“I swear I’ve never had a cough like this,” Dr. Jean McDonald said, catching her breath after a string of wheezy barks. “Would you mind doing a quick consult?”

Summer was over, and back-to-school bugs were swirling among hospital workers like leaves in a squall. Still, something about that call bothered me. To pediatricians like Jean, coughs and colds were bread-and-butter medicine. It had to be serious if she asked for help.

“No problem. I can meet you in the clinic in 15 minutes,” I said.

“Um, can we make it a little later, please?” Jean sputtered. “Right now I’m doing rounds with the transplant team.”


“Just make sure you wear a mask around patients,” I joked.

I had hit a nerve. “Girl, I’ve been wearing masks for the last six weeks. See you in an hour,” Jean replied. 

The first time I crossed paths with Jean McDonald, I liked her right away. A lively expert in childhood liver disease, she had come to me about getting shots and pills for a monthlong trip to Africa. By the time I’d fixed her up, we were friends.

We never got a chance to talk about the trip. Once back from the bush, she seemed consumed by work. When I saw her in the hallway, she was usually sprinting like a rabbit. One quick wave and off she’d go. But the Jean who showed up in my exam room that day was very different: step slowed, eyes hollow, face drawn.

 

Photograph by Phil Toledano

After colonizing the respiratory tract, the pathogen Bordetella pertussis provokes convulsive coughing for up to six weeks. Cases among American teenagers and adults have been increasing since 1980.

“I’m running on empty,” she said. “It’s this cough. Even with codeine, it keeps me up half the night.”

Despite her illness, Jean still had a heavy workload, so I got right to the exam. Vital signs: temperature, 98.6 degrees; heart rate, 60; respiratory rate, 12 breaths per minute. I checked her ears, throat, neck glands. Everything was fine there too.

“Let’s move on to your lungs,” I said. “I need to rule out pneumonia.” As I fished for a stethoscope in my pocket, I imagined the moist, snuffling sounds of pneumonia, like bubble wrap filled with fluid and cells. Then, in my mind’s ear, I heard the plaintive melody of asthma. After all, adults with asthma can also present with chronic cough. Then I listened. After rubbing the metal rim of the stethoscope to take away its chill, I moved it around Jean’s back as she slowly inhaled and exhaled. Nope. Her lungs were clear.

“Tell me more about this cough,” I urged, eager for a clue. “What about unusual exposures? Have you had any recent close contact with someone sick, any bird or animal encounters, desert dune buggy rides, overseas travel?”

“Contact with the sick? That’s the story of my life. But nothing exotic, as far as I know.” Jean paused. “As for the cough, at first it was no big deal. But after that-man, oh man-it got so bad I could barely catch my breath. And not just once or twice, but over and over and over.”

Aha! Could it be? I began thinking of a pathogen famous for provoking coughing fits, a disease that once plagued infants. Now in countries with high rates of childhood immunization, it targets young and middle-aged adults. Most would never know what hit them.

“Jean,” I said, “did you ever think you might have whooping cough?”