Soon after I took a similar plane on my first real cross-country flight to see my wife’s cousin play Tevye in “Fiddler on the Roof” in Palo Alto. All was blissful until somewhere over Monterey Bay when the electricity went out. That meant no gauges or radios. There had been headwinds (somehow there usually are, even on round trips) and I wasn’t sure about my fuel supply, so I landed at a little mountaintop airport near Santa Cruz. After gassing up, I realized I had no starter power. Fortunately little planes have a socket for just that purpose, and after a jump start we arrived alongside Palo Alto tower. One of the things you learn that seems superfluous is flashlight signals from the tower when unable to communicate by radio. I expected a green and white light clearing me to land, but instead saw a green/red flash – extreme danger! Turns out some bozo was cutting me off, entering the pattern illegally. After landing I had to present my case to an FAA official who certified that it was a true emergency.

In 1973 my pal John (I had three close friends named John, all of whom were pilots and all died, two in crashes) and I flew to Wichita with Kearnes to pick up our first airplane, a beautiful Cessna 172. Nicely equipped for instrument flight, it cost about $23,000. That same plane with same airframe but with modern avionics and safety features now goes for about $200,000; most of the difference goes to our friends, the trial lawyers. We had a memorable trip home and were greeted by our wives and children as if we were Lindbergh.

In 1974 I earned an instrument rating, which among other things made me realize how little I knew about flying up to then. In some ways it was tougher than medical school. Given the weather in this area, it’s hard to clock enough real instrument hours so we fly “under the hood” with an instructor. A pilot must also undergo training every time he wants to rent a new model aircraft or rent from a new facility. In those early years there were a lot of $50 hamburgers, but I also discovered a few enchanted spots that pilots can get to quickly such as Sedona, Catalina, the Gold Rush towns and so many others.

In the bicentennial year I took my first real vacation in my new Rockwell Commander, which I picked up at the factory in Oklahoma City with my two older sons. The 112 was the prettiest and most comfortable in its class, although not that fast. In April we departed on a great adventure, overnighting in Tulsa and then spending a day in Nashville, where a doctor friend showed us around his beautiful city. Then on to Atlanta and a CDC alumni conference, thence to Washington where we met up with wife and two younger kids for a tightly-planned DC tour. On deplaning, my wife mentioned that the youngest, Laurence (7) had a few bug bites. After doing the Capitol, White House, FBI, Library of Congress and Smithsonian, we visited Arlington National Cemetery. By that time the bites had blossomed into full-blown chickenpox, a fact I announced loudly while we waited behind hundreds of folks waiting for the bus out of Arlington. (Nobody budged). Narrowly averting an international incident, we flew Laurence to his grandparents’ house in Atlantic City where he recuperated while the rest of us visited more historic places including Philadelphia, where I had interned, and Yale, where our pal and best man, Sam Thier, had become Chief of Medicine at age 39. After returning to Atlantic City where we landed in the midst of a rainstorm with 50-mph winds, I wrote a letter to the Press complaining about the airport’s miserable service and maintenance. It was published on the front page. Within a few years the casinos arrived and Atlantic City finally got a serious airport, but they didn’t name it after me.

The rest of that trip resumed with my two older boys visiting Cornell (we tried for Cooperstown but in the 95 degree heat and haze were unable to find its airport, a 1600-foot strip indistinguishable from a driveway). We did make it to the Football Hall of Fame in Canton, Ohio, where I had also arranged to visit with an old patient who nine years earlier had been my smallest premie to survive, at 1 pound 9 ounces. The hamburger she ate that day was probably bigger than she had been. (Sadly she was killed by a drunk driver at 18). We stopped in Chicago to visit Steve’s birthplace at the University of Chicago, where an old black nurse greeted us and actually remembered his birth! We then spent two days with a former mom in my practice on a ranch near Sioux Falls SD, where she had moved following a high-profile divorce and child custody battle. Her girls were beautiful and of similar ages, and my boys had a lot of fun going into “town” with them and infuriating the locals who did not care for these intruders from “Hollywood”. Eighteen days after we left, and a last stop in Casper WY we made it home. Compared to that adventure, flying cross-country in an airliner is flat-out boring!

