What Else Could Be Okay? (2)
Here's one important fact. Some might wonder why pseudomembranous colitis is such a big deal.
Simply put, it's a disease that can develop after taking antibiotics. It's way more common than you'd think. Even in modern times, there were always one or two patients on any given ward who had it. If an inpatient had diarrhea, they'd immediately test for it. Tens of thousands of cases a year in the US alone? Weird that its mechanism still wasn't figured out back then... but it wasn't a simple problem. It took time. This was the kind of discovery that could change the world. And right in front of me was the experimental proof of that mechanism. An effective treatment was basically already in hand.
This was the diagnostic lab's experimental room. I stood with Professor Harrington and a few hospital researchers, staring at the cell culture dishes.
Prep hadn't taken as long as I'd expected. Most of the materials were already on hand at the hospital.
Professor Harrington scratched his head. For days, he'd been trying to disprove my claims, but every experiment pointed the other way. Now, with the culture tests complete, he had no choice but to admit my hypothesis was right.
"It's real. What the hell."
"It's a disease caused by toxins produced by Clostridium difficile colonies that overgrow when antibiotics disrupt the gut flora."
I explained.
"Complicated. This is ridiculous..."
The culture dish showed a clear cytotoxic reaction. Even without the bacteria themselves, the substance extracted from the stool was killing cells. Professor Harrington peered at it again through the magnifying glass, as if he couldn't believe it. The man was stubborn as hell.
"Even without the bacteria, the extract from the patient's stool shows cytotoxicity. That proves the toxin is causing the tissue damage."
"Yeah."
"Further tests will satisfy Koch's postulates too. Most pseudomembranous colitis patients will test positive for C. diff, we've cultured it successfully, and we've confirmed it produces the toxin."
Koch's postulates are the logical framework for proving a specific bacterium causes a specific disease.
Anyway, the antibiotic resistance tests on Clostridium difficile showed similar results. It was naturally resistant to most antibiotics, which made sense.
The lab researchers glanced at me. The experimental mice squeaked behind us.
The professor let out a quiet sigh.
"What the hell are you?"
"Ah, I've just studied hard."
"Studying's one thing. But designing experiments to prove this bacterium causes pseudomembranous colitis? That's a whole different league. It's not even in the same ballpark as clinical skill."
I had no real answer for that. I'd pegged him as an oddball personality, but apparently that came with sharp instincts. I just nodded.
"Thank you."
"A devilish talent, really."
As if on cue, one of the lab mice started running on its wheel. The clattering echoed loudly in the quiet room.
"Do you know what this means?"
"What does it mean, sir?"
"We... no, your insight might have just pinpointed the cause of one of America's most common diseases."
Probably. Even Professor Harrington had to concede that much. He looked quietly impressed.
"We need to alert the academic world ASAP."
"Already sent it off."
"What?"
"A two-page letter to Nature hypothesizing the pathogenesis of Clostridium difficile and pseudomembranous colitis."
The professor dropped the culture dish he was holding in shock. It shattered on the floor with a sharp crash.
Truth be told, I'd been mulling this for a while. I just needed the right patient and some help. Whenever I had time.
"You're insane. We didn't let in a devilish talent—we admitted the devil himself, Clayton."
High praise, I suppose.
"Thank you...?"
"Good work. I never imagined any resident—let alone you—could pull this off."
"I'll keep at it."
"Someone clean that up."
Professor Harrington kicked the shards aside as he left the lab. The researchers grabbed tongs and a broom.
Wow, true legend-level personality. I followed him out.
The fallout was massive.
Pseudomembranous colitis—and antibiotic-associated diarrhea—had been lumped into various diagnoses, treated based on the doctor's preferences. Some thought it was an allergy and switched antibiotics. That was the mainstream view back then. Others treated it like regular enteritis with fluids and antidiarrheals.
But now it was clear: from mild antibiotic diarrhea to full-blown pseudomembranous colitis, it was all the same disease at different severities. All caused by gut dysbiosis letting Clostridium difficile thrive.
Overnight, Professor Harrington and I became famous. At least among doctors.
I sat with Alice at a café near Stanford Hospital. She stirred her vanilla latte vigorously. Dark coffee swirled through the white milk, blurring the boundaries.
I just watched it.
"I'm exhausted. You went through hell too. Suddenly a meningitis patient shows up."
"Meningitis?"
"Neurosurgery's trying to treat some amoebic meningitis case. That was a nightmare."
What's that? Hard to say just from hearing it.
Alice rambled for a bit, then turned back to me, like she'd remembered something important.
"Heard you nailed that pseudomembranous colitis case. Professor Harrington was singing your praises. How'd you do it?"
"Figured out the mechanism."
Alice sipped the latte she'd just stirred, silent for a long moment. Even to me, it sounded absurd.
"What...? You gotta win a Nobel just to get a pat on the back from him."
Definitely a weird guy. I'd only gotten praise as an exception for rewriting medical history by accident.
He was the type to work residents like lab rats otherwise. As we'd seen...
"Yeah, he's got a weird personality."
"Seriously, how? Textbooks say the cause is unknown. That's what they said when I studied it."
Textbooks didn't have it, no.
"Isolate the toxin from stool extract, confirm cytotoxicity, culture C. diff, verify it produces the toxin... and done."
Solved with the simplest experiments. Molecular biology took forever back then and was rare. But centrifugation for toxins, bacterial culture, tissue assays? A few days' work.
"No, don't even—explaining it would just hurt my mouth. Anyway, impressive."
Alice laughed, gazing out the window.
The pseudomembranous colitis research wrapped up nicely. Well, not wrapped—more like the beginning. Now that the cause was nailed down, academia would dive in for real.
Next up. I sat alone, fiddling with my pen.
Time to prep my Lasker Award speech. Called America's Nobel, it was the ultimate honor for medical researchers... What should I say? Perfect opportunity and all.
As I pondered, the landline rang shrilly out of nowhere. Weird timing. I picked up.
"Hello?"
"Ah, Weiseman Foundation. Connecting you to Ms. Rigelotte Weiseman."
Rigelotte? What's this about. I waited. A few seconds of throat-clearing from the other end.
"I told you to tell him."
"Tell him what?"
"You're heading to New York for the Lasker, right? Doctors say it's like a Nobel. You should've mentioned it."
"Ah, yeah."
Rigelotte chuckled.
"Okay then. How about we meet at Kennedy Airport in New York on the morning of the ceremony?"
"You're coming? It'll be boring."
"You have no idea. Bankers are the most boring people on earth... money talk. Even if you explain it and I don't get it, that's still better."
Rigelotte-style humor.
"Sure, whatever."
"What's the topic, anyway? I tried looking it up, but you have way too many papers to sift through."
She'd looked into it? But even contemporary docs didn't know this stuff, so no way she'd get it from skimming.
"Something on the immune system."
Rigelotte made a vague sound of perfect understanding.
"Alright, see you at Kennedy then. We'll book the flight and have staff handle it—no worries."
"You don't have to."
"My protégé wins America's biggest award? Of course I'm watching."
I hung up. At least no travel planning hassle.