It's been an interesting month. I've been receiving post-exposure prophylaxis for rabies, which consists of multiple injections of both vaccine and immune globulin, after a close encounter with a bat roosting in a crack at Index. While several other people certainly saw the bat that day, I think I'm the only one unfortunate enough to have made accidental contact with it. At least, I'm pretty sure I did: with my hands stuffed in a crack millimeters away from a fairly unhappy bat, and with the conviction that I indeed felt something on my hand, I wasn't about to take the situation lightly. This is because I knew that bats carry rabies often enough to be of concern. I still wasn't sure if I was at risk, but I decided to at least find out who to call for information.
In the meantime, after relating my story to a few other people, I realized that I needed medical advice fairly urgently both because this was a possible exposure and because treatment, if advisable, must begin a.s.a.p. after a possible exposure. Now, my idea was fairly simple: call the consulting nurse to find out whether my incidental contact was actually of any concern. After all, I didn't feel an obvious bite and I didn't have any obvious bite marks. All that I recalled was contact with something in the crack and the extremely close (inches, in fact) proximity of a bat who was hissing with indignation at being disturbed. The answers to my question were myriad and contradictory. The first nurse asked if I was sure it hadn't been a snake. She told me to go to the ER, but didn't really evaluate my question (which was whether I needed to go in the first place). The nurse at my clinic told me that I should definitely be seen right away. The doctor at my clinic gave some useless and potentially harmful advice, but also maintained that I should be seen in an Emergency Room for a definitive answer and that no one in the setting of a neighborhood health clinic could really do anything in this situation. His advice was really that he had no advice to give.
Lesson learned, of course. At this point I did what I should have done in the first place and called Harborview. The nurse there was extremely knowledgeable and immediately concerned; she explained succinctly that bats often don't leave a bite mark at all, that I may not have felt the bite even if it happened, that this was sufficient grounds to contact the Department of Health to consult them about vaccine use and that I should get to the emergency room immediately to be evaluated. I had also found a puncture-like wound on my wrist after my doctor visit, which certainly reinforced my decision. Harborview is obviously top notch and their emergency room is correspondingly busy: bring a good book if you ever go there in any capacity other than as an unconscious trauma patient. Eventually, I was seen by the nurse; she contacted the Department of Health and related my story; after clarifying that I did indeed have potentially suspicious wounds on my hand (which I did), they gave the go-ahead for the vaccination.
From everything I've read and heard since, I made the right decision. Most or all of the human rabies cases in the United States over the last twenty years have been bat-related. A further unsettling statistic is that of those twenty-odd victims of the disease, many couldn't recall any contact whatsoever with a bat. In line with this fact, I was told by the nurse in the ER that if someone were to wake up and notice a bat nearby, they would be vaccinated in the absence of any obvious bite marks because of the potential for exposure and because of the grim prognosis for those who actually get rabies: a near 100% fatality rate. With that in mind, it makes sense to err on the side of caution especially in light of the fact that I had contact with the animal. Still, there is that part of me that wonders, after seven shots and at least one to go, what I would have done had I been uninsured, a little less informed, a little less concerned about things like this...
Not worth the time to doubt, I suppose. Meanwhile, a billing statement for an unspeakably high amount has arrived in the mail; thankfully it has yet to be processed by my insurance company. All I can say is this: if you ever have to go through this same process, make sure you have a trust fund or a stash of gold doubloons close at hand.
Oh, and get Minecraft: it's only 10 euros and it's the best damn computer game I've played in a long time. It will help you to ignore the ridiculous political spectacles that continue to lower the standards for everything and everyone in this country. Huzzah.