In the next few years I continued to upgrade planes and stake out more places. One trip took us to Mazatlan and some of the best beaches in the world. A year later we attempted to fly to New Orleans (made it to San Antonio but had to fly commercially over a stationary front which hadn’t moved four days later – the pilot had to climb to 45,000 feet for a 45-minute flight – and found our luggage compartment flooded after a 6″ rainfall). The rest of the trip, to Puerto Vallarta, was delightful.

In 1978, and again in 1980, I joined the Flying Physicians on fantastic Alaskan tours. We met up in Edmonton, Alberta (the second trip included a stay in Grand Teton National Park) and flew the Alaska Highway, stopping in Whitehorse, Yukon for a world-class burlesque show and ending up in Anchorage. There were 39 planes on the first tour, 26 on the second (after four years of Jimmy Carter everyone was going broke). Side trips included Fairbanks, Denali (Mt. McKinley to the uninitiated), Kotzebue (north of the Arctic Circle!) and almost Nome. Almost because I had a mishap that could have been disastrous; my oil cap came loose and the windshield became almost useless, to say nothing of the real risk of the engine seizing up. Now the Alaskan tundra is like nothing you’ve ever seen, and it was covered with an almost solid undercast. My five passengers (I had a Cessna 210 by now) did not panic because I did not panic. Straight ahead was an old airbase which, unlike commercial airports, had what’s called Precision Approach Radar. That fellow talked me down (turn 2 degrees left, etc.) like an invisible hand, and when we broke through the clouds that runway looked like Shangri_La. I had lost 4 quarts of oil, about a pint short of calamity. N761YM needed a bath and we all enjoyed a beautiful, although unscheduled, detour back to Anchorage. Later in the week we visited Kodiak Island, one of the most scenic and unique places I’ve ever been. We also got to fish for salmon in the Bay of Alaska aboard boats belonging to the sons of our hospital administrator. I love salmon almost any which way, but barbecued salmon right out the bay is incomparable. They have a saying up there: when you visit Alaska you never come all the way back. It’s true. Seeing it from such an intimate height, its glaciers and unspoiled beauty, is challenging but unforgettable. And by the way, we saw what was then the new Alaska Pipeline up close; it is one of the most handsome man-made structures you’ll ever see, and the caribou love it too!

People always ask about close calls, and besides the one above there were several others. The most memorable was so much so that I had it published in a magazine. I shared a condo in Sun Valley, ID for a few years. While my wife and the two youngest flew commercially, an 8-hour ordeal by way of Salt Lake City, I headed north with my two big guys for what was forecast to be a clear flight. Of course within two hours we were in a huge snowstorm. Strangely, it was totally calm but like the inside of a ping-pong ball. I planned to stop in Ely NV but the tower operator discouraged that because he couldn’t see his own runway! That meant climbing back up to altitude, burning extra fuel and hoping to make it to Twin Falls ID. A helpful Western Airlines pilot got on my frequency at one point and said I could circle down through the clouds from my present position and I’d find a little airport on the Nevada border, but I calculated that with my 35-knot (40 mph) tailwind I could make it, and I did. But the tower asked me to go around and approach from the north and I declined. My fuel bill was 64 gallons; I probably had half a gallon of usable fuel left. But we did beat the rest of the family by several hours!

There were many other adventures. In 1981 I took my daughter to several colleges she was interested in, and visited old friends on the way. (She wound up at UCLA for her freshman year). In 1983 I joined a bunch of friends from Valley Presbyterian in an investment program in a beautiful spot in Colorado, Pagosa Springs. On the sunny west side of the Rockies at 7500 feet, with a ski resort an hour away, it seemed like Paradise and a sure bet for eventual retirement. What could go wrong? We bought several acres on a golf course, time shares, and other parcels. Some of the group actually moved up there. Best thing for me was that it was an excuse to fly. I made about ten round trips, less than four hours each way, seeing Grand Canyon, Monument Valley and so many other incredible sights. But the oil bust in 1986 wiped out most of the investor base, virtually all of whom were from Texas and Oklahoma. The rest of our group was hit by death and bankruptcy, and I had to walk away from what had become a dream. Lesson learned: stick to medicine.

