Chapter 9
The business card from Weisman that Lieselotte had given me.
It was a key that could open countless closed doors in Palo Alto. If I thought about it a little, it might even be a chance to turn my vision into reality…
Good thing I hadn't drunk last night.
I went to the hospital early in the morning and was flipping through medical records. I wondered if any new patients I needed to see had come in today.
If possible, I hoped it would be some fascinating disease.
“Oh, you're here. I've been looking for you.”
I turned at the familiar voice.
It was Alice, a fellow student who'd graduated with me.
She was currently a pediatric resident. But why would someone from pediatrics be looking for me?
“What's up?”
“We have an Asian patient in pediatrics who's had a 104-degree fever for 36 hours. The maximum dose of antipyretics hasn't helped, so we're treating her with an ice-water bath. Any idea what it is?”
I thought I might have an idea.
A few possible diagnoses came to mind.
If a child had a 104-degree fever and it was a pediatric illness difficult to diagnose even at Stanford Hospital in the 1970s, there weren't that many possibilities.
***
Alice led me to the pediatric research area. When she opened the door, four pediatricians turned to look at us.
Like a bunch of meerkats.
I laughed to myself, and Alice presented me to the gathered doctors with a flourish.
“Professor! I've brought an expert.”
“At last, you're here.”
James Hollis, professor of pediatrics.
He was one of the most distinguished pediatricians in America. The moment he saw me, he smiled as if he'd been waiting for this very moment.
“Good morning, Professor.”
“I hear you can identify a patient's illness just by looking at their face. Is that true?”
Were they relying on magic to treat people now?
Amazing, Stanford.
This is the level of America's self-proclaimed best medical school and hospital, everyone. I sighed inwardly and shook my head.
“Even so, how could I tell just by looking at someone's face, Professor? I'm no shaman.”
“Let's go see the patient.”
Professor Hollis led the way, with Alice, me, and two pediatric residents following him. What kind of illness was it?
“What kind of patient is it?”
“A three-year-old Japanese girl. Her fever's over 104 degrees, and antipyretics aren't working at all. We gave her antibiotics, but her fever went even higher.”
I nodded.
“What about meningitis?”
“We've already checked for that.”
Meningitis was fairly common in children. But surely Stanford's doctors had checked for it.
“What about Still's disease?”
“Sharp. But there's no family history, and she isn't showing any of the characteristic symptoms.”
A rare genetic disease.
I thought they might not have checked for that either, but apparently they had. The pediatricians at this hospital were sharper than I'd expected.
“Tuberculosis.”
“We've checked that, too.”
Well, they'd have to be idiots not to check for tuberculosis.
What were they expecting from me?
Even if I had knowledge fifty years ahead of theirs and some clinical experience, expecting me to immediately identify a disease that four Stanford pediatricians couldn't solve was way too much—
“Oh.”
Through the glass in the hospital-room door, I met the patient's eyes. I froze.
What?
The patient, a three-year-old girl, was sitting beside her bed with her guardian.
As ridiculous as it was, Alice and Professor Hollis had been right. I could tell what was wrong with this child just by looking at her face.
“Well? Can you tell what it is just by looking at her?”
“Yes…”
“I knew it. Tell us the diagnosis.”
I awkwardly scratched my head.
***
As ridiculous as it was to admit, this was a case where you really could tell just by looking at someone's face.
Redness in both eyes. Red lips, facial flushing, and swelling beneath the chin.
A textbook case of Kawasaki disease.
It's also called mucocutaneous lymph node syndrome.
“Wait, you really can tell what the illness is just by looking at their face? I thought it was a joke.”
“Yes, well.”
I scratched my head.
“It's Kawasaki disease. The redness in both eyes and the red lips caused by increased blood flow are characteristic findings, so you can see them just by looking at her face.”
“If you hadn't brought her in, by tomorrow we'd have needed a coffin about this tall.”
Professor Hollis indicated the child's height with both hands.
That must have been gallows humor.
“Treatment isn't difficult. If we administer steroids and intravenous immunoglobulin, she'll start to recover within hours. However, because of the possibility of a coronary artery dissection, we may need to give aspirin preventively.”
“Do you have all of that memorized?”
“Yes.”
