Focus on Vaccines



It was my first day back at the office after a 2-month medical leave, which included 14 days of hospitalization for severe depression. I'd had plenty of time to ponder whether this was an endogenous or exogenous depression. There were many things that could have caused me to be depressed: the death of my wife a few years ago, a pediatric career devoted—in large part—to abused children, conflicts between the medical school and the hospital, administrative decisions forcing my division to "do more with less" that made life difficult, and a general pervasive attitude that making a profit mattered above anything else.

I sat at my desk and started to open the mail that had accumulated in my absence. One of the first envelopes I opened contained a second envelope, on which was written "Howard—We can never thank you enough." Inside was a graduation announcement from a prestigious state university and a photo of a smiling young woman. When I read her name on the announcement, I remembered her story without difficulty. When she was 8 months old she had a fever. Her father, a first-year pediatric resident, brought her to the emergency department (ED), where blood was taken for culture. The child was sent home. Her father had his continuity clinic that afternoon, so he brought her along to clinic. He told me about the ED visit while he held his daughter on his lap. She did not look well to me. I took an otoscope speculum (just the speculum) from my lab coat pocket and put it in her ear. She did not react. I advised her father to bring her back to the ED for a lumbar puncture. He did. The child had Haemophilus influenzae meningitis and spent some time in the ICU.

Her parents, both physicians, continue to believe—rightly or wrongly—that I "saved her life." Their letter—a wonderful reminder of some of the good I had done as a pediatrician—surely came at the right time.