There were a few more thrills, such as flying into Chicago for my 25th medical school reunion, several samaritan trips to Baja California with a group of doctors, dentists, nurses and others to minister to a remote village called Punta Prieta; trips to Carlsbad Caverns, White Sands National Monument, the 1986 Worlds Fair in Vancouver. My penultimate trip was to the Bay Area where I took my oldest son and his new bride on a scenic tour of San Francisco that was magical. But after one last trip to Palm Springs (ironically, to an aviation expo where I could salivate over the new planes I couldn’t buy), I hung up my magic carpet key for the last time. Perhaps 200,000 miles later, after 1268.9 hours, there’d be no more $100 hamburgers (forget $50!) but the memories have grown more wonderful. What a privilege to have been a pilot!

I am now qualified as an expert on New York. (See, the attitude is back already). New Yorkers are, I believe, not so much rude as self-absorbed. They walk quickly and recklessly, faces pinched, shoulders hunched, in a hurry, not enjoying life. The women are often beautiful, especially the ethnically mixed; they tend to have wonderful legs because they walk all day, Plastic surgery is seldom as obvious or prevalent as in Los Angeles. Except for the lawyers and CPA-types, dress codes have gone the way of the Hula Hoop. Manhattanites always talked to themselves; now they talk into their cell phones which makes them even more dangerous because their elbows stick out. White lines on road surfaces, “Don’t Walk” signs, red lights and “No Parking” signs are mere suggestions, to be ignored. A typical street might be four cars wide but five or six vehicles occupy that space at any given moment. Crossing on the green is never a given; just when you’ve dodged gridlocked taxis and cars, a kamikaze bicycle will fly by. In one of my few quiet moments of contemplation, sitting with Gucci in Union Square, I realized that if the $350 “no honking” and $500 anti-gridlock rules could be enforced, our $14 trillion national IOU could be wiped out!

We walked about 35 blocks from our appointment to our hotel. That’s not as impressive as it sounds, since New York blocks are 20 to the mile instead of eight as in most places. But the humidity – oh the humidity – makes any physical exertion like navigating through Jello. Every block has dozens of tiny businesses, restaurants and shops as small as closets; every neighborhood has its distinctive aroma: curry, sauerkraut, whatever. Trees are almost unheard of except in Central Park. Dogs are rare until after working hours. Walking a little one like Gucci would be suicidal during the day. Taxis are no longer lumbering Checkers but have been replaced by Escape hybrids and even an occasional Prius. Buildings occupy almost every available block and soar up so high that sunrise is at 11 and sunset at 2, give or take. But only tourists look up and take pictures. Also, it seemed that only tourists were overweight; most New Yorkers seem athletic and fit, perhaps because they walk so much and the food is so expensive.

My mother-in-law’s mother had an expression: “I wasn’t there yesterday and I won’t be there tomorrow.”

It was the first of February 1974. I was at Childrens Hospital of Los Angeles making my teaching rounds when I got an emergency call from the hospital next to my office, 15 miles away. A newborn was delivered who was blue and desperately ill. Nowadays a team of neonatal specialists would have been on the spot. In fact the diagnosis likely would have been made by ultrasound. But in 1974 we had not quite opened our first Neonatal ICU. The general pediatrician attended high-risk deliveries, treated sick newborns, did spinal taps and other procedures as we were trained to do. My neonatal training had been almost a decade earlier, but under the legendary Bill Silverman at Columbia-Presbyterian. He had literally “written the book” that every budding neonatal specialist, doctor or nurse, used.

The date was significant. OPEC had come upon the scene and disrupted our love affair with the auto. Gas was rationed. The Highway Patrol had new marching orders that day. Speeders would be rounded up without mercy. I don’t know how fast I was going the first time I was pulled over in my BMW, but the officer was sufficiently alarmed at my story that he put on his flashers and had me follow him the last few miles to the hospital. Was he a great humanitarian, or was he just checking out my story? He did tell me he had a new baby at home.

