“The What If’s”

Prairie Doc Perspective Week of October 12th, 2025
“The What If’s”
By Debra Johnston, MD

Let’s call her Sarah, although that wasn’t her name. I’d had the privilege of delivering her, and the fun of watching her grow into a precocious toddler, with an impish smile and a joyous laugh. Then I had the responsibility of explaining her autopsy report to her devastated parents. 

She’d died from an infection that her young, previously healthy body just couldn’t fight. It hadn’t taken long; she’d started running a fever the night before, and her parents brought her to the clinic the next afternoon. The flight crew hadn’t even gotten to our ER before she lost the battle.

Of course we all had “what ifs” to torment ourselves with. What if mom had breast fed for longer? What if dad hadn’t taken her to that play date, with the little friend who had a runny nose? What if the doctor (me) been more detailed in the “how to tell when she’s really sick” discussion? What if her parents had brought her to the ER that morning, instead of to the clinic that afternoon?

The “what if” that has tormented me the most, though, is what if she’d been born just a year or two later?

The infection that killed my little patient was caused by streptococcus pneumoniae. The original version of the Prevnar vaccine, which taught a child’s immune system to fight 7 strains of that bacteria, was introduced in 2000. Shortly after, the rates of serious infections from these bacteria dropped precipitously, and not just in the children who got the shots. Adults also benefited, to varying degrees. 

One modernized version of the Hippocratic oath contains the phrase “I will prevent disease whenever I can, for prevention is preferable to cure.” I don’t remember if my classmates and I said those particular words on graduation day, but it’s a philosophy I wholeheartedly endorse, and one I try to live by. I nag my patients to eat more fruits and vegetables, and to get their calcium. I nag them to exercise more. I nag them to quit smoking. I urge them to get to the eye doctor, and to the dentist. I remind them that seatbelts save lives, that helmets save lives, that smoke detectors save lives. That vaccines save lives. 

I don’t know that the Prevnar vaccine would have saved little Sarah. No vaccine is perfectly protective. She might still have gotten seriously ill. She might still have died. 

But I do know it would have shifted the odds in her favor.  

Dr. Debra Johnston is a Family Medicine Physician at Avera Medical Group Brookings in Brookings, SD. She serves as one of the Prairie Doc Volunteer Hosts during its 24th Season providing Health Education Based on Science, Built on Trust. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, YouTube, and Tik Tok. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm, YouTube and  streaming on Facebook), 2 podcasts, and a Radio program (on SDPB, Sundays at 6am and 1pm).