My Great-Aunt Died From Diphtheria. This is Her Legacy.

There are no photos of Wilma Dean, but this photo shows the home where she spent her short life. The young man on the far left is her father. The photo was taken about 15 years before her death.

I never met my Great-Aunt Wilma. She died before I was born—long before I was born, in a time and place when children’s lives were a dime a dozen, when parents had twelve children in hopes that three might survive. The closest that I came to her was when I laid flowers on her grave in May of 2012. She sleeps in a forgotten cemetery among the oaks and hickories of rural Alabama. This is the last of her short and small legacy.

My grandmother invited me to drive her to her family’s graveyard for “Decoration Day.” It’s an old term for Memorial Day, which was, at least to my grandmother, a day for honoring all the dead, not just veterans. She hadn’t been to her family’s cemetery in years, so my toddler and I accompanied her on the long and lonely drive. We disappeared onto dirt roads. Soon, there was no cell phone reception. Later, no power lines. Eventually, unpaved paths with no names.

“Are you sure you know where we’re going?” I asked.

“I’m sure,” she said.

“What’s this place called?”

“There’s not a name for it. I think they get their mail on the Ragland route.”

We arrived to see a bleak cemetery with mostly un-engraved grave markers, crooked boulders sticking out of the Earth like teeth. The few that had words written on them were misspelled. Some had the names of mothers and babies who were buried together. Some had dilapidated confederate flags on tiny wooden poles in front of them. On a hill, half-choked by weeds, was one small, unassuming tombstone.

“That was my sister Wilma Dean,” my grandmother said, tearing a few weeds away with her gnarled fingers.

“What happened to her?” I asked.

“Diphtheria. She was three.”

I clutched my own daughter’s tiny hand. I was barely, at that point, beginning to realize the error I’d made by eschewing immunizations.  I had wanted so desperately to believe that “childhood illnesses” were no big deal and that the world had never been as dark and scary as the history books say. I had wanted to believe that she didn’t need vaccines and that children were safe without them.

“I can’t imagine how upset your parents must have been,” I sighed.

“They weren’t,” my grandmother said with a shrug, “Kids died so often back then, I really think, it was almost like we were just all used to it. They’d buried another baby right before that, and had nearly lost your Aunt Charlsie, too. You know, I can still remember the day she died, better than I can remember last week.”

“What was it like?”

My grandmother looked like she was staring into some place very far away, some place sepia-toned and earthy. A little wooden cabin in the forest. Little girls in cotton sundresses. Mules.

“She got… a real high fever. And swelled up real bad, in the face. Mother and Daddy had a doctor come and see her but I don’t reckon there was anything he could do. Mother was holding her when she died. She was the awfulest color. Daddy thought that she’d caught it from a cat—people was so ignorant back then—and so he shot every single one of our barn cats.”

“Why did he think she got it from a cat?”

“People was ignorant,” she repeated, “And I remember thinking that maybe I was fixin’ to get sick with it, too, and what would happen if Mother and Daddy buried both of us together.”

“How awful.”

“I reckon. But you don’t hear much about diphtheria no more, do you? I think there’s a shot for it now.”

“They say it causes autism,” I said, flinching while I said it. I had to somehow defend my choice not to immunize my daughter. It was too complex of an issue to even begin to explain to someone who knew next to nothing about vaccines, but I still felt a defensive need to say it.

“Autism? What Kelly’s boy across the street has?”

“Yeah. People didn’t have that when you were little, did you?”

“There's always been goofy people," she said plainly, "That ain't nothin' new."

“But autism is different. It’s a vaccine reaction. A lot of people think it is.”

She shrugged, “I’ve seen people get real sick from shots. One time I got a flu shot, and boy did I get sick. But all I know is, I haven’t heard of no one dying from diphtheria in a long time.”

I tried to think of something to say. I was still struggling. I was increasingly aware that my daughter was autistic and increasingly aware that I had made a mistake. Standing in front of the grave of a little girl who died in her mother’s arms of a disease my child would never get, my mistake was that much more painfully apparent. And, as much as I didn't want to know them, I knew the statistics: the DTaP vaccine is highly effective in preventing diphtheria, and without it, diphtheria claims as many as one in five lives.

I lay a flower on her grave and pushed aside the clumps of clay that had mostly buried  the marker.

My grandmother rarely criticized me, especially on topics that she thought I knew more about than she did. She only had a seventh-grade education and she regarded most of her knowledge as passé and unimportant. But, as she got into my car, she wasn’t too shy to tell me what she was thinking.

“People… You’re confused, sweetheart. Everybody spends their whole life trying to make the world better for their kids and their grandkids. But not you. You’re trying to go backwards. I’ll never understand it. Things wasn’t good back then. You want to think that they was, but they wasn’t. You’re going to figure that out one day.”

My car got stuck in the mud as we were leaving, and my grandmother commented that it would be hard to come back without four-wheel drive.

“Do you want to be buried there?” I asked when we finally saw pavement and power lines again.

“Lord, no,” she coughed, “I want people to come and visit me. It’s just a matter of time before that place is forgot altogether.”

My aunt, forever three years old, lies in the earth in some graveyard I will probably never see again. When my grandmother passes away, so will the last remaining memory of what Wilma Dean’s face looked like. That will be the very, very end of a life that was too short, in a time and place when life was cheap.

