The young ER nurse was steady, pleasant, and absurdly unassailable.
“There’s no treatment for rabies,” he said.
On one hand, I thought, having the victim of a mild to moderate animal bite on deck might be a welcome respite for healthcare providers in an otherwise fraught and chaotic realm. There is a finite, necessary, and completely clear-cut course of action, a medical lodestar with airtight logic.
On the other hand, it must really suck, because they have an otherwise healthy person who is lucid and ambulatory and not breathing through a tube, and they must stick large needles in all her limbs, in a series of injections that will probably cause pronounced pain and swelling. Seems like a far cry from the Hippocratic Oath.
But there’s no treatment for rabies.
Whether or not I had been exposed to rabies became the defining question of my weekend, after a strange dog chomped on my arm in my home neighborhood of Philadelphia’s East Passyunk, which is a paradise for everyone who ever wanted to take her dog everywhere, from the local pastry shop to the CVS.
It’s lovely. Until some asshole and his best furry friend sashay by.
It was early on Saturday evening and I picked up Ginny, my eight-and-half-pound Yorkie mix, to walk into the local dog-friendly beer shop with her. I always hold her, sometimes in my arms but usually in a zip-up dog carrier, when I walk into public indoor areas. A man was coming out the door of the shop with a six-pack in one hand and a leashed German Shorthaired Pointer mix in the other, and I waited on the sidewalk for them to clear the narrow entrance.
Ginny, who is often fearful of large dogs, growled as it passed, but I didn’t worry, because she was secure in my arms. The other dog swung around on its slack lead and lunged toward us. I didn’t realize it had bitten me until I felt a deep, stabbing pain in my left arm.
I think it was going for Ginny, but fortunately my arm was in the way.
“Your dog just bit me,” I said. My date heard me and dodged out the door where he’d already walked in, his hand landing on my back.
Incredulous, I handed Ginny to him and yanked up the sleeve of my sweatshirt. There was a small puncture and a spreading bruise on each side of my lower arm. On the underside of my arm, a spot of blood oozed up from under a small white peel of skin.
The dog’s owner backed up several feet away on the sidewalk and watched me.
“Your dog bit me,” I said again. He was expressionless, so I stuck my arm out toward him and pointed to the teeth marks. “Look at this. Your dog bit me.”
“Are you going to press charges?” he said.
My mind felt blank except for the pain in my arm and the surprise of the bite.
“No,” I said, “but you need to be more careful of your dog!”
“What, did you vote for Trump?” he said, apropos of nothing, and then turned and walked quickly away with his dog, disappearing into the crowd before I could even close my mouth.
What not to do
What I should have done was notify the store manager, call the police, and then get my arm checked by a medical professional.
What I actually did was flounder in shock for awhile and tell myself it wasn’t so bad, and that if I called for any help, it would just cause a big ruckus and annoy everyone from cops to customers. Doctors would roll their eyes over something as minor as a dog bite that was hardly even bleeding. Plus, it was too late anyway, because the culprit was gone.
So my date and I picked up some beer and a pizza we had already ordered. I poured disinfectant over the bite when I got home and then wrapped my arm in an ice pack while I ate two slices of pizza one-handed. My arm throbbed and swelled and the purple deepened around the teeth marks. It was too painful to use. The bite was worse than I’d thought when it happened.
Better late than never
On Sunday, I did what pretty much any mildly traumatized Millennial would do, and asked my Facebook friends for advice, thinking that it was too late to do anything about Saturday’s bite, but I could learn what to do if needed in future.
But my friends are an obstinately practical bunch, and it became clear to me that the present bite needed to be reported.
So I called the manager of the store where the bite had happened and described the incident and the man and let them know I was reporting the bite.
As soon as the city’s animal bite reporting line opened on Monday morning, I called with all the details I had.
“Did the bite break the skin?” the woman asked.
“Yes,” I said sheepishly.
“Is there swelling?”
“You need to see your doctor,” she said.
Steeling myself for irritation from the receptionist, who surely had people with Lyme disease or badly sprained ankles waiting, I called my primary’s office and said I had been bitten by a dog.
