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The Bat – Part Two

August 6, 2009

Part Two

(This is the final part in a two-part series. If you haven’t read The Bat: Part One, published on July 27, 2009, you might want to do so. Otherwise, you’ll be confused as hell.)

The next day the man from the CDC, who we now refer to as Accent Guy, calls Jen to see whether we’ve caught the bat. When she tells him that we did and that we chose to let it go, he gets very perturbed.

“Oh no, NOW you’ve done it” he scolds. “Now your daughter is going to have to get ALL the shots.”

 “What are you talking about?! We had a whole discussion about the protocol. You explained to me about the babies and the drunk people. It was perfectly clear!”

“I didn’t tell you that.” Accent Guy clearly senses a storm of controversy brewing, with him caught smack in the eye. He goes into full denial mode.

“Yes, you did,” Jen corrects him.

“No, I didn’t.”

“Yes, you did. I had you repeat it three times to make sure we understood one another. If you’d said otherwise, we would have killed the bat. But you didn’t. So we didn’t.”

“Fine!”  Accent Guy shouts, sounding very frustrated with the tone and direction of the conversation. “Don’t listen to me! And good luck!” By that we take him to mean “good luck coping with your eternally mangled conscience when your daughter dies a horrible death from rabies.” I’m just paraphrasing here, reading between the lines perhaps, but still, not a very nice thing to maybe sort-of imply.

Jen is incensed. She calls the CDC again and asks to speak with someone else. The woman who gets on the phone next is Accent Guy’s co-worker. Ms. Co-worker understands our plight completely, and is properly apologetic. She excuses herself, telling Jen she’ll call right back. Five minutes later, Ms. Co-worker is phoning from an elevator where she’s gone to speak in private. Like a modern day Deep Throat, she confides in Jen that we’re not the first people to call and lodge a complaint about Accent Guy. “He only has a few weeks left here, then he’s gone,” she assures. Jen imagines a typical day at the CDC resembling an episode of The Office.

“A few weeks? He misinformed us about the proper handling of a bat in our house. Now our daughter requires shots. You’re the CDC! It’s your job to protect and defend, not cause panic and anxiety!! This is a big deal!!!”

“Well, actually Mrs. Tabb…and you’re not going to like this…but your whole family needs to get the shots.”

“WHAT?!”  Yes, it was true. Up until the moment we locked it in Lucy’s room, the bat was free to roam the house. According to the CDC, it could therefore have spread its saliva all over our sleeping bodies. The CDC has something of a “scorched earth” policy when it comes to handling possible exposure to infectious disease; needles for everyone, kill the family pet*, and burn the house down for good measure.

(*Author’s Note: The CDC also informed us that Rufus, our dog, would require a rabies booster. We consulted the vet, who thought this was nonsense – Rufus had recently had his rabies booster, as part of an annual check-up. It was unreasonable and expensive to administer another. But then the CDC contacted the vet directly and explained that, if the booster wasn’t given per their instruction, they could order Rufus be put down and an autopsy performed to test whether rabies was present. Needless to say, we got Rufus a booster for his booster. No sense fighting with the authorities, particularly when they’re unreasonable, dictatorial and demonstrably demented.)

Some healthy intra-marital debate ensues. I think this whole thing is a sham, a text book case of government run amok, covering their asses, advocating needless treatment to defend against the possibility of future class-action lawsuit. “Everyone we know has had bats in their house at one time or another. None of them have gotten rabies shots. Our big mistake was calling the CDC.” Jen is concerned though, and understandably so. More than concerned, she’s afraid. The CDC has effectively terrorized her with their rabies propaganda machine, and what if?

 “What if one of the children contracts rabies, Sean? We couldn’t live with ourselves. Can you guarantee me that won’t happen?”

Of course, I couldn’t.

The old rabies treatment involved 20-30 shots in the abdomen and had a well-documented reputation for being agonizingly painful and unpleasant. The new treatment is slightly more humane. In theory, it requires only six shots: the first, administered on day 0, include an immune globulin injection and a dose of vaccine. Single vaccine shots follow on days 3, 7, 14 and 28. Because access and availability to rabies immune globulin is limited, the first shots cannot be given by your primary care doctor. They must be administered at a local hospital.

The whole damn family shows up at Maine Medical Center Emergency Care at 5:30 PM that evening. Like a good concierge the CDC has contacted the hospital too, to prepare them for our arrival. We’re told to register at Emergency Care; the whole thing shouldn’t take more than thirty minutes. Fortunately, the E.R. is quiet on a Tuesday night.

The nurse who greets us is very warm and welcoming.  “The Tabbs!” she exclaims. “Had a run in with a bat, huh?  Did you realize that ‘bat’ is ‘Tabb’ spelled backwards? Isn’t that funny?!”

