Chapter 14
A man in his forties. He had no history of heart disease or high blood pressure, but now he had a heart murmur and swelling in his legs.
He was in a dangerous state.
He'd said he was too short of breath to have a proper conversation, so I stepped out for the time being.
There were signs of various infections, too.
I was starting to see what it might be.
“Doxycycline!”
I turned toward my senior.
Doxycycline was a type of antibiotic used to treat certain atypical bacterial infections. It wasn't an antibiotic used in ordinary circumstances.
“Why are you using that?”
“I think it's psittacosis.”
He didn't seem to understand right away.
James looked at me as if I'd said something insane. Psittacosis wasn't exactly a common disease.
Research into it might have been limited in the '70s. The bacteria that cause psittacosis are difficult to culture.
“Why? Does the patient keep parrots?”
“I don't know yet. He said he doesn't keep birds, but the symptoms still fit.”
“Then why...”
“Rather than focusing on psittacosis itself, I think we should look at the nonspecific pattern of infection. There aren't many infectious diseases that can cause both pneumonia and endocarditis.”
For example, some tick-borne bacteria could also be treated with doxycycline.
“What about his legs?”
“It looks like edema. I examined him, and I think it's fluid buildup from heart failure.”
“So you want to try doxycycline as an empiric antibiotic for now?”
When an infection is suspected but the causative organism can't be identified, doctors use the antibiotic—or combination of antibiotics—most likely to work based on experience.
That's empiric antibiotic therapy.
Doxycycline would treat not only psittacosis but similar bacterial infections as well.
“Yes.”
James was seriously considering what I'd said. An internal medicine textbook was open in front of him.
“You might be right.”
“I'd like to start antibiotics soon. Whatever this is, it seems dangerous because it's affecting his heart.”
James finally agreed.
“All right. I'll get the professor.”
Even if the patient wasn't in immediate danger of dying, we didn't have time to spare. I hoped the professor would get here soon.
I might as well get the medication ready.
***
Professor Ellison heard that a patient had come up from the ER and hurried over.
Edward Ellison.
He was a professor of internal medicine at Stanford.
I was loading medication onto the cart I would take to the patient. The most important drug I'd packed was doxycycline, of course.
At least, that was my assessment. The professor came toward me, breathing hard.
“Are you the first-year resident? The famous young Asian doctor the dean keeps bragging about?”
“Yes.”
I looked Professor Ellison squarely in the eye. We didn't have time to waste on anything else.
“All right. How's the patient?”
“He's in precarious condition. I suspect an atypical infection. The X-ray shows pulmonary edema and signs of atypical pneumonia.”
“What disease do you suspect most?”
“Taking the main symptoms to be endocarditis and pneumonia, I suspect psittacosis or a similar illness. I think we should start doxycycline as an empiric antibiotic.”
“Psittacosis. Isn't that rather rare?”
Same reaction as James.
Still, I was convinced an atypical bacterial infection was the most likely. If I had to consider another possibility, perhaps a tick-borne disease?
I shook my head.
Who knows? He'd said he was short of breath, so I hadn't been able to question him closely, but maybe he kept pigeons at home and ate them.
That seemed a little unlikely, though.
“It's rare for a disease to affect both the lungs and the heart. Psittacosis is a classic example.”
“That's true. Let's go see him.”
We headed back to the patient's room.
In any case, what mattered now was whether doxycycline would work. Edward looked at the list and sighed.
“James and I thought it was a heart attack, because of the murmur.”
“That's possible too.”
A myocardial infarction, or heart attack, could cause similar symptoms. It just didn't explain the fever or pneumonia very well.
I'd seen that happen occasionally when I worked as a doctor in Korea.
If things went even a little off track at the start, patient care could go badly awry in no time. Quick decisions mattered, but so did getting them right.
We stood beside the patient's bed.
He seemed to be having more trouble breathing than before.
I prepared a syringe of furosemide, a diuretic, from the cart. It would help with the edema. We needed to get the fluid out of his lungs.