I spent most of the day at little Guadalupe’s incubator, keeping her oxygenated and doing what I could until the Childrens Hospital ambulance arrived hours later. She was blue because her heart wasn’t structured correctly. Most of the heart’ s output was shunted away from the lungs and oxygen could not get where it was needed, a so-called right-to-left shunt. Perhaps you have heard of Tetralogy of Fallot. This was worse; in fact there was no name for her mess of a heart.

At about 5 p.m. she was on board the ambulance and I was to follow. However, the driver did an odd thing. Instead of turning right toward the nearest freeway on-ramp, he turned left into the teeth of rush-hour traffic. Of course he had a siren, but he was wasting precious minutes. I headed west and entered a busy freeway. In a few minutes I transitioned to the 101, only to be pulled over by another CHP officer. The usual question: “Where are you going in such a hurry”? I said “I’m following an ambulance to Childrens” but he saw no such vehicle. I did quite a sales job explaining that the driver had gone the wrong way, and again I was let off the hook. At 11 p.m. I finally headed wearily home. This time I had no excuse for being pulled over a third time. ( The BMW just won’t go slower?) Somehow he let me go, and I’ve only been pulled over for speeding twice since then.

“Lupe” survived her emergency surgery but the best the team could offer was a palliative procedure to correct the shunt partially. She was given at most seven years to live, and likely much less. Digitalis, diuretics and many other drugs would be daily necessities.

Like most handicapped children I’ve known, she radiated a joy for life. Seven came and went, and so did grade school, middle and high schools. At 22 she got married and moved to Texas. Of course having a baby was too risky, but she did that too. Today she introduced me to her 7-year-old son Daniel.

If you look real hard you can see the bluish skin color, well-hidden by her dark Hispanic skin. She breathes harder than normal and her fingertips are “clubbed”. But what I see is a miracle.

A few years ago Alan Rickman and Mos Def did a TV movie called “Something the Lord Made” about the pioneering team of surgeon Alfred Blalock and pediatrician Helen Taussig at Johns Hopkins, and the first successful heart surgery. It was just after World War II. In the movie Dr. Blalock and his brilliant lab tech, Vivien Thomas (who was black) saved the first infant.

It wasn’t quite that neat. About a half-dozen patients died before their first success. One was my cousin Harriet. She was 21 and had months to live at best. She had never left her house. Her life was home-schooling, knitting and family. She was a stunning beauty but for her plum color. Any exposure to infection would have been life-threatening. She knew the risk of surgery and welcomed it.

Harriet was one of my inspirations for my choice of career. How far we’ve come in just my lifetime! Seeing Lupe reminded me of that today.

George Will published a great column yesterday called “The Last Doughboy” in which he paid tribute to our last surviving WWI soldier, who is a spry 107 and not only served in France with over 4 million other Americans but spent most of WWII in a Japanese prison camp, having been a civilian contractor in Manila on December 7, 1941.

Our nation is at war but I wonder where we’d be without the thousands of young folks who volunteer to keep us free and safe. Our schools do such a poor job of teaching history, and the Blame-America-First crowd dominates our media and academia so thoroughly that patriotism has been on the defensive since the 60′s. In 2004 presidential candidate Jean-François Kerry famously warned that our kids better do well in school or they’d “wind up in Iraq”, thus insinuating that the military is for dummies. Au contraire the ranks of our military are better-educated than their peers who stay out of the service. General David Petraeus, the counterinsurgency expert now running our liberation efforts in Iraq and Afghanistan, has a masters and PhD from Princeton, for example, and could be making millions as a CEO.

Growing up during WWII, I saw a nation united. People did without; staples were rationed, everyone had a “victory garden” to grow vegetables, there were no new cars. People in coastal cities patrolled for submarines and aircraft (I still have my Aircraft-Spotters Handbook). Gold stars hung in so many windows, denoting lost sons. More Marines died in one day on Iwo Jima and Tarawa than all military deaths in over five years in Iraq.