Heh heh. That is kind of funny, but we’re in no mood for rib-tickling. The kids are anxious as hell, worried about the shots, and Jen and I are silently fuming, angry that any of this at all is happening, just wanting to get it over with. Quickly.

We find ourselves telling the story of the bat ad nauseam, to every doctor, nurse and administrator we meet, mainly because no one in the hospital can understand why we’re there if none of us was bitten. It’s clear they all think the CDC’s direction is insane. Our resident physician offers a glimmer of hope. First he checks us each for bite marks. I’ve got a few tiny spots on my left leg I’m keen to show him, two in particular side-by-side that have bugged me since I first noticed them the day before.

“I mean, I’m sure they’re nothing, right? They’re small. They don’t hurt, or anything…” I stammer.

“They look like pimples,” he says, and pats me on the knee.

Finding nothing of consequence, Dr. Resident says the words that Jen and I are dying to hear. “We might not need to give you these shots. I’d rather not, really. It seems like overkill to me. I’m going to consult with the attending physician, to get his opinion. Sit tight.”

Tightly we sit, Jen and I, trading meaningful “wouldn’t it be awesome if we could somehow manage to extricate ourselves from this crap-tastic situation” glances with one another, but secretly I’m doubtful. I can’t imagine the hospital contradicting the CDC; if one of us did get sick, their legal exposure would be enormous. Of course, we could always take the matter into our own hands, just gather our things together, thank the personnel for their hospitality, and waltz on out the door. But that doesn’t seem possible anymore. This whole ordeal has assumed a gravity and momentum of its own, and we’re sitting tightly, glued to our seats, incapable of breaking free.

Time ticks by, fifteen, twenty, thirty minutes. Dr. Resident finally returns with news from his attending physician. “I’m sorry folks. It appears that the saliva of the bat can potentially aerosolize. If those tiny particles get into the air, if they find their way into the eyes, the nose or mouth, an infection might occur.” Just like Animal Control Guy said. Bat drool in the eye. We do need to have the shots.

The sitting continues. Dr. Resident leaves, the nurses come and go, updates are delivered periodically on the status of our care. The hospital pharmacy is taking longer than expected to supply them with the rabies immune globulin. They’re working on it, but it could be another hour. At this news, children begin to cry.

“Can I get you guys a popsicle?” Nurse Friendly asks. Everyone nods. At the pace which things are proceeding, a popsicle may be the closest thing we see to dinner this evening. My son and I follow Nurse Friendly to the kitchen area to review the flavor options and make our selections. While we’re there, I dig for any bit of useful rabies-related information I can find.

“What’s taking so long with the pharmacy? They aren’t out of the drug, are they?” I ask.

“No, no. There’s a shortage of rabies immune globulin. There’s always a shortage. They do run out occasionally, but not this time. With supplies so limited, the pharmacy is extremely deliberate whenever they need to dispense it. They don’t like to see any go to waste.”

“Shortage? Is the supply limited because there’s so much demand? Or so little?”

“Cherry, grape or orange?”  Nurse Friendly asks my son, Isaac.

“What would you do if they didn’t have any immune globulin on hand? Send us home?”

“We’d probably send you to your primary care physician.”

“But they don’t have the drug either. That’s why the CDC sent us to you.”

Isaac continues to deliberate the merits of orange over cherry, having officially ruled out grape. The popsicles look like they’ve been in the hospital freezer a very long time. Their wrappers are all a bit tattered; the flavored ice showing through appears to have melted and refrozen. Nurse Friendly has not answered my question.

I press on. “How many cases of rabies do you see in Maine each year?”

“I’m not sure,” Nurse Friendly answers.

“How many cases do you see here in the hospital? Do you treat many people like us?”

“You’re my first in a long time,” she admits. Isaac settles on orange for himself and grape for his sister, who has granted him permission to choose “whatever.”

I’m getting the sense that we are a rare bird indeed; a nurse who almost never administers the shots; doctors who aren’t aware or don’t agree with the CDC’s direction on handling rabies exposure; essential medicines in short supply. Maine is a big, rural state with a lot of unchecked bat/human commingling. So why aren’t more people receiving this treatment? And if they’re not, why aren’t more people rabid?

It’s almost 8 PM when Nurse Friendly and her colleague, Nurse Accomplice, finally arrive with four fistfuls of hypodermic needles.  Friendly explains the process. The first shots are the worst shots. These are administered with a needle whose gauge is just a little bit larger than a whale harpoon.  “The immune globulin is thick, like maple syrup,” Friendly explains. “The needle has to be big to push the medicine through.” The medicine is prescribed by weight, and because it’s so viscous it usually requires more than one injection to administer the full dose. The kids will each require two, Jen will need three, and it will take four to bring me down.

