Chapter two

John felt strange sitting in the driver's seat with Roy in the passenger side. Sure Roy let him drive from time to time but as a rule Roy was much more comfortable behind the wheel and Johnny was good at navigating the fastest way to where they were needed.

Cap had pulled him aside while Roy was getting dressed and told him the final diagnosis on the young boy they had been hoping and praying would recover. Johnny was still reeling from that revelation. Sure they asked about rabies whenever there was any kind of a bite, well any kind of a bite from animals. John never thought he'd see a case of rabies in a human nor did he ever consider that human biting another human.

"You all right, Roy?" John made an effort to get his totally silent partner talking, as well as show some concern.

Roy let out a deep breath followed by another sigh. "To be honest, I'm not sure. For days now I've been remembering how sick you got when you came down with that monkey virus and just hoping what Dr. Brackett was doing to keep me from coming down with anything would do the trick. I never saw this coming."

"You can say that again." Johnny let out a breath of his own. "I thought they had decided the kid had some kind of encephalitis."

Roy looked over at his partner then turned his focus to the road they were traveling again. "That's what rabies is, a form of viral encephalitis, it just happens to have a real crappy survival rate."

"You know you're going to be alright, don't you? I mean they'll get you on the shots and after you're done you'll be just fine. They've never had a case of the person dying if they got the shots started in time."

"Yeah, Yeah, I hear the shots aren't any fun but, a, once they're done there's no record of the person actually getting rabies." In his mind he repeated Johnny's last remark, 'That is if they get them started in time.'

"Did Brackett say how they figured out what the kid had?" Johnny inquired; he could now see the lights from the upper floors of the hospital in the distance.

"He said that they got a report of some sick baby raccoons. When animal control checked into it they got the story of how these kids found a momma raccoon with her babies only the mother was real sick and died while the kids were watching them. They thought it would be nice to keep the babies for pets so they took them home and hid them from their parents while they figured out a way to convince their parents to let them keep them.

"Apparently one or more of the kids found out that the county wouldn't allow them to keep them as pets and that they would likely be euthanized so they changed their plans to just keep them till they were old enough to set them free again. They've managed to keep them a secret for a little over a month but one of the boys got concerned when it looked like the babies were starting to get sick and yesterday sometime he finally told his parents and they called in the authorities. They were all friends of the Worthington boy and they kind of remember the mother may have bit his finger before she died."

"I bet the parents are having a real hard time with this," Johnny offered after a moment of not able to think of anything else to say. "From what I remember from reading about rabies the kid didn't stand a chance even before his doctor diagnosed him as having the flu."

"I seem to remember Dr. Brackett saying something like that on the phone a little while ago. But I have to admit that after he told me the kid had rabies I can't really remember a whole lot of what he said."

"I can understand that one." Johnny sighed as he pulled into the drive to the hospital. As he stopped to shift the truck into reverse he looked over at his partner. "Well, here we are; do you think they're going to make you ride in a wheelchair?"

Roy blew out another breath, "I can walk."

Johnny didn't respond to his partner's claim nor was he in the least surprised when he saw Dr. Brackett and Dixie standing in the emergency entrance waiting for them, Dixie had her hands on the handles of a wheelchair.

As much as Roy didn't want to get in the wheelchair before he knew it that's right where he was. Dixie was pushing, Johnny was at his side and Dr. Bracket was holding the door to a treatment room open for him to be pushed through.

The head of the county health department, Dr. Brainer, was there as well as a representative from the CDC in Atlanta, a Dr. Holt. While Dixie and John helped Roy into a hospital gown there were questions to answer. They started by asking for the details of the run where Roy was bitten, asked how he felt until now and of course they asked if he had bitten anyone else. The last question was an attempt at humor but Roy wasn't able to laugh. He did lay back and sigh before adding the information that he hadn't kissed his kids or wife or made love since he'd been bitten.

"Right now I'm glad I didn't," Roy whispered against his emotions as he laid his head back against the raised treatment table. Both he and Johnny were noticing that Dr. Brackett was wearing a fresh set of scrubs and that Dixie was putting out a surgical pack as they talked.

Roy swallowed back his panic and looked up at Dr. Brackett before diverting his gaze back to the tray Dixie was setting up. "Doc, what are you going to do to me?"

Roy had heard stories of the muscle being cut away from the area of the bite to prevent spreading the disease and the thought of losing his upper arm muscles not only didn't appeal to him, he saw it as an end of his career.

Dr. Brackett explained what was happening. "We're going to start by taking a couple of small tissue samples. I don't want you to worry; we're only going to need a local anesthetic and the samples will be very small, from three different places around the bite. We shouldn't even need stitches to close you back up again." Dr. Brackett moved closer to the exam table and looked Roy in the eyes. "Then we're going to follow the CDC recommendations and while your arm is still numb, we're going to inject a dose of HRIG, Human Rabies Immune Globulin, into the area around the bite. That will be followed by the first injection of the Rabies Vaccine."

"They give those in the stomach right?" Roy asked and could feel his stomach muscles tighten into a knot as he spoke.

"No." Dr. Holt from the CDC stepped forward. "We no longer do that. We've found that the vaccine is absorbed better if it's injected into the deltoid muscle in the arm than if it's injected into the stomach or hip. The vaccine is better absorbed into the blood stream where it can get to the rest of the body, not just absorbed into the fatty tissue. "

While Dr. Holt was talking Dixie draped a warmed blanket over Roy and tucked it in around his legs and stomach. "Well that will never be a problem here." Dixie spoke up once the CDC man stopped to take a breath. "Roy's a fireman, one of the best in the business, there's not an ounce of fat on him."

