One generation passeth away, and another generation cometh, but the earth abideth forever. The sun also riseth, and the sun goeth down, and hasteth to its place where it rose. The wind goeth toward the south, and turneth about unto the north; it whirleth about continually, and the wind returneth again according to its circuits. All the rivers run into the sea; yet the sea is not full. Unto the place from whence the rivers come, thither they return again. Ecclesiastes 1:5-7
“He’s had fever for two days. He’s been so fussy, he won’t let me put him down.”
This mother looks exasperated, exhausted as well. And she’s not a new mother. This 7-month-old infant was her caboose. Up until today, she’s only brought him in for well-child care.
“Has he been eating?”
“Not well. I could only get him to take 4 ounces all day.”
“No, no vomiting—just extreme fussiness.”
“How high has his fever been?”
“102 to 103.”
I study the infant in her arms while we talk. At this point he seems comfortable. He even smiles at me, always a good sign in my book of clinical diagnoses.
“Any one else at home sick?” I ask, reaching for my stethoscope.
“No, not at home. But we did take him to see my husband’s grandfather in the nursing home a week ago. He was bedridden with pneumonia.”
I nod and listen to the baby’s back and chest. Nothing but normal breath sounds greet my ears, another good sign.
“Let’s lay him down,” I say, standing at the head of the exam table with otoscope and tongue blade in hand. The mother pins her infant son’s arms at his sides while I peer into his ears and throat. The tympanic membranes appear pearly grey, but the throat is red and swollen with a small amount of exudate on the tonsils.
“He’s got a sore throat,” I announce. “Let me swab it and run a quick test.”
“I knew he had a sore throat from the way he was acting,” the mother muses. “He cried every time he tried to swallow.”
Even without running the test, I know that this infant has contracted a virus. It’s exceedingly rare to see strep throat in such a young child. But I need confirmatory evidence to prove it.
By the time I return with the news that the results show no strep, the baby has calmed down. Even his fever has dropped — another good sign. I tell this seasoned mother that in all likelihood her little boy will turn the corner in 24 hours. “Give him some acetaminophen, hang in there and call me tomorrow morning to let me know how he’s faring.”
“By the way,” I say, “what did his great-grandfather think of him?”
“He was pleased to see him. Could the baby have picked up pneumonia from him?”
I pause to ponder her question. “Do they know what sort of pneumonia he had?”
Tears fill the mother’s eyes. “Terminal,” she says. “He wanted to see his great-grandson before he died.”
Pneumonia, the dying man’s friend. It settles into the lungs of the exhausted aged bedridden patient and whisks him away in the night.
“When did he pass away?”
“Ten days ago.”
“I doubt that the baby contracted pneumonia from him,” I say. “The incubation period is too long, and there are no signs of a lung infection on exam.”
The mother seems reassured. She will follow my instructions and call me in morning.
One generation makes its entrance while a former one fades away. Standing at the bend in the great river, I look upstream and marvel at how the new white water cascades down over the smooth rocks as downstream the current meanders around the far oxbow and silently slips from sight.