Chapter 10
There's no place as desperate as a pediatric ward.
There's no one who has it harder than parents with a sick child. The pediatric ward is the most gloomy place in the hospital, and yet the brightest.
I passed the little bear painted on the wall.
The ward was painted in pastel colors, and the pediatricians went around smiling brightly, as if everyone in the world were a child.
Because the patients they had to see were children.
Of course, that wasn't always the case.
“Kawasaki disease. How did I not know about it?”
“The English paper on Kawasaki disease was published only two years ago, Professor.”
“Then how did you know?”
“I got lucky.”
Kawasaki disease is dangerous.
It mainly affects children under five, and if untreated, a high fever can persist for weeks.
Even after this period, the risk of sudden death from coronary artery dissection is significant.
Even after the disease was identified, it took decades to find an effective treatment.
The treatment is immunoglobulin.
You can think of it as giving the patient antibodies extracted from someone else's blood.
In the 1970s, treatments using immunoglobulin had not yet become widely available.
Fortunately, Stanford had some.
Professor Hollis and I were sitting in the clinical laboratory at Stanford Hospital. A centrifuge filled with someone's blood was running.
We were making the treatment.
“Thanks for all your hard work. You saved that child's life.”
Professor Hollis stared seriously at the humming centrifuge as it spun, as if gazing blankly at a campfire.
Professor Hollis let out a sigh.
Compared to his joking demeanor from earlier, he looked much more serious and gloomy. It was as if he'd seen a ghost on the way to the lab.
“The weight of the white coat. A syndrome discovered abroad just last year. It's only natural that I didn't know about it, and it's not wrong not to know. But someone nearly died just because I hadn't read that paper…”
“Didn't it work out all right?”
The professor shook his head.
“That child. If the child hadn't met you today, the other doctors would have started treatment without having any idea what disease the child had. Even I was thinking of scarlet fever or an Epstein-Barr infection.”
I nodded solemnly.
“I see.”
“I don't even want to think about it. How many of the scarlet fever patients I've seen up to now might actually have had Kawasaki disease?”
“Uh, I don't think there's any way to know.”
It wasn't a good thing to wonder about.
Most doctors didn't think this way, but perhaps pediatrics was different?
Professor Hollis clapped his hands.
As if to cut off his train of thought.
“Anyway. I didn't understand what you meant by diagnosing an illness just by looking at a patient's face. Now that I've seen it myself, it's unbelievable.”
“You saw the child too, Professor. It isn't difficult when the syndrome has such distinctive features.”
“If it weren't difficult, one of the four Stanford doctors there would have diagnosed it.”
Professor Hollis sighed.
Beep!
The sound of a triangle kimbap being ready.
The centrifuge finished spinning. Professor Hollis put on sterile gloves and carefully took out the test tube containing the plasma.
“It's well known that intravenous immunoglobulin therapy can regulate the immune response, but… is there a particular reason you think it'll work for Kawasaki disease?”
“Severe cases of Kawasaki disease are usually treated with plasma exchange. But for this patient, plasma exchange would be too dangerous, so we're using a method that can produce a similar effect.”
“We can use it along with steroids.”
I nodded. Wearing sterile gloves, Professor Hollis mixed the immunoglobulin solution with normal saline for an IV.
It was ready.
There was no time to waste.
As soon as the intravenous immunoglobulin was ready, we headed straight to the child's room.
Maybe because the child had received steroids, the child looked to be in somewhat better shape than last time.
That's a relief.
Professor Hollis pushed me forward, and I stood in front of the child with the treatment in hand.
“How are you feeling today? You look better.”
The child nodded.
“Yeah.”
I gestured to Alice, and she poked the child's cheek to distract them.
While the child was distracted, I carefully administered the new medication through an IV in the child's arm.
The next day.
The child's fever, which had been threatening to climb past 40°C, came down quickly. Professor Hollis and I sat looking at the patient's chart.
It was a huge success.
“The child really did get better. Just like you said.”
It worked remarkably well.
The fever had returned to normal, and the child's guardian was asking when the child could go home.
