Brian Tan, Hwa Chong Institution
Blood. So much blood.
At first, it wasn’t obvious. In retrospect, maybe I was too negligent. Negligent of the tiny details, negligent of the little indicators that something was wrong.
I don’t remember when the coughing started. She had been a sickly child since birth, but her rock-hard resolve pulled her through incidents of pertussis, hand-foot-mouth disease and gastroenteritis. I think I recalled Sue Ann telling me one evening that her coughing had become more violent with the onset of fever, that maybe we should have her checked out.
The quintessential irony failed to strike me back then: A doctor failing to identify the medical affliction his own daughter was going through. I laughed at Sue Ann. “I’m pretty sure it’s nothing serious. Have you given her dextromethorphan for her cough and ibuprofen for her fever? It’s the pink bottle. In the medicine cabinet.”
I stopped laughing when she started to cough blood. Haemoptysis. I recognised it too quickly.
The year was 2026. All 193 UN member states gathered at the third general assembly meeting on drug-resistant bacteria, the first of which was held in 2016. It was now estimated that more than 3 million people die each year due to drug-resistant infections. The cavalcade of new diseases declared to be drug-resistant or even drug-immune increased exponentially in the last decade, each introduced with shrill press releases and posters of grim-faced researchers peering through microscopes. In fact, we were not the first ones to declare antimicrobial resistance as an impending crisis. “There is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant,” Alexander Fleming first sounded the alarm in 1928 while accepting his Nobel Prize for his discovery of penicillin.
Nevertheless, many people remained insouciant about the unfolding of a post-antibiotic era. All too often patients discontinue treatment by truncating the full course of prescribed antibiotics, resulting in the bacterial infection not completely wiped out, giving rise to a resistant strain which might be more difficult to treat in the future. Moreover, it is increasingly harder to develop new effective antibiotics – only one or two new antibiotics were developed in the last 30 years. But as the number of super-bug fatalities peaked every year, so did the public call for action to tackle this increasingly pernicious issue. People wanted solutions.
We had none.
The incandescent lights overhead, aggravated by the faint smell of iodoform made me walk faster, stabbing the linoleum flooring with every step. Sixteen years working in the hospital, yet I could never truly shake off the pervasive atmosphere of sterility. I bit my lower lip and slowly pushed open the door to Ward 401.
She laid there, as fragile as a breath of air.
I pulled a chair over and grabbed her hand. Her eyes met mine. All of a sudden, her hand flew to her mouth and she coughed violently. One. Two. Her hand clutched a piece of tissue. It was flecked with red.
“I’m terribly sorry to interrupt,” the door swung open. Dr Lee walked in, the creases in his brows wrinkling. We studied medical school together. It was a long time ago.
“She already finished three rounds of antibiotics. No effect. We believe it’s a strain of highly drug-resistant streptococcus pneumoniae. We tried everything: rifampicin, cephalosporin…” Dr Lee trailed off.
Something cold and dark gripped my heart. Drug-resistant strain of pneumonia? What were the odds? How did she get infected? Why her?
For a brief moment, her tired grey eyes met mine. She wanted answers.
I had none.
Instead, I turned around, opened the door and sunk down in a heap in the corridor, outside Ward 401. Why her? Why not… me? After all, I was the one experimenting with drug-resistant bacteria. I was trying to find alternatives that superbugs could not develop resistances to. I narrowed my eyes. I had spent too much time in the lab. That was the answer to her unasked question. I neglected her.
My phone jumped in my hand.
“Hello? Dr Tan! You need to hear this!” I squinted. In the years that I had worked with Jonathan, my laboratory assistant, never once did he ever raised his voice. “Remember the polymers you were working on? The results are out! Listen to this very carefully – in the eight strains of drug-resistant bacteria we tested on live mice, one hundred percent of the bacteria in every single strain were killed! This just might work!”
In the last six months my team had developed what we affectionately called SNAPPs, or otherwise known as structurally nanoengineered antimicrobial peptide polymers, which work by killing bacteria through multiple pathways, unlike most antibiotics which kill with a single pathway. One of these pathways includes directly penetrating and ‘ripping apart’ the bacterial cell membranes. What was even more important was the fact that this polymerised peptide is non-toxic to human cells as the polymers we designed were too large to infiltrate the healthy cells. Furthermore, the bacteria failed to develop any sort of immunity towards these polymers.
“Dr Tan! Are you listening? We can have our first tests approved for human patients in less than four months’ time!” Jonathan said, his voice sharp with animation. Desperately, I tried to find the same level of enthusiasm within myself.
There was none.
They say the smallest coffins are often the heaviest. I hugged Sue Ann as she wept into my shoulder. She didn’t last four months. I pushed for an immediate testing of the new peptide polymers on human patients, but medical bureaucracy did not work that way, and I knew it. I pushed myself harder. Maybe if I did more tests and showed them more results of success rates in live animal subjects, they would bring forward testing dates for human patients…
They did not, and in achieving one of the greatest medical breakthroughs that could be revolutionary in defining the future of a post-antibiotic world, I lost something even greater.
I lost the time to spend with her. That was all she wanted, and I failed to give her that.
Something was lodged in my throat. I raised my handkerchief to my mouth and coughed.
Blood. So much blood.