Dixie's statement had the desired effect and Roy managed to smile. After a calming breath Roy had one more question he needed answered. "What about how long it's been since I was bitten; is that going to be a problem? I know they like to start these shots right away, the same day if they can."

Dr. Brackett rested his hand on Roy's shoulder as he offered an apology. "I'm sorry Roy. Rabies was never even a consideration on our part until yesterday afternoon. And then even when the testing on the raccoons came back positive we needed to confirm the diagnosis in the boy. We just weren't sure he had been exposed to the raccoons until much later in the day. The tests that are done directly on the brain tissue give us results in a matter of minutes but when the patient is alive you have to take samples from several different sites and the tests to identify the virus in a live patient take up to a couple of days to confirm."

"It's true that we like to start the vaccine within the first 24 hours after exposure but we've had cases where it wasn't started until two weeks after exposure and the person didn't get the disease. Quite frankly we now have no trouble waiting as long as three days to give authorities the chance to locate the animal in question. Not too long ago we had to give up to 21 shots, but due to some refinements in both the vaccine and the way it's administered; now we only have to give five doses of the Rabies vaccine."

It was Johnny that let out the most noticeable sigh of relief with that information, but Roy did close his eyes and lay back against the bed in relief.

After letting out a deep breath Roy turned to face Dr. Brackett once again. "Okay, let's get on with it."

With that declaration Dr. Brackett set out the needed injections and loaded a syringe with the local anesthetic while Dixie gathered a set of vitals on the patient. After recording her readings, Dixie took the chart into the next room and held it up for Dr. Bracket to read while he was scrubbing his hands and arms.

Dixie returned to Roy's side with a syringe. "This is just to help you relax a little," she said as she injected the medication into Roy's hip. She tucked the blanket back around Roy and flattened out the bed.

Johnny stayed at Roy's side while Dixie placed an arm rest to the side of the bed and positioned Roy's arm on it. Dr. Brackett then stepped up with fresh sterile gloves on his hands and Johnny was asked to step into the hall.

Once the door closed behind him, Johnny felt his hands begin to tremble. He let out a couple of deep breaths then decided it was as good a time as any to give Cap a call and get his next instructions.

Author's Notes:

I have spent some time doing some research before taking on this story; I've long lost count of how many pages of material I've gone through. I found a lot of it was written by researchers who have long forgotten the English language in favor of medical language that is part Latin and the other part egotistical researchers that have made sure to get their name in there somewhere.

Not all of the reports I've read agree with each other, especially when it comes to dates and places, but below is a smattering of details that I thought were interesting enough to pass on.

Rabies has been around since the beginning of recorded time but wasn't given a name until sometime in the 1800's, Rabies is Latin for Madness.

September 28 is World Rabies Day, which promotes information on, and prevention and elimination of the disease.

All human cases of rabies were fatal until a vaccine was developed in 1885 by Louis Pasteur and Émile Roux. Their original vaccine was harvested from infected rabbits, from which the virus in the nerve tissue was weakened by allowing it to dry for five to ten days.

The incubation period, the time from exposure to the first symptoms can be anywhere from two weeks to one year, depending on the size of the person or animal exposed and how advanced the disease is when they are exposed. Most often symptoms present themselves with in one to two months.

The first pre exposure vaccine was developed in 1967 and was a human diploid cell (A diploid cell is a cell that contains two sets of chromosomes. One set of chromosomes is donated from each parent.) rabies vaccine however, a new and less expensive purified chicken embryo cell vaccine and purified vero cell (From the area around the kidneys first from green monkeys but now more commonly from cows) rabies vaccine are now available.

In the U.S., since the widely spread vaccination of domestic dogs and cats and the development of effective human vaccines and immunoglobulin treatments, the number of recorded human deaths from rabies has dropped from one hundred or more annually in the early twentieth century, to one to two per year, mostly caused by bat bites, which may go unnoted by the victim and hence untreated.[4]

The Missouri Dept. of Health and Senior Services Communicable Disease Surveillance 2007 Annual Report states that the following can help reduce the risk of exposure to rabies:[23]

Vaccinating dogs, cats, and ferrets against rabies

Keeping pets under supervision

Not handling wild animals or strays

Contacting an animal control officer, if you see a wild animal or a stray, especially if the animal is acting strangely.

Washing the wound with soap and water between 10 to 15 minutes, if you do get bitten by an animal, and contacting your healthcare provider to see whether you need rabies post-exposure prophylaxis.

Getting pets spayed or neutered. Pets that are sterile are less likely to leave home, become strays, and reproduce more stray animals.

My research is a little sketchy in the area of domestic animal vaccination laws but two things seem to stand out,

1. Laws requiring pets be vaccinated against rabies started sometime in the 1970's.

2. Laws as to how early and how often pets are to be vaccinated vary from state to state.

Fifty five thousand people die from rabies each year more frequently in underdeveloped countries and mostly because of the high cost of life saving and preventative vaccines.

To this date there is only one recorded incidence where a human contacted rabies from another human. That happened when a person received a cornea transplant from a person who died for other causes and no one involved had any knowledge that he was carrying the disease. All donated organs are now tested for rabies before they are transplanted.

There are only six people who have been recorded as surviving rabies after developing symptoms, all of those since the development of the vaccine. As much as I have tried to find out I have no idea in what shape these people are now or what quality of life they have.