Fighting the MAC Attack

Denver is home to many of the nation’s great medical institutions including National Jewish, its preeminent boutique hospital. Once a center for TB excellence, with the near eradication of TB in the US it has had to move on to other mycobacterium and other lung diseases to remain relevant. It is therefore now also the nation’s best MAC (Mycobacterium avium-complex) hospital, and provides both an award winning breadth of care and an award winning mani-pedi. 

I spent four weeks there to learn all about Mycobacterium: its likes, its dislikes; hopes, dreams; everything. Having a particular interest in tuberculosis I figured I’d get an excellent education on the whole family of bugs in general, with a little bit of TB on the side to keep me interested. Instead, it was pretty much all MAC. There certainly was some M. abscessus masquerading as MAC and an interesting other NTM here or there, but there was essentially no TB and essentially nothing but MAC. MAC, MAC, MAC. Soooo much MAC.

MAC for those unaware, is America’s great undocumented plague. It’s in your jacuzzi, it’s in your shower, it’s in your pool. It’s probably sleeping with your wife. It’s also in the environment as well, and we all likely eat and breath it every day, but for some reason a very small – exceedingly small – portion of the population gets permanently infected with it and develops disease. They are, largely, the Lady Windermere population. There’s also a classic subset of tobacco-smoking, beer-drinking, middle-aged males who get it, but they’re a minority at National Jewish. Instead the Lady Windermeres are thin, tall, middle-aged Caucasian females historically with a tendency towards fastidiousness, but now, all too frequently, a tendency for breast augmentation surgery.* They are what keep NJH’s engines moving.

At Denver’s national Lady Windermere health center and spa, men and women are scheduled for two week stay where they get their MAC treated, their comorbidities managed, and explore all that cosmopolitan Denver has to offer. While there they get the attention of a personal physician dedicated daily to their care for (just about) as long as they want. Consultants, dietitians, and masseuse are readily on hand. The laboratory is ready to run a generous and likely excess number of tests. And top Michelin rated chefs prepare the day’s specials in the facility cafeteria. Although at a hospital patients are not actually hospitalized, but instead spend their nights at any one of many luxurious local accommodations. Throw in a novelty T-shirt and a romantic dinner for two the final night of their stay, and the boutique experience is complete.

Because the NJH MAC ExperienceTM is so long and intensive it is typically the realm of those who can afford to stay in a hotel for two weeks and receive countless tests and procedures. In other words, it is the affluent portion of the Lady Windermeres who make it to Denver for care. Thankfully both cash and credit are accepted. 

As much as I give it a hard time, National Jewish is an amazing place. The thoroughness of care and the research being done there are remarkable. Although it does attract the rich for financial reasons, the poor and underserved are present as well. Moreover the physicians and nurses who work there are dedicated, hardworking, and give much of their lives to their patients. It’s likely entirely unreproducible due to the realities of medical finance in the rest of the world -- and perhaps with some of its excesses this is for the best -- but truly there is no institution that can compare. NJH is a place like no other. At least that's what all the travel agents say.


*It is apparently a well known, but unscientifically established, fact among radiologists that the positive predictive value (PPV) of breast implants for MAC in a woman with right middle lobe and lingular bronchiectasis is high. Similarly, male nipple rings in a chest CT? Diagnostic of HIV.**

**This is not meant to slander HIV+ individuals or men who like nipple rings. Just radiologists. What louts.