The Costs of Not Dying From Rabies

by Michael Dempster

On Sept. 22, I collided with a bat while riding my bike near Montauk, N.Y. a little after 7 p.m. I’m talking about the winged mammal (I’ve had to specify this often. Is hooliganism on the rise?). It passed over my left hand and slapped my bare skin, just above my tank top’s neckline, and whipped around, likely stunned, or pinned by wind before falling to the pavement. So far, the cost of this incident totals over $16,600. Bills are still coming in.

I was too spooked to stop. I was on the last few miles of the annual bike ride my friends and I do. Our group had gradually separated, leaving me alone in the middle — the many-geared miles ahead, the single-geared miles behind. The final, rolling stretch of the Old Montauk Highway is eerily quiet after dusk, too far above the shoreline for any white noise. I heard only my tires, my breath, and maybe 30 yards later, another bat’s wings just inches from my right ear.

After a truncated celebration at the “Welcome to Montauk” sign, I stripped in front of a lamp at the Lido motel, where we had booked four rooms for the night and examined myself. There were no apparent bites or scratches, but the area was red, so my girlfriend called Animal Control in East Hampton (they were closed) while I scrubbed my nipples raw in the shower. I had a beer. I let Google do what it does best — horrify.

Here’s what I learned:

1. Bat contact often results in micro-abrasions — bites and scratches you can’t see. Rabies can be transmitted this way, but it’s rare.

2. About 1 in 100 bats have rabies.

3. Still, if you’ve made contact or even possibly made contact with a bat, you have 72 hours to begin a multi-course vaccination: rabies post-exposure prophylaxis (RPEP).

4. Because without RPEP, rabies is almost 100% fatal.

5. The alternative, a ketamine-induced coma called the Milwaukee protocol, has saved just 6 people (out of 41 or 42) that missed the RPEP window.

6. RPEP costs a flippin’ ton. This site, the first Google result for “cost of rabies vaccine,” offers a poor estimate of “anywhere from $2,000 to $7,000+ per person.”

7. If you’ve trapped or have access to the bat/animal, immediately get it tested. RPEP might be unnecessary. (In hindsight, bagging the bat would have only cost me a backpack: $42.)

On Monday, I called NYC’s Animal Bite Unit. They issued me a 9-digit bite/”hit” number, and referred the case to the city’s Bureau of Communicable Diseases, who, in turn, recommended RPEP.

Here, I had to confront a second problem. I’d been approved for health insurance (through my girlfriend’s employer) just days prior to the ride. Her employer would cover a percentage of the monthly health care costs, and I’d pay $325 a month for my part. Approval was retroactive to Sept. 1, but I didn’t have an insurance card yet to show care providers. Still unfamiliar with my policy and coverage, I wondered if I’d be dropped. If, through some loophole, I’d be left with the “$2,000 to 7,000+” tab. But ultimately: If I’d die.

Or worse. Back at the motel, my friend Kelsey had read her favorite rabies symptoms aloud. There was the obvious: hydrophobia, a paralysis of one’s swallowing muscles. Coupled with dehydration and throat spasms, hydrophobic patients can sound as if they’re barking. Then there was hypersexuality, an uncontrollable sex drive triggered by a patient’s swelling brain. I pictured myself dying, surrounded by family, a barking, compulsive masturbator.

So on Tuesday, 65 hours after exposure, I took a ferry ($4 each way. Worth it, should nausea assuage your fear of needles) to NYU-Langone for the Day Zero course of RPEP, a series of 6 injections: rabies vaccine in one shoulder, tetanus in the other, and “heat-treated rabies immunoglobulin” in each glute and quad. I passed out between the 5th and 6th shots — the ones in my ass.

Since you can’t make clinic appointments for the RPEP follow-up courses, I returned to the ER on Days 3, 7, and 14, and went through registration, triage — the whole bit — each time. (Helpful note: On Day Zero, a sympathetic doc gave me the ER lowdown: Avoid Mondays. Arrive at 9 a.m. to skip the shift change delays at 8 a.m., and if you must come after 4 p.m., triage is faster through the Urgent Care “next door.” I never found said Urgent Care, but I found many doors.)

One shot per follow-up course, for a total of 9. This is the bill for the Day Zero course of RPEP, which included both $1,200 for the ER visit and a $1,300 “patient surcharge.” The immunoglobulin alone counts for $12,000, half of which, again, went into my butt.

The Day 3 bill totaled $1,330. Kisses to Day 3’s nurse, Rose, who made no attempt at sincerity when she targeted my ass and winked, “It’s easier for me.” Day 7 totaled just $332. They’ve yet to send anything for Day 14. A few days ago, the Day Zero doctor billed me an additional $268 for an “emergency department visit.” The math is easy, the lesson hard. In short: the cost of RPEP is considerable, often compulsory, and yet another argument for health insurance. Even if I’m billed a co-pay for each ER visit, I’ll have saved a good $16,000.

Michael Dempster is from Tacoma.

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