by Beth Hersant
“I know you’re doing everything you can…”
“The thing to remember is that there is a lot we can do. Encephalitis is rarely fatal, especially among the young.”
While Dr. Brubaker attempted to reassure her father, the Head Nurse in Pediatrics, Edith Creighton, tended to Rachel. With thirty years experience on the ward, she’d been there longer than anyone and during that time had earned the nickname “Sybil” among the doctors. Like her fictional counterpart, the woman seemed to display at least three distinct personalities on the job. There was “the machine”: a tireless, relentlessly efficient worker who ran on a steady supply of coffee and Hershey’s chocolate. She kept the department running like clockwork. And then there was “the dragon” — the scourge of sloppy interns and condescending specialists alike. Once, when she misheard Dr. Naseby and ordered a PET scan instead of a SPECT scan for an epilepsy patient, he threw his stethoscope at her yelling, ‘Are you stupid or something?’
She informed him that no, she was in no way stupid, and if he ever spoke to her like that again, she’d make him eat that stethoscope. This pronouncement was delivered calmly and quietly, but in a tone that made the man take a step backward.
For all the efficiency of “the machine” and all the ferocity of “the dragon,” Edith Creighton was — to the children in her care — a veritable Mother Goose. She was soft and warm and funny. And it was this person who sorted out Rachel’s catheter and IV drip, all the while talking to her quietly in gentle tones.
“There, I think you’re all set for now,” she said.
“Where’s dad?” Rachel croaked.
“He’s just talking to your doctor, honey. He’ll be along soon. Do you want me to stay until he comes back?”
The girl nodded.
Edith looked at her watch. She was supposed to be on her break now. She sighed. “Would you like a story? Something to take your mind off of how yucky you feel? The boy who was in this room before you had me reading to him every night. It was a really funny book. Hang on.”
She nipped out and was back in a jiffy. “Here it is: My Big Fat Zombie Goldfish.”
She showed the cover to Rachel and the girl smiled at the picture of a big orange fish with crazy eyes and pointy teeth. Edith looked at it with her head cocked to one side. “The fish kinda reminds me of the nun who taught me Math,” she said drily. She settled into the chair next to the bed and fanned herself with the paperback. “It’s warm in here!”
The child twitched away from her. The movement was so sudden and violent that Edith stopped short. She had helped Dr. Brubaker perform the lumbar puncture on the girl shortly after she’d been admitted to the ward. The doctor, she knew, had ordered the test to rule out rabies. But no one really believed that that was the cause of Rachel’s illness. And yet…
She waved the book again. The child recoiled from the breeze, jerking her head away, her eyes squeezed shut, her mouth agape.
“Honey,” Edith said softly, “I’d like you to try something for me.” She helped the girl sit up and brought her a plastic cup of water.
At the sight of it Rachel became agitated. As Edith brought the cup toward her, the child started to shake and pant heavily. Her breaths came in a steady stream of exhalations (“Hu, hu, hu, hu”), her chest heaving and shoulders bouncing with each hitch.
“Ok, ok, no water.” Edith backed up and leaned out the door, glancing down the hallway. She desperately wanted to talk to Dr. B, but he was still deep in conversation with Aaron Pickman. She’d wait.
Returning to her patient with a warm, practiced smile on her face, Edith settled once again into the chair and began to read: “Yesterday my big brother Mark turned into a real-life actual EVIL SCIENTIST…”
They did not get far into the story — they had not even met Frankie the goldfish yet — by the time Aaron returned. Edith vacated the chair for him. As she left, she caught Brubaker by the sleeve and gently tugged on it. Her face was so grim that he followed her out into the hall.
“What is it?”
“Not here.” She led him to an empty room and closed the door behind them. “It’s rabies.”
“What?”
“Rachel Pickman.”
“How … how do you know?”
“She’s aerophobic and you should have seen her reaction when I offered her some water.”
