James H. Brien, DO, Vice Chair for Education, Pediatric Infectious Disease Staff at the McLane Children’s Hospital Scott & White in Temple, Texas, is known for his ability to diagnose difficult-to-diagnose cases, particularly in fevers of unknown origin and infectious diseases. For 20 of the past 26 years that Pediatric Annals’ sister publication, Infectious Diseases in Children (IDC), has held its annual IDC NY CME symposium, Jim has been on the faculty. He’s very popular with attendees, who often form a line to talk with him after his presentations, typically delivered with his dry wit. ~ Stanford T. Shulman, MD
Dr. Shulman: You are known for being able to tackle the tougher cases that come along. Is the puzzle-solving quality of this line of work what drew you to become an infectious disease specialist?
Dr. Brien: I think so. It’s really fun to approach a patient that seems to be mystifying to people and figure out what the problem is. I guess it brings out the detective in me, which is very rewarding if I can get it right.
Dr. Shulman: Did you always know you wanted to enter this specialty?
Dr. Brien: Not really. I got my undergraduate degree in applied chemistry and had a brief career working as a swing shift lab technician at the Shell Oil Company refinery in Deer Park, Texas. I tested pilot plant samples; ran various types of analysis on them from distillation to elemental analysis; whatever they needed. It paid good money, but I saw people who’d been there a longer time than me doing the same thing I was doing. I didn’t have any special talent that they didn’t have, so I thought this isn’t what I want to do the rest of my life. Since I have had an interest in medicine for as long as I can remember, I decided to resign from Shell, and with the help of my wife, Ellen, went back to college to get the pre-med courses I needed.
Dr. Shulman: How did you end up specifically in pediatric infectious disease?
Dr. Brien: When I was in medical school, the Vietnam War was still going on, and everybody pretty much had some sort of military obligation in those days, so I volunteered to be on something called the Health Profession Scholarship Program. It was great. They paid my way through medical school, gave me and my wife and 2 kids a monthly stipend of $400, and paid my required expenses. We lived in a little trailer house and just saved everything we could. I did my residency on active duty in Denver at Fitzsimmons Army Medical Center, and then spent 2 years at Fort Hood as a general pediatrician.I liked it, but I didn’t see myself being very professionally satisfied doing general pediatrics in a non-teaching environment, so I applied for and was lucky enough to get an infectious disease fellowship with the late James Bass, MD, in Hawaii at Tripler Army Medical Center. He died a while back, but his legend still lives. He was a remarkable teacher and infectious disease specialist. After my fellowship, I taught for 8 years at Brooke Army Medical Center in San Antonio, and then moved to Walter Reed Army Medical Center in Washington, DC as the pediatric consultant to the Army’s surgeon general. I finished my Army career assigned to the Pentagon as one of the 5 physicians on the surgeon general’s staff. I was the tertiary care staff officer. I’m still not sure what my job description was, but I was fairly busy. After I retired from the Army, I was recruited to Scott and White to help begin a pediatric hospitalist program. We now have a free-standing children’s hospital, McLane Children’s Hospital.
Dr. Shulman: How did you become a regular presenter at the annual IDC NY meeting?
Dr. Brien: My involvement with IDC started in, I can’t remember, 1988 probably. I was reading IDC’s other sister publication, Infectious Disease News, and wrote the editor, Ted C. Eickhoff, MD, and told him that the publication had a lot of quality to it. Ted said, “Well, why don’t you be on the editorial board with us?” I said, “Well, fine. What do I need to do?” He said, “Why don’t you write a column?” We decided that it would be a visual diagnosis column called “What’s Your Diagnosis.”I did that for a few years for IDC, but they mostly wanted adult material, so when IDC started, I transitioned to writing pediatric cases for them. I was asked to speak at the IDC NY meeting in 1992, when due to an emergency, Phil Brunell, MD, wasn’t able to run the meeting, so I did it. It’s been 20 consecutive meetings now that I’ve been on the program.
Dr. Shulman: What do you like to do to get away from thinking about medical mysteries?
Dr. Brien: I’ve had a fascination with motorcycles since I was a little kid. I made my own little motorbike by mounting the motor of a lawn mower onto a bicycle. It actually worked. Now, I have a big boy motorcycle that I ride if the weather is nice. I also read some. The books I’ve enjoyed most are just about anything by John Steinbeck. My favorite, however, is Magnificent Obsession, by Lloyd C. Douglas. I found it inspiring.