Pediatrician’s Journal (standing head)

Chicken Pox: Why The Vaccine?

By Jeff Cersonsky, MD, FAAP

I was called to the emergency room one morning to assist in the care of a critically ill child. When I arrived, I found the child was “Mark,” a five-year-old boy I had cared for since he was two. The first child of a lovely couple, he had just begun kindergarten and was doing quite well. Mark’s parents were in the waiting room, anxious and eager to hear news of their son.

Mark was in a coma. Although he was breathing, he was not responding to any stimuli – not when we talked to him, moved him, or even pinched him. We feared he had increased pressure inside his head, a condition that could progress to severe brain damage and death.

The emergency room doctor quickly filled me in: Mark was in the last stages of the chicken pox, with the remaining pox beginning to scab over. He was running a low-grade fever and had been vomiting. He became groggy and gradually became unresponsive. His parents rushed him to the hospital where the emergency room physician immediately called me.

After assessing Mark’s condition, we quickly did what was necessary. Mark wasn’t in shock so the intravenous (IV) line was turned down to a minimum. In fact, too much fluid could worsen the problem of rising pressure inside Mark’s head. To help keep down this pressure, we gave Mark a diuretic, putting in a catheter to measure his urine output. We also put a tube down his trachea to breathe rapidly for him because rapid breathing lowers the pressure inside the head. Tests were run – including blood and urine tests and a spinal tap.

A call was placed to the Yale Children’s Hospital, and the doctor there agreed to send a transport team immediately to take Mark to their facility, where he would be best cared for.

Finally, with Mark critical but stable, I went to the parents to explain what we thought was going on. I explained that Mark showed signs of a condition inside the brain called encephalopathy (a condition of brain disorder caused by infectious or other conditions). This encephalopathy was probably a complication of the chicken pox. Chicken pox can cause an immediate encephalopathy such as Mark had, or a delayed one, called Reye Syndrome. Reye Syndrome carries a very high rate of brain damage and death. The encephalopathy that Mark apparently had was less grave, although he was still very ill and could possibly suffer some permanent brain damage even with the best of care. The parents were extremely worried but seemed to understand the situation. I led them into Mark’s room after forewarning them about the tubes in his veins and the respirator.

The transport team arrived shortly thereafter. They talked with the parents and me and took Mark in an ambulance to Yale. When they left, with the parents close behind, I found myself alone in the hallway of the emergency department. I felt spent. The care we had given Mark had been done very professionally, with very little emotion, performing the tasks we knew needed to be done. Now, I thought of Mark when he was healthy, playful, intelligent, loving. As a parent, I could imagine what intense worry his parents were feeling. And as a physician, I now allowed myself to feel the weight of the situation and the worry for my patient. I sat down in an empty room and cried. I couldn’t stop. The hospital chaplain, not knowing who I was, came in the room and laid a comforting hand on my shoulder. All the stress and worry and energy came out in those tears.

Mark came out of his coma in two days and made rapid progress. The end of the story is a happy one. Mark is now a sophomore in high school and doing very well. I am still his pediatrician and I will always feel a special bond with this family. When the chicken pox vaccine was released four years after this incident, I became one of its strongest advocates. The chicken pox vaccine can help prevent repeats of the serious situation Mark, his parents, and his medical caregivers experienced.

(Note: Most of the questions used in my articles are derived from questions I’m asked in my practice. I welcome questions, which can be sent to my email address at jmcdii@erols.com or to my office at 30 Quaker Farms Road, Southbury, CT 06488. I cannot respond to all questions nor give medical direction for specific children, but I can give helpful general advice. Previous articles can be found on my Web site at www.erols.com/jmcsdii/page2.html.)