A Universe Within

Space. It was supposed to be the final frontier of discovery. On October 4, 1957 the Soviet Union launched its satellite Sputnik, kicking the race for supremacy of the skies between the United States and USSR into full throttle. Advances in space technology enabled humankind to walk on the moon, send dogs into orbit, and successfully land rovers on Mars. One could say we’ve come a long way.

But it turns out space wasn’t the final frontier. Over the past few decades, scientists have increasingly turned inwards for exploration. In the 1980s and 90s, mapping the human genome to unlock the mysteries of our DNA became the next big target. The Human Genome Project was an international effort spearheaded by the National Institutes of Health and U.S. Department of Energy to sequence the human genome as well as species such as fruit flies, influenza, and mice. It concluded in 2003 with the successful mapping of the human genome—a feat geneticists compared to the moon landing.

The journey inside continues. In 2008, the Human Microbiome Project was initiated to understand how the trillions of microorganisms such as eukaryotes, bacteria, and viruses found in and on our bodies affect our health. The human body contains about ten times as many microbial cells as human cells. Think about that for a second. By a cellular count, we are comprised more of microbes than ourselves. And the microbiomes in our gut are as individual to us as our fingerprints. Some of these strains we inherit at birth, others we gather over the years through diet. So does this mean health is more of a reflection of our genes or of our microbes?

The Microbiome Project aims to find out how these tiny microbial communities living (and thriving) in our nasal passages, urogenital, and gastrointestinal tracts work to keep us healthy, and how we might manage them to treat disease. For example, some microbes have been found to produce vitamins like folate in babies. However, separating and culturing individual microbes for study in experimental settings is largely impossible because many can’t be isolated for analysis. This is believed to be because they require specific environments for growth we haven’t been able to replicate in a lab setting.

The workaround this problem is metagenomics. Microbiologists use DNA sequences of microbial communities to analyze these populations in their natural habitat and compare them to strains they can isolate for a clearer picture of the roles they might play in our health. Understanding how these communities operate to protect against inflammation and infection could lead to advances in how physicians treat patients with debilitating conditions such as Crohn’s Disease.

Microbial samples were collected from 242 healthy adult men and women between the ages of 18 and 40 for the project. So far more than 1,300 reference strains that have been isolated from the human body have been sequenced to date. While the Microbiome Project is no longer recruiting participants, the American Gut Project, a similar mapping endeavor conducted by a consortium of university researchers around the world still is. So next time you’re looking up at the stars with wonder, consider the universe within you that remains unknown.

-KM

A Light Touch

Before clinic hours begin, Dr. Richard Peavey can be found reviewing the day’s cases in the workspace he shares with other PCC physicians and nurses on duty. He’s wearing his traditional uniform: button down dress shirt, bolo necktie, and stethoscope draped around his shoulders. Ten patients are on his schedule.

“It’s going to be a busy day,” he says, picking up a metal clipboard before heading into the hallway.

Peavey understands busy. He began practicing medicine in 1977 and came to People’s in 1999 after spending two decades working in urgent care, general practice, and occupational and rehabilitation medicine. He saw it as “a chance to see the other side of care,” he says.

Peavey earned his medical degree at the University of Texas Southwestern Medical School, and since 2003, he has served as PCC’s director of adult medicine. Most of the patients he sees battle at least one chronic health condition such as diabetes or heart disease. For them, there is no easy fix, no Band-Aid solution, but rather, continual management of their illness.

However, even patients with the best intentions can wind up in the emergency room when familial or work demands trump obligations to monitor their own health. At PCC, a network of support exists to help patients stay on top of their disease. One of those institutional supports is Dr. Peavey. He makes sure he spends time building trust with his patients so that together they can prevent symptoms from spinning out of control.

“All humans deserve the same dignity,” Peavey says, “and part of that is being able to take care of their health.”

Peavey practices medicine with a light touch. When a diabetic patient confesses he’s lapsed in testing his blood sugar as often as she should, Peavey refrains from lecturing. He doesn’t try to guilt the man into action. Instead, he touches the man’s feet to test his circulation. He asks about the man’s family. Peavey listens to what’s really going on in his life. He explains how diabetes affects the blood vessels in the body, often constricting the vessels of the eyes and feet. Then Dr. Peavey focuses on the path forward. A nurse will start calling the patient daily for his numbers to get him back on track.

Fear is a lousy motivator for long-term behavior change, Peavey later explains in his office. There are myriad reasons people don’t follow through with treatments. Never assume anything about a patient’s motivations or the obstacles that they may face.

“I try to encourage people with the prospect of living longer,” he says. “The most important thing with patient care is empathy. That’s not sympathy—it’s just walk a mile in someone else’s shoes. And don’t judge.”

In between patient consultations, Peavey and a volunteer hematologist discuss a mysterious case she hasn’t yet solved. A nurse pops in with a question. A PCC employee shadowing him for the day asks a few more.

“There’s an art and science to practicing medicine,” Peavey explains. “As a young doctor I focused more on the science. Now, perhaps more on the art.”

The art he displays during every patient encounter that day. He isn’t sure how one visit will go. The patient recently won a battle with cancer, but the last few months haven’t been easy. She has chronic pain. Peavey gently knocks on an exam room door before entering. The elderly patient perched on the table gives him an update.

“I’m trying to stay upbeat,” she tells him, her voice wavering. “There’s just a lot of stuff piling up on me.”

Dr. Peavey places his hands on her shoulders. She takes a deep breath and visibly relaxes. She smiles into her tissue.

“I respect what you’re going through,” he says. “It’s good to see you smile.”

-KM