After 30 years in the doctor trenches, every so often I think about patients I desperately wanted to save—and didn’t. At the top of my list is Arthur Lewis. A quiet, well-mannered teenager, Lewis developed a fungal infection that attacked multiple organs. Three years and many treatments later, the fungus claimed his life.
Most infectious diseases are color-blind; their outcome has nothing to do with their hosts’ hue. But Lewis’s illness, coccidioidomycosis, was different. His African American ancestry put him at special risk for the battle he bravely fought and lost.
His struggle reminds me of a basic truth in medicine. Although excellent care can tip the balance between life and death, in some cases patients have genetic vulnerabilities that all the high-tech care in the world simply cannot conquer. Genes aren’t everything when it comes to coccidioidomycosis, a rare soilborne illness that can be acquired by inhaling dust. Other variables (like the dose of inhaled organisms, underlying lung anatomy, and subtle or overt immune problems) also influence the course of the illness. But genes can gravely color the outcome. Some patients with acute coccidioidomycosis experience a short-lived infection that takes no more of a toll than the flu. In other cases, patients develop a chronic hacking cough, unexplained rashes, and joint pain. Many patients do not require specific treatment, but those who do can have tragically different outcomes.