How old is your pediatrician?

Much like different types of scientists use different methods for dating natural phenomena, artifacts, fossils, etc., I have developed a way of figuring out how old a pediatrician is. Unlike the aforementioned scientific pursuits, my method is purely anecdotal and decidedly unscientific, though I do think it has merit (and is consistent with the data).

The method is to ask which infectious diseases kept the pediatrician in question up at night. This could be awake at night worried about having missed something or up at night actively caring for a sick patient in the hospital.

One of the infections that kept pediatricians a bit older than me up at night was Haemophilus influenzae type b (Hib). A vaccine for Hib was introduced in the mid 1980s and by the time I graduated from medical school in 1993, Hib was no longer something we saw. But my older colleagues had many stories to tell about children with Hib meningitis and other Hib infections. We had “airway drills” so we knew what to do if a child came in with epiglottitis, a condition caused by Hib which caused the upper airway to swell shut and basically strangle the child. I remember when taking my board exams the first time there were a bunch of questions about Hib infections and I chuckled to myself about why the old folks who wrote the exam questions were so obsessed with infections that no longer existed.

For pediatricians my age, pneumococcus was a common, scary infection. Especially in infants, it was difficult to tell if they had a viral infection or potentially a blood stream infection or meningitis with pneumococcus so we did a lot of blood work and spinal taps on sick babies to rule out the scary things. And pneumococcus was also a frequent cause of pneumonia, sometimes causing large collections of pus in the chest requiring drainage with a chest tube which was inserted between the ribs into the chest cavity. Pneumococcal conjugate vaccines were introduced in the early 2000s and newer formulations have covered for more and more strains of pneumococcus and I have not seen an invasive pneumococcal infection in years. Once a colleague was waxing nostalgic about pneumococcus, a once familiar formidable foe. It was like talking about what one does on rivalry weekend if your arch-rival has dropped their football program.

Rotavirus and chicken pox were less scary but common infections early in my career and they pretty much vanished after the introduction of vaccines for them. Both of these infections could lead to complications requiring hospitalization. Our community hospital used to have an 8-bed pediatric ward which was often full in the winter. Occasionally pediatric patients spilled over into the adjoining adult ward because there wasn’t space for everyone on the peds ward. Now our hospital doesn’t even have an inpatient peds ward and the closest hospitals to our north and south also do not. In the infrequent event that one of our patients does need to be admitted to the hospital, they go across the mountain to the university hospital.

I’m not sure what keeps the doctors younger than me awake at night. They must just sleep soundly (except for when their children wake them).

It is pretty amazing to think back about the changes I have personally witnessed over the past 30 years. It is also concerning to see some of these illnesses making a comeback. There have been multiple outbreaks of measles in various parts of the country (almost all in unvaccinated patients) and we have recently seen both whooping cough and chicken pox in our office in unvaccinated patients. I really hope I do not need to practice my spinal tap skills and that we do not need to reinstate airway drills.