America is great because America is good. We have conquered fascism and communism but have helped rebuild their breeding grounds into vibrant and free societies instead of seizing their lands. We have conquered slavery at home and built the most successful multicultural society ever known. The rows on rows of crosses and stars in military cemeteries across the world speak to the sacrifices that we honor today. I’ve been to Normandy, to Pointe du Hoc where the shattered guns and barbed wire remain, but it’s the sea of white row on row that I remember.

As I write this I’m wearing a T-shirt that says “Freedom Is Not Free.” Indeed.

Medical graduates must serve at least a year of training before being eligible to practice medicine. The internship no longer exists as such, perhaps because the memo about the Emancipation Proclamation finally got to the powers that be. As was typical of the time, I worked 90-plus-hour weeks for $100 a month. It had been $59 the year before but some interns’ wives marched to City Hall with a contingent of reporters and applied for welfare, embarrassing the mayor and his cronies enough to get us a 70% raise.

There were 90 of us from all over the country. It was an old-fashioned tour called a “rotating” internship, with thirteen 4-week assignments ruled over by faculty from Philadelphia’s five medical schools. Penn, right across the fence, was the best, and I lucked out in getting several of their best teachers.

Our only outlets were the baseball field and poker. Philly had its snowiest winter on record with three 18-inch blizzards, but during the warm months we had a league with several teams. The doctors had two and were usually no match for the orderlies, techs, kitchen crew, security, etc. but our guys were good. I had the honor of hitting the year’s most talked-about home run which broke a window on the fifth floor of the student nurses’ dorm (for the single guys the 500 future RN’s from the hills of Pennsylvania and West Virginia did constitute a third outlet, but I wouldn’t know about that).

Across the street was the Palestra, a popular venue for sports. To our dismay we discovered after a rainy spring night that a number of cars belonging to people attending a boxing match had parked illegally on our baseball field, leaving nasty ruts. Most were big black Cadillacs with New Jersey plates. The administration would not respond to our pleas, so next time our field was misused certain interns went out and flattened one tire on each car. There was a lot of cursing in Italian at about 11 PM, but the field was left alone for a few weeks. Next time they tried, each car got TWO flat tires. Now there is a major difference between having one flat and two. The last car didn’t leave the lot until almost dawn. But the field was ruined and our season ended early.

Our class showed its mettle early. We had been warned by the outgoing group that the administration was going to put a divider along the tray line in the cafeteria so that everyone had to pass through single-file. Our meals were free and time was precious so we’d grab our grub and head straight for a table. Soon after we started an ugly plastic barrier went up, preventing us from breaking out of line. It lasted a day. A furious administrator called an emergency meeting of our 90 rebels and demanded a confession, whereupon all 90 raised a hand and admitted fault.

The next week an even uglier partition was erected, this time anchored by a very sturdy pole through the floor and ceiling. One of the locals in our group had an uncle with a machine shop; this time the removal was challenging but by 2 a.m. the monstrosity was in pieces on the floor. The head honcho called a truce and we promised not to destroy any more city property.

The poker games were great fun and intense. About eight or nine of us were regulars, and what made the risk manageable was the presence of two Irani doctors on fellowship who seemed to have a limitless supply of the Shah’s money and no idea how to play good poker. Every time they’d fill an inside straight we’d tell them how brilliantly they played, assuring enough money at the end of the night for the rest of us paupers. Our best player was a 6’7″ rube from Louisiana named Travis Jeter Harrison. He’d win forty dollars or more every game. It was odd that in our last game he was nowhere to be found – that is until he strolled in wearing an outrageous green plaid suit and said, “Ah wanna thank you boys fo’ bahin’ me this-heah suit!”

One night the game was disrupted by a yell from the first floor – “Chicky the cops!!” By the time the fuzz had run up three flights, seven of us were sitting in chairs in the lounge reading sections of last Sunday’s NY Times. Cards and dollars were nowhere to be seen.

