WhiteCoat

Crazy Rabid Squirrels — Part Deux

And I thought that there was only going to be one case of a crazy rabid squirrel. Boy was I wrong. A previous post on the subject a year ago had a lively discussion.

This visit started by a mother bringing in her six-year-old son because her son got bitten by a squirrel.

Actually, the event started before the patient arrived in the emergency department. The patient found two young squirrels whose parent had apparently made a nest inside of an old coffee can. The patient attempted to reach in and pet the squirrels and one of the squirrels, apparently mistaking his finger for an acorn, bit him in the finger.
After the bite occurred, the mother called a veterinarian who stated that squirrels could have rabies and that she should call the state immediately. That freaked the mother out. The mother then called state Department of Health. The medical professional with whom she spoke stated that she must observe the squirrel for at least a week to make sure that the squirrel is acting normal. If the squirrel was acting OK, then they did not need to test the child or the squirrel for rabies.

The mother then called the police who brought the squirrels and the patient to the emergency department for evaluation. So in walk the police, the patient, and the mother carrying a box with Alvin and Theodore inside. Of course, there were holes poked in the top of the box to provide the squirrels with air. Without those holes the squirrels surely would have turned into suffocation zombies.
Of course, if you talk about any baby animals – especially cute little squirrel zombies – several members of the staff will instantly become interested. One of the nurses and one of the techs both tried to open the box to pet the squirrels as well. Several other staff members then chimed in … “Hellllooooo! They bit someone. You want to be next?”

The patient was put in a room. Then the doctor walks out of another room and sees everyone looking at a cardboard box.
“What’s in the box?”
“A couple of squirrels that bit one of our patients.”
“WHAAAAT? This is a hospital, not a vet clinic. What if they get out of the box? Get them outside NOW!” With that, the police took the squirrels from the emergency department to either release them into the wild or to execute them. No one ever asked which.

The mother relayed her story of what happened. She wanted the doctor to call the state Department of Health. Reluctantly, he did so. The medical professional on the line repeated the sage advice to observe the squirrel over the next 7 days for abnormal activity. First of all, who is going to keep the squirrels? If they can chew off some kid’s finger, they sure as heck can burrow their way out of a cardboard box. You want them to wait until everyone’s sleeping and go get a bunch of their zombie squirrel friends? Second of all, who in tarnation knows what “abnormal” activity for a squirrel is? Hasn’t anyone in this town watched this clip from Over the Hedge?

An infectious disease expert was then contacted. He wanted to know if everyone in the emergency department had gone stark raving mad. Squirrels and other rodents do not transmit rabies to humans. Besides, a documented case of rabies has not occurred in this county for more than 20 years.
So the patient was discharged home.

The story doesn’t end there though.

On the way out the door, the mom wanted to know where the squirrels were. When she was informed that the police had taken squirrels from the department she became very upset.
“Why did you let them take the squirrels away? My son wanted to say goodbye to them.”
The boy then began crying because he was unable to say goodbye to the squirrels that viciously attacked his finger.
So the patient and his mother both left the emergency department very upset. Straight “fives” on the Press Ganey scores, I’m sure.

The story doesn’t end there, though.

The following Monday, the hospital gets a call from the state Medical Licensing Board. The patient’s grandfather decided to get into the act by calling them and complaining that the patient did not receive proper medical care from the emergency department physician. First of all, the patient was not officially tested for rabies, so they didn’t know whether he should get rabies shots [after all, blood testing for rabies turns positive instantaneously, you know]. Second of all, the grandfather stated that the squirrels should have been decapitated in the emergency department and their heads should have been put on ice and sent to a zoo for analysis. Because the staff in the emergency department allowed the police to confiscate the squirrels, they could no longer be tested and now his grandson would unnecessarily have to go through 17 painful rabies injections into his stomach.

Yyyyeah.

Apparently following the “guilty until proven innocent” meme, the state Medical Licensing Board did no research into the matter before calling to demand that the hospital justify the medical care of the medical practitioner. Kind of like calling to demand that the hospital justify giving antibiotics to pneumonia patients or sending MI patients to the cath lab, but that’s another story.

So one of the hospital administrative staff is now being paid a salary to spend time interviewing physicians and looking through textbooks in order to justify appropriate medical care to the state agency that is supposed to protect the public from unsafe medical practitioners.

As for me, I think I’ve discovered what happens to all of those medical practitioners who lose their licenses due to mental illness.

