Saved by the County.

Note to readers: with a change in editors, this column has not been appearing regularly. I will continue to publish the column on-line for those who follow it here.

I didn’t see the dog until its teeth were in my leg. There was no bark. There was just a blur heading toward me as I headed for the door of my boathouse. It hit like a shark, charging me again and again as the blood ran down my leg. I couldn’t get away. Finally, with the two owners, my summer cottage rental guests, yanking on its chain, I was able to get out of range. When I stopped shaking I headed for the Schuyler County emergency room and called the Seneca County sherif.

It turns out that when you are bitten by a dog in the United States an entire protective system that I had been unaware of swings into place. After dressing my wound, the nurses got all the information about the owners and dog to double-check that its inoculations were up-to-date. She called it in, although it was night, to the Seneca County Health Department. The deputy sheriff also took this information, and also called it into the county health department. This is how that system works. In Tompkins County the staff of the Environmental Health division rotate night coverage. No matter what their “day job” for the department, they take the bag with all of the procedure manuals home so they can respond within an hour no matter what time of day or night. The person I spoke with had been up three times the previous night.

I gradually noticed that the entire response that enveloped me over two counties had one main purpose. It was not to protect citizens from dangerous dogs - that currently takes a record of multiple attacks. I realized what, in fact, this rapid governmental response was all about: it was to prevent me from getting rabies.

Nobody alive in the US, I think, has seen somebody die of rabies. If you get rabies you die, 100% of the time. If you look at the descriptions and illustrations from old medical books it is clear that this is the most horrible of deaths. Your muscles became so spastic that only the top of your head and your heels touched the ground. For this dreaded disease there is no treatment. It can only be prevented.

Preventing anyone in any county from getting rabies