Twelve months of tension came to a head the last night. Someone started a bonfire on our baseball diamond and soon hundreds of medical text books were ablaze. The fire was at least three stories high and attracted the Philly PD and FD. As the fire was extinguished by hoses, turning the former ball field into a smoking swamp, a police officer mounted the bleachers with a bullhorn to give us a lecture on civics. At that moment the wildest intern in our group, a full-blooded Cherokee from Oklahoma, came storming out of the kitchen on a hand-pumped cart, whooping as if on horseback, beer bottle in his free hand, picked up speed down the ramp and crashed into the bleachers, sending the sergeant face-first into the mud. We felt lucky to finish the year without criminal records.

A year later while serving my stint in the Public Health Service, I picked up a local California paper and read that a “crazed mob” of young doctors had run amok in the streets of Philadelphia, turning over a trolley car. Now why didn’t we think of that?

The old hospital is no more, a victim of progress. For two hundred years the Blockley Medical Society, as the training staff was called, turned out future physicians who went out into the world knowing how it felt to deliver a baby in an unheated, rat-infested tenement, how to tend to dying patients with no family to care, how to save premature babies in a low-tech world (my son Danny among them). I believe medicine is not well-served by having young doctors go straight from school to specialty training, but I’m glad I had the opportunity. Last time I visited in 1976 the old place had lost its accreditation and was eerie in its silence, like an empty cathedral. And fittingly, the former baseball field was now a parking structure.

CDC in Atlanta, originally created to combat malaria, had by the early 50′s become the world’s top communicable disease command post. In order to put trained investigators at the scene of outbreaks and research facilities they came up with an elite group called the Epidemic Intelligence Service (EIS) which took about two dozen physicians, veterinarians and statisticians yearly, trained them and assigned them either to Atlanta or around the nation. EIS officers spearheaded the conquest of smallpox and polio, and its alums make up a major share of heads of health departments and professorships in the spheres of infectious and chronic diseases around and beyond our nation.

Doctors were subject to the draft when I graduated and finished the required internship in 1961. Were my number to come up then with no specialty training, I’d likely be assigned to a dispensary in Greenland. With a wife and two kids, that sounded grim. When one of my favorite teachers recruited me for the EIS, enabling me to satisfy my military obligation, I jumped at the chance.

The science of epidemiology (the study of epidemics) began about 1840 with Dr. John Snow of London and the Broad Street pump. A cholera epidemic was ravaging the city. Dr. Snow spotted cases on a street map and showed that the closer one lived to the infamous water pump, the more likely one was to get cholera. It must have been like a police station tracking a serial murderer.

Learning this exciting discipline from Dr. Alexander Langmuir and his staff was like learning astronomy from Galileo. “Alex” had come from Johns Hopkins to set up the program and treated us like princes. After training for a summer in pre-airconditioned Atlanta, we were encouraged to choose our assignments in a surprisingly open way. The requests for EIS officers far outnumbered us, so Alex took the five of us who were left unmatched because we lacked the years of residency and field experience that others had, and made sure we were all happy with our destinations. I had always wanted to live in California and could barely contain my glee when he suggested I take Berkeley and the California State Health Department (since moved to Sacramento).

My primary responsibilities were tracking influenza, hepatitis and other major diseases and reporting back to CDC. I had a lot of latitude to pursue whatever medical problems popped up around the state, and managed to get into all but three of its 58 counties. When I needed some R&R with the family I’d often find some potential calamity threatening the good people of San Diego or Santa Barbara. I also saw trachoma in the Coachella Valley and took part in the annual health fair for Alpine County, America’s least populated (800), in its county seat of Markleeville (pop. 300). Getting snowed in just added to the adventure of it all.

My biggest project in my two years was a hepatitis epidemic in the little town of Los Banos which occupied the better part of six weeks in my first summer. They speak of “shoe-leather epidemiology” and indeed my associate and I met most of the 7800 people living there. I eventually published a description of the peculiar outbreak in our state medical journal.