“Do you know the dog?” she asked. “Do you know if it was vaccinated?”
“No,” I said. “It was a stranger’s dog. He got away before I could get any info.”
She offered me an appointment in twenty minutes, sooner than I could arrive. I took the next one, in an hour, with a nurse practitioner.
Julie, a middle-aged woman, glanced at my arm, heard the story, and had no nonsense to spare.
“There’s no cure for rabies,” she said.
There followed a brief conversation in which I pointed out the sheer improbability of a leashed dog in a major city carrying rabies, and she pointed out that there is no cure for rabies. Then I ventured that I had heard the prophylactic rabies shot series for humans was quite awful, and she answered that it was not so bad; she had administered many herself when she was an ER trauma nurse; and also, there is no cure for rabies.
The doctor’s office did not stock the rabies vaccine. Julie gave me directions to the nearest emergency room, two blocks south. She told me to go right away.
I opined that I would rather not lose any more of my workday waiting around in the ER, and Julie noted that there is no cure for rabies.
Millions of dogs—how many bites?
It turns out that I’m in the minority of dog bite victims. According to the Centers for Disease Control and Prevention, children age five to nine are at the highest risk for dog-bite injuries, and men are more likely to be bitten by a dog than women. In addition to this, a majority of dog-bite injuries happen at home, from a dog you already know.
The CDC estimates that about 4.5 million dog bites happen annually in the US. This is a lot, but in the context of the sheer number of pet dogs in the US, the culprits are a small percentage: the American Veterinary Medical Association estimates that well over 43 million households nationwide have at least one dog (more than 36 percent of all American households), for a total of nearly 70 million pet dogs. The vast majority of dogs pose no threat.
And maybe it’s an unfair parallel, but for anyone who argues that the risk of dog bites outweighs the benefits of having dogs in the neighborhood, the National Coalition against Domestic Violence reports that one in three women and one in four men become victims of some kind of physical violence from an intimate partner during the their lifetime. Tragically, we’re more likely to be attacked by a lover than we are by Fido, but I don’t hear anyone calling for an end to romance and marriage because of this risk.
I’ve been bitten three times by dogs. Once, as a young child, my family had a litter of Labrador puppies at home, and I caught them chewing chicken bones they had tipped out of a trashcan. Knowing that dogs shouldn’t have chicken bones, I tried to take them away, and one puppy bit right though my cheek. I remember sitting on my distraught mother’s lap while she called the pediatrician, and sitting in the office shortly thereafter, but I have no other memories of recovering from the bite, and no scar.
When I was bitten the second time, I was probably about 10 or 12, and a neighbor’s cantankerous free-range Shih Tzu ran into our front yard, bounded up to me, and sank its teeth into my calf. It hurt, but it healed without complications.
None of my experiences, including the most recent one, dampen my lifelong love of dogs, or my enthusiasm for public spaces that include dogs, with safeguards like training, leashes, vaccinations, and behavior standards.
Of course there are exceptions, but many dog bites are preventable with proper human behavior and supervision (especially supervision of children). Most dogs will dispatch a plethora of visible stress signals before they bite, and we can stay safe by watching and respecting them, and never approaching a strange dog, or touching a dog without the owner’s permission. Owners, in turn, are responsible for supervising and restraining a dog that poses any threat to people or other animals (as the owner of the dog who bit me last week failed to do).
In other words, many dog bites are the result of human negligence. But even worse than the negligence that leads to a bite is running away when someone is injured.
Deadly and preventable
That’s partly because it’s just straight-up shitty to bolt if your dog injures someone (a bite-and-run?), but also because anyone who was bitten by an animal that can carry the rabies virus must either confirm that the pet is up-to-date on its rabies vaccination (required by law in my home state of Pennsylvania), or undergo immediate prophylactic treatment.
That’s not because rabies is common. The CDC says that there have been only 55 diagnosed cases of human rabies in the US since 1990, but the deadly virus is much more common outside the States, with an estimated 40,000 to 70,000 rabies-related deaths worldwide each year, most of them caused by unvaccinated dogs.
