Rabies Vaccine Hesitancy

“I stepped on a bat!” my daughter screamed from down on the dock. “Someone help!!”

I mentally anointed my husband as that “someone.” I was five minutes into Saturday afternoon nap, complete with earplugs and a face mask that might as well have had “Go Away” quilted into it. I burrowed deeper into my scratchy cabin blanket and leaned into my neglect. I wasn’t even sure I’d heard her correctly, frankly. Who steps on a winged animal known for agility and speed? Maybe she meant baseball bat. Or maybe she said mat.

After several ensuing door slams and high-pitched screams I eventually felt guilty and went to investigate. She had, in fact, accidentally stepped on BAT. A small mousy thing with wings, and it was flopping around on the dock in a sickening fashion.

“I didn’t realize it was there until I heard it squeaking!” she explained in breathless panic. Her face was white and she looked nauseated. “Please put it out of it’s misery!” she wailed at my husband, who was already looking for a way to do just that. He grabbed a rotting plank from the wood pile, and Delia and I both turned away so we wouldn’t have to watch him use it. I heard a loud crack of wood-on-wood, and when I turned back around, the bat was lifelessly floating in the lake.

Thinking the worst was over, I looked down and noticed my daughter was wearing tennis shoes. Leather ones. Like the pair Forest Gump wore. Clearly no creature of that size could have bitten through those clunky clunkers. But unfortunately someone had, years ago, taught my daughter to read, and in no time she had a very rational argument in favor of a trip to the ER for a rabies vaccine. She passionately shared data from the CDC, NPR, and a few dubious sources including a Will Smith movie based loosely on rabies to make her case. Convincingly.

My husband and I exchanged a look familiar to anyone who has waited an entire pandemic for a few relaxing days at the lake, rolled our eyes, and immediately called the family pediatrician for a quick consult.

The family pediatrician who, in this case, is also this child’s grandfather.

My dad can always be counted on to give anything related to his grandchildren careful consideration before telling us that we’re all a bunch of lunatics and to stop wasting his time. That was the kind of cold bucket of water this situation required. Unfortunately, uncharacteristically, he didn’t pick up.

Sidebar 1: Rabies is spread through animal bites and bodily fluids, and is, for all intents and purposes, 100% fatal. A person who has been bitten by a wild or domesticated animal should have that animal tested for rabies and get vaccinated. The CDC standard course involves four shots over 14 days, and two additional shots of immunoglobulin at the bite site in tandem with the first dose.

“Deals,” I said, trying to quell her rising panic. “Honey you weren’t bitten,” I said, trying to hide my own uncertainty and aversion to one more stroke of drama after the past eighteen pandemic laden months.

“Maaahhhm!!!” She yelled sharply, and shoved her phone into my face. I whipped my head back because I’m old and I can’t see anything that close to the end of my nose, groped for my readers and tried to make sense of why she was so frantic.

Sidebar 2: Even if you aren’t sure whether you’ve been bitten, seek medical attention. For instance, a bat that flies into your room while you’re sleeping may bite you without waking you. If you awake to find a bat in your room, (OR UNDER YOUR FOOT?) assume you’ve been bitten. (Mayo Clinic)

“I literally don’t know if I was bitten. Like…FOR REAL,” she said, pressing her point. Husband and I exchanged looks again, this time sheepishly. She was quite right. We were ER bound.

Finally motivated and on the move, my husband retrieved the doomed bat from the water’s edge where it had been pushed by the wake of passing boats. He wrapped it first in a plastic zip-lock and concealed it in a brown paper bag. “In case they are able to test it,” he explained. I tried not to think about the soggy mangled thing I was carrying out to the car. Instead, I ignored the protracted and revolted “ewwwww….” coming from my lightly traumatized daughter, and headed out to save her life.

. . .

The hospital closest to the lake house is a rural one. The kind that everyone in America hopes won’t go out of business, but not one that anyone actually wants to go to. After decades of my husband’s family living in this area they certainly had strong feelings about the place, and most of them weren’t good. But I told myself, and Delia, with great confidence, that rabies would be the kind of thing they’d have down pat. With all the hunters and generally outdoorsy people in the area, this would be a population health management challenge squarely within their wheelhouse.

I was incorrect.

