME’s office after an atypical journey through the system that ensures each death is properly vetted by the county forensic officials. It’s not her real name, but we’ll call her Jane. Jane had died in a hospital and her cause of death was fairly evident: a fatal infection of methicillin-resistant Staphylococcus aureus or MRSA that spread to the blood. Blood cultures had long before confirmed her diagnosis, but because Jane was young and first admitted to the hospital for a different reason, the medical examiner investigators decided to order an autopsy. As a microbiologist, I thought that was a wise decision too. She was young, healthy, with complications post C-section. She shouldn’t have developed a severe infection and then died of it after weeks of treatment and surgeries.

But in a minor mix-up, she had been taken to a funeral home first, then transferred back to the ME’s. When I entered the morgue room to look over the bodies and saw her form on the metal gurney, I froze. Jane was a strange misty gray from head to toe, her body playing black-and-white in a Technicolor scene.

“Why is she . . . Isn’t this the young one who was septic?” I asked my investigator friend.

“Yeah. The funeral home guys embalmed her, like five minutes after she got there.”

“Why?” That would prevent many critical steps in the autopsy process, the most important being blood tests.

“Because they were terrified of getting MRSA.”

Their reaction seemed extreme, but people at the time didn’t know as much about why these resistant infections were happening more and more. I did, though.

As with many medical travesties, we did it to ourselves, and in ways innumerable. We took a miracle drug and used it so much that the bacteria, awash in it, naturally evolved ways around it. We demanded doctors prescribe us antibacterials for viral infections. In some countries, you can still buy antibiotics without a prescription. We threw antimicrobials into soaps, body gels, even cutting boards. We gave it to our cattle, our chickens, our fish farms, our pigs are given as much yearly as we use annually in healthcare. Why? Until January 2017, mostly for money. The meat industry has learned over half a century that these antibiotics can increase growth and overall herd yield. Now, it’s restricted to use for treatment of illnesses—but those are only getting worse too. It’s predicted that 10 million people will die of antibiotic-resistant bacterial infections by the year 2050, but we haven’t approved a new human antibiotic in the last 30 years.

Until the Affordable Care Act, we didn’t hold health care facilities responsible for giving patients preventable infections. They got paid if you got sick due to their poor cleaning or neglect. A healthcare finance executive explained to me that treatment is more profitable than cure. And developing a cure isn’t profitable for pharmaceutical companies because we won’t buy that cure and use it with abandon. Now that we are learning from our mistakes with antibiotics, we’ll use new ones scarcely and responsibly. Not exactly a huge ROI for Big Pharma.

These truths frighten me. As a microbiologist and a lover of medical history, I can vividly imagine the day when a simple scratch could develop into an infection for which amputation is the only cure. While I don’t nibble my fingernails about it daily, I strictly enforce antibiotic stewardship on my family and remind friends that antibiotics won’t fix their cold. The image of Jane’s body has never left me. I still wonder how her child fared.

After years working to battle healthcare-associated infections, I realized I was tired of writing technical articles, marketing brochures, and polite blogs on the dangers ahead as our antibiotics lose their power. I was sick of stretching military metaphors to explain in layman’s terms how resistance builds among bacteria. I thought of the novels that have moved me, the authors whose imaginations left a dent in our collective awareness: Aldous Huxley. Upton Sinclair. Michael Crichton. Crichton saw genetic dabbling in recombinant DNA and fathomed a pterodactyl reanimated through a technology he knew could be both powerful and dangerous. Now “Jurassic Park” is a fable for several generations: research of dubious intentions yielding disastrous results.

And often, the lessons we chisel onto our collective consciousness are those in our fables.

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Rachael Sparks was born in Waco, Texas. She graduated with a degree in Microbiology from Texas A&M University. After a decade-long career in Austin, Texas, as a transplant specialist, she joined a startup fighting healthcare-acquired infections, thus satisfying her lifelong interest in infectious diseases and the science of human health. After relocating with her husband, daughter, and mother to Asheville, North Carolina, she finally put her first novel onto the page. In her free time, she serves on the board of the Asheville Museum of Science and loves to cook, brew, garden, and spend time with friends and family.