Smoke, mirrors and immunizations

By Tom Burke | For The Olympian • Published September 29, 2008

T he call came from an emergency room just north of the city. It sounded routine at first. Sometimes our region's practitioners ask for rather straight-forward advice; other times, we are equally stumped. I'd rather be called too often than not enough.

The patient was 14 and had body aches, a fever, runny nose, nausea and vomiting. The subsequent words were alarming: "a slow heart rate," "yellow skin" and "blood in her urine and vomit." An ambulance would bring her to us.

At the Massachusetts General Hospital for Children, referrals from other hospitals make up 20 percent of our pediatric emergency room visits. Perhaps a quarter of our referrals are children with a problem related to a complex medical disorder that requires specialty care.

Among those other three-quarters are the most challenging patients: the children who arrive with unusual and unclear life-threatening illnesses.

In the ER

I followed the ambulance duo into the room and introduced myself after the pa tient had moved from the ambulance stretcher to the waiting ER gurney. Her mom was stationed on her right side, holding her hands and stroking her daughter's sweaty, matted blonde hair while her dad paced uneasily near the foot of the bed. One glance told me she was critically ill. Both parents had fright etched across their brows.

The three had returned from Gambia in Africa just a week before. For 14 days, they had volunteered in a rural community, helping build a church and school. Neither parent had felt ill. They said during the mission trip, they were religious about drinking bottled water and taking malaria pills.

Their daughter always had been the picture of health. She has been a better-than-average student and an avid soccer player. She was the "light of their life."

But the 14-year-old had become ill two days after returning from Africa. Her initial symptoms included a runny nose and generally feeling run down. It seemed like a routine virus. Unfortunately, during the following three days, she became weaker until that morning her skin seemed tinged yellow and blood appeared.