We were never given the option of seeing an attending physician, and after two hours of explaining why we were there and what I was carrying around in a really suspicious looking brown paper bag, a nurse practitioner came to evaluate Delia’s lower extremities for bites. I noticed immediately that she didn’t wear gloves, but Delia’s feet were pretty dirty, so I figured it was probably more the NP’s problem than ours. We repeated our story again, explaining that we couldn’t rule out extremely tiny bites, and contact with saliva and other fluid was possible.

The NP clearly thought this was all a lot of bullshit. But she squinted at Delia’s skin through thick glasses and eventually simply shrugged. When we finally ran out of details that might justify our presence in the ER, she lowered Delia’s filthy foot and raised her glasses to the top of her head. “I don’t see any indication of a bite,” she said, and stood to leave as quickly as possible. “But we can start her on the vaccine if it would make you feel better, and you can contact the health department to get your bat tested on Monday morning.”

My bat? Yeah that was fair. I was the one clutching it possessively, which was making the paper bag crumple giving it an increasingly creepy vibe.

“They should have the results back in 48 hours or so. Just be sure to keep it dry and the head needs to be in tact so they can examine it’s brain.”

“Oops…” my husband responded when I called later and told him this last part. His swift work dispatching the bat on the dock now felt regrettable. I didn’t tell the NP that my scientist husband had literally done everything conceivable to make it impossible to accurately rule out rabies in “my” bat short of putting it in a blender. But we knew, and we felt like assholes.

Despite this, on the ride home, Delia and I felt relieved. She was covered in band-aids from her first round of shots, but our earlier anxiety about even the slightest possibility of contracting rabies was subsiding. The utterly unimpressed hospital staff was clearly reluctant to proceed with the vaccination, but we’d persevered and gotten her jabbed. Most vaccines are worth the risk, and with a universally fatal disease, there is very little to lose, and no upside to gambling. The immunoglobulin and first of four vaccines was coursing through her veins, and our senses of humor slowly started to return.

“I don’t feel good about having killed a pollinating animal,” Delia said as we made our way through town. I suggested she consider making a donation to an organization focused on the preservation of bats. She liked that idea and quickly found one called Bat Conservation International on her phone while expertly relieving my wallet of my credit card with her free hand. “I’m naming him Ronald,“ she said with a totally straight face and typed this into the “in memory of” field on the fundraising page.

I sighed feeling a little sorry for the poor administrator who was going to have to write that thank-you-for-your donation letter for tax purposes.

“What happens if Ronald doesn’t have rabies?” She asked. The carefully wrapped yet mangled little creature still sat on my lap on its way to its tiny bat autopsy. “Do I still need to get all the shots?”

“You don’t have to,” I said, giving her the illusion of choice, same as when I’d suggested she participate in the Covid-19 trial for 12–15 year-olds late last year. For the record I hadn’t forced her to do that either. She’d embraced that opportunity, and this one had potential as well, but I wanted her to have agency while I still had the right to make medical decisions for her. “The shots aren’t a huge deal, and then it will be one less thing that can kill you.”

She considered this and said “I was the first in the family to get the Covid vaccine.” I knew it was something that gave her great pride. “I could just trail blaze my way past rabies next!” I didn’t mention that nobody else in the family was going to follow her up that hill, but considering she had several more shots to look forward to in quick succession I let it go.

Four days later, the little bat tested negative.

But before we got this information from a cheery health department employee, several physicians in our lives had weighed in on the importance of aggressive treatment in an information void, validating the positively Karen-like pressure we’d brought down upon the healthcare professionals who were justifiably overworked and exhausted by the horrors of the past year.

“There should have been no question,” the family pediatrician weighed in, hours after the first doses had been administered, but days before we learned they weren’t necessary. I didn’t remind him of the time I woke up, age eight, and saw a bat flying through the upstairs hallway our house, resulting in mayhem, and tennis racquets and fishing nets being pressed into service. I didn’t recall any of us getting a rabies vaccine at the time.

“I’m cool with it,” Bat Girl replied when we asked her what next, giving the question her trademark one-shoulder shrug. Six shots she didn’t need made me wonder about the freaks out there hesitant to get one or two that they absolutely do. “Two more to go and I’ll be bulletproof for a while,” she said, and literally flexed.

And compared to a great many in the world around us today, this is almost certainly, painfully, true.

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This post was previously published on A Parent Is Born.

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