I fell in love with vaccines early. Years before committing myself to a career in medicine, decades before committing myself to becoming a parent, I was already fascinated.
I could chalk it up to an early, powerful personal experience. When I was eight years old, my father and I often stayed up together, watching science programs on PBS. One night, he stepped outside with our dog during a commercial. By the time he stepped back inside, he was confused and hallucinating. A voracious reader, I promptly diagnosed him with consumption from the night air, L.M. Montgomery being my first medical text. Within twenty–four hours, he was in an ICU, diagnosed with septic shock from invasive pneumococcal disease. In the waiting room, my mother drew pictures of the tubes tethering him to life. She warned us that his toes had turned black from clotting triggered by the bacteria and resultant inflammation.
It was years before I understood that what had happened to him, what had almost killed him, was a “vaccine–preventable disease.” Vaccines against Streptococcus pneumoniae existed for both older people and those with weak immune systems and for young children. Many years earlier, his spleen had been removed when he was diagnosed with Hodgkin disease, leaving him at increased risk for encapsulated bacteria like pneumococcus. His doctor had failed to warn him of that risk and to recommend the appropriate vaccine. [End Page 159]
That experience left many marks, but the honest truth is that vaccines, to my teenage self, were a marker of sophistication. Their cachet was worldliness, not wellness. In my peer group, raised in pre––Andrew Wakefield over –privilege, vaccination status had roughly the same cachet as a passport stamp. At age 14, I wanted nothing as badly as a yellow card, that internationally accepted proof of yellow fever immunization. By 18, my bucket list included finding a reason to get the Japanese encephalitis B vaccine. It took very little persuading for me to offer up my arm to the tip of a needle. When the human papilloma virus (HPV) vaccine came on the market, I felt lucky to be young enough to have my health insurance pay for it.
Did I think deeply about the risks and benefits? Did I carefully read the studies and research potential conflicts of interests? Did I study the science, applying the immunology that I had begun to learn in the classroom to my own choices? No—vaccines and the physical fact of being vaccinated were still largely symbolic. They represented many things, but above all, they represented the life I was just beginning to choose for myself as a young adult. Not coincidentally, vaccines were among the first things I gave my consent to receive as a legal adult. I saw those vaccines as part of the ticket to a life of adventure, of embracing the unknown, exploring distant lands and finding my calling there.
Eventually, I started to understand the real beauty of the science of vaccination, the wonder and darkness of the history of vaccination, and of course, the significance of my father’s medical history to the history of medicine. He was in the first cohort of children, adolescents and young adults to survive cancer in large numbers. He benefitted from extraordinary advances in medicine, and he also suffered from medicine’s most devastating failures. In 1990, the concepts of “survivorship” and “long –term follow–up” after cancer were barely on anyone’s radar; there was no systematic effort, as there is now, to assure that young people understood the long–term consequences of their treatment and received appropriate preventive care for late complications of therapy. My knowledge, intimate as it was, didn’t erase the symbolic meaning of vaccines, but it added depth and complexity to the symbolism.
This is the autobiography that I brought with me to parenthood. Seven and a half months into my training as a pediatric oncologist, I gave birth to my first child. I am irrevocably defined by the order of events in my life: I was a daughter before I was a doctor, and a doctor...