24 Jan 2021

The story included all of the typical elements, but I still had to test it for myself. Bitten by a dog a few weeks ago, but the dog was immediately killed. The wound had healed. For a couple of days now, the patient had been showing signs of altered mental status. She was afraid of water. She had no fever, no other signs of infection. They were sure this was rabies ("rage" in French). Symptomatic rabies. 100% fatal no matter where in the world you live (give or take a few possible survivors in all the history of the disease).
They had described it for me already, but I confirmed it myself before acknowledging the death sentence. I picked up the bottle of drinking water sitting on the floor and offered it to the patient. Horrified, but compliant, she struggled, but took it in her hand. She held it for several moments before moving it toward her face and then jerking it away again as if she found the thought of ingesting this liquid revolting. So strange. Is this really how rabies looks? I looked for and empirically treated every other explanation that seemed reasonable and more hopeful for her delirium, but in the end no other diagnosis seemed to fit as well as rabies.

With the nurse interpreting my French into their language, I explained to the family that we would treat her symptoms, that we would do everything we could to help make her comfortable, and that she had an incurable illness from which she would die very soon.

Taking care of someone with rabies, it's easy to see why so many people here are afraid of dogs. With no veterinarians around and no rabies shots for the animals, many people have watched this miserable, irreversible process of death from rabies.

The next day she was lying on the floor, somewhat sedated, and her family was sitting next to her on the floor laughing. She was telling them stories. "It's the illness," they said. It was also the medication--altering her cognition, but also hopefully mitigating her suffering.

The next evening, she died. The family expressed gratitude for the time spent repeatedly checking on her and managing her symptoms. We hadn't cured her, but this generous, hopeful, tight-knit family remained positive and grateful for every little effort to help her.