There’s really no choice when confronted with a needle this big. I can’t imagine the arm is even an option, given the proximity of muscle to bone. And the abdomen? That must have felt like good old fashioned medieval torture. No, the one and only place soft and fat enough to cushion the impact of a needle like this is the butt. In an effort to help the kids see that this was no big deal, I turned around and did what any good dad would do: I pasted a great big goofy grin on my face,  dropped my drawers in front of everybody*, and challenged the nurse to bring it on.

(Author’s note: It wasn’t a full, “turn your head and cough,” pants around the ankles sort of pants drop. More a sportive half-moon, if you know what I mean. Lucy was embarrassed as hell, and turned to hide her face in the draped curtains. Isaac thought this was the greatest thing ever, and moved in to get a closer look.)

I’m not squeamish about shots, but this was rough going. Nurse Friendly has a “jab first, apologize later” policy. She makes like Captain Ahab, plunging the spear deep into my blubber. My glute muscles, sensing something gone terribly wrong, seize in a full “Charlie Horse” style contraction to protect themselves, but it’s a useless reflex. Three more times she stabs me. “I’m really sorry,” Nurse Friendly keeps saying, though her apologies don’t sound particularly heartfelt. Through all this I manage to keep smiling, teeth gritted, assuring the children that there’s nothing to fear. Lucy is freaking, Isaac is laughing maniacally, and Jen is smiling right back at me, a smile that says “holy shit.”

Jen is next, followed by Lucy. Nurse Friendly’s accomplice ushers Isaac and me out of the room, to give the women their privacy. We follow her obliviously down the hall, both of us genuinely thinking that we’re going to get another treat, a toy or an ice cream maybe, neither of us suspecting what’s to come. Like lambs to the slaughter, she leads us into another of the exam rooms and closes the door behind us. We’ve been duped, and Isaac knows it. Nurse Accomplice growls instructions at me to “hold the boy down,” and suddenly I’m wrestling to get my poor son over my knee, pulling down his shorts to expose his buttocks, with him shrieking “NNNOOOOOO!!!!”

In goes the harpoon-sized needle. Isaac actually screams “YOW!” in response to the pain, like the howl emanating from a cartoon character who just whacked his thumb with a hammer. “YYYOOOWWWW!” And a few more times, “YOW!” Having recently experienced the same, I know “yow” is an understatement. I would like to congratulate him for his self-restraint.

The other shot is hardly worth mentioning; a vaccine, administered in the shoulder with a nice, sensible needle. Child’s play compared to the immune globulin (though hell the next day, sore like “a bunch of thugs jumped me in a blind alley and unleashed their proletariat anger on my shoulder with a dozen brass knuckles” sore).  And with that, we’re done. We are now and forever immune to the ravages of rabies. It’s all hugs and handshakes with Nurse Friendly and Dr. Resident, and a cold shoulder to Nurse Accomplice, who can never, ever be forgiven. None of this is their fault, after all. We only have ourselves to blame. Ourselves and the by-now-hopefully-unemployed Accent Guy, who failed to inform us decisively and without question that, when the CDC is involved, the bat must always, always die. Had we known that, maybe none of this would have happened.

It isn’t until we get home and begin to mend the physical and psychic scars of our ordeal that Jen, purely out of curiosity, reads the literature that the hospital sent home with us, the information supplied by the drug manufacturer of the rabies vaccine. Herewith, a few choice excerpts:

  • “Annual human deaths (from rabies) have fallen from more than a hundred at the turn of the century (Author’s note: yeah, that would be the 19th century) to one to two per year…”
  • “Two cases of rabies have been attributed to probable aerosol exposure in laboratories, and two cases of rabies in Texas could possibly have been due to airborne exposures in caves containing millions of bats.”

In addition there’s this, from the World Health Organization’s web page on rabies:

  • Aerosol transmission of rabies has occurred, but only under specialized conditions in which the air contains a high concentration of suspended particles or droplets carrying viral particles. Such conditions are unusual, but have occurred in laboratory settings, caves with extremely high populations of colonial bats, and perhaps once in animal quarters where rabies-infected wild animals were housed near uninfected ones. There is no danger of aerosol rabies transmission under most circumstances, and rabies virus has not been isolated from skunk musk (spray)

All this turmoil, all this costly hospital intervention, all this fear mongering on the part of the CDC over a disease that kills two in 300,000,000 people each year?!  And don’t get me started on the subject of aerosolized bat drool! Two probable cases in a controlled laboratory experiment, in the whole history of modern medicine?!! Come up with the most impossibly rare disease you can think of: bubonic plague? Mad cow? Ebola? You stand a much better chance of dying from any of these than you do of dying from rabies.*

(Author’s note: At least here in the United States. If you’re in some other country, you’re on your own. In the words of my arch-nemesis Accent Guy, “good luck!”)

