Toads-in-the-Hole

To say that I am a fan of infectious disease is perhaps an overstatement. Still, I’ve had a healthy interest in the viral, bacterial, and fungal co-habitation with the human species since high school. What could be more fascinating than learning about the intricacy of infestations and the body’s immune response? To me, reading a microbiology chapter on Vibrio cholerae is like jumping under the covers with a flashlight and delving into an elaborate science fiction tale of an elite battalion of soldiers defending their home turf against the tiny, little green space invaders. For my Theatre Arts undergraduate thesis effort, I penned nearly fifty pages on how Shakespeare’s early writing was impacted by a rash of Black Death in London. One of my favorite annual reads is Connie Willis’ Domesday Book, a time traveling jaunt whose protagonist finds herself in medieval, rural England in 1348, the year that the bubonic plague arrived on the Isles. And I’m sure you can easily envision my shining, eager face at my infectious disease lectures during nursing school …

Reality has a way of unceremoniously kicking over the sets and scattering the props of our fantasies, however, and confronting a real disease outbreak among my friends and family has proved to be a little less fun. My fantasies were built behind a protective wall of effective antibiotics and vaccinations. These days, those walls seem poorly-maintained at best, and of course having my first child throws open the gates to Fear in many new and exciting forms.

Just as rehearsals for the latest VCT production began in earnest, we learned that one of our cast members has developed Bordetella pertussis, or Whooping Cough. Rehearsal was canceled yesterday after a second actor tested positive. Pertussis is a severe (but generally not lethal) respiratory infection that causes an incapacitating cough that lasts for weeks to months after the body is free of the bacteria. Once the paroxysmal cough sets in, antibiotics have no effect on the disease progression as your bodies lung tissue slowly knits back together.

All of this is supposed to be moot, however, as we’ve had an effective vaccine since 1926. An apocalyptic mood has settled over the field of infectious disease in recent years as more and more bacteria have defeated our standard (and many brand-new) pharmementarium of antibiotics. The gloom has deepened somewhat as a few bugs have, for unknown reasons, been able to overcome our vaccines. Pertussis is one of those bugs, and it’s already left its mark on the Miron family. Joel’s sister, Phoebe was struck with the Whoop last fall, and coughed until she vomited for months.

And now this morning Joel has arisen with a runny nose and a sore throat. The initial stage of Pertussis (the catarrhal stage) resembles a normal cold, so our suspicion is high. He’s called in sick for his work at the Vermillion clinic, and scheduled an appointment for this afternoon, wherein he hopes to get a culture and maybe some prophylactic antibiotics. And maybe some extra pills for Adelaide who, because of a freak failure of refrigeration, wasn’t able to receive her first shot of pertussis vaccine at her two-month check up.

Knowledge can perhaps bar the door against fear, so we’re striving to keep our relationship with infectious disease as academic as possible. Joel looked up the antibiotic he’s hoping to get this afternoon (500 mg of azithromycin) and we’ve both read through the government fact sheets and what little we can glean from our class notes and textbooks. Flimsy ephemera piled against the door.