The old doctor sank down to sit on the vacant bed behind him. His eyes were fixed on the floor.
“We need to tell her father…”
“No,” the doctor interrupted. “Not yet. I’m not going to diagnose rabies until the test results are in.”
“But he’s a doctor himself!” Edith protested. “If I can pick up on the signs by spending fifteen minutes with her, he sure as hell can!”
“Yes, he’ll see it. But he won’t know it. If you’re right, Edith, these are the last moments of hope he has left.”
Aaron Pickman sat and watched his daughter sleep. She was a beautiful child. She had her mother’s heart-shaped face, crooked smile and dark hair that fell in waves to her shoulders. But now her cheeks were sallow, her hair hung limp and dark brown patches underscored her eyes. It wrung his heart to see it.
He admitted to himself that he had trouble connecting with her. He didn’t really understand her — kids in general were … hard for him to comprehend. But he loved her. And he was so, so afraid.
Meanwhile Dr. Edmund Brubaker slumped at his desk with his head in his hands. After a moment, he straightened up, put his wire-rimmed glasses back on and read the report again. He’d called in a favor from Malcom Wallace at the CDC in Augusta to give the test top priority. The results came back in a matter of hours: cerebrospinal fluid tested positive for lyssavirus antibodies that could only be present as the result of infection. The child had rabies.
“I’m getting too old for this,” he muttered. But he stood, straightened his lab coat and put his game-face on. He now had to go tell a friend and colleague — a man who lost his wife in a hit-and-run accident six months ago — that his eight-year-old daughter was going to die.
Upon hearing the news, Aaron Pickman ran to the nearest men’s room and threw up. Brubaker leaned against a sink and waited for his friend to stop retching.
“It can’t be,” Pickman gasped. “I just lost Mary.”
“I know. Aaron, I am so sorry.”
“What about PEP?”
“Post-Exposure Prophylaxis?” Edmund shook his head. “It’s too late for that. PEP requires five injections over twenty-eight days and …”
“… and she’ll die long before that.”
“Yes.”
“Then what?” Pickman shouted. “What can we do?”
“We have two options. We can provide her with palliative care. Basically, we drug her up and keep her as comfortable as possible.”
“Or?”
At that moment the men’s room door swung open and an orderly walked in, whistling.
“Out!” snarled the doctor.
Wide-eyed, the man spun on his heel and left.
Brubaker took a long, calming breath. “Or we could try the Milwaukee Protocol.”
“Milwaukee …” Pickman muttered to himself. “I remember reading an article about it, but I can’t …”
“I’ve got all the information back in my office. Come on.” And with a hand on Aaron’s shoulder, Edmund guided him out.
“The Milwaukee Protocol was devised by Dr. Rodney Willoughby at the Children’s Hospital of Wisconsin,” Brubaker read from an open file on his desk. “He used it to treat Jeanna Giese. She contracted rabies from a bat bite and had not had any of the shots. It’s based on the theory that rabies doesn’t actually kill the brain. Instead it disrupts communication between the brain and the central nervous system. Essentially, the brain can no longer regulate autonomic functions such as heart rate or respiratio
n. That’s why most rabies patients die of suffocation. Without instructions from the brain, the body just shuts down.”
“And so?”
“And so he placed Giese in a medically-induced coma. Machines kept her alive in order to buy her immune system time to fight off the infection.”
“With the help of antivirals.”
“Yep. Ketamine, Amantadine, Ribavirin — combine it with a range of sedatives and you’ve got quite a chemical cocktail.”
“And she lived?”
“She now has a BA in Biology, is married and gave birth to twins.”
“That’s wonderful!” Pickman stopped short. “What’s the catch?”
“The Milwaukee Protocol has been attempted thirty-five times.”
“How many survived?”
“Six. That’s a seventeen percent survival rate. Other studies put the survival rate as low as eight percent. It’s a bad bug, Aaron. Of the six survivors, one died of pneumonia and three were left with,” he read from the report, “profound neurological disabilities.”
