Imagine this: Your six-week-old baby is doing the things that babies do—eating, sleeping, growing. One day your baby starts to cough a little. Then a fever develops. Very quickly it starts to look like breathing is hard work. You take him to the ER and he’s admitted to the hospital. Your baby is diagnosed with pertussis, or whooping cough.

I’m a pediatric intensivist, which means I’m the doctor in the pediatric intensive care unit (PICU). My patients are kids who have anything from infection to organ failure, cancer, or any other cause that requires intensive medical care and constant monitoring. In other words the PICU is where we take care of the sickest babies, children, and young people up to about age 18. And in some tragic cases it is where a child will die.

About half of all babies who get whooping cough need to be admitted to the hospital for treatment. Some of those children will be admitted to and treated in the general pediatrics ward. But in some cases the baby will show severe enough symptoms like difficulty breathing or periods where their breathing stops completely (apnea) that they’ll need to be treated in the PICU. And if a baby comes into the hospital with symptoms that severe, they’ll be admitted to the PICU immediately.

Only 1 percent of babies with pertussis will die from it—but having witnessed this tragedy before, I can assure you that even 1 percent is still way too many. From my experience I can paint a picture of what happens when a baby dies in the PICU from pertussis. What I’m about to describe doesn’t represent the most common experience but it does happen. This isn’t theoretical for me or for the parents who have lost a child to this disease. Witnessing this scenario has left an indelible impression on me as a physician and as a human being.

First the baby is admitted to the PICU for respiratory distress or respiratory failure (depending on the severity of his symptoms in the ER). He would likely be tested for many kinds of infections, including pertussis, and placed on multiple broad-spectrum antibiotics at that point. When the pertussis test comes back positive while the other tests are negative, his antibiotics would be changed to azithromycin only. However, since antibiotics only treat pertussis if given early, it's frequently too late to entirely cure it with antibiotics by the time the baby is admitted to the PICU.

The baby is put on oxygen to help him breathe. He has blood drawn and medications are given—acetaminophen and ibuprofen (depending on age) for fever, sedating meds for ventilated patients, and fluids and nutrition.

The parents watch as we—members of his care team—stick him with needles over and over. But he struggles, breathing so fast and working so hard. He doesn’t even cry anymore. He just tries to breathe. He sets off alarms when he stops breathing, and then starts again on his own. It happens again and again. We have to put a tube into the baby’s lungs so a machine can breathe for him. When it’s done the baby is hooked up to a ventilator, dependent on this machine just to live. Still he struggles. He gets medicine to keep him asleep and calm, but his body is still trying to breathe. We change the ventilator, do more tests, change it again. Still he struggles. We tell his parents that his lungs are getting worse. The next step is a heart-lung bypass machine called ECMO. The surgeons come and put catheters into his veins. The baby’s blood is now being circulated through a machine to keep him alive. And even this isn’t working.