A 12-year-old nephew of a local rancher deplaned at SFO from Italy with a sickly yellow complexion. The town had no hospital but one of the four local doctors had a “clinic” with a few beds. The youngster was treated there but for some reason his sickness was not considered contagious. Infectious hepatitis (The A/B/C system was yet to be defined) has a long incubation period but eventually 19 of 21 clinic employees caught it. By strange coincidence some snake-oil salesman passed through town hawking a miracle cure for liver ailments. Since the four doctors were overwhelmed (and undertrained) the word went forth: leave a urine specimen by the back door and if it shows hepatitis we’ll call you in and give you shots for it. Blood tests weren’t done and of course there is no treatment, but we were able to determine through interviews that about 500 cases occurred.

A side issue is worth mentioning. During the six weeks of tooling about in the motor pool Studebaker Lark without air conditioning (choice 1: close windows and suffocate in the 105-degree heat or 2: open windows and inhale the pungent dust of the San Joaquin Valley) I expressed concern about catching Valley Fever (coccidioidomycosis), a fungal disease of the lungs, but I was reassured by my colleagues. That summer the state hired Dr. Bill Reynolds to come down from Seattle and organize medical surveillance of the migrant worker program. Bill contracted Valley Fever and spent almost a year in the hospital!

While assigned as I was to the state, I was a federal officer and CDC made sure its young pups got a taste of real-world epidemiology. My Mission Improbable was to fly to Ketchikan, Alaska (by Constellation and Grumman Goose) to investigate a diphtheria outbreak. The locals greeted me with a banner headline (“Top Epidemiologist Arrives From Alabama”) – not quite geographically accurate – and I got to give a speech at the Lincoln’s Birthday Toastmasters meeting. I spent five days touring the village’s 35 bars doing nasal swabs. The patrons knew of the outbreak and were more than helpful; no one objected to a poke in the nose but first I had to hear their life story!

I found one diphtheria carrier, and left in triumph. On my EIS diploma is a cartoon of a well-dressed fellow who looks a lot like Dr. Langmuir sliding downhill on the right side of a graph, the message being to arrive after the peak of the outbreak so as to add to one’s air of wisdom. I revisited Ketchikan to refuel in later years, and by then there was a real airport and a more prosperous town. That first arrival in the Goose in 1962 was memorable. No one announced that it was an amphibian because it seemed obvious, except to the poor older lady opposite me who screamed and about fainted when the plane splashed down in the bay.

The patient was a 14-year-old black boy. He had been brought to the Emergency Department by police ambulance. He was admitted because the ED doesn’t like to handle deaths. We had no history. His mother came along soon afterward, and when the cause of death was suggested to her she became outraged. “My boy didn’t do drugs; he was a good boy!” He had stayed home from school with mild symptoms of a viral infection.

The intern on the floor then did something I can never forget. He examined the boy thoroughly. Although no rash could be seen on his mahogany skin, the young doctor retracted an eyelid and on the inside fleshy part he saw what he was looking for – a petechia, a broken capillary, purple and star-shaped. He ordered the stunned nurse to bring him a large syringe and needle, which he plunged into the still heart, drawing a post-mortem blood culture which did indeed yield the dreaded Neisseria meningiditis.

The intern’s diligence did two things. It removed doubt that his death was the result of drugs, giving the family some peace. It also alerted all the personnel who were in contact with the victim to obtain preventive antibiotics, thereby averting further tragedy.

Meningococcal disease is the stuff of medical drama. It is one of the three major causes of spinal meningitis, all of which are now preventable with vaccines. In my one year at County I saw about 350 cases. When the first vaccine arrived in 1985 (against “H. flu”) I had treated about ten cases in my own practice. Thousands of American children died yearly; now a case is so rare that most young doctors have never seen one.

You may have seen the TV ads for Menactra, the newest of the three vaccines and one targeted especially at adolescents. Young people in dormitories or military barracks are at somewhat greater risk, although actual numbers are quite small (about 3 per 100,000) and the victims are often smokers and party-animal types. Whereas the other two types of meningitis are essentially always fatal without treatment, some 40% of meningococcal patients recovered in the pre-antibiotic era, many with severe disfigurement from loss of extremities. At the other extreme are patients like the youngster described above who die so quickly that meningitis has no time to develop.
The only other infections I can think of that kill so quickly are plague in its pneumonic form and Ebola virus. Yet the bacterium is commonly found in healthy people. It is analogous to being struck by lightning.

