Is It Contagious? ‘‘Is it contagious?’’ Mom wants to know. JJ is a 6-month-old child in the fight of his life. Little JJ never saw it coming. He had a fever all week and had been coughing, but today, upon arrival to the ED, things took a major turn for the worse. Mom’s eyes glare wide as she watches JJ’s tiny body arch; his eyes roll back in his head and he begins to shake . . . violently. It is over in less than 30 seconds, but to Mom it must have felt like a lifetime. In the blink of an eye, residents swarm from every direction with oxygen, needles, and IV lines to help poor little JJ. Each and every physician in the emergency department catches the scent of a ‘‘sick’’ patient and converges to see if they can lend a hand. The adrenaline bug flashes over the room, engulfing each team mem- ber like a chain reaction until all are working at maximum speed and efficiency. It is magnificent to watch how everyone pulls together in a time of crisis and functions like the proverbial well-oiled machine. Mom is shaken by all of this but asks once again, ‘‘Is it contagious?’’ JJ lies lifelessly in a sterile white crib; lines, wires, and tubes crisscrossing in all directions. His fever is now 105.2 and he is not looking any better. In fact, things have gone from bad to worse. The slow hum of the respirator almost seems to harmonize with the rapid ping of the cardiac monitor. Purple blotches are now noticed on the legs. Were they there when JJ arrived? No one noticed them. Are they bruises from the seizure? Proba- bly not. Alarms sound signaling the start of round two in JJ’s battle with an invisible microscopic foe. It looks like JJ is losing this round and the match for that matter. The monitor shows a flat, straight line where a saw-blade pattern used to exist. Multiple rounds of medications are called for and slammed in but none seem to be the magic bullet. Some unknown quantity of time passes. The monitors are turned off and silence fills the room except for the sound of Mom weeping in the corner. Just as quickly as the adrenaline high filled the ED minutes ago, sorrow and despair blanket everyone involved. It appears that depression is as communicable as adrenaline today. Through sobs and tears, Mom asks one last time, ‘‘Is it contagious?’’ ‘‘Yes Mommy, I fear that it is. We believe that JJ had meningococcemia which is a bad infection of the blood. Everyone in the house will need to take an antibiotic pill to make sure that they don’t end up with anything that JJ had.’’ So will all the doctors in the room, I think to myself. Difficult times and hair-raising experiences form bonds between the emergency medicine team members, as highs are flipped into lows as quickly as they first occur. Meningococcus may be passed person to person, but it seems that everything in the ED this night is contagious. Mark Silverberg, MD ([email protected]) Emergency Medicine Kings County Hospital Brooklyn, New York doi: 10.1111/j.1553-2712.2009.00485.x ISSN 1069-6563 ª 2009 by the Society for Academic Emergency Medicine 920 PII ISSN 1069-6563583 doi:10.1111/j.1553-2712.2009.00485.x REFLECTIONS

Is It Contagious?

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Is It Contagious?

‘‘Is it contagious?’’ Mom wants to know. JJ is a 6-month-old child in the fight of his life. Little JJ never saw it coming. He had afever all week and had been coughing, but today, upon arrival to the ED, things took a major turn for the worse. Mom’s eyesglare wide as she watches JJ’s tiny body arch; his eyes roll back in his head and he begins to shake . . . violently. It is over in lessthan 30 seconds, but to Mom it must have felt like a lifetime. In the blink of an eye, residents swarm from every direction withoxygen, needles, and IV lines to help poor little JJ. Each and every physician in the emergency department catches the scent of a‘‘sick’’ patient and converges to see if they can lend a hand. The adrenaline bug flashes over the room, engulfing each team mem-ber like a chain reaction until all are working at maximum speed and efficiency. It is magnificent to watch how everyone pullstogether in a time of crisis and functions like the proverbial well-oiled machine.

Mom is shaken by all of this but asks once again, ‘‘Is it contagious?’’ JJ lies lifelessly in a sterile white crib; lines, wires, and tubescrisscrossing in all directions. His fever is now 105.2 and he is not looking any better. In fact, things have gone from bad toworse. The slow hum of the respirator almost seems to harmonize with the rapid ping of the cardiac monitor. Purple blotchesare now noticed on the legs. Were they there when JJ arrived? No one noticed them. Are they bruises from the seizure? Proba-bly not. Alarms sound signaling the start of round two in JJ’s battle with an invisible microscopic foe. It looks like JJ is losing thisround and the match for that matter. The monitor shows a flat, straight line where a saw-blade pattern used to exist. Multiplerounds of medications are called for and slammed in but none seem to be the magic bullet.

Some unknown quantity of time passes. The monitors are turned off and silence fills the room except for the sound of Momweeping in the corner. Just as quickly as the adrenaline high filled the ED minutes ago, sorrow and despair blanket everyoneinvolved. It appears that depression is as communicable as adrenaline today.

Through sobs and tears, Mom asks one last time, ‘‘Is it contagious?’’

‘‘Yes Mommy, I fear that it is. We believe that JJ had meningococcemia which is a bad infection of the blood. Everyone in thehouse will need to take an antibiotic pill to make sure that they don’t end up with anything that JJ had.’’

So will all the doctors in the room, I think to myself.

Difficult times and hair-raising experiences form bonds between the emergency medicine team members, as highs are flippedinto lows as quickly as they first occur. Meningococcus may be passed person to person, but it seems that everything in the EDthis night is contagious.

Mark Silverberg, MD

([email protected])

Emergency Medicine

Kings County Hospital

Brooklyn, New York

doi: 10.1111/j.1553-2712.2009.00485.x

ISSN 1069-6563 ª 2009 by the Society for Academic Emergency Medicine920 PII ISSN 1069-6563583 doi:10.1111/j.1553-2712.2009.00485.x

REFLECTIONS