Once Bitten and Dead

It was a usual day at the clinic: complex referrals, difficult diagnoses and frequent power shutdowns. Patients in the waiting area had been waiting for over two hours and were agitated and quarrelsome. In the midst of all this, I got a call on the desk phone from the Emergency Department: “I have this 12-year-old boy with rabies. What should I tell the parents?”

“Oh, God”, I thought, “This is the most difficult task of the day. I left the clinic with the feeling of apprehension that the word ‘rabies’ always evokes in my mind. The boy’s uncle who sensed the danger of his nephew’s symptoms but wanted to confirm the diagnosis, met me. “I have to see the boy first”, I said.

Lying on the stretcher was this handsome looking boy, alert and observant; his face was flushed and he was breathing with difficulty. Interns, nurses and doctors in training were around him. I got permission from the boy and his uncle to video film his conversation on my cell phone. I asked his name and the circumstances of his illness. “My name is Umar, I am 12 years old and I am a student of class six in Hyderabad.” He spoke fluently, but in short sentences, as he was short of breath.

“I was playing in the park, there were nearly forty children. A bitch suddenly came and started running around the park and bit many kids.”

“Where did she bite you?” I asked.

“I tried to run, but I fell and she bit me on upper arm, thighs etc.” He then lifted his shirt to show wounds on his chest and back. It happened more than two months back.”

“What did your father do then?”

“My father has passed away. My uncle took me to the hospital. They washed me up and gave me injections in both my arms.

“Did they give any injection into the wounds”? I probed a very important question. Umar looked perplexed. “No, but I went back at least three more times to get the shots, and they said I would be safe.”

“Are you thirsty? Would you like to drink some water?” I asked.

He said, “I have not had food or water for two days now. I can’t swallow. But I can try.”

A nurse brought him water in a cup. Umar accepted the cup, hesitated, then attempted to drink. Immediately he began to choke, and the water regurgitated through his mouth. “Please, please, no more. Doctor, I am frightened, please help me get better. I haven’t slept and I don’t know what will happen to me”. His eyes were wide with fear and he took shallow and fast breaths.

I stroked his forehead and said all would be well, just close your eyes and relax. He gave a faint smile and said. “Doctor, please send me the video on my email. It’s umar@gmail.com.”

My heart couldn’t take it anymore. The nurses lowered their moist eyes, while some simply walked away to hide their tears. I composed myself and spoke to the uncle about the futility of

further care. We could only give him terminal comfort care with heavy sedation so that he would suffer no more. His mother would be left just with her eight-year-old son. The uncle was prepared for the worst. That night Umar died.

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KARACHI

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