Wilma was given far too little time in life, but her small legacy is that her tragic and untimely death was one of the factors that made me realize how lucky I am to live in a world where deaths like hers are rare. She helped me realize how fortunate I am that modern medicine, including immunization, can give my kids much longer and happier lives than she had.

Rest in peace, sweetheart.

The Unsung Vaccine That Means My Kids Won't Suffer Like I Did

It wasn’t until fairly recently that I learned that one of the biggest and most stressful obstacles of my early childhood wouldn’t have happened today, thanks to one of the least-praised but most important vaccines in history.

The Hib vaccine, which grants children immunity to a nasty little bacterium called Haemophilus influenzae type B, is so little-known that most parents don’t even recognize the name. Many of those parents even waive it when they take their kids to the pediatrician, dangerously assuming that a vaccine for a disease they've never heard of must be an unnecessary vaccine. Yet thanks to the Hib vaccine, I can be confident that my children won’t suffer the same disease I did.

In addition to preventing limitless suffering, it has also saved countless lives. The CDC estimates that, prior to the vaccine’s introduction in 1990, 20,000 children in the U.S. developed infections from Hib every year, and about six percent died. That means this one underappreciated vaccine has saved the lives of some 30,000 children, and has prevented the suffering of 470,000 more.

That’s a big deal.

Personal stories always reach further and deeper than statistics, though. So here is my own story of Hib before the vaccine.

It was mid-April of 1990. I had just turned three, so my memories of the illness are foggy and surreal. Most people don’t have memories this early in life, but my experience with Hib was traumatizing enough that flashes of the details were burned into my memory forever. I even still sometimes have brief flashbacks to the experience when I’m sick with a fever.

I remember that my eye itched and burned. I remember my mother telling me that I had pinkeye, and I was confused because I had been told before that my eyes were brown. It hurt more and more, and my vision grew weird and blurry. I lay down on a hard tile floor somewhere and drifted in and out of strange dreams while I listened to the murmur of grown-up conversation. By now, it seemed that half of my face was a big, painful, hot balloon. I couldn’t open my eye anymore and the pain was terrible.

I remember the smell  of my grandmother—Misty cigarettes—and I remember her distant-sounding voice saying, “This baby is burning up,” in a tone that sounded urgent. I thought she meant that I was on fire, and I was confused but felt like it explained a lot. I remember her lifting my face, leaning close to me, and saying, "What happened to your face, sweetheart? Did someone hit you? Did someone hit you?" I know now that she thought I had been beaten, because the severe facial swelling of a child with orbital cellulitis looks to a layperson like extreme physical trauma.

I remember being in the hospital in a strange room. A lady I didn't recognize kept telling me, “It’s okay,” and I kept hearing her say the word “shot.” The shot she was trying to give me was different from the ones I'd had before, though—it was hooked up to something. It was wrong. This whole place was wrong, and I was confused and scared. I screamed and I cried, and when I couldn't escape from her, I tried to hit her. She said, “Shhhh,” into my ears several times and gave me a lollipop, but I didn’t want it. The needle went into my arm. I cried, “I want Mama!” over and over again. I’m certain that my mother was with me most of the time that I was in the hospital, but in the moment that my memory preserved, she wasn’t there, and there was nothing in the world that scared me more than that.

I remember seeing people from my family come to visit me—lots of them. Some of them brought candy or small toys. My father brought me a playset of baby-dolls, tiny ones the size of my hands. I didn’t want any of them.

Easter passed while I was in the hospital. The Easter Bunny himself came to my hospital room, big and brown and furry. He gave me an Easter basket and a small fuzzy toy called a “boo-boo bunny” that was made to make me feel better. I thought it was magical and held onto it for several years afterward.

My mother told me years later, when I mistakenly mentioned “the time I was in the hospital with pinkeye,” that I’d actually been suffering from a severe case of orbital cellulitis, which is inflammation and infection of the eye and the surrounding area. Although the prognosis wasn’t too bad, it was the kind of thing that needed intensive treatment: without fast antibiotics, orbital cellulitis spreads into the bloodstream, nerves, and brain, claiming the lives of 17% of children who contract it and causing permanent blindness in another 20%. This is what happens when children contract and recover from Hib "naturally." And it's not pretty.

I’m a sucker for science and fascinated by the way that memory in early childhood is preserved, so, as a young adult, I ended up collecting my records from the hospital that had treated me, and I still have them in my possession. I expected nothing but a confirmation of the accuracy of those hazy memories, but I was surprised by four words that I saw: Haemophilus influenzae type B. Those words meant nothing to me before I became a vaccine advocate, but seeing them now, it hit me: this wouldn’t happen today.

Studies have confirmed that, since the introduction of the Hib vaccine, very, very few cases of ocular cellulitis have occurred. The last twenty-five years have seen a sharp decline in the number of cases, and the ones that still happen are almost always caused by other bacteria, like strep and staph. Children today rarely go through what I went through.

That’s not all the Hib vaccine does, of course. Prior to the vaccine, Hib was a major cause of pneumonia, airway inflammation, and meningitis. In fact, its efficacy in preventing meningitis has earned it a reputation as the “bacterial meningitis vaccine.” This is a slight misnomer, since Hib causes more than just meningitis and since bacterial meningitis has other causes. But the facts and data are clear: the Hib vaccine has saved countless lives.

I wasn’t always a vaccine advocate. I used to be far on the other side of the fence. But I’m glad that I learned my lesson, and I’m glad that my children will almost certainly never have to endure the fear and agony that I went through as a toddler. Hib infections are terrible, and children deserve protection.