John was admitted through the emergency department on a brilliantly clear autumn afternoon. A healthy kid from an upper middle-class neighborhood, he had run in a high school cross-country track meet the previous afternoon. That night he'd awakened complaining of a fever and headache. By the time his physician saw him the next afternoon, the boy was severely purpuric from fulminating meningococcemia. He was referred to our emergency department and admitted to intensive care almost immediately.
From the day he arrived, John's situation was special. As rarely happens in a tertiary-care center, John's disease and the medical complications arising from it were overshadowed by the human context and consequences of his situation. Its impact rippled out from the intensive care unit. By Friday, 2 days after he was admitted, even people who had never met him were asking, "How's the kid in the unit?" This was not just banal curiosity