Kawasaki disease is about ten times more common in Asians, so it's something we're required to learn in Korea.
It was still a very rare disease in America. The pediatricians here had never seen a case, so that was probably why they were reacting this way.
“Alice. Go see if you can find anything about Kawasaki disease.”
The professor looked back at me.
“All right. What kind of disease is Kawasaki disease?”
“It's a type of autoimmune or hypersensitivity vasculitis. The cause isn't clear, but as you can see, it causes inflammation of the blood vessels. That includes the coronary arteries.”
The coronary arteries are the blood vessels that supply blood to the heart itself.
As I explained,
Alice came back carrying a journal.
“Professor. It was real! A doctor named Kawasaki published a paper in the journal Pediatrics in 1974.”
“Wow…”
Professor Hollis looked serious again as he flipped through the journal Alice had brought back.
“You're right. Just as you said.”
“Yes.”
“But how did you know? How did you happen to read a Pediatrics paper from two years ago? And to have its contents memorized…”
The pediatricians looked at me, their eyes full of shock and dread.
I thought it over, but once again, I couldn't come up with an answer that would make me seem like a normal person.
It was an important disease commonly seen in Korea, so I'd memorized it. Let's just go with the idea that I could tell by looking at people's faces.
“Oh, I was looking into immunology because I find it interesting, and I happened to read about it.”
“What have we pediatricians been doing all this time, if someone just passing by can diagnose our patient? We need to reflect on ourselves, goodness.”
Alice frowned.
“Didn't you only find out about it just now, too, Professor?”
“Exactly!”
The pediatricians took out their notepads and hurriedly wrote things down. Kawasaki disease, characteristic facial appearance, and fever that didn't respond to antipyretics. Treatment: steroids and intravenous immunoglobulin injections.
***
The patient's guardian waited for us outside the room amid the commotion. The guardian looked anxious, while the child sat there, unaware of anything.
Professor Hollis entered the room with a smile as if he owned the world.
“Oh, dear. Are you feeling a little less sick today?”
“It hurts.”
The little girl mumbled.
“Yeah, you look like you’re in pain. You have a 104-degree fever. If you weren't hurting, you'd be a cat, not a person.”
The professor chuckled again and turned his gaze to the patient's guardian. The girl's mother looked at us with a bewildered expression.
“Did you find anything out?”
“We've finally figured out what your child has! There's a paper that came out a year ago. It was written by a Japanese doctor named Kawasaki, and anyway…”
The patient's mother grabbed the professor's arm.
“Is it something she can recover from?”
“Yes. She'll get better soon. But we'll need to monitor her for vasculitis for a few months.”
The professor looked at the child.
“You heard me, right? You'll be better in just a few days.”
The child didn't seem to understand what he was saying, but when her mother smiled, she simply smiled along. The professor beckoned to me.
“We figured it out thanks to this young doctor, who has the latest journals memorized word for word.”
I greeted the patient's guardian. The girl's mother bowed politely to me.
“Thank you…”
“You should thank this fellow.”
Professor Hollis beckoned to me again.
***
We returned to the ward station.
The professor smiled as if he'd just gotten relief from months of constipation, then looked at me again as if he'd thought of something.
“Still, I can understand the steroids, since this is an immune disease, but the journal didn't say anything about intravenous immunoglobulin.”
“Oh, is that so?”
I guess Dr. Kawasaki hadn't figured that part out yet. I scratched my head.
“Was that your idea?”
“Yes. If it's an immune disease, then immune mediators would be the problem, but we can't exactly do plasmapheresis on a pediatric patient like this. The simplest way to get a similar effect would be…”
The professor frowned at that.
As if to say, Does that make any sense?
“The human body isn't a machine. Can you really just take a wild guess and expect it to cure the disease?”
“There's a sound theoretical basis for it. Of course, high-dose steroids should also resolve the disease.”
Professor Hollis nodded.
“If intravenous immunoglobulin really can treat Kawasaki disease, our Stanford team will be the ones to bring it to the attention of America and discover its treatment…”
Even modern medicine didn't clearly understand exactly why intravenous immunoglobulin therapy could treat Kawasaki disease.
But there was no doubt that it worked. I'd seen it used to treat patients in Korea many times.
“I'm sure it'll work.”