Diagnosing Illness from a Single Glance? (1)
Rigelotte's gift—the Weiseman calling card. It was a key that could unlock countless closed doors in Palo Alto. A little pondering, and it might just be a chance to turn my vision into reality...
Good thing I hadn't drunk last night. I arrived at the hospital early in the morning, flipping through medical records. Maybe a new patient worth seeing had come in today? Ideally, something rare and intriguing.
"Oh, you're in. I was looking for you."
I turned at the familiar voice. It was Alice. My classmate from graduation. She was a pediatrics resident now.
But why would pediatrics need me?
"What's up?"
"We've got an East Asian kid in pediatrics with a 40-degree fever for 36 hours straight. Maxed out the antipyretics, no dice, so we're cooling him with ice water. Any idea?"
I had a pretty good hunch. A few diagnoses came to mind.
A 40-degree fever. Even in 1970s Stanford Hospital, pediatric cases this tough weren't all that common.
Alice led me to the pediatrics research area. As we opened the door, four pediatricians turned to stare at us like a pack of meerkats. I chuckled inwardly, while Alice presented me with a flourish.
"Professor! I brought in an expert!"
"Finally."
James Harris, pediatrics professor. One of America's most renowned pediatricians. He smiled at me like he'd been waiting for this exact moment.
"Good morning, Professor."
"I hear you can diagnose patients just by reading their faces. That true?"
Now we're resorting to fortune-telling for treatment? Impressive, Stanford.This is the level of America's self-proclaimed top medical school and hospital, folks.
I sighed inwardly and shook my head.
"Come on, Professor, no one can diagnose from physiognomy alone. I'm no shaman."
"Let's see the patient."
Harris led the way, with Alice, me, and two pediatric residents following. What could it be?
"What's the patient's deal?"
"Three-year-old Japanese kid. Fever over 40 degrees, antipyretics doing nothing. Antibiotics made it worse."
I nodded. "Meningitis?"
"Already checked."
Meningitis is common in kids, but Stanford docs would've ruled it out.
"Still's disease?"
"Sharp. But no family history, no characteristic symptoms."
Rare genetic disorder. I'd hoped they missed it, but no dice. These pediatricians were sharper than I'd thought.
"Tuberculosis."
"Checked that too."
Of course—skipping TB would've been idiotic. What did they expect from me? Even with 50 years of foreknowledge and some clinical experience, cracking a case that stumped four Stanford pediatricians on the spot was a stretch—
"Huh."
Through the glass in the room door, my eyes met the patient's. I froze.
What the—
The three-year-old girl sat by her guardian's side on the bed. Absurd as it sounded, Alice and Harris were right. You could diagnose this just from her face.
"What, can you tell from a glance?"
"Yeah..."
"Knew it. Name the diagnosis."
I scratched my head awkwardly.
As ridiculous as it was to admit, this was a case you could diagnose from physiognomy alone. Bilateral eye conjunctivitis. Reddened lips, facial erythema, swelling under the jaw. Textbook Kawasaki disease. Also known as mucocutaneous lymph node syndrome.
"No way—you really diagnosed it from her face? I thought it was a joke."
"Yeah, well."
I scratched my head. "It's Kawasaki disease. The bilateral conjunctivitis and hyperemia cause those characteristic red lips—visible at a glance."
"If we hadn't called you, we'd be sizing her up for a coffin about this long by tomorrow." Harris gestured with his hands at the child's height.
Professor humor.
"Treatment's straightforward. IV steroids and intravenous immunoglobulin—she'll start recovering in hours. Might need prophylactic aspirin for possible coronary artery involvement."
"You memorize all that?"
"Yep."
Kawasaki hits Asians ten times more often, so it's drilled into us in Korea. Still ultra-rare in the US. No wonder these docs had never seen it.
"Alice, look it up. See if there's anything on Kawasaki disease."
The professor turned back to me. "So, what's Kawasaki disease?"
"A kind of autoimmune or hypersensitivity vasculitis. Cause unknown, but as you see, it inflames blood vessels—including the coronary arteries."
Coronary—crown-shaped—arteries supply the heart itself.
While I explained, Alice returned with a journal.
"Professor, it's real! Pediatrics journal, 1974—paper by a Dr. Kawasaki."
"Whoa..."
Harris flipped through the journal, face serious again. "Yep, just like you said."
"Yes."
"But how? You just happened to read a brand-new peds paper from two years ago—and memorize it?"
The pediatricians stared at me in shock and awe.
I racked my brain, but no normal-person answer came. It was a common, important disease in Korea, so we'd memorized it. Best to play it as physiognomy.
"Uh, I was digging into immunology stuff that interested me and skimmed it."
"What have we been doing all this time that a passerby diagnoses our patient? Time for some soul-searching."
Alice squinted. "Didn't you just learn it yourself, Professor?"
"Exactly!"
The pediatricians whipped out notebooks, scribbling furiously. Kawasaki disease: characteristic face, fever unresponsive to antipyretics. Treatment: steroids and IVIG.
The patient's guardian waited outside amid the commotion, anxious-faced, while the oblivious child sat nearby. Harris entered beaming like he'd won the lottery.
"Aigoo, feeling better today?"
"It hurts."
The toddler mumbled.
"Yeah, you look it. 40-degree fever—if that didn't hurt, you'd be a cat, not a kid."
He chuckled heartily, turning to the mother. She eyed us incredulously.
"Did you figure it out?"
"We've nailed the diagnosis! Paper from last year by a Japanese doc named Kawasaki..."
The mother grabbed his arm. "Is it curable?"
"Yes. She'll bounce back fast. But we'll monitor for vasculitis risks a few months."
He looked at the child. "Hear that? Few more days, good as new."
She didn't seem to fully get it but smiled when her mom did.
Harris beckoned me. "This young doc memorizes whole journals—that's how we cracked it."
I greeted the guardian. The mother bowed politely. "Thank you..."
"Thank him." Harris gestured at me again.
We headed back to the ward station. Harris grinned like he'd cured his chronic constipation, then eyed me thoughtfully.
"But steroids make sense for immune issues. The journal didn't mention IVIG, though."
"Oh, really?"
Guess Dr. Kawasaki hadn't gotten that far. I scratched my head.
"Your idea?"
"Yeah. Immune disease means immune mediators are the culprits. Plasma exchange is no-go for a kid this small. Simplest equivalent..."
Harris squinted skeptically. "Human body's not a machine. You sure rough-dosing works?"
"Solid theoretical basis. High-dose steroids alone would work too."
Harris nodded. "If IVIG really treats Kawasaki, our Stanford team could introduce it to America—and pioneer the cure..."
Even modern medicine doesn't fully grasp why IVIG works on Kawasaki. But it does—I'd seen it in Korea plenty.
"It'll definitely work."