Down the rabbit-hole of rabies post-exposure treatment

I am the devoted slave of a couple of cats and because I live next door to a large piece of public land on a hillside, stray tomcats often turn up at my place and cause havoc with my resident cats. Some of these intruders are homeless and I take care of them but many others are just wanderers whose owners are too irresponsible to have them sterilised. One of the latter type of cat was a persistent nuisance and one day, after he was inside my house for the umpteenth time causing fights, I managed to catch him and took him to the vet to be neutered, so as to keep the peace at home.

When I got him back from the vet, I kept him overnight to ensure that he had recovered before release. I don't trap feral cats on a regular basis so I don't have proper cages for them and as I was taking him out of the room I had him in, he bit me on my forearm, sinking all four canine teeth in deeply, causing extreme pain but no bleeding.

I washed the bites immediately because cat bites are deep puncture wounds and notorious for getting seriously infected, very quickly. True to form, I had a case of cellulitis 24 hours later. Because it was Sunday, I went to the casualty department of my local public hospital. There I was treated as an object of amused amazement by the nurses because no-one on duty had seen a serious cat bite before.

The province I live in is currently experiencing a rabies outbreak but there have been no reported cases near to my home. The attending doctor started asking questions about whose cat it was and whether it had been vaccinated against rabies. I replied that I didn't know. I was told that since I knew nothing about the cat, rabies post-exposure treatment was necessary and chided for not having immediately presented myself for treatment after the bite. I said I doubted it was necessary and that I had had to go to work. I was given a tetanus shot, large quantities of antibiotics, the first of a series of vaccinations that are given 0, 3, 7 and 14 days after the bite and told to return to the hospital the next morning for rabies immunoglobulin injections because it was unavailable on the weekend. Immunoglobulins are designed to provide immediate protection against the rabies virus, which travels up the nerves of the body, because the vaccinations take time to provide protection. Rabies is 100% preventable but 100% fatal if left untreated and is a truly unpleasant way to die. I seriously doubted that the cat was rabid but I thought that I had better comply. Had I known what was coming next, I doubt I would have.

The next day, I returned to the hospital and was told to sign consent forms for the treatment. The doctor on duty deeply resented the fact that he had to fill in a large quantity of paperwork and left me skulking in a cubicle. When I went looking for him 1 1/2 hours later, he said he'd forgotten I was there. Irritated from waiting, I went off to the pharmacy to collect the injection. On returning, a student doctor looked at the box and told me to ask the nurses to administer it. The nurses said that they didn't know how to and the doctor must do so. The student doctor eventually got hold of the senior doctor and the two of them took me into a cubicle and he instructed her, using me as the practice dummy. This involved injecting 20mls of refrigerated fluid, about 3mls each in 6 places under the skin all around the bite area. I felt nauseated watching the large fluid bubbles forming under my skin. Finally, I was allowed to leave, highly annoyed at the massive waste of time to accomplish this small task.

Once home, I found out why I was made to sign consent forms. Human rabies immunoglobulins are very expensive and unavailable in my country so they make do with equine immunoglobulins, which is produced in a similar way that snakebite anti-venom is. The danger with these treatments is that human bodies can have life-threatening allergic reactions to the horse serum.
Great. The hospital hadn't even bothered to inform me of this, let alone waited to see if I developed a reaction.
A few hours later the bite site was very swollen, red and painful and I was feeling extremely light-headed. I had a mild case of serum sickness. I took painkillers and antihistamines and tried to sleep it off. The next 2 days passed in a blur as I felt as if I was more than a little drunk and the most basic tasks were extremely difficult to focus on and complete. I missed an important appointment because I simply forgot about it in my light-headed state.

The next task to find a clinic to administer the remaining three of the vaccinations. The clinic I was recommended to use by the hospital is notoriously busy and incompetent but in the absence of other alternatives, or money to do it privately, I dragged myself off there fully expecting to have my day wasted. To my surprise, the process was quick and efficient because it was done in the casualty department.

One down, two to go. "I can do this" I thought.

The next time I went was on a Monday and I was notified that I had missed the date. Double checking the clinic slip, I had indeed gotten the date wrong. Evidently, the whole experience had mangled my thinking processes. I fixed it in my head to get my final injection on the Sunday instead of Monday. That time, there was a fairly mad woman dressed in a filthy dressing gown and shorts wandering the halls. She was obviously known to the staff, who humoured her good-naturedly and left her to her own devices. She's obviously a regular.

Sunday morning at in a casualty department of an inner-city area that has become a slum tends to resemble a war-zone and this Sunday was no exception: there was a trail of bloody footprints leading up to the front doors and some blood-stained young men sleeping off the previous night in the flower-beds outside. Inside, the gate guards were sitting at the doors with sticks to keep all visitors outside. Only the wounded allowed inside, everyone else to remain out. The reception counter was smeared with blood. The young man next to me in the queue still reeked of booze, moaned and cried had dried blood all over his face. He looked like he'd been hit with a bottle.
Once inside the ER, the staff were kicking out the wounded that had been stitched up earlier and been allowed to sleep it off. One man couldn't find his shoe. The guards were encouraging him to leave with traditional weapons known as "sakhile" or knobkerrie. I guess they get sick of the alcohol-fueled Saturday night mayhem. I think the admitting nurse was grateful that I was about the only person they could get out of there within 5 minutes. Anyone presenting at casualty on a Sunday that isn't seriously ill or bleeding gets given 2 Panado (paracetamol) and told to come back on Monday. Public hospitals truly are trench warfare. I was very grateful that this visit would be my last.

As to the cat that caused all the trouble, he made an appearance at my house once after that but wasn't seen again. I suspect that he stays at home now.