The first thing I noticed about this patient was how well he looks. In an ICU full of emaciated, jaundiced and comatose patients, he stands out because he seems fine. He's fully conscious and notices us as we come to stand at his bedside, looking down at him. He begins to talk to Dr Nguyen - perhaps he's asking how much longer he has to stay here. He smiles and laughs, and then returns to his thoughts while we examine him.
His bed is oddly placed within the ward. He's not lined up with the other patients in the bays; instead he lies in the middle of the ICU despite there being ample space elsewhere. We probe Dr Nguyen for answers. "Afraid", he says, in very broken English. "Afraid, er, of... of wind". This doesn't make sense to me - I must have misunderstood. But Dr Nguyen illustrates the point: taking his notepad in his hand, he waves some air into the patient's face. Suddenly, everything changes. A terrified look is in the patient's eyes, and he draws in a sharp breath, as if he's seen a ghost. A few seconds of wide-eyed stares; and he's back to normal. Looking calmly around the bed, breathing quietly. He asks Dr Nguyen another question.
The look of terror that overcame our patient is probably matched only by the look of amazement on my face. "He's afraid of air?" I ask, still skeptical despite the obvious demonstration. Dr Nguyen repeats the process. Again, the patient gasps as soon as the air reaches him. The fear in his eyes is unlike anything I've ever seen before. And then it's gone again, melting away almost instantaneously.
That's it. That's all there is to see in this patient. He was brought in to the hospital this morning, because of his strange behaviour. His bed is strategically placed to avoid the drafts from the two large air conditioning machines: they would be unbearable for him. On questioning, it emerges that he was bitten by a dog two months ago.
Fear of air and water are pathognomonic for rabies: no other disease produces these symptoms. And while he may look well between the flashes of terror, he will be dead in a matter of days. Just as there is no doubt about the diagnosis, there is no doubt about the outcome: once symptoms appear, the mortality rate is 100%. An urgent course of vaccinations after the bite might have saved his life, but it is too late now.
For the past two months, the virus has been slowly making its way through his nervous system and up to his brain. Once there, the virus begins to replicate and then spreads back out via the neurones to most organs including the heart, eyes and kidneys. Signs and symptoms then begin to appear, including paralysis, confusion, agitation and the tell-tale phobias. The salivary glands are hijacked, churning out millions of virus particles in the hope of infecting a new host.
Patients with rabies don't usually stay in the hospital very long. Once the diagnosis has been explained to the family, patients are usually taken home: there is no point paying for medical treatment when it can ultimately do nothing for the patient.
Before leaving the ward, I take a last look at him. He still looks very well. The calm before the storm.
His bed is oddly placed within the ward. He's not lined up with the other patients in the bays; instead he lies in the middle of the ICU despite there being ample space elsewhere. We probe Dr Nguyen for answers. "Afraid", he says, in very broken English. "Afraid, er, of... of wind". This doesn't make sense to me - I must have misunderstood. But Dr Nguyen illustrates the point: taking his notepad in his hand, he waves some air into the patient's face. Suddenly, everything changes. A terrified look is in the patient's eyes, and he draws in a sharp breath, as if he's seen a ghost. A few seconds of wide-eyed stares; and he's back to normal. Looking calmly around the bed, breathing quietly. He asks Dr Nguyen another question.
The look of terror that overcame our patient is probably matched only by the look of amazement on my face. "He's afraid of air?" I ask, still skeptical despite the obvious demonstration. Dr Nguyen repeats the process. Again, the patient gasps as soon as the air reaches him. The fear in his eyes is unlike anything I've ever seen before. And then it's gone again, melting away almost instantaneously.
That's it. That's all there is to see in this patient. He was brought in to the hospital this morning, because of his strange behaviour. His bed is strategically placed to avoid the drafts from the two large air conditioning machines: they would be unbearable for him. On questioning, it emerges that he was bitten by a dog two months ago.
Fear of air and water are pathognomonic for rabies: no other disease produces these symptoms. And while he may look well between the flashes of terror, he will be dead in a matter of days. Just as there is no doubt about the diagnosis, there is no doubt about the outcome: once symptoms appear, the mortality rate is 100%. An urgent course of vaccinations after the bite might have saved his life, but it is too late now.
For the past two months, the virus has been slowly making its way through his nervous system and up to his brain. Once there, the virus begins to replicate and then spreads back out via the neurones to most organs including the heart, eyes and kidneys. Signs and symptoms then begin to appear, including paralysis, confusion, agitation and the tell-tale phobias. The salivary glands are hijacked, churning out millions of virus particles in the hope of infecting a new host.
Patients with rabies don't usually stay in the hospital very long. Once the diagnosis has been explained to the family, patients are usually taken home: there is no point paying for medical treatment when it can ultimately do nothing for the patient.
Before leaving the ward, I take a last look at him. He still looks very well. The calm before the storm.
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