Beside me, Professor Edward began speaking to the patient. The patient furrowed his brow.
“Hello, sir.”
“Yes...”
“Do you happen to keep parrots?”
He looked at me as if I were talking nonsense.
“Why would you ask that all of a sudden...? No.”
Professor Edward shrugged at me, but I shook my head. Parrots weren't the only birds that could transmit psittacosis.
“What about pigeons or other birds?”
The patient coughed for a long while.
“No? I don't keep birds at home, and I haven't even seen any recently. Ah, but—”
The patient paused to think.
“And?”
“But are chickens birds?”
I knew it.
I smiled to myself, but Professor Edward nodded slowly with the patience and gravitas that came from decades of experience.
“Chickens... I can see how that might be confusing. I don't think of chickens as birds either.”
He's just saying anything now.
We gave the patient doxycycline, then wheeled the cart out of the room.
***
Professor Edward looked at me.
“How did you know?”
“Well, when there's no clear cause for a fever but a bacterial infection seems likely, I think we should try giving doxycycline empirically.”
That was the protocol in modern medicine.
Maybe doctors in the '70s didn't know much about atypical bacterial infections. Perhaps that's why Professor Ellison wasn't familiar with them.
“Sharp thinking.”
“Thank you.”
“Doxycycline should help him recover.”
The doxycycline should take care of the bacterial infection. The question was how much of his heart function would return; we'd have to wait and see.
We'd only cleared one hurdle.
I looked back at the professor.
“Also, I think we need to decide quickly whether to treat his heart failure. If the antibiotics don't resolve his heart condition, he'll likely need separate treatment for heart failure.”
Professor Ellison let out a quiet sigh.
“Dean Rich was right.”
“What did he say?”
“He said he'd admitted a monster. I can't even begin to guess how you figured out doxycycline... Is that in the textbooks too?”
I thought about how to answer.
“I wondered if there was one disease that could explain all the symptoms.”
“Right. Good work... Let's see whether the patient's symptoms improve after the antibiotics. Go get some rest. I'll look through the textbooks.”
I returned the cart to the station and left the ward, leaving the professor behind.
***
A letter for me had arrived at the Stanford internal medicine residents' room. Was it a Nobel Prize?
Come to think of it, it wasn't Nobel season.
What a shame.
On closer inspection, it was a letter from the Lasker Foundation. It was addressed to me, wasn't it?
I opened the envelope.
-To the Lasker Foundation.
-Greetings.
-The committee is honored to nominate Dr. Jisoo Parks of Stanford for the ‘Future-Oriented Research’ award.
I scratched my head. I wasn't a PhD yet, though. No one without a doctorate had ever won a Lasker Award, after all. Old habits die hard.
I continued reading.
-Your research, conducted alongside world-renowned scholars, laid the groundwork for studying genes and developing methods to investigate them, and demonstrated that methodology through the discovery of human immune complexes.
I'd been active for seven years, ever since I was an undergraduate. In that time, I'd published four papers in Nature.
There was the paper with Professor Berg, who had discovered a way to edit genes, and my proposal that enzymes from simple organisms could be used for gene editing.
There was also the paper with Professor McDevitt, who had uncovered the principles of the immune system, and my proposals for the future direction of immunology research.
I hadn't expected to receive a Lasker Award this soon, but... was this really happening?
-Your research suggested and demonstrated that the language of life could be worked with at a level unimaginable before.
-The committee hopes to shine a light on your research and bring this new frontier in medicine to the attention of researchers and the public.
I folded the letter.
The rest was routine. They hoped I'd come to New York at the end of the year to receive the Lasker Award, and asked me to prepare a short speech.
-Thank you.
I was already getting a Lasker Award. At this rate, a Nobel Prize was well within reach, too.
Then...
James came through the door of the residents' room.
“The psittacosis patient is awake.”
I stuffed the letter from the Lasker Foundation into my coat pocket and got to my feet.
“How did it go?”
“He seems fine. Let's go take a look.”
Let's go see whether the treatment worked. Hopefully, doxycycline had brought his high fever down.