My trip to the ER

3ringnursing, BSN

Two days ago events occurred that this choice was taken off the table and I had no alternative but go, or risk dire consequences.

Let me back up a bit, and first explain I've cared for a couple of feral cat colonies for around 5 years, and my family helps out with the trap-neuter/spay-release (TNR), feeding and watering. Our neighborhood had been overrun by feral cats, but lately, our efforts have started to pay off and the breeding has decreased dramatically. That being said, they are still domestic animals of a sort but without a home, and require food, water, and shelter or they would die.

Some are obviously lost or abandoned and very used to human interaction, while others are wild and have never been touched by a human - ever.

All should be treated with extreme caution because they are not spoiled, pampered house pets, having more in common with their wild cousins running on the African plains than Fluffy the house cat. The only difference is having been domesticated in their lineage they have lost their innate ability to hunt enough to feed themselves, even if they weren't living in an urban area.

The other night a scuffle broke out behind me and I got bit in the ensuing chaos. Not my first cat bite, not by a long shot. Of course, it was my luck (or lack thereof) to have been inflicted by one I hadn't trapped and neutered, or got shots for yet. Lucky, lucky me.

I bet you didn't know the average domestic house cat has 7 rows of long, sharp, serrated teeth tipped in flesh-eating poison? Well ... perhaps that is a bit of a stretch - but it sure feels like it when one is biting you!

Cat bites are nasty business and should never be taken lightly. This is partly due to their unique teeth: their fangs are extremely long and wicked sharp. When a cat bites their canine teeth puncture the skin and inject bacteria from the cat's mouth and the environment deeply into tissue. Because their teeth have small diameters, the seemingly minor wounds heal rapidly. This is unfortunate, because this bacteria thrives in an anaerobic environment - such as when trapped in healed over bite wounds, and severe infections result.

The other reason is due to one organism in particular, a pretty potent and aggressive bacteria known as Pasteurella multocida (an aerobic to facultatively anaerobic gram negative coccobacillus bacterium). This bacteria is the frequent cause of infection after cat bite injuries. Symptoms usually are swelling and local infection around the wound, which left untreated will lead to a very painful abscess.

I knew I would be quite sick very soon, so rather than expend energy trying to trap the cat now (if I was lucky and actually caught the right one immediately) I opted for the rabies vaccine and immunoglobulin injection along with the inevitable antibiotics.

After calling the health department I soon discovered the ER is the only place that carries the rabies immunoglobulin. I had no choice but to go. Rats!

My childish ER aversion stems in part from bad past experiences, and also from not wanting to inappropriately utilize the services of the ER which is in the life saving business. If I could meet my needs anywhere else then that is where I would be going.

With trepidation, I trudged into the ER, sheepishly smiled at the front desk staff and apologetically told them what idiocy had brought me in that day. No one blinked an eye, and all were very nice and professional.

I want to add there was nobody else in the waiting room (which was unexpected). I spent a few minutes chit-chatting with the woman at the check-in desk about caring for cats on the family farm she grew up on, then I was brought right back.

I'll skip over the immunoglobulin injections, which were horrible and made me cry like a big baby (they have to injection into the wound, and all around it too - like an immunological solar system or something). The ER PA kept up a series of nonstop chatter about his son the whole time in an effort to distract me, which was sweet. Then the actual rabies shot (one of a total of four: day 0, 3, 7 & 14) in the shoulder with a large bore needle that could also double as a drinking straw.

I'm not sure why I lied about my pain level but I did. ER nurse: "How would you rate your pain?". Me: "Um ... a 1?". Everyone's eyebrows went up, but I got no challenges about it. Even still, the nurse brought me a ibuprofen 800 mg tab along with my first dose of Augmentin. Again that was pretty nice, since the area surrounding the bite already appeared to have cellulitis less than 12 hours later, and was hot, red and shiny - sort of like a mini sun blazing behind my knee, putting out enough heat to warm a small house.

In my short time there I was offered refreshment more than once, and spent time hanging out with some of the staff who had wandered in just to look at the bite and scratches - then debate amongst themselves on whether a set of scratches were, in fact, another set of bite marks, and with others who came in to carry out orders then sat and told me hair raising stories of their own. Although I brought my own entertainment (a battered, much loved kindle) I rarely used it.

All things considered, I was in and out as fast as someone needing the full rabies package could be - in just under 4 hours. The longest part was the wait while pharmacy mixed up the immunoglobulin as it is weight based (which is kind of funny, because they had a difficulty convincing me to get onto the scale to begin with). The staff were kind and friendly and overall treated me like an old friend instead of the imbecile that I am for turning my back while a catfight was brewing.

I can't honestly say I hope to go back any time soon (or ever) but two days ago all the stars aligned for an unexpectedly pleasant ER experience.

My trip to the ER

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