Faculty Bibliography

Any normal person reading, say, a magazine article about the insidious onset of certain forms of cancer might feel the urge to check for enlarged lymph nodes just along the collarbone (so much more suspicious than lymph nodes in the neck!).

As I go from room to room and examine those children and swab their throats for strep or dig the wax out of their ears, I think quickly about meningitis. O.K., the giggling 3-year-old eating crunchy junk food snacks while he runs busily around the exam room may have a temperature of 103, but he does not have meningitis. Fever, headache, stiff neck, photophobia -- these are the clinical hallmarks of meningitis, an infection of the membranes that surround and protect the spine. It can be caused by a variety of viruses and bacteria, and the bacterial form, in particular, can be a virulent fast-moving infection, an infection that can devastate or even kill a child. I have seen plenty of children with meningitis. I did my residency in the days before children were routinely vaccinated against Haemophilus influenzae Type B and Streptococcus pneumoniae, two bacteria with propensities for spinal infections, and I took care of plenty of hospitalized children with meningitis

The toddler had been in a car accident two days earlier, the mother explained, and ever since, she had been worried that something was wrong. I collected the details of the accident, a fairly ritualized set of inquiries, which yielded a ritualized medical summary: Patient was in a forward-facing car seat strapped into the back seat, passenger side, when car was struck on driver's side by another car, moving slowly. It didn't sound like anyone had been badly hurt. The child hadn't banged her head, thanks to the car seat. She had been alert and crying immediately after the accident. And crying, in these circumstances, is a very good thing; it's not a signal of pain or fear but instead it's evidence that the child hadn't seemed dazed or stunned and definitely hadn't lost consciousness. It was the 11-month-old she was worried about. Since the accident, she told me, the girl had begun to sneeze. She hadn't slept so well last night. And today her nose was running and she hadn't eaten as well as usual. Could her back be hurting her, the mother wondered. Could her stomach be sore? Could something be going wrong inside her nose?

An excerpt from Every Mother Is a Daughter: The Never-ending Quest for Success, Inner Peace, and a Really Clean Kitchen by Perri Klass and Sheila Solomon Klass is presented. Among others, Klass and Klass share their perspectives on the wonder of new births in their family

Usually, though, it's one of the others: most of our teenage patients are the others, essentially good kids, pushing the envelope no more than adolescents everywhere. Then there are the stars -- the college-bound, the honor society inductees, the athletes, the scholarship winners. The children of immigrants, living out the trajectory that their parents, working nights as hotel housekeepers and nurse's aides, imagine. I have a very small, very sad array of clippings like these -- a house fire, a murder, a car accident. And for every clipping that actually turns out to belong to me, there are dozens I scan quickly -- the abused foster child, the baby who died at day care, the drive-by victim, the kidnapping, the meningitis stories, the flesh-eating bacteria, the drownings -- and then shake my head in relief. I don't think that's one of mine. I suppose there are different kinds of sadness for different kinds of deaths. When an adolescent whom you know is already out there on the edge falls off, when an adolescent who has obviously been circling gangs and drugs and guns ends up dead, there's a certain frustrated fury. Why did it have to be like this? Why wasn't there some way to change the situation? Why did we have to stand by and watch?