Helicobacter (2): The Australian Lead
Here in the gastroenterology outpatient clinic, this is Professor Smith’s exam room. There’s plenty to do. While the professor is away, digestive patients have been piling up. Maybe assigning this to me is an expression of trust. A sign that he thinks I can handle it. On the other hand, even if I only work until Professor Smith returns, patients who’ve had endoscopies still need to hear their results and pick up their medications.
An upper endoscopy isn’t the end of it. Treating gastric ulcer patients is the more important issue. It’s frustrating that certain tests and treatments haven’t been invented or discovered yet. Especially when you see patients suffering unnecessarily. You’ll understand once you see what I mean. At least all the drugs needed for Helicobacter pylori eradication therapy are already available. That’s a relief.
The patient sitting in front of me is still frowning deeply as he waits outside the exam room.
“Where does it hurt the most?”
“My stomach’s been burning lately, and the area right above my solar plexus hurts so bad I feel like I’m dying.”
I paused for a moment. “I see. Have you tried any medication?”
“Didn’t help.”
Normally, we don’t automatically start Helicobacter pylori eradication therapy just because someone has a gastric ulcer. But right now there’s still no clear way to test for it, and the symptoms look fairly severe. The patient sitting in the exam room right now has a pretty significant gastric ulcer. At this point, we could probably start eradication therapy without testing, right?
The patient let out a sigh. “Is there anything that can be done?”
“Well, I’ll prescribe antacids and antibiotics to kill the suspected intestinal bacteria.”
My patient scratched his head. “I see……”
Gastric ulcers aren’t something to take lightly. They cause heartburn and other symptoms, and later on they can even lead to stomach cancer. “It’s a somewhat new treatment, but the medications aren’t dangerous, so you don’t need to worry.”
After some deliberation, I decided to prescribe the antibiotics as well. Professor Smith might find it odd when he returns and reviews the chart, but I noted on the prescription that the antibiotics were added due to suspected enteritis and sent the patient on his way.
I need to publish this soon. Even if it doesn’t seem as dramatic as the drugs used for heart transplants, the cause and treatment of gastric ulcers is a matter that affects countless people’s well-being. Just like the patients I’m seeing now. The sooner I publish the research on Helicobacter pylori, the more people I might be able to save. Just from what I’ve seen today and yesterday alone, there are so many people suffering from gastric ulcers—something that in the 1970s was simply considered a condition you had to endure.
The outpatient clinic finally ended, and I returned to the pathology lab to continue yesterday’s work. Let me take a look. It didn’t take long to find the researcher currently studying gastric ulcers: Professor Robin Warren at Royal Perth Hospital in Australia. So it’s him.
Even though the academic world doesn’t yet know such a thing exists, strictly speaking, he’s the one who came closest to discovering Helicobacter pylori. Dr. Robin Warren. He’s the man who would later win the Nobel Prize for discovering that Helicobacter pylori causes gastric ulcers. But traveling all the way to Australia would be difficult, so I’ll just send a letter instead.
The content was simple. There’s another intestinal bacterium called Campylobacter. If you use the culture medium designed for that bacterium, you can culture Helicobacter pylori. It takes a while, but then Professor Warren’s team might be able to discover Helicobacter pylori quickly. I hesitated over what to write.
— I am writing because I heard your research team is studying the cause of gastric ulcers.
— I’ve heard a recent hypothesis suggesting that the cause of gastric ulcers may be bacterial.
— Considering the epidemiological data and pathological evidence of gastric ulcers, I also believe the bacterial hypothesis is correct.
— If the causative bacterium of gastric ulcers truly exists, wouldn’t it be possible to culture it using a process similar to intestinal bacterial culture methods?
— I believe that by creating an environment similar to the inside of the stomach in a test tube, we could grow the causative organism in a low-oxygen serum medium.
That was how I concluded the letter.
Next task. I moved the slide under the microscope to check whether the silver staining had worked properly. The reason this is difficult: Helicobacter pylori technically belongs to the Gram-negative bacteria. However, because the spiral body of Helicobacter is so thin, Gram staining—which colors the inside of the cell wall—doesn’t show it well. So how do you make it visible?
