२५ नोव्हेंबर, २००४

Rabies.

Read the amazing story of the doctors--here in Wisconsin--saving the teenage girl who developed rabies after being bitten by a bat. It is the first time a human being has survived rabies without receiving the vaccination. Sometimes people don't go in for treatment because they don't realize they've been bitten, but this young woman did know. A bat flew into her church during a service:
"As society has developed, people have forgotten the folklore about don't play with stray animals, or stay away from bats," Dr. Willoughby explained. The bat drew blood, he said, but the bite was quick and small, so Jeanna thought she had just been scratched. Her fellow churchgoers assumed that only healthy bats could fly, so they picked it up after it flew into a window and threw it out the door.
The girl was not taken to a doctor, or she would have received the vaccination. Ah! People need to know not to touch a bat!

I used to have problems with bats getting into my house. As I later figured out, they came in through the attic. More than once, I went up to my bedroom at night, turned on the light, and had a bat swoop right at me. I always scream, quite hysterically, but then I try to figure out a solution. One night, a few years ago, I had already prepared a box to trap the next bat. It was a shoe box with one edge of the lid removed so that the box could be placed over the bat when it landed on a surface and the lid slid under. Then, I planned to toss the box out the window. The first time I tried this maneuver, the bat squiggled its way out as I was trying to get the lid under. It flew lengthwise figure eights in the room over and over and never found the open window. Finally, it flopped onto a table, I got it in the box, and I threw the box out the window, feeling quite triumphant. I closed the window and went to wash my hands and saw a tiny wound --- just four little lines -- on the back of my right ring finger.

It took me a few hours to decide I ought to go to the hospital. It was such a tiny wound. I knew even a scratch could lead to rabies, but I kept thinking maybe I had scraped my finger on the sand-textured wall. What made me go to the hospital was the observation that the four little lines were symmetrical, like this: | '' |. That is the pattern of teeth. The wall might, by chance, produce such a symmetrical pattern, but that was much less likely. I felt silly going into the emergency room with such a tiny wound, especially when a moaning boy with gauze wrapped over his eyes came in. Later, I was in a room where the opthamalogist came in to get some equipment, and we talked for a moment. I asked what happened to that poor boy, and he said "I'm not at liberty ... someone poked him. He's going to need surgery."

I was apologetic when I arrived at the emergency room. I said things like "maybe I'm overreacting," but I also mentioned over and over again something I'd read in a Harper's Magazine Index about how many people die from rabies after they don't realize they've been bitten. In fact, as is usually the case, there were very few people using the emergency room at the University of Wisconsin Hospital. I was quickly seen by a nurse, then a doctor, then a second doctor. All three had me tell my elaborate story and expound my symmetry theory, and all three spent a lot of time puzzling over the wound. Doctor 1 thought maybe it was from the wall. Doctor 2 said it was my choice, but he'd get the treatment. He said, you could get 1000 bat bites and do nothing and nothing might happen, but considering that you would die if you bet wrong and the treatment, done now, is 100% effective, you should get the treatment. This puzzling over the wound process took three hours for some reason. Slow night? State law required them to call the police when an animal bites someone, and that call resulted in a long visit from police officer, who took pages of notes, apparently about how I caught the bat in a box and threw the box out the window and so forth.

Finally, I got the treatment. And the rabies shots, which were given in the arm, did not hurt any more than a tetanus shot. It did hurt to get one of the immunoglobulin shots that preceded the rabies shots, because it was injected at the site of the wound. It is damn hard to find a place to put anything in the middle of the back of a finger! But they did. Afterwards, I felt faint and they had me rest for another twenty-five minutes. At midnight, the nurse said "The witching hour," and I said "I'm going to turn into a bat."

The next day, when I came home from work, I found a legal notice posted on my door. It was a formal demand for me to surrender the animal that, according to a police report, had bitten a person. I had to call animal control and explain how I had thrown the bat, in a box, out of a three-story window. The person I talked to was very chatty, and I had a long interesting discussion about rabies and bats. She told me about Americans who get rabies shots before traveling to certain parts of the world where there is great danger of exposure and difficulty obtaining treatment. (The linked article notes that "rabies kills tens of thousands of people in Asia, Africa, and Latin America.")

Later, I was asked to come in and talk to two doctors at the UW Hospital who specialized in infectious disease research, and these two men also talked to me for a long time. I heard all sorts of stories about rabies. I asked if it was true that if you had the vaccination there is zero chance of getting the disease, and they told me that there are cases of people with very deep, tearing bites from wolves who still get the disease. The disease creeps slowly up through your nerves to your brain, and that time gives the vaccine a chance to work. But with the large wolf bites, the disease reaches the brain much too soon. In the cured case in Wisconsin, the treatment consisted of using drugs to induce a coma, to deliberately shut down the girl's brain while the disease passed through.

So, wonderfully, there is now hope for those who fail to get treatment, but it is much better, still, to go in for treatment, even for a tiny scratch. Once the symptoms appear, as in this recent case, it is too late to prevent the disease. The other thing I learned from my rabies experience was to catch a bat in a little plastic margarine container, with a snap-on lid, and take the bat in for testing. It wasn't that long after my experience, that I woke up one morning hearing that leathery flapping sound, and I tried to convince myself that I was still dreaming. Then I felt that leathery wing brush my hand, did some preparatory screaming, then got the margarine container and caught the bat against the window. I snapped on the lid and took it over to the animal testing lab. When I handed the container to the woman at the counter, she asked "How long has it been dead?" I said, "It's alive."

Not long after that, I spent $800 having the house bat-proofed. The bat proofing guy told me all the houses in my nicely wooded neighborhood probably had bats, unless efforts had been made to seal out the bats. I know he was in the business of providing that service, but based on my experience, I'd say get an older house bat-proofed. I haven't had a bat in the house since I did. I do still worry, though, when I hear a little noise in the night, and many times I've turned on the light to look around for a bat!

UPDATE: Let me add that awful as a bat in the house is, bats outdoors are perfectly excellent. Here's a bat conservation website. And here's a cool blog entirely devoted to bats.

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