I’ve seen exactly one case in my practice. My first Labor Day on call in 1967 an alarmed grandmother phoned me. Her daughter had taken her 8-month-old baby girl to an urgent care but was sent home with reassurance. Grandma wasn’t buying it. She called one of the pediatricians she knew (she was an LVN) and I was on call and in the office (our hospital did not have an Emergency Room yet). The baby was there in 20 minutes and had the classic petechial rash of meningococcal disease. Many children develop these little spots after vomiting or coughing, and they also appear on the soft palate in strep throat, but these were not benign little red spots. They were purple and star-shaped, caused by plugs of bacteria and dead cells clogging up small blood vessels. I gave Baby Paula a shot of penicillin and followed her with Grandma to an ED 5 miles away where she was admitted. My spinal tap was diagnostic of bacterial meningitis (she needed no anesthetic, so lethargic was she by that time) and she recovered fully.

Truthfully, I’ve never regretted my choice. Kids do grow up; by 3 most are great patients, and many have stayed with me and are bringing me their children. Mothers continually inspire me, and this entry is about one of those mothers who taught me that a wounded baby can turn a mother into a lioness.

Celeste was delivered on a January morning in 1976. Her mom had been seeing me with her son since the year before. He has the distinction of being the only baby ever to urinate all over me (I’ve had many close calls). The reason was simple; I was too distracted by the dazzling mom and let down my guard. Baby Celeste was critically ill; she had hydrocephalus and spina bifida, far too severe to correct surgically. The diagnosis had not been made before birth as it would be now, but Mom worried all through the pregnancy and refused offers of a baby shower. Her intuition was right. I was returning from a ski trip to Idaho with my kids and missed the delivery.

By the time I entered the picture Celeste had been transferred to Childrens and Mom, who had not been permitted to see her baby, had signed herself out of Valley Presbyterian (after a cesarean!) and driven her Flower Power VW van to Hollywood to be with her. At the time I was quite active teaching there and held a clinical professorship at USC (I do to this day) so I was able to intervene on her behalf. The nursing staff tried to take over the baby’s care and keep Mom at bay. Mom knew the prognosis but demanded her rights, including nursing the baby with a pump and taking her home. I put myself on the line for her and got the staff to back off and let her do just that. Regional Center had demanded that she relinquish guardianship, and when she refused a psychiatrist was dispatched to “reason” with her. Perhaps in 2008 this doesn’t seem remarkable, but in 1976 parents didn’t challenge the system like that.

Mom was alone in her battle. Dad (20 years older and from a macho culture) warned her, “Don’t bring that thing into my house.” Also “That can’t be my baby or she’d be perfect.” Grandma’s contribution was to tell her G-d was punishing her for being such an evil child (I later learned that on the contrary she had been severely abused by her family for years as a child.)

Celeste clung to life for three months, getting enough nourishment to survive. Mom barely slept. I dropped by often to support her as I could. On one visit I was holding her hand when her husband walked in. His reaction was to accuse her of having an affair with me. Mom and I agreed that she needed to place the baby in institutional care. The best facility was Pacific State Hospital in Pomona. Their waiting list was a year; Celeste didn’t have a year. I contacted the Medical Director, a former colleague from Childrens, and got her in right away. I drove Celeste and Mom out there because no parent should ever have to make that trip alone. I was curious as well. The children’s ward was cheerful and immaculate. I asked my colleague how he and his staff did it, how they kept up their spirits amid dying and insensate children. His answer has stayed with me. “They elevate us, make us feel privileged because their lives are so innocent and they need us so much.”

No one ever questioned whose baby Celeste was, or whether her death was to be as comfortable and dignified as possible. There would be no “Code Blue”. Mom never stopped thanking me for my support. The experience strengthened my belief in the sanctity of all human life and in the proper role of a physician. A year and a half later a perfect daughter arrived, a gift Mom earned for her courage.

They say no good deed goes unpunished. Au contraire! That Mom is now my wife Cynthia, still dazzling and still inspiring.