The immediate prophylactic is necessary because rabies is fatal nearly 100 percent of the time, and, as I may have mentioned before, there’s no treatment for rabies. But it is preventable, even if you’ve been bitten by a rabid animal.
When confronted with a patient who has been bitten by an animal whose vaccination status is unknown, however innocuous the encounter seems, healthcare practitioners practically glow with their own righteousness. We’re talking about an illness with that rare and magical mixture of being both completely deadly and completely preventable. It’s the kind of thing to make any nurse’s eyes light up.
According to the CDC, the death sentence of contracting rabies means that up to 39,000 people get a precautionary rabies vaccination in the US each year, after getting bitten by any animal with even the slightest likelihood of being infected, from wild animals like skunks, bats, or raccoons, to cats and dogs whose vaccination status is not known.
Having written about rabies in the past (a confirmed rabid raccoon attacked someone in a Philadelphia park in 2012, and I covered the story and its follow-up for our local NPR affiliate), I’m embarrassed to say now that I didn’t seek immediate treatment myself after I was bitten by a dog whose owner wouldn’t give me any information. It goes to show that even when you have the info, it can be hard to put it into practice, especially when you’re feeling a lot of pain and stress.
Fun in the ER
But the nurse practitioners who evaluated my bite said I had come in time for a vaccination — in my case, within 48 hours.
And there’s no cure for rabies.
So I trudged down to the emergency room at Pennsylvania Hospital, and spent two hours waiting for six injections. (Fortunately, my tetanus booster was up to date.)
First, one nurse announced a large injection at each puncture site on my arm, explaining that it was an immune globulin that would combat any exposure to the rabies virus directly at the bite.
Already so bruised and swollen from the bite that the cold swipe of the disinfectant was painful, I had no raptures to offer at this state of affairs.
“This is going to hurt. I’m sorry,” the nurse said, and carefully sank the needle in. A physician’s assistant who said he had never seen a rabies immune globulin injection before observed the whole thing with interest.
Afterwards, my skin seemed to sport small balloons underneath the wounds.
A little while later, another nurse stepped into the bay, his hands full of syringes.
“Oh, you’re gonna hate me,” he said. “You’re really gonna hate me. I’m gonna stick you all over.”
This was the vaccination part.
I had the option of putting on a hospital gown, or pulling my sweatpants down to my knees.
“Oh, just do it,” I said sulkily, and yanked my waistband down for the final humiliation. I got four additional large injections: one in each thigh, and one in each upper arm.
Finally, I was able to leave the ER with a prescription for ten enormous Amoxicillin pills (to prevent other infections), sore in every limb, itchy and sticky with Band-Aids, $180 poorer, and very behind on my work.
Bad and worse
A manager at the store where the bite happened (which now has a sign on its door about how it’s dog-friendly, with a long list of rules) told me yesterday that they were able to identify the man and dog I described on their surveillance footage, but naturally, barring a police investigation, they won’t share his name. But they did promise to bar his dog from the shop in future.
This morning, I returned to the hospital for the second in a series of four vaccinations. The triage nurse, George, had his own slight variation on the rabies shots refrain.
“It hurts, but it’s better than dying of rabies,” he said cheerfully as he took my blood pressure.
So if your dog bites someone, and you can prove that your dog is vaccinated for rabies, you can spare the person who is bitten the pain, stress, time, and cost of getting vaccinated herself.
I understand the zero tolerance policy for potential rabies exposure. I had heard that the rabies vaccination series is bad, and it is bad, from the pain and soreness of the injections to the inconvenience of going to the hospital four times over, not counting a follow-up visit with my primary doctor. But it’s not unbearable. In my experience, it’s like a tetanus shot (albeit one that you have to get four times over).
And the worry, however small, that I might have been exposed to rabies would have been worse.
And dying of rabies would have been much worse.
The ER nurses ruined my day, but there’s no way to know with absolute certainty that they didn’t also save my life. I offered up all my limbs to their unbearable rightness.
And I offer everyone else this friendly advice: keep your dog vaccinated, and don’t let it bite anyone. If you get bitten, seek medical care. Even if the bite doesn’t seem serious, there’s