“But there were two success stories.”
“It would appear so.” The doctor looked old and tired and infinitely sad. “They’re not great options, Aaron. Either we drug her up until she slips away or we fight and hope for our own little miracle. But understand that if you decide to see what’s behind door number two, you are rolling the dice.”
Rabies, from the Latin rabidus meaning furious or raging, is thought by many to be the worst way to die. After the initial (or Prodromal) phase of flu-like symptoms, the disease progresses to the Excitation Phase. The victim experiences high levels of anxiety, confusion, delirium and aggression. She will have seizures and lose muscle control. She will be hypersensitive to everything: touch, breeze, light, sound. And despite her terrible thirst, she will be unable to drink. Attempts to sip a little water (even the mention of the word water) can induce agonizing spasms in the muscles of the throat and larynx. These spasms are not only accompanied by intense pain, but also by great fear. Hence the name hydrophobia, the fear of water. When Charles Lennox, fourth Duke of Richmond and Governor-General of Canada, contracted the disease in 1819, he could not stand the thought of remaining in a house near a river. The sound of running water and, I suspect, just the knowledge that it was there upset him so much that he asked to be moved further inland. Unable to drink or swallow, the victim literally “foams at the mouth” as saliva accumulates and dribbles over the chin.
It wouldn’t be so bad if the virus addled your mind with an all-encompassing delirium and left it there. But this is not the case. While Hamlet was afraid “to sleep, perchance to dream,” rabies patients must dread the moment of awakening. Despite all the ravages, all the hell of the disease, it pauses for moments of terrible lucidity when the victim knows exactly what is happening. She is fully aware that she will suffer and then die.
It was during one such clear-headed moment that Dr. Brubaker spoke with Rachel. Rabies is a public health concern and he had to find out where she had contracted the virus and who else might be at risk.
“Were you bitten, honey, by a dog or a cat or something else?”
The child nodded. “But that was a while ago, before school started.” Her voice was raw and weak.
“Over the summer?” The doctor asked and the child nodded again. “Can you show me where?”
Rachel pointed to a small, light scar on her arm.
“It broke the skin? It bled?”
“Yeah.”
Listening to this conversation, Aaron cast his mind back over the events of the summer. And he remembered: the missing dog flyers that had been posted around the neighborhood. Each bore the picture of a perky-looking Jack Russell with a snow-white body and chestnut-colored patches of fur over his ears and each eye. Rufus. Knowing how Rachel loved the dog, he’d said to her at the time, ‘That’s a shame about your friend. Have you seen him around anywhere?’ The girl, who had been playing with her Barbie dolls at the time, didn’t even look up. ‘Nope.’ He’d looked at her curiously. Something about that response wasn’t right — she should have been worried and upset. But then the fatigue, the fugue he’d been in since Mary’s death settled over him again and he’d retreated back to his work.
“Rufus bit you, didn’t he?” he asked.
Tears welled up in Rachel’s eyes.
“Where was Mrs. Williams when this happened?”
“She wasn’t there.”
“She left you alone?”
Rachel shook her head. “It was her day off.”
Oh my God, he thought. I was there. This happened on my watch. “Why didn’t you tell me?”
“I was afraid you’d get mad.”
“Why the hell would I get mad?” he snapped.
