My first patient with rabies

I will always remember Joey, the first patient
I ever saw with rabies.

I was a medical resident on a rotation at San Lazaro Hospital, in the heart of Manila, 10,000 miles from home.

Joey was a small boy, not more than 5 years old. Two months ago, he suffered a dog bite on his leg from the neighbor’s puppy. It was just a small nip in the skin, with only a few drops of blood produced. The puppy seemed alright, but it died a few days later – seemingly a victim of the stifling Manila heat. The parents struggled to make ends meet for their family of 5, it would be too much to take Joey to see a doctor – instead they would visit a local faith healer.

After some incantations and a procedure where a black porous stone was affixed to the wound (tandok), the family felt reassured rabies would not strike. The family had heard of rabies, but trusted the faith healer, as he proclaimed to have saved many lives from that cursed illness.

When Joey started to get sick 7 weeks later, the parents thought it was just a cold. He didn’t have much appetite and had some headache. A few days later he had some fever and felt tired. Then, he started to complain about itching on the leg where he had been bitten before. That night, he didn’t eat any dinner. His older sister thought he should at least try to drink something, so she brought him a glass of water. Joey suddenly shrieked and held his hand to his mouth when he saw the water, trying to get away from the threat in front of him. Terrified, the mother realized her son had rabies!

The family rushed him to San Lazaro, which had a reputation for handling rabies cases. Most other hospitals refused rabies patients, but at least San Lazaro could take him in. Maybe something could be done. Before their trip to the hospital, the family said a prayer, like they always did before traveling anywhere. ‘Dear God, please help Joey and let him recover, he is just an innocent child’…

When Joey came into the E.R., there was a commotion. Someone was shouting ‘rabies, rabies! Doctors, nurses and patients looked startled.

I saw Joey for the first time – he seemed OK – he wasn’t having any trouble breathing or vomiting. He was taken to a separate room in the E.R. with his mother, who never left his side. The doctor on duty came into the room to perform the confirmatory tests. He took a glass of water to test for hydrophobia and showed it to the boy. Joey screamed, and went wild, backing away, trying to get away from that awful substance. I could see the fear in his eyes, the animal nature taking over, anything could happen.

I felt sick to my stomach. I knew this was a death sentence, there was no cure for rabies. His condition would only get worse and he would die a most cruel death. Such a young victim who had every right to live and could have so easily been saved by a vaccine. I felt great sadness for something that in my country was so easily prevented. I looked at the mother and realized she didn’t know the fate of her child, she was still hoping, believing in any tiny miracle that might help her child…

Joey was taken up to the rabies room at San Lazaro later that night. For the safety of others he was locked inside, and strapped down to the bed. The staff tried to sedate him as best as possible.

His condition declined through the night – worsened by the dehydration from hydrophobia. He wanted to drink, yet couldn’t bear the sight of water. His mother stood anxiously by, mopping the sweat from his brow, trying to soothe him. He was getting more agitated. Certainly she was now at risk from rabies as well, given her close contact. She and the other family members would have to get vaccinated.

In the Philippines, that vaccine series costs around $50, a couple months wages for the working poor. How could they afford this? This was all a terrible terrible disaster that never should have happened. Yet to the doctors at San Lazaro, here was a familiar story. 2 or 3 rabies victims come in each week, hoping against hope for a cure.

Joey died early that morning. His breathing had become erratic, slowing to a periodic gasping. Joey’s eyes developed a glassy look. He stopped breathing.

His mother wept.

Here was my first rabies patient. I questioned — How could this have happened? How could rabies still exist? How could rabies kill a human being, a boy, an innocent child, little Joey?… It seemed like such a primitive and violent disease. It showed no mercy, with a fatality rate of 100%.

Rabies is entirely preventable, and no one should have to suffer from it. For as little as 8 million dollars, rabies could be wiped out from the Philippines. The long term goal of Rabies Free World is to eradicate this disease. We believe it can and must be done.

Although Joey’s no longer with us, I will always remember him.
RW