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Back to School

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Sunset was coming early. The leaves were starting to turn, and the threat of snow, although slight, hung in the air. Sitting around the low campfire, the surrounding fields were pale with the light of the full moon, and then trees cast shadows of giants against the tent sides. With the cool nights and blustery days, few mosquitos bothered, and aside from the occasional deer fly bite, time spent in the outdoors was marked only by cool mornings, sunny afternoons, and quiet, albeit chilly evenings. Eleven-year-old twins Molly and Mindy Jackson were busy squeezing every moment out of this final family vacation. Next week they would be back in New York, and back at school.

Their father, William, traveled a great deal with his job as an engineer with a Spanish Energy company while mom Ellen volunteered on three committees that included an Animal Rescue organization, an Art Museum, and a Neighborhood Revitalization Committee. As their parents were often busy, the girls had come to depend on themselves, and with frequent assistance of their housekeeper Maggie, they managed the day-to-day drama of being a pre-teen with moderate success. Neither girl was overly fond of their classmates and had come to consider each other as their truest friend. There was the occasional row, however, usually centered around what clothes they would wear so as not to look too much alike, or what day they wanted, Maggie, to take them shopping, but all in all, they were remarkably mature and easy going for their age, or so their mother had said.

It was during the second week of school that Molly began to feel ill. What began as a sore throat and a mild headache now included fever and chills. A phone call to the family doctor ended with a diagnosis of “The flu.” Bed rest was ordered, as was fluids, particularly water, and aspirin to help with the aches and fever. Mindy was temporarily moved to a guest bedroom so as to limit the spread. The next morning when her sister knocked and peeked in, she seemed tired, but she smiled and asked for her homework. When Mindy knocked again after school to ask where her sister wanted her homework, she didn’t answer. Mindy asked again, louder, but still, no answer came. Her mother was downstairs, and she called down to get her attention.

When Ellen Jackson arrived at the emergency room, following closely behind the ambulance that carried her daughter, she was in a state of panic. She had left three messages for her husband, but he had yet to return her calls. She knew the time difference between New York and Madrid, but still she grew more concerned at the lack of a returned call. When William Jackson called, his daughter had been admitted and was on her way to the pediatric ward.

“What happened,” William asked, clearly in a panic, to which Ellen replied angrily “Where were you?” William responded, calmly, “I was stuck in a meeting. Can you tell me what happened?” Ellen replied that she didn’t know. She could only say that when she came home from her committee meeting, Maggie had met her at the door, and told her of Molly’s turn for the worse. Unable to get her to wake up, she had called and ambulance, and now they were sitting in Molly’s room while the nurses took her blood pressure and temperature. They had hooked up some IV’s earlier, and the people in the lab coats had been in to take blood.

William asked what the doctor had said. Ellen replied he was waiting for the tests to come back, but that it was probably a very bad case of influenza, and that Molly had become dehydrated. A day or so in the hospital, some rest and fluids, and she would be “good as new” he had said. But the next morning when Ellen awoke in the bedside chair her daughter was not as good as new. If anything, she may have been a little worse. He fever had not changed; she felt sweaty, and she was wheezing. Ellen called the nurse who came in and took her temperature. Then she called the doctor.

When he came in an hour later, he asked if the lab report was back. After reviewing it, he felt Molly’s neck. Her lymph nodes were distended. He pulled an eyelid open with his thumb and noticed swelling and redness. “Conjunctivitis,” he said to no one in particular. This was not influenza. And despite his five years in pediatrics, he wasn’t at all sure just what this was. From the nurse’s station, he called the local public health office and, after a short discussion with a public health worker who didn’t seem to be of any help, came away with the impression he was on his own.

As he rose to walk back to the room, one of the nurses asked if he had spoken with “Dr. Emery in diagnostics.” The pediatrician asked who that was, and the nurse smiled and said, “That’s the go-to guy here. If he can’t figure it out, then you better start praying.” A call to the switchboard was routed, and a page went out for Dr. Emery to dial155. When the phone rang at the nurse’s station the charge nurse, Gloria, said hello, and handed the phone to the pediatrician.

By lunchtime, Molly had developed migraine-like headaches, and the drapes were closed to darken the room. When Greg Emery walked in Molly’s room, a very frightened mother and a very concerned pediatrician greeted him. After Dr. Emery had introduced himself, he asked some questions of Ellen. The symptoms had just started a few days ago. Could it be the flue? The pediatrician shook his head.

Blood work? Yes, all normal for the most part. Had Molly traveled overseas recently? The pediatrician lowered his head… why had he not thought to ask this? The answer came back as “No.” Dr. Emery said to the pediatrician, himself “this seems almost like typhus.” But you say she has not been traveling.

Ellen turned to the epidemiologist and remarked, no, we have not been overseas. We did go camping for a week at the end of August. Dr. Emery asked if a Lyme test had been done. A call was placed, another young lady appeared in a white lab coat, and another vial was drawn. Ellen asked if the test would tell what was making Molly so sick. “It should tell us if she has Lyme”, the pediatrician said, “but the test may take a week before the results are back.” Looking at her daughter, Ellen did not think she could wait that long. Ellen asked if t were Lyme disease, how would they treat it, and she was told with an antibiotic named Doxycycline. What harm could it do to treat her for it now?

Dr. Emery stood up. “Where did you say you were camping,” he asked? “In Nova Scotia,” she answered. “I don’t think this is Lyme,” he said. “We assumed you were camping here in New York State, but I don’t think Lyme is as big a problem in Atlantic Canada as it is here in New England.” Having spent his summers in Yarmouth, Nova Scotia, Dr. Emery recalled that while they hadn’t had many White Tail Deer or White Footed Mice, both carriers of Ticks; mostly because in many parts the exploding Rabbit population consumed all the available vegetation.

Dr. Emery turned to the pediatrician and said, “What infection would appear like Lyme disease that a person would be susceptible to if they were bitten by a fly in an area where there were an abundance of Rabbits?” The pediatrician thought for a second before saying “Tularemia.” “Exactly” the epidemiologist replied.

Molly was started on streptomycin and an anti-inflammatory regiment. The next morning the nurse found her sitting up in bed and requesting the curtains be opened. At 11:00 am William arrived after an overnight flight and was greeted by his daughters smile.

About Lyme disease and Tularemia

Lyme disease is caused by the bacterium Borrelia burgdorferi and is transmitted to humans through the bite of infected blacklegged ticks. Typical symptoms include fever, headache, fatigue, and a characteristic skin rash. If left untreated, the infection can spread to joints, the heart, and the nervous system.

Tularemia is a caused by the bacterium Francisella tularensis and can be transmitted to humans through tick and deer fly bites; skin contact with infected animals, or drinking contaminated water. The symptoms of tularemia are similar to Lyme disease, and the preventative measures are much the same: Use of insect repellent, wear gloves when handling sick or dead animals, and check for tick bites when in forested or grassy areas. In the United States, naturally occurring infections of both Lyme disease and Tularemia have been reported from all states except Hawaii.

 

 

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