ESSAYS & WRITING

Inspiration can originate from beauty, but what is beauty without the taste of pain? Pain and inspiration have one thing in common: they both cause sleepless nights of tossing and turning and make the mind go. For some, the mind goes to an imaginary painless self, while for others, pain builds solutions. Pain is the first tone of life, beginning with the first cry and ending with the last eek. It dwells in the benign growth spurts of childhood and the bottomless sorrows of death; without these divine stimuli, our growth would be truncated in conformity. While pain is the muse of art in all its forms, it is the estranged muse of science. The deeper you dig into a healer's soul, the more you'll find a story about pain.

We seek to understand pain through the quantitative reproducible scope. Yet, it is a feeling seen through the artist's eye. We tamper it with pharmaceutical-grade potions that threaten our own free will. Yet, pain transforms into addiction and control over our weakened souls who seek to understand the dark muse of our existence. In life's journey, we, as healers, see the inevitable side effects of life and decide to act rather than counteract.

While animals and humans will run away from it, we recognize that it is an essential life for us. Our relationship with pain gave us the comfort that makes life better, whether it be shoes, medicine, or the sounds of opera. We overcome pain in life.

As I chart review before my next patient, I notice the Epic highlight on her chart: "Needs Interpreter: Persian." As an immigrant from a non-English speaking household, the thought of an interpreter brings back many memories. I can remember the anxiety on my family's faces as we waited in the ICU solarium while my grandfather was hospitalized for heart failure, or the frustration of my mother's physician when the interpretation between them was clumsy. Yet, one of my most cherished memories was that of my grandfather's cardiologist trying a simple "hola" and "que te mejores." Beyond the medical jargon, the sentiment of humanity stuck with me. In the essence of that unnamed physician, I promptly googled hello in Farsi and headed to the exam room.

As I knocked and came in, she sat in the same fashion as many of my family members, who were anxious but lighthearted. I smiled and said, Salâm aleikom, as I dialed for an interpreter. Then her eyes opened up, and a whole-body smile arose; her body relaxed. Our consult smoothly started with an interpreter, but at the end, as I left the room to return with my clinical preceptor, the interpreter ended the call. When my preceptor and I returned, my patient apologized, although it was not her fault. Her "sorry" reminded me of the countless times my own family felt like a burden when all they wanted was to be understood.

We called another interpreter and started by letting her know that the call ended due to a misunderstanding that the visit was over, and that we wanted to explain what we had discussed and the next steps for her care plan. Her smile returned, filling the space again, and when she left, the final merci and thank you carried her away.

After her encounter, I meditated on the layers of trust in our profession. Many of us are privileged to serve diverse multicultural and multilingual communities, which involves working alongside colleagues and interpreters with an array of knowledge beyond medicine. Our patients and we must trust that what we say is being relayed appropriately. Beyond the language and the terms, we have to hope it speaks to them in their tone and sensitivity. Medicine, as complex as it can be, is a beautiful example of the best sides of humanity.

As a child, I was inspired by the empathy shared with my family, and today, giving an extra humane part to medicine is my trust language. As medicine becomes more electronically centered and less face-to-face, I keep grounded by giving a patient a call or trying to scoot them into an empty slot so that I can see how they feel. Barriers are what we fear can alienate us from connecting. Trust in medicine is often built in the smallest of gestures. A simple greeting in a patient's language, an extra moment to clarify, or even a well-timed follow-up call can transform an interaction. While technology floods our lives and our in-basket, it can also remind us of the little extra acts of kindness that can help us connect, whether it be a happy birthday or using a patient's preferred name; those are the privileges we should build upon.

The difference between a hero and a villain is based on their choices from their hardships. The interpretation of life's hardships is the essence of agency and the beginning of change. In an era of information and connectivity, reality is silenced by the static generated by the loudest stories. Life and values are confounded by the overload of problem-based division rather than solution-based unity.

As healers, our struggle starts in the realms of health and moves into the horizons of transformational change. While the societal expectations for us may lie in the beds of pandemic preparedness or vaccine equity, the reality of our mission is to deface the shackles of illness; that divisive illness that separates unequal access, intolerance, and human rights violations.

