Rabies, Laziness & Privilege
It was the night of the recent 5-state assembly elections. One of my company's clients is a major news channel, and I was at the studio late into the night, until the election commission announced that they had cancelled their press conference which was supposed to make an announcement about the final vote counts in Madhya Pradesh. A colleague offered to drop me home, and I got off at the gate of my colony, not wanting to subject my colleague to navigating the labyrinth that is any gated colony in South Delhi. I made my way home, humming to myself, thinking about what the elections portended about 2019 - as any dutiful Indian would. (Everyone in India is a political Pundit. Say 'politics' to the nearest Indian and you'll know what I mean.)
I had in mind the images of certain Indian politicians and how they'd act all nonchalant the following day. The inside of my head might have looked like a typical prime-time TV debate screenshot, with everyone yelling at each other and no one making sense. Too much TV or even YouTube does that to you. You can't imagine a civilized discussion between people, especially if they are clad in saffron or green. The whole collage almost resembled a Tricolor, with the Ashok Chakra representing the debate's all-encompassing sense of rubbish.
It's not healthy to dwell on such images. That is at least one reason why I am thankful for what happened next. The image was shattered when, right in the middle of a stride, I felt a sharp pain in the back of my right knee. I instantly yelled out a couple of obscenities. When I looked behind me, I saw a dog a few feet away, looking as nonchalant as a certain saffron-clad spokesperson I had seen a few hours earlier, behaving as if nothing out of the ordinary had happened that day.
The shock of the dog-bite perhaps made me a little numb and I stood there for a moment, just staring at the dog. It stared me down intently, stealthy little bastard. I was wondering if I'd invaded its territory or stepped on it's tail. I don't think I did. I normally stare a few feet ahead of me on the ground as I walk, especially at night in poorly lit streets. I was less than a hundred yards from home, so I just kept walking. I hoped that it was just a scratch. My wife, Aditi, was up waiting for me. When I looked at the wound I found that the dog had managed to sink three canines right through my jeans well into my skin. One of them was bleeding pretty bad. I wondered why I didn't feel it. Perhaps the shock didn't let me. Well, shit happens, I thought.
I was tired and in a little pain. All I wanted was to wash the wound, go to sleep, and worry about this problem tomorrow. That's what I do to my most pressing problems - first aid, sleep, deal with it tomorrow. Only Aditi wouldn't let me. She insisted that I keep washing and rewashing the wound for a good twenty minutes, and that I dab it with antiseptic. I didn't see what the big deal was. To me, it was just a bloody wound, like any other. Not to be too dramatic, but I now realize that Aditi probably saved my life. The possibility of getting rabies hadn't remotely occured to me. After all, who gets fucking rabies?
'Other people', that's who.
The next morning, I looked up rabies on Google. I did that while I was making coffee. After all I can't be expected to start the day without coffee, can I? Rabies can wait. And here was the first shocker. Apparently since 1985, 25,000 to 30,000 Indians die every year from rabies. Even malaria and dengue are rarer, clocking in at nearly 23,000 and 20,000 annual deaths respectively (source). Still, the extent of my laziness is such that even this did not shock me enough to do anything about it. Now I knew that a rabies diagnosis is practically a death sentence. There's no cure and no treatment. If the symptoms show up, you're dead in less than a week. But, after all, what were the chances that that particular dog was rabid? After a bit of Aditi's life-saving nagging, I got an appointment at a local hospital. The doctor I saw told me that since the attack was unprovoked, there's a good chance the dog might have been already mad. This was the first time in the entire episode that I felt something close to fear.
I took two shots - tetanus, and one of a series of rabies vaccines. (The fourteen injections to the stomach story isn't true, by the way. If it's any consolation, you need at best ten injections.) Apart from these two shots, you need something called Human Rabies Immunoglobin (HRIG), which has to be administered within 24 hours of the bite. The doctor warned me that these were expensive, but critical. Well, I thought, jaan hai toh jahaan hai. The pharmacist told me he'd try to find the HRIG and call me. I went home and waited for the call. An hour later the pharmacist told me they couldn't find it. I called every pharmacy in the neighbourhood to no avail. Not many people get bitten by strays in South Delhi, apparently. Then where do those 30,000 dead people come from?