“I suppose so?”
I didn't explain at length.
I already knew. For modern doctors, treating Kawasaki disease was a frequently tested question they'd seen many times since medical school.
“The inflammation markers have already dropped. I thought it'd take at least a few days.”
Professor Hollis seemed pleased.
What a change of mood.
Anyway.
With Kawasaki disease, symptoms usually start to noticeably improve the day after treatment. In about two days, the patient is close to fully recovered.
Especially since we used steroids too.
“I'm glad the child is doing well.”
“Glad doesn't begin to cover it, Dr. Parks. We've just discovered a reliable empirical treatment for Kawasaki disease… It's our duty to tell the medical community as soon as possible.”
I nodded.
“Yes.”
“Get going. After getting consent from the child's guardian, write a case report about this with Alice. We need to get the word out quickly.”
How many children across America had Kawasaki disease? If we could spread the word even a little sooner, we might save people who got sick in the meantime.
“Understood.”
It hadn't been that long since I'd written my last paper. This was getting a little tiring.
Of course, a case report only required describing what the disease was and how we treated it.
My workload just went up.
Though it wouldn't take long, would it?
***
Professor Hollis wrote the abstract himself.
All that remained was to write the body of the paper. Alice and I were sitting in a corner of the library, wrestling with an old-fashioned typewriter.
Alice glared at the typewriter.
“This is such a pain.”
“I know.”
The 1970s were still the age of the typewriter.
Computers were still tools used only by specialists. It would be a while before they became popular and word-processing software spread widely.
Was Steve Jobs the one who invented computers?
Come to think of it.
Palo Alto was about to become the heart of Silicon Valley, and if I remembered right, Jobs was from around here, too.
Maybe I'd run into him if I wandered around. If I got the chance, I should ask someone at the Weisman Foundation about him.
Anyway.
The plan had been to finish the paper today.
The quality of a paper dashed off in half a day was obvious without having to say.
Still, it was readable.
Alice stretched as if tired, then looked over at me.
“I heard the baby was discharged yesterday? They made a complete recovery, as if they'd been washed clean…”
I'm glad the child was discharged safely.
It bothered me that we hadn't been able to do an echocardiogram to check for coronary artery dissection or aneurysms.
And so.
The tedious paperwork continued for several hours. The hospital had told me I could spend the day doing research without seeing patients, but I would've preferred the ward.
‘Done!’
I put down the final period and lifted up what I'd just typed, as if it were the Holy Grail.
At last.
I carefully gathered up the paper. If it got crumpled, I'd have to type the whole thing over from the beginning.
Still, one good thing was that writing a paper was much simpler than it was in the modern era. No editing or proofreading.
Once you typed it on a typewriter, you had to submit it that way. What else could you do?
The review process and such were simpler than they were in modern times, too.
There weren't as many papers circulating around the world as there are today.
Alice let out a sigh of relief.
“Finally, we're done! Let's go get coffee.”
“Let's.”
I stood up. One good thing about being with Alice was that she always paid for meals and coffee.
That aside.
I followed Alice, lost in thought. Where could I go to find Jobs?
He was probably hanging around a café somewhere in Palo Alto.
***
The chief of pediatrics at Stanford.
Melvin Grumbach.
Amid the mountain of medical records piled up in the pediatric ward, he was reviewing this case. They'd sent a case report to The Lancet?
‘That's quite an achievement.’
If it was a case of a newly discovered disease like Kawasaki disease successfully treated with a new method, publication in The Lancet was entirely possible.
Melvin fiddled with his tie.
A little while ago, rumors had spread that some undergraduate had gotten their name on a paper in Nature.
Was it pediatrics' turn this time?
It had been a while since pediatrics had submitted a paper to a prestigious journal. The chief looked up the paper that had just been accepted for publication.
“Wait, what?”
It was the very person who'd become famous for publishing a paper in Nature as an undergraduate. A doctor who was only in their first year had gotten their name on a Lancet paper.
That person again?
It was as if world-class research sought that young doctor out. Or maybe that doctor could see what other people couldn't.