Health is the fuel of development, and until we step up for the challenge of health as an intangible value, the economic interests that dominate the world will never assimilate into the next phase of human development. As we exit the crimson nest of an equitable stronghold of academia, it is our responsibility to stand up, speak up, and be creators of the unmeasurable value of health. Stories will be told of those who act in times of moral peril, and the impending action has to be led by the wholehearted people who chose a profession of moral values. Our time is now.

Pain and inspiration have one thing in common. They cause sleepless nights of turning and tossing. Sometimes that turning and tossing are so constant that it'll follow you all the way to work. What if your job is to lead a country? I bet that pain would make it difficult to think, but what if you're a scientist? Lucky or unlucky enough, pain can turn into creation. Such is this painful inspiration that one of the nine Muses (Melpomene) represents the pain that awakens pleasure. Many famous men and their not-so-famous fraternals have been known for being very bad at tolerating pain; myself included. But this is not a story about pain itself, but about something that causes it.

We've all heard about Nobel prizes, but the word Nobel has a very different meaning to those who hear it. When researchers hear Nobel they think of the season finale of their favorite show; the paradox of what's next? When institutions hear it they start calling donors, but if you were Alfred Nobel's physician back in the mid-1800s, that last name sounded like aches.

According to his biographers, Alfred was plagued by chronic stomach pain. Stress was attributed as the cause of all his maladies, but his diaries described his pain as a bad relationship with everything to do with his gut. A line from his diary reads that he considered himself a misanthrope who was nonetheless deeply idealistic, and prone to digesting philosophy more easily than food. Unbeknownst to physicians of the time, his stomach pains were caused by something much smaller than the stress of his dynamite business empire.

Decades ago the world's biggest-selling drugs were antacids. Stomach ulcers seemed to be everywhere. Before the association of Helicobacter pylori with peptic ulcers, thousands of medical articles described stress, and capitalism itself, as an "ulcer-causing agent." Counterintuitive to logic, this bacterium can survive harsh acidic stomach juices. Years of debate led to a Nobel Prize for Warren and Marshall's discovery of H. pylori and its role in gastritis and peptic ulcer disease.

The ulcer-causing bacterium can be found in half of the world's population. Today's knowledge of that acid-resistant bug is so vast that it has been forgone for trendier subjects, but decades after its discovery, its most dreaded outcome still prevails. Gastric cancer is the second most common gastrointestinal cancer worldwide, with H. pylori crowned as a leading carcinogen of that realm; so much so that it has displaced Human Papillomavirus as the principal cancer-causing infection in the world.

The United States lacks a clear picture of the problem. There is no standardized national data on how often it's diagnosed or how good we are at treating it; a current study found that only seven states track drug-resistance rates, all of which exceed 30 percent. These numbers are concerning given that the presence of H. pylori can lead to cancer. As a way to target these gaps, the Division of Gastroenterology created a program to treat and follow up on patients recently diagnosed with H. pylori, evaluating pre- and post-program rates of treatment, testing, and eradication.

You might ask yourself why this is important. The answer is quite simple, and sometimes simple is the most overlooked. If we want to target the consequences of H. pylori, we first need to see who it affects and how those affected relate to our current beliefs about the disease. Science is about facts, and let's be honest; yesterday's facts might not be today's truths. When it comes to human dynamics and the interactions we have with the world, including the microscopic world, no fact is ethereal. As humans, we are predisposed to fallacies of thought where our previous experiences define our actions. Describing the dance between who gets treated and who gets cured is the best way not to fall into the same hole twice.

H. pylori's story goes beyond the dreaded stomach aches of Alfred Nobel. It's the hidden culprit of the legendary stomach cancers of Chinese seamen and the misconstructed story of Latin American water contamination. As far as, or as close to home, H. pylori is a multigenerational companion of migration, and We the People are a country of migrants. Data that explores how language and human dynamics relate to a disease with a consistent human prevalence helps us target a modern, cost-effective solution for an old foe. So today, I challenge you to find new answers to old questions, because the answer might sound different from what you expected.