Diagnosing Just by Looking at the Face? (2)
There's no place in the hospital as desperate as the pediatrics ward. No one suffers like parents with a sick child. The pediatrics ward is the hospital's most somber spot—and yet, its brightest.
I passed by the teddy bear painted on the wall. The ward was coated in pastel paint, and the pediatricians wandered around beaming as if the whole world were full of children. Because the patients they had to see were children, of course. Not that it was always like that.
"Kawasaki Disease. How did I miss it?"
"It's only been two years since the English paper on Kawasaki Disease came out, Professor."
"Then how did you know?"
"I got lucky."
Kawasaki Disease is a dangerous illness. It mostly strikes kids under five, and without treatment, they suffer high fevers for weeks. Even after discovery, there's a non-negligible risk of sudden death from coronary artery aneurysms. And it took decades to find an effective treatment. The cure is immunoglobulins—think of it as injecting antibodies extracted from someone else's blood.
The 1970s hadn't widely commercialized immunoglobulin therapy yet. Luckily, Stanford had it. I sat with Professor Harris in Stanford Hospital's clinical lab. A centrifuge whirred, filled with someone's blood. We were preparing the treatment.
"Good work. Thanks to you, she'll pull through."
Professor Harris stared at the humming centrifuge with a grave expression, like someone lost in a campfire trance. He let out a sigh. Compared to his earlier joking demeanor, he looked far more serious—positively grim. Like he'd seen a ghost on the way here.
"It's the weight of the white coat. A syndrome discovered abroad just last year. Of course I didn't know about it—no shame in that. But because I hadn't read that paper, we nearly lost her..."
"Didn't we sort it out in the end?"
The professor shook his head. "That girl. If she hadn't met you today, the other doctors wouldn't have had a clue what to treat her for. Even I was thinking scarlet fever or Epstein-Barr infection."
I nodded solemnly. "I see."
"I don't even want to think about it. Among all the scarlet fever cases I've seen so far, was there ever a Kawasaki Disease hiding in there?"
"Hard to say."
A pointless thing to dwell on. Most doctors wouldn't think that way, but pediatrics might be different?
Professor Harris clapped his hands, as if snapping out of his reverie. "Anyway. I couldn't wrap my head around diagnosing just by looking at the patient's face. But seeing it myself? Mind-blowing."
"You saw it too, Professor. The symptoms are so characteristic for the syndrome—it's not that hard."
"If it weren't hard, one of the four Stanford doctors in the room would've caught it."
Harris sighed again. Beep! The sound of a triangular kimbap being perfected—or rather, the centrifuge finishing its spin. He donned sterile gloves and carefully removed the test tube with the plasma fraction.
"We know intravenous immunoglobulins can modulate immune responses. But what makes you think it'll work specifically for Kawasaki Disease?"
"Severe cases are typically treated with plasmapheresis. But that's too risky for this patient, so we're using something with a similar effect."
"Pair it with steroids, then."
I nodded. Still gloved, Harris mixed the immunoglobulin solution with saline for the IV bag. Done. No time to waste. As soon as the IV immunoglobulin was ready, we headed straight to the patient's room. Thanks to the steroids, she looked a bit better than before. Thank goodness.
Harris gave me a nudge, and I stepped forward with the treatment in hand.
"How're you feeling today? Looking better."
The girl nodded. "Yeah."
I signaled Alice, who poked the kid's cheek to distract her. While the patient's attention was elsewhere, I carefully injected the new drug into her arm.
The next day, the fever that had been pushing 104°F dropped right away. Professor Harris and I sat reviewing the patient's chart. A resounding success.
"She's really better. Just like you said."
The effect was crystal clear. Temperature normalized, and the parents were already asking when she could go home.
"Yeah?" I didn't elaborate. I already knew.
To a modern doctor, Kawasaki Disease treatment is a staple quiz question from med school days.
"Inflammation markers are already down. I figured it'd take days."
Harris looked pleased. A bit of a rollercoaster, this guy. Anyway, Kawasaki Disease symptoms typically improve visibly the day after treatment. By day three, it's practically cured. With steroids on top, even faster.
"Glad she's okay."
"More than okay, Parks. We've discovered an empirical treatment for Kawasaki Disease. It's our duty to spread the word to academia ASAP."
I nodded. "Yes, sir."
"Go get parental consent, then write up a case report with Dr. Harrington. We need to share this fast."
How many Kawasaki Disease kids across the U.S.? The sooner we announce, the more lives we save.
"Got it."
Wasn't it just the other week I wrote a paper? Starting to feel the grind. Case reports are simple, though—just what the disease was and how we treated it. Workload's piling up, but it shouldn't take long.
Professor Harris wrote the abstract himself. Now for the body. Alice and I hunkered down in a library corner, wrestling with an old typewriter.
Alice glared at it. "This is such a pain."
"Tell me about it."
The 1970s were still typewriter territory. Computers were for experts only. Widespread word processors? Not yet. Invented by Steve Jobs, right? Come to think of it, Palo Alto's about to become the heart of Silicon Valley, and Jobs was around here, if memory serves. Might spot him wandering. Should ask around via the Weiseman Foundation sometime.
Anyway, goal was to finish the paper today. After half a day of frantic typing, it was... well, legible. Barely.
Alice stretched, yawning, then glanced my way. "Heard the baby went home yesterday? Clean recovery, like she was washed with water..."
Great news on the discharge. Only thing bugging me was not doing an echocardiogram to check for coronary aneurysms.
And so, hours of tedious paperwork dragged on. Hospital gave us the day for research—no patients—but honestly, ward rounds sound better.
Done! I hit the final period and lifted the pages like the Holy Grail. Finally. I gathered the paper carefully. Wrinkles mean starting over.
One upside compared to modern times: paper writing was simpler. No proofreading marathons or edits. Type it once on the typewriter, and that's it. No other way. Review processes were lighter too—fewer papers floating around.
Alice exhaled in relief. "Finally! Coffee run?"
"Let's do it."
I stood. Perk of working with Alice: she always covers meals and coffee.
Daydreaming, I followed her out. Where could I find Jobs? Probably haunting Palo Alto cafes.
Stanford's chief of pediatrics, Melvin Groomback. Amid mountains of charts in the pediatrics ward, he eyed this case.
Submitted a case report to The Lancet?
They pulled it off.
A successful treatment of a newly discovered disease like Kawasaki Disease with a novel method? The Lancet was a real shot.
Melvin fiddled with his tie. Word had spread recently about some undergrad landing a Nature paper. Pediatrics' turn now? First big-journal submission from the department in ages.
The chief pulled up the approved publication list. "What the...?"
It was that same guy—famous from his undergrad Nature paper. A first-year resident now on The Lancet.
Again? It's like world-class research seeks him out. Or maybe he sees what others miss.