Mirabel

Every doctor can recall a case causing yesteryear bewilderment and realize that its complications would be coped with today as a matter of course. That kind of nostalgia never grows calluses.

Around Northpine in 1952, wintertime heating often involved a ubiquitous implement known as the barrel stove. The smaller the dwelling, the more likely it was that a rusty old fifty-five-gallon barrel had been equipped with a clanking metal door on one end and an oval stovepipe fitting near the opposite end. Burns from contact with its metal sides were frequent causes for a visit to the doctor’s office. Metal heated just short of red-hot cooks skin promptly.

Most such wounds were of the nuisance variety. Sore for a month, a patch of redness like a baboon’s behind for another month or two, occasionally a scar as a lifetime badge of courage.

—————

Mirabel was five. At that age, warnings such as, “Stay away from the stove!” fall on ears more attuned to inner diversions. Coordination is still developing. A stumble, an outstretched arm, and a patch of skin on her left forearm was singed. The injured area was 3-by-1½ inches, representing what doctors call a first to superficial second-degree burn. Minor, even though painful.

Mirabel’s mother brought her to the emergency department of our tiny hospital on a Sunday afternoon. I heard the commotion as soon as I opened the hospital door. The cries evoked images of monstrous grief. I followed my ears and peered into our emergency room.

Mother clutched Mirabel in a near-strangulation hold, rocking the child back and forth, wailing, sobbing. “She’s going to die. Oh God, she’s going to die!” Not surprisingly, the little patient cried as fiercely. I separated them enough to examine the girl’s arm, then cocked an eyebrow at nurse Edna Freeman, hovering alongside. Edna widened her eyes.

I convinced Mother to await in the hallway while I laid the youngster on the gurney in our examination room. A little pediatric distraction, and Mirabel subsided to tearful sniffles. I cleansed the wound gently with non-irritating soap and applied a non-adherent antibiotic dressing. I winked at her and rummaged through the box of lollypops we used as bribes for patients of the proper ages and temperaments.

I caught up with Mother in the hallway, where she paced like a caged tiger with claustrophobia. She clutched my shirt front. “She’s going to die! I can’t bear it. Doctor, do something!”

I had had no intention of doing anything other than sending young Mirabel home with her mother, but I was on the way to changing my mind.

“If it will make you feel better,” I said in my best parent-soothing voice, “I can keep her here overnight. I’ll need to change her dressings in the morning anyway.”

I waded through a stream of continued prophesies of doom, death and destruction, then got Mirabel settled into our only pediatric room.

The night nurse called me at six the next morning. I heard anxiety taut in her voice.

“It’s about Mirabel. We can’t seem to wake her up.”

Those prickles of concern a doctor learns about early in a career crawled my spine. I dressed quickly and trotted next door to the hospital. Mirabel was comatose, unresponsive even to pinching.

I sent the girl to Duluth, one hundred and sixty-five miles away. My usual pediatric consultant... call him Dr. Pediatrician... was available. He chuckled when I explained what had happened. It was the last time either of us felt levity. Young Mirabel had gone into complete kidney shut down.

Techniques that we today take for granted lay across a horizon not yet imagined. Dialysis to grant a struggling kidney a breather was unavailable. Drugs to combat profound shock, such as steroids, were barely on the drawing board. Caring and wishing and wanting made medicine personal, but when they were inadequate to the task at hand...

Mirabel died four days after her arrival in Duluth. Dr. Pediatrician and I conducted a somber “debriefing.” What had caused a response so lethal from a burn I might not even have brought to an emergency room? Today we recognize a rare condition known as gram-negative shock, a full-system assault from toxins released by very common bacteria that can be grown from anyone’s intestines and skin. Did a few such invade Mirabel’s bloodstream? None were discovered in blood cultures taken. Was it possible that some neurogenic, sympathetic response had occurred?

For me, echoing down corridors of time, I still hear her mother’s Cassandra-like predictions of disaster and I wonder, how powerful is suggestion when it is truly believed?