'Other places', that's where.
Here, I panicked, and decided to call in the cavalry - my father, a physician himself, his medico friends and some of my own medico friends. I've enjoyed the privileges of being born to a doctor all my life. The only problem was that my father lives in Nagpur, I was in Delhi, and there were roughly ten hours left of the 24 hour deadline. Even if he did manage to locate the HRIG somehow, it was extremely unlikely that I'd manage to end up in Nagpur in less than ten hours. A friend of my Dad told me that pharmacies near big government hospitals usually have HRIG in stock. So I set off to AIIMS. (Not before waiting another hour and half to squeeze in a presentation draft which needed to be made yesterday. People needing things 'yesterday' is so common, I'm surprised no one has considered seriously working on time travel.)
Every single chemist near AIIMS took a full ten minutes to determine that they didn't have the HRIG. But, marta kya na karta, I made sure I had thoroughly combed the area. Now nearly six hours from the deadline, I started to realize that I was trembling a bit, and I wasn't thinking straight.
While I was standing near AIIMS, wondering where to take my next Uber, a friend of mine, Uday, sent me a link to an HRIG alternative. He told me that he'd spoken to a pharmacist in Connaught Place, who had confirmed he had that specific drug, all ten milliliters of it. In a few minutes, Dad sent me the same link. I went to Connaught place, bought the medicine and went back to the local hospital where I'd received my earlier shots.
By this time I knew that HRIG is supposed to be injected in the wound area. The remainder, if any, can be injected anywhere else. The wound area by now was so swollen that I couldn't bend my knee. I had been limping the whole day. The doctor warned me it would be painful. True enough, the three long, hard shots I received right in my wounds were far far more painful than the canines that had created those wounds. I was yelling and shreiking in the emergency room. Thankfully the pain subsided as quickly as it had come. The good doctor did his best to explain to me why this pain was necessary, and I kept nodding my head and smiling in embarrassment. After a final word about dressing the wound, he sent me home.
Later that night Dad asked for a picture of a wound - he wanted to get a second opinion. It turned out that the wound needed further debridement, and the next morning, he sent me to Maulana Azad Medical College. He insisted I go with someone, since the wound was deep and the procedure might leave me unable to walk properly for a while. My friend Prashant was kind enough to accompany me throughout. Bro, I really owe you one. Dad had a colleague there who would hook me up. As it turns out, the wound was fine and didn't need anything except regular cleaning. I came home with a small voice in my head lamenting that it was a wasted trip, but with a much louder voice saying, 'shut the fuck up, this was important!'
I'm fine now. There's not much pain or swelling. All that's left is for me to take the periodical vaccine shots spread over a month.
I kept reading all news reports I could find on dog bites. The WHO says that over 59,000 people die of rabies every year. That means almost every other rabies victim is an Indian. There may be some sampling bias, of course. But even in this little cranny of rabies and dog bite related deaths, things are clearly very bleak. Inadequate treatment is what kills dog bite patients. You take the vaccine but ignore the wound, an infection will kill you. You ignore the tetanus shots, the tetanus will kill you. You take care of the wound and take vaccines - turns out that by the time the vaccines start acting, you're already infected. The biggest killer is the scarcity of HRIG. There's an equine variant of HRIG which is harvested from infected horses. There's a human variant which is harvested from tissue cultures (infected humans don't last too long for harvestation, I guess). It's very expensive and not well stocked. Even I - with all my money, all the access to good hospitals and doctors, with all the privileges of being in a city like Delhi - had a harrowing time of it. I can't even begin to imagine what happens to less privileged patients.
Secondly, my laziness is the stuff of legend among my friends and family. Even a death scare couldn't completely cure me of it. I hate to think how much damage it has done over the years. It's not pretty, this realization.
If there's one thing you take away from reading this, let it be this:
Other people is you.
Other places is home.