There are nurses from whom vaccine administration might be described as being pricked by a needle. From others the same procedure is closer in sensation to how one imagines it would feel to have driven into muscle a metal stick with barbs. It was the latter that characterized my final in a series of rabies vaccinations.
Given that the rabies vaccine is commonly thought of only as a standard protective measure for pets, and that its human variety so rarely injected has fostered in the popular consciousness a nebulous amalgamation of unknowns regarding the matter, I recognize there may be some who would appreciate from me a firsthand account replete with syringes.
Briefly, an explanation of how it was I came to be directed to the ER. Though there yet remained items for the collective to move, all my things were in our new home, and I chose to spend the night there alone. Sleeping in the attic, I awoke near 2 a.m. to sounds from the floor below and descended to investigate. I stood quiescent in the hallway junction between staircases, doorless bedrooms to one side, and listened with quiet vigilance. From one of the bedrooms a bat thrashed noisily upon the scene, darting aimlessly and with the frantic chaos of a newly-caged animal. Twice it swooped and twice I ducked and then it disappeared, restoring stillness. The next evening I had a dream involving something crawling over my face. A concerned friend knowledgeable of the disease through her responsibilities as a volunteer for an organization that assists both stray and feral cats informed me that bats are its primary carrier and that a bat bite may leave no visible mark nor wake a sleeping victim. After several days of death defying procrastination, I found myself relating the story to a nurse who subsequently advised I begin the post-exposure vaccine regimen.
The pre- and post-exposure regimens are identical save for one important and nauseating difference: the first installment of the latter additionally involves receipt of rabies immune globulin, a clear and very viscous substance chock-full of rabies antibodies. Aspiring linguists are invited to determine whether its name has anything to do with the expectation that it drips down in great globs. The rationale for globulin is that if a person is infected with rabies, they cannot afford to wait for their immune system to develop its own antibodies in response to the vaccine, for the rabies virus has already begun its determined march to the brain and must therefore be intercepted forthwith by a generic allied force. NB, the brain itself is a defenseless and pacifistic organ, and the tutelary cells of the BBB make poor choices, such that even when the brain is under attack they stubbornly refuse to admit aid. Consequently, upon reaching its destination the virus need not fear retaliation for its harmful deeds, and if the victim is a lady, it behooves her lover to play on repeat ‘Girlfriend in a Coma’.
Prior to my hospital visit I had researched what I might be in for, and as I passed along through the bureaucratic system of policies and procedures, queried briefly, successively, and on occasion redundantly by variously-titled staff, some of whom detailed with bedside manner what I’d already read of the vaccine sequence, I was not surprised at the mention of globulin. The surprise came later, when a nurse entered the private room in which I’d been waiting, carrying a tray of needles primed to puncture. It was then I learned that they jack you with such a volume of globulin that it must be spread over four injection sites. Fucking bat.
Strangely, the 5 intramuscular shots I received that day all registered so far below the pain threshold I’d established for them that I questioned whether they had been properly given. Despite this, and despite lying down for the duration, in accordance with custom I let my blood-pressure drop while the fourth syringe was being emptied. The familiar white-noise distortion swept into my ears, nausea winked at me, and I considerately indicated to the nurse I’d be passing out soon. It was a brief ride, no longer than tens of seconds, and evidently not severe enough that I lost all concept of time. I emerged from the whirlpool of unconscious glue with a cold-soaked washcloth on my forehead and an attentive nurse at my side. After several minutes of observation, combined with assuring data from the blood pressure monitor and finger-mounted O2 sensor, she arranged that the bed support my sitting at an incline and asked if I would like some juice, listing the two sorts available, and in a gesture of limitless hospitality offering also a combination of both.
On my three subsequent visits, each one spaced from the preceding by a growing number of days, I received only the single rabies vaccine. The idea is that each administration increases the likelihood that the immune system will create antibodies, until at the end of four, nearly all patients have developed immunity. Foaming mouths never looked so nonthreatening.