I’m sure the CDC and the manufacturer of the rabies vaccine would argue it’s only by virtue of their combined and valiant efforts to immunize the public that such tremendous strides have been made to stem the spread of this pernicious disease. To counter their argument, I can only point to the evidence observed in our case:

  • We asked roughly 100 friends, neighbors and co-workers whether they’d ever had bats trapped in the house. About 60%* said “yes,” most of them more than once. Whether it’s a Maine thing, or a New England thing, or something all Americans deal with, I have no idea. All I know is, of the 60% population with bats, only two ended up being treated for possible rabies post-exposure. The rest just went on living their lives. And none have died from rabies.
  • Every doctor we spoke with, from our own physicians to the hospital staff, thought it utterly, completely, jaw-droppingly ridiculous that the CDC was advising vaccination for the whole family. My doctor’s office has a full schedule of patients, and they admit never having administered the rabies vaccine before.  A few of the doctors even told us, in confidence, that we shouldn’t tell the CDC next time we have a bat. Just keep it our own little secret. This inspires a tremendous lack of confidence in the government and the health care system at large.
  • The shortage of rabies immune globulin. If 60% of Mainers have had indoor contact with bats, then 600,000 people in this state would require immunization, at least according to the CDC. Simple supply-and-demand economics suggest that fewer than that – far, far fewer than that – are pursuing the recommended course of treatment. And I can’t find any information regarding human deaths from rabies in Maine. You can draw your own conclusions.

(Author’s note: I am not a scientist, nor have I applied any serious principles of scientific investigation to my “research.” This is just back-of-napkin stuff, you know? But still, it stands to reason…)

Had we known then what we know now, would we have chosen to have the shots? Hard to say; things would have played out much differently. We would have brought the bat to the CDC for testing; it’s our nature to be cautious. I suspect they would have found it rabies-free. And the story would have ended there.

But once the CDC handed down their edict, our course was set. No matter how sympathetic the medical establishment claimed to be, no doctor was willing to go so far as to contradict the CDC. Because there’s always a chance, I suppose. A chance that one of us might contract the disease. Better to put us all through hell than pay us in a court of law.

What I object to most is the way the CDC manipulated our emotions and our response, overstating the danger and withholding the facts. They provoked panic and fear, scared my wife and my children into thinking their lives were truly in danger, and rushed us to an expensive and probably needless treatment before we could do our homework, before we could weigh the evidence and make an informed decision on our own. After all that, it’s hard to trust the CDC. I can’t help wondering how they will handle an H1N1 influenza epidemic. Will they order immunizations for every child? Immunizations whose long-term side effects are untested and unknown? Will they order you to burn down your house? Will they order you to kill the family dog? If so, what will you do?

All I know is this: I can now rest peacefully knowing that no one in my family will be among the one or two rabies deaths in the United States this year. That’s a tremendous burden off my shoulders. Now if you’ll excuse me, I’m going to make the best of my immunity and head out into the wilds of Portland to taunt a few nocturnal animals, badger some raccoons maybe, kick a fox, hurl insults at an opossum. “Hey opossum! Yeah, you! Yo’ momma’s got a fugly old pouch!”

8 Comments leave one →
  1. Laura permalink
    August 6, 2009 11:08 am

    HOLY GOD IN HEAVEN! YOW is right. If only you could sue for assholishness.

  2. clara allen permalink
    August 6, 2009 5:47 pm

    sean when i have woodchuck problems i can just call you now i think some one should havechannel 13 do a thing on the cdc as you know we have had to deal with woodchuck issue and each time we get different advice just a thought

  3. Bill permalink
    August 10, 2009 11:32 am

    Made me queasy, angry, sweaty.
    What an ordeal on many levels.
    For you guys, too.

    The Bat would also be a great short film.

    Also, I agree this story should be in the National News…

  4. Bill permalink
    August 10, 2009 1:14 pm

    Also, a CDC story on NPR today…

    (Not sure how to make that a real link, so it’s a copy-and-paste deal.)

    • seantabb permalink*
      August 10, 2009 8:18 pm

      Some day, the CDC are going to show up in a van on a random street corner, toss a pillow case over my head, and “disappear” me. Count on it.

  5. September 15, 2009 9:08 pm

    Oh. My. God.

    Maybe you guys can get a family gig as high-level wildlife consultants, you know, work at very close range, since you’re totally immune?

    I have to say I’m awfully glad the aerosolized bat saliva threat turns out to be a lab-condition-only situation because my husband and I used to swim at night in the pool at our old house and hundreds of bats would make thousands of swooping dives to grab sips of water out of the pool while we laughed, our mouths gaping open to receive their rabies-infested spit.

  6. September 15, 2009 9:09 pm

    Oh and P.S. H1N1 vaccine or no at your house?

    We are NO here.

    • seantabb permalink*
      September 15, 2009 10:47 pm

      No one’s offered it to me yet, but I’ll try anything once.

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