You have to use silver staining, which colors the outside of the bacteria. It’s a staining method rarely used except for something like the syphilis spirochete. I told you—this bacterium has a nasty personality. It doesn’t even take the stain properly. But…… fortunately, even with an ordinary light microscope, the silver-stained Helicobacter pylori was clearly visible, including its characteristic spiral shape. So it works. I let out a sigh of relief. In the original history, the spiral shape of Helicobacter wasn’t discovered until much later.
With that, the letter to Australia has been sent. It’ll probably take at least a week before their hospital runs the experiment and I hear back. Maybe a reply will come sooner. In the meantime, I should prepare the paper I’m going to write. Or should I present at the internal medicine conference? While I was thinking about it, someone with a pale face walked past carrying a bag. A first-year resident. My junior, Luna. She looks exhausted. She stared at me with the expression of someone half-dead.
“How does it feel after working here for a few days?”
“I feel like I’m dying.”
The first few weeks after starting any job are always the hardest. Being an internal medicine resident was no different. Luna let out a sigh. “No one died, right?”
“We did CPR. The patient woke up.”
At least the patient survived. That’s something. “You must’ve worked hard.”
“The strange thing is, after we gave epinephrine, the blood pressure stabilized and the patient got up again…… Oh. Senior, buy me coffee.”
I should just go home. But she’d only been working here for a few days, and after being in a war-zone-like ward, she must be stressed. It felt wrong to just tell her to go home. So we moved to a café near the hospital. Normally cafés in America close early, but it’s different near hospitals. There are always people wandering around looking for coffee twenty-four hours a day. The cafés around here tend to stay open later. We went inside.
“One strawberry smoothie—actually, make it two.”
Since it was evening, the café was fairly quiet. The drinks came out almost immediately. Luna silently sucked on her strawberry smoothie and started looking a little more alive. Once the sugar hit her brain, she seemed to recover quickly. Luna looked at me again. “What did you do today, Senior?”
“Gastric ulcer patients. I had some new research to work on, so I finished late.”
“Ah, because of that professor with the broken arm.”
She was staring into space. She didn’t seem particularly interested in the research. Well, that depends on the doctor’s personality. I sipped my strawberry smoothie. Luna was explaining how exhausting her first week at the hospital had been. She’d even given epinephrine twice during that cardiac arrest, and because the intubation was delayed, they had to switch hands three times, yet the patient waking up was still a miracle……
Meanwhile, at Royal Perth Hospital in Australia, Professor Warren was staring at the letter in question. A mysterious message from Stanford. It could be complete nonsense, or it could be a hypothesis that would change the world. Professor Warren was leaning toward the former for now. It was something he had been pondering himself. Almost as if someone across the ocean had read his mind.
“So. You’re saying that using the culture method for those finicky intestinal bacteria, we might be able to culture the causative organism of gastric ulcers? Is that it?”
Barry Marshall, the internal medicine doctor sitting with him in the lab, nodded. Marshall was still a resident who hadn’t even earned his doctorate yet, but he was an expert in this field. Why? Because there weren’t many doctors in the world who believed gastric ulcers were caused by bacteria. Only a handful. The mainstream academic community kept repeating that bacteria couldn’t survive in stomach acid. It was a scholarly wall no one had yet crossed.
“Yes, Professor. That’s what the letter says.”
It wasn’t something they could simply ignore. The letter from Stanford wasn’t a paper, and it didn’t contain any completed research, but if Professor Warren and Marshall’s hypothesis was correct, it was entirely plausible. Besides, Professor Warren knew who had sent this letter. It was that person, wasn’t it? Stanford’s monster. The youngest Lasker Award winner.
He didn’t know why someone like that would send a letter to an obscure pathologist across the ocean, but there had to be something they were missing. Suggesting they try a medium for special intestinal bacteria like Campylobacter wasn’t an impossible piece of advice either. They’d never tried it before, but……
“We should give it a try.”
“Yes. Who knows? This research might finally give us a clear treatment for gastric ulcers.”
Professor Warren shook his head. “Don’t get your hopes up too much. Even if we find the bacterium using this method, that doesn’t prove it’s the cause.”
Still, it was worth experimenting. If they could truly prove that gastric ulcers were caused by bacteria rather than stress…… Marshall scratched his head. “Well…… couldn’t someone just ingest the bacterium and develop a gastric ulcer? That would satisfy Koch’s postulates, wouldn’t it?”