Unlike antibiotics, bacteriophages make more of themselves as they work, eventually outnumbering and eradicating the bacteria they are sent to destroy. But, while antibiotics are effective against a wide variety of bacteria, each phage is specific, meaning that microbiologists must spend days and sometimes weeks in the lab identifying the bacteria in a patient's tissue sample and finding a phage that will eradicate it.
The diagnostic center at the Eliava Institute determined that Fred's infection was caused by two types of bacteria, Pseudomonas aeruginosa and Staphylococcus aureus, and Alavidze and her coworkers set to work. They grew up bacteria from Fred's wound in a series of petri dishes, each containing two cloudy stripes of a single germ. Alavidze keeps her pseudomonas phages, of which she has around 20, in small glass bottles capped with eye droppers. A coworker of hers placed one drop of the first phage on the left side of one of the pseudomonas stripes. The next phage she dripped over the opposite end of the stripe, and so on. Each bacterial stripe got two different phages, four per plate. Then, she put the plates in an incubator for 18 hours, to allow the phages to reproduce and do their job. The next morning, they read the results.
Some phages did not work at all. In these areas, the stripe was as cloudy and opaque as it had been the day before. Others had left patchy circles—small areas where some of the bacteria had been eaten away. Only one phage had worked perfectly: where Nino had dripped it, it had eaten away a clear circle where the foggy bacterial growth had been. This is the one they would use for Fred. They performed a similar experiment on Fred's strain of staph bacteria, and then mixed, multiplied, sterilized their phage solution and poured it into a set of small glass vials that were sealed shut over a Bunsen burner. The process took 10 days.
In the meantime, the Bledsoes were getting to know their neighbors at the hospital. In a room across the hall from them lived a family of refugees from Abkhazia, one of Georgia's two breakaway provinces. The two simmering conflicts had uprooted 10 percent of the country's population, and there was not enough housing for all of them. The hospital had given the family a room where they installed a makeshift kitchen and made themselves at home. They frequently invited Fred and Saharra across the hall for lunch and dinner. The matriarch of the family had a small loom on which she wove handicrafts to sell on the streets. She made Fred and Saharra each a pair of socks and a small tapestry with an illustration of Georgia woven into it.
When Fred's phage preparation was ready, doctors doused his foot with it. Three times a day, a nurse would come, take two glass vials of phage out of a cardboard box, cut the tip of the vial off with a razor blade, transfer its contents into a syringe and squeeze it over Fred's toe. Physicians also put him on a low-sugar, low-fat diet and administered electrical stimulation to improve the circulation in his leg. After 30 days, his wound healed—and he had lost 19 pounds on his diet. What was once a gaping hole that would not close had become a large but benign callus. Fred had arrived on crutches and left on his feet.
Bledsoe's case exposes deadly gaps in one of the world's most advanced medical systems. After penicillin was first mass-produced in the mid-1940s, wealthy nations enjoyed decades of relative peace of mind when it came to infectious diseases. Pharmaceutical companies pumped a steady stream of antibiotics into the marketplace, drugs that tamed once-fatal diseases like pneumonia and strep throat. But, as patents have expired and germs seem to have been bowed into submission, that once fertile pipeline has dried up. Major drug companies have turned their attention toward newer, more profitable areas, like the diseases of aging: hypertension, heart disease, and diabetes. Patients take these drugs for life, while a typical course of antibiotics lasts a few days.