Kate Scannell, MD

By Kate Scannell, Contributing columnist Bay Area News Group
PUBLISHED IN PRINT 07/11/2010

MY NEPHEW is a self-proclaimed connoisseur of scary movies. Over time, he has refined his tastes, and he is no longer interested in the "boring" films that lamely depend upon rivers of blood, high-octave screaming, high-octane lethal pursuits, and passe props like hatchets, knives, and guns. For him, a "quality" horror film now requires potent doses of supernatural and psychological thrills and a smattering of aliens or interspecies creatures. Multicolored slime, however, has maintained its perpetual allure.

After delivering his critique of yet another gruesome film during a recent dinner together, he asked whether I had seen any good horror stories.

Well, yes, I thought. I had been watching the nightly news, following the wars, monitoring the Gulf Coast oil spill, reading the financial pages, and ... to top it all off, I was also a doctor.

Being a doctor can bring you up-close and personal to a variety of frightening circumstances that can make your toes curl permanently. It often casts you with a group of strangers into chaotic and urgent scenes for which no one's written a solid script. And it always draws you into the action as a lead character, makes you complicit and responsible for what transpires clinically. Your mind shifts into overdrive and your hands orbit wildly around a sick patient, and, still, someone sometimes suffers or dies in your care. Failures can haunt with terrifying ferocity. Life and death provide a constant pressing backdrop to your work.

But, I decided not to share these thoughts with my nephew. For him, playing "Operation" still delights, and terror remains neatly contained within two-dimensional portrayals on a fake-bloodied silver screen. Real, living, three-dimensional horror — when it arrives in one's life — always visits soon enough, in its own time.

For me, current news of California 's burgeoning whooping cough epidemic — so far involving at least five infant deaths, and more than 1,300 confirmed plus 700 suspected cases — has unearthed an old horror story rooted in my early career. I was a medical student in the pre-Internet and pre-computer era, learning my diagnostic skills from library textbooks and from direct hands-on experience with patients and their families. There existed no remote learning through web-based educational programs — no medical training videos or photographs on Google; no virtual patients or cadavers; no substantive audio-library from which to study the sounds of hearts or lungs in distress. You carried your medical knowledge within your head or inside what notebooks could fit into the bulging pockets of your white coat.

I had been reading about whooping cough — the common name for a bacterial infection of the respiratory tract medically known as "pertussis" — but I had never seen "a case." At that time, in the late 1970s, an ominous pertussis outbreak was sweeping through England and Wales. Although an effective vaccine had existed for years, public fears in the U.K. about possible side effects had resulted in dramatic declines in immunization rates. And history had taught us that before pertussis immunization had become available, whooping cough used to kill five of every 1,000 children born in the U.S.

Knowing that pertussis was both highly contagious and potentially lethal, I wanted to be able to recognize its purportedly distinctive cough and "whoop" in a timely fashion. I was worried that someone would suffer if I didn't know.

One day, I was instructed to head to the pediatrics ward where "a very sick baby" had been admitted. As handmaiden to my physician-mentor in such circumstances, I would be expected to observe and learn from him — and to carefully document a detailed patient history from the family.
I was ill-prepared for the horror unfolding when I entered the baby's room. Things happened so fast, and urgent clinical developments precluded any meaningful discussion with the family or my mentor.

There was a small baby trying to sit upright inside an oxygen tent — a plastic, see-through cone misted by oxygen that draped over her crib. A tiny hair bow gathered the few strands of her thin limp hair. She looked like a new toy doll trapped behind the plastic lid of its original packaging.

But the baby was distressed and failing badly. Her mouth turned blue, the color of dread. She occasionally reached for her sobbing mother who stood helpless on the other side of the tent. Mostly, however, the baby was too weak to do anything but cough and breathe.

My mentor tried valiantly to keep the baby awake while a nurse labored to remove the secretions that kept pooling within her mouth. The child's coughing was violent and uncontrollable. And when she could finally eke in a short breath here and there, it slid into her lungs as a feeble "whoop" — and into my brain as a sound I've never forgotten. Before the baby collapsed within her plastic tent, she seemed to glance at all of us in utter confusion, in consummate exhaustion. The usual attempts were made to salvage her life, but they did not succeed.

I turned to my nephew and answered that I hadn't seen any "good" horror stories. Because the horrors I'd witnessed as a doctor had involved tremendous pain and suffering for real patients and real families. I saw no good in any of it.

Besides, nothing that Hollywood could ever churn out — no matter how many slimy aliens or psychotic robots — will ever prove as terrifying to me as that baby's struggle, her mother's screams, my helplessness.

Later, after dinner, I spoke with my nephew's mother, checking to see that he and his family were up-to-date with their pertussis vaccinations. Some horrors are preventable.
-------------------------------------------
Kate Scannell is a Bay Area physician and syndicated
columnist. Her new novel is "Flood Stage."

ABOUT WHOOPING COUGH
• Whooping cough: Medically known as pertussis, it is a potentially serious bacterial infection of the respiratory tract that is generally vaccine-preventable.
• Pertussis is the "P" in the childhood vaccine DTaP and in the booster vaccine Tdap that is used for preteens and adults. Both vaccines also help to protect against two additional bacterial infections: tetanus (the "T") and diptheria (the "D").
• The Centers for Disease Control and Prevention (CDC) recommends that children receive a series of five doses of DTaP vaccine, beginning at 2 months of age and completed by ages 4-to-6 years.
• A single booster dose of Tdap is recommended for preteens at 11 or 12 years, and for many adults through 64 years of age who have not previously received a Tdap booster.
For more information, contact your health care provider and visit the CDC vaccine website at http://www.cdc.gov/vaccines/


Copyright Kate Scannell 2010