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Patient Stories: David Ricci

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A 19-year-old from the Seattle area battles several NDM-1 positive antibiotic-resistant infections as he recovers from a train accident that cost him his right leg.

In just one moment my life changed forever. In June 2011, I was 19 years old and working as a volunteer with HIV/AIDS orphans in Calcutta, India, through the social justice organization YWAM, far from my home in the Seattle area.  One morning while I was walking to the orphanage, I took a shortcut across some train tracks to avoid the trash-filled roadside. All of the sudden I was hit and dragged by a train, resulting in the brutal amputation of my right leg above the knee.

You never know when it's the biggest day of your life until it's happening. It was as if I was in the middle of a nightmare turned reality; I didn’t receive pain relievers until a week after the accident. When I received clearance to be airlifted back home to Seattle after a hazy three weeks of agony, I thought the worst of my journey would be over: Maybe I would need some antibiotics and other treatment, but I could get on with learning how to live with only one leg. Little did I know how wrong I was.

When I arrived back in the U.S., I soon learned that my wounds were infected with multiple drug-resistant bacteria (including Pseudomonas aeruginosaKlebsiella pneumoniaeMorganella morganii, and Enterococcus), several of which tested positive for New Delhi metallo-beta-lactamase-1 (NDM-1), a dangerous and recently discovered enzyme that makes bacteria resistant to a whole class of very important antibiotics. I had never heard of any of those bacteria, nor NDM-1, let alone thought that one day I would become infected with them. I remember when the lab results came back, the hospital staff was so concerned by the NDM-1 that everyone went into crisis mode, and I was immediately isolated in my room. After another surgery to remove infected tissue from my residual limb, I was put on broad-spectrum antibiotics as a precaution. They thought the infection was gone, so I was released and returned home to my family.

After four weeks at home, the pain still hadn’t subsided, and my doctor knew something was wrong. Another surgery was required, and the surgeon found the tissue was still infected with the highly drug-resistant bacteria. I began a course of strong antibiotics, including an antibiotic of last-resort called colistin, which is rarely used because it’s so toxic. I felt my body shutting down from the toxicity of the treatment. My immune system, kidneys, and liver were failing, and I could feel my body giving up. Top doctors were giving me potent cocktails of the most powerful antibiotics available, and we were not sure if the drugs were even working. To know that the drugs that were strong enough to damage my internal organs might not be powerful enough to fight the bacteria they were intended to treat, made me feel incredibly powerless. 

I stopped the antibiotics at the end of September when the infection was thought to be gone. By December, it was back again in the form of a golf ball-sized abscess in my thigh. A biopsy revealed that the resistant bacteria were back full-force, and I underwent another emergency surgery to have more infected tissue removed. The antibiotics I took during this time were even stronger than the first course, and the side effects completely exhausted my body. The treatment was very similar to chemotherapy, making me vomit daily. It felt as though each of my organs were slowly deteriorating. I felt my body dying. When my white blood cell count dropped, I was so weak that normal daily activities were impossible. 

Now, eight months after my accident, my wounds are closed, but my worries are not over. My life consists of watchful waiting and praying that the infection, like some awful type of cancer, does not return. I have weekly doctor visits and monthly hospital visits so that we can keep a close watch on my progress. The learning process for my new prosthetic leg has been slow going because I had to re-start my physical therapy treatments after every emergency surgery, which removed more of my leg tissue. Plus, losing more and more of my leg to these antibiotic-resistant infections has made it harder to use a prosthetic, since I have less muscle to work with.

My battle is not over, but I'm thankful to be alive. I survived an impossible accident and continue to fight the deadliest of infections.  My family, friends, and faith keep me going, and it is for them that I stay optimistic. While things may never be the same as they were before that June morning, I am grateful for life. Recovering from a traumatic accident isn't easy, saying it is exhausting is an understatement. The infections leave my body weak and broken, but I continue to fight every day. I cheated death because I found life too beautiful to resist.

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