The child began to weep and he knew. He was always mad at her — mad at her for interrupting him, mad at her for piling extra responsibility on him when he just needed peace and distraction and time. Mad at her for the noise and mess she generated, for the loss of control he felt in his own house, in his own life. Mad at her for looking at him with Mary’s eyes — but these eyes held no love for him. The only thing he saw in those implacable eyes was her need, a need that was tyrannical, insatiable and left no room for him to fold into himself and there, in the quiet, to mourn. Well, the house will be quiet now, won’t it? But it would not be quiet enough to stifle his thoughts. He was a doctor — a fucking doctor — and his only child was dying a stupid, senseless, preventable death because he had not been paying attention. He could make all the excuses in the world about the grief and trauma of Mary’s death, about his own pain and the importance of his work, but the bottom line was that he had utterly failed her. God, if he could just stop thinking, just retreat into other thoughts and escape this…
Rachel stopped crying abruptly. Her right arm jerked spasmodically, followed by convulsions that shook her tiny body. Her eyes rolled back in her head and her spine arched off the mattress. Her face and hair were wet with tears and sweat and foam dribbled from her lips. A warning beep sounded nearby — her heart monitor.
“200 bpm. She’s tachycardic,” Edith said as she tried to hold the child still.
Rachel shrieked — a harsh, guttural sound that sliced through everyone in the room.
“It’s decision time, Aaron,” Dr. Brubaker announced, “because this is only going to get worse.”
Doctor Aaron Pickman watched his daughter writhe and knew that he was a short hop from madness. “We’ll roll the dice.”
Rachel was heavily sedated and hooked up to machines that would run her body for her. As she sank under the influence of the Midazolam, the word went out on WABI5 that the rabies virus had reared its head in Bangor. Brian Sullivan introduced the story in the studio and then cut to a segment with Taylor Kinzler standing in front of the hospital. Brubaker had asked her to graphically describe the disease so that no one would harbor any doubts about the seriousness of infection. A picture of Rufus followed with a warning issued: anyone who had come into contact with the dog (or who had been bitten by an unknown animal) should contact the Maine Center for Disease Control and Prevention.
That was the key: prevention. Infected bites we can deal with. But if you ignore even a small transdermal bite (a bite that breaks the skin), you risk an agonizing death. We see it again and again in countries with large populations of stray dogs. There was one outbreak of the disease in Angola in 2009 that killed ninety-three children in three months. They died either because of a shortage of the vaccine or because they sought medical help too late. No one thought that Bangor, Maine would turn into another Angola tragedy. Most pets were vaccinated against the virus. But still Brubaker was afraid. How many more kids had come into contact with Rufus over the summer? Of those, how many had believed that the bite was not serious enough to cause a fuss? How many more children would he see convulsing and foaming at the mouth? Ho
w many more parents would look at him with that mixture of terror, anguish and insanity — just as Aaron Pickman was looking at him now?
Writer Tony Cleaver once said that “Desperation is the best innovator.” As Dr. Aaron Pickman sat by his daughter’s bedside, he was certainly desperate and now turned his mind to what he would change — what he would fix — if he was given a second chance. He’d take time off work at the hospital and stop hiding in the book (Case Histories in Neurosurgery) that he was writing at home. The thought of the book tugged at him. He wanted to be there now — in the quiet sanity of his study working on it. No. Stop it, stop hiding. He needed to change: he’d talk to his daughter and, more to the point, he’d listen. He’d play Candy Land with her and they’d go for walks in the Bangor City Forest nearby. He could put it right, he knew he could, if he was just given the opportunity. He begged God for this as he sat and stared out of the window at a November sky heavy with clouds and dark with rain.
Sometimes, however, that crucial second chance is not offered and sometimes when you pray, the answer is “No.” Rachel Louise Pickman, eight-year-old daughter of Mary and Aaron Pickman of Bangor, Maine, died two days later. She never regained consciousness.
When a parent has to bury a child, it is the most gut-wrenching of stories. Unfortunately, it was not the story’s ending.
Part One
Mighty Oaks
Chapter One
Mourning
“I had begun life with benevolent intentions, and thirsted for the moment when I should put them in practice, and make myself useful to my fellow-beings. Now all was blasted: instead of that serenity of conscience, which allowed me to look back upon the past with self-satisfaction, and from thence to gather promise of new hopes, I was seized by remorse and the sense of guilt, which hurried me away to a hell of intense tortures, such as no language can describe.”