Pediatrics

Tiny Tim and Big D

JOHN W. HARRINGTON, MD
Eastern Virginia Medical School

Dr Harrington is associate professor of pediatrics at Eastern Virginia Medical School and division director for general academic pediatrics at Children’s Hospital of The King’s Daughters, both in Norfolk, Va.

I started my first year as the division director for general academic pediatrics at Children’s Hospital of The King’s Daughters (CHKD) in Norfolk, Virginia in January 2007. 

It was nearly a year later when I first saw Dr Donald W. Lewis, chairman of the department of pediatrics at Eastern Virginia Medical School, present the case of Tiny Tim from the Charles Dickens’ classic, A Christmas Carol.

Dr Lewis presented the Tiny Tim case at CHKD every year in December just before the holidays. His quest to identify Tiny Tim’s illness began simply with a question. One evening while watching A Christmas Carol on television his wife Penny asked, “What was wrong with Tiny Tim?” Dr Lewis would begin his lecture with this question, and as it hung in the air, he seemed to become a conductor directing an orchestra of new medical students, residents, and attending staff through the process of identifying what ailed Tiny Tim.

Tiny Tim was weak, he limped, he was pale, and he was going to die, but why? As Dr Lewis worked through the differential, he reviewed the intricate steps he took to find the answer. He described his time spent at the Medical College of Virginia’s historical library going through textbooks, archived writings, and journals to understand the medical and clinical knowledge that was available from the mid-1800s, when Dickens was alive. If you have read Dr Lewis’ 1992 article from The American Journal of Diseases in Children, then you know what he thought was wrong with Tiny Tim.1
Dr Lewis’ conclusion did not intrigue me as much as the way he provided the clues to help those in the audience arrive at the same diagnosis.

It was then—on seeing the Tiny Tim case for the first time—that I truly appreciated Dr Lewis and the gifts he was imparting to his audience. He reminded us to be passionate about the diagnostic process: to remain true to the principals of basic bedside medicine and to keep our minds open to all diagnoses, even in a factitious character like Tiny Tim.

Dr Lewis died suddenly on February 17, 2012 of a presumed ruptured brain aneurysm.2 His passing left a huge void in our department because of all the energy and life he brought to everything he did—teaching, advocating, researching, and mentoring. Don, or “Big D” as I heard him called at his funeral, had been a pediatric neurologist at CHKD since 1993. He was an expert on childhood migraines. He published more than 50 studies and wrote countless chapters on the topic. He also led a team of neurologists who developed the first national guidelines for evaluating and diagnosing recurring headaches in children.

You would think with a nickname like “Big D” that Don was a large man; however, he was thin and of average height. The “Big,” I can only assume, came from his knowledge of medicine and passion for teaching and advocacy. Big D had a youthful spirit and a playful nature. He would often interview patients and parents at our neurology rounds. I remember many occasions when, in the middle of his examination, he would coyly ask the patient, “By the way, who is your favorite doctor?” The young child being examined would knowingly smile at all the other neurologists and care providers in the room and answer proudly, “Dr Lewis.”

Don’s passing reminded me of an earlier mentor of mine, Dr Paul Woolf, who died a little more than a year ago in New York. Drs Lewis and Woolf, both my mentors and friends, had many similarities. They had a passion for their clinical work, patients who loved them, and a desire to educate medical students and residents. However, the one common bond that overarches all of these missions was a devoted wife who understood them. I remember asking Beth Woolf how some computer equipment was paid for in the residency program at New York Medical College, and she smiled and said, “I’m sure that it is on our credit card statement somewhere.” I heard from the pediatric residents at CHKD that Penny and Don would bring Thanksgiving lunch and dinner to the unlucky staff members who were on call for the holiday.

Moving forward after a great loss is something that is engrained in the human spirit, but it also epitomizes the life of a medical practitioner and his or her relationship with patients and colleagues. I am thankful for the privilege and the chance to have shared these tiny moments with my mentors and for the big impact they had on me. In the words of Ralph Waldo Emerson, “It is not length of life, but depth of life.”

Rest in Peace Big D.