———————–

This and all posts about patients may be fictional, may be my experiences, may be submitted by readers for publication here, or may be any combination of the above. Factual statements may or may not be accurate. If you would like to have a patient story published on WhiteCoat’s Call Room, please e-mail me.

13 Responses to “Crazy Rabid Squirrels — Part Deux”

  1. MedHead says:

    Yes! Great entry White Coat.

  2. Pedi ED Doc says:

    Certainly, small rodents (squirrels, rabbits, rats) are not known to transmit rabies to humans, and the treatment plan was 100% appropriate. But contrary to what your ID consult said, rabies still exists in the US, with a handful of cases every year. In the 2004 a Wisconsin girl survived rabies by being put in a ketamine coma for several days. Other children have been similarly treated in recent years.

  3. Eric Atkinson says:

    If it had been my kid, I whould have wanted HyperRAB S/D. One shot, 20IU/kg, in the deltoid.

  4. Tarl says:

    In many ways, this case illustrates the difference between “good social policy” and “expected care”.

    It’s unlikely the child gets rabies from a squirrel. Note, *UNLIKELY*, not impossible. Last I searched, there were documented cases in Europe of people getting rabies from rodents, even if we don’t have any documented here. Some of that may be from fewer rodents infected on our continent.

    From WhiteCoat’s perspective, it’s unlikely enough to ignore. Look for Horses not Zebras. From a general policy perspective, it’s probably not a good use of resources to treat every squirrel-bite patient for rabies, he may never see an actual rabies case in his entire career.

    On the other hand, I don’t want my memorial to be “First US case of rabies transmitted by rodent”. It’s a potential exposure to a disease which by the time you find out you did get it, your lifetime is measured in days or weeks – and it’s a pretty miserable way to go. So from an individual perspective, it makes sense to endure pain and expense to preclude it.

    If it’s the patient paying for it, there is no reason to object to an expense that makes little sense from a societal point of view (and unlike antibiotics, overuse of rabies vaccine does not create uber-rabies). But these days when everyone expects someone else to pick up the tab for their medical expenses, we have to face decisions made for the benefit of the society rather than the individual.

  5. Niko says:

    Dogs, cats, and ferrets
    Healthy and available for 10 days observatio

    the only animals you can observe cause we know the disease progression in these 3 only.

  6. Niko says:

    also the attack is suspicious. Trying to feed or pet a squirrel and you get bit does not constitute strange behavior. Hunt that expert down and give him a stern talking to.

  7. whitecap nurse says:

    Oy! We had a squirrel-bit patient too. I started by saying squirrels don’t carry rabies and finished by getting an order for rabies shots anyway “just in case.” I feel ya.

  8. ThorMD says:

    I can never understand people’s irrational fear of getting rabies from a rodent (squirrel). But then again these are the same people who demand to take antibiotics for viral infections like bronchitis and sinusitis. And these are the same people having unprotected sex – and they’re more likely to get HPV, HIV, Hepatitis than they are of getting rabies from a rodent…..

    As an aside, my cat used to love to bring half-dead rodents into the house (squirrels, mice, chipmunks). I’ve had more than one bite while trying to get shoo these animals out of the house – and I never even considered getting rabies shots. Because rodents don’t transmit rabies to humans.

    • Kim says:

      Except bats, I guess. A bat was the vector for the girl who survived in 2004.

      Anyway, I can understand people being freaked out about rabies, because it’s not only very deadly, but it had excellent PR for decades thanks to “Old Yeller”.

  9. DataGirl says:

    LOL Great story – good laugh to start my morning!

  10. SeaSpray says:

    When I was working in ED Patient Access, we had more people than one might think come in from a bat bite or even potential rabies exposure from a bat.

    The most unusual order for the rabies series from the ED doc (well – I thought it was unusual)was because a woman opened her patio umbrella and a bat flew out and away from her without ever making contact. The ED doc said there was a chance she could’ve been exposed via airborne contamination. Something about aerosol spraying of saliva from bat.

    I had the rabies series based on two puncture wounds I had even though I never saw the bat. Took me to the last day to do it and I did it because the punctures looked like what I saw on some patients and after reading about the hideous death from rabies ..I didn’t want to chance it. I honestly don’t know if I did the right thing, but we do have bats flying around the pond and over the pool and yard at night. And last I knew rabies was in the area. At that point in time they had been tracking it from the south coming up north.

    This is a gruesome thought …but, for some reason …cracked me up. Yeah …like you don’t have enough to do and so now you and ED staff have to add decapitation of squirrels to your job descriptions. Might be questionable on a resume though. ;)

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