The battler: CRE can't beat an indomitable spirit
Our money is on David Ricci becoming a doctor
Of all the motivations to become an infectious disease doctor, this is one of the more unusual paths taken: lose most of one leg and nearly all of your life to a series of recurrent near pan-resistant bacterial infections that you've finally fought into remission — but still have a 30% chance of coming back and trying to kill you.
Meet David Ricci, a twenty-something Seattle kid with a kind heart and immeasurable resilience: the battler.
"Absolutely, I'm hoping to become a doctor," he tells Hospital Infection Control & Prevention. "I am studying my pre-med requirements to get those out of the way and I am hoping to go into infectious disease. I just started getting really passionate about it. Before any of this happened, before I went to India I wasn't a hundred percent sure what I wanted to do."
Yes, India, where in June 2011, Ricci was a 19-year-old volunteer trying to do some good in the world.
"I was working at an HIV orphanage over there in the Calcutta slums," he recalls. "It was so condensed with people and so dirty."
Taking a shortcut to work one morning, Ricci began crossing some train tracks when he was hit by a rail car. As a result his mangled leg had to be amputated above the knee, but his ordeal was only beginning.
The many-headed hydra
Returning to the States he was told his wounds were infected with multiple drug-resistant bacteria — including Pseudomonas aeruginosa, Klebsiella pneumoniae and Escherichia Coli. Remarkably, each pathogen apparently carried the New Delhi metallo-β-lactamase (NDM) enzyme. That meant Ricci had several varieties of carbapenem-resistant Enterobacteriaceae (CRE) and had effectively left the world where miracle antibiotics easily clear infections of all stripes. He was in the post-antibiotic era.
Ricci recalls that his first impression after being diagnosed with the NDM variety of CRE was seeing the hospital staff go into scramble mode and quickly isolate him in a room. Thus the battle was joined. A series of infections, failed treatments, and surgeries ensued.
"It came back three or four different times," he says. "They soaked me in antibiotics basically and drugged me to the point of almost death because the antibiotics were so extreme. It was surgically cut out many times. They assumed they got it and a few months later it came back. They doubled up on the [antibiotic] dosages and cut more of my leg away. It came back again six months later."
The last drugs of choice were not good choices, and he suffered at times as much from drugs like colistin as the recurrent infections.
"I was on colistin for a long time — it was horrible," he says. "I was on it four different times, and every single time they pushed it because they couldn't really test with 100% accuracy whether I still had the infection. Basically they would keep me on colistin as long as they could to make sure it was doing its job. So they would wait until my white blood cells and everything were at the lowest possible level and then they took me off it. "
He is not on antibiotics now and has been infection free for about two years.
"As far as I know it's not present right now, but [my doctors] don't have 100% certainty," Ricci says. "There is still a 30 percent chance that it will come back. They don't really know because of how complicated it is to test for this gene. We don't know whether it has been eradicated or if it's just lying dormant."
Focusing on what remains
The residual limb that once was his leg, limits him from doing some things that even other amputees do. And he had to give up travel to stay in the Seattle area and have access to his medical team. However, Ricci chooses to focus not on what has been taken away, but what remains.
"I can still ride a bike. I can still walk," he says. "It is really all about perspective. I only lost one leg — I could have lost both. I could have shattered my spine. I don't feel limited in any way really."
His ongoing trial has engendered a passion for medicine, particularly for infectious diseases.
"It has really inspired me," he says. "If I have the opportunity and the mind capable of going into medicine it would be a crime not to. Infectious disease is a big thing around the world, especially in the Third World, whether it is TB, HIV/AIDS, malaria — a lot of this is preventable stuff. I feel obligated almost."
It tells you all you need to know about Ricci's undaunted spirit that after so much suffering he sees himself as having an opportunity that many people don't.
"I want to become a doctor because I can become a doctor — there are many people that can't even if they wanted to," he says. "They just don't have the means or the opportunity. If anything this has given me the opportunity to open more doors and talk to more people. To me it is an opportunity to really just give back because I have first-hand experience of what these patients are going through."
Ricci has medical checkups every three to six months. He believes the squalid conditions in the Calcutta slums are the likely explanation for his subsequent aggressive infections. However, he says he may go back there some day — as a doctor.