Dealing with C. Diff makes you think you’re crazy. It’s insanely hard to get rid of (hence the name difficile), spreads in hospital environments, and can be very destructive to those with compromised immune systems. After my awful bout last week, I imagine little spores of C. Diff everywhere even though they’re too hard to see. It’s tough to see progress when you’re cleaning something invisible.
I have/had a relatively mild case and am in the middle of the antibiotic treatment. It’s changed my transplant status temporarily to “on hold” until I’m off the antibiotics and the C. Diff is cleared up. It makes perfectly logical sense, but no matter how temporary the hold status, or how remote the possibility of getting “the call” with my current MELD score, it’s disheartening. Instead of talking about my feelings (remember, I’m the pragmatic one) or getting back on the transplant list (which my first discussion will be Monday), I’ll talk about my thoughts on simpler life forms which stretch all the way back to middle school.
In a middle school biology lab section, we each had a Planarian tapeworm (Girardia tigrina) in a little dish. We were taught that it would regrow if it lost part of its body. Each one of us were to hypothesize which of the following would grow back the fastest to full size: just the head, just the tail, or the middle section of the Girardia tigrina (each option was 1/3 of the total size). Then, we carefully cut the tapeworm and watched over the upcoming days to see which hypothesis was correct. At that time, I chose the middle section because the front and back could regrow concurrently. Unfortunately, I don’t remember whether my hypothesis was correct but I learned one thing – it’s really hard to kill a tapeworm by cutting it.
“Very small pieces of the planarian, estimated to be as little as 1/279th of the organism it is cut from, can regenerate back into a complete organism over the course of a few weeks.” – Wikipedia
This simple thought made me think about how humans and tapeworms differ in the ways they can die. As my mind thought of the many ways a tapeworms could die–hydrofluoric acid, removing it from water, etc.–there was a comparable way for a human to die–hydrofluoric acid, removing it from an oxygen environment, etc.. But the human body was infinitely more complex and had infinitely more ways it could die: cutting off a limb, eating too much, eating too little, bleeding to death, heart disease, cancer, etc..
“There are more ways of killing a cat than choking it with cream” – Charles Kingsley Westward Ho! (1855)
Instead of me remembering something simple like whether my tapeworm hypothesis was correct, I thought of a deeper and more complex hypothesis: the more complex the machine, the more likely it would be to break or die. Which brings me back to today and Clostridium Difficile.
It’s a very simple bacteria, and thrives in many environments. It’s difficult to kill; alcohol hand sanitizer and disinfectant wipes–which are 99.9% effective on most bacteria–do not harm this thing. The CDC recommends one option: a 10:1 ratio of water to bleach in order to kill spores outside of the body and on hard surfaces. There are not many other options. Inside the body, stomach acid and good bacteria can fight, and when that doesn’t work, a hard core antibiotic is introduced which wipes all the bacteria out, good and bad. Which makes me think that these simple organisms actually rule the world. We humans and other complex organisms are just along for the ride.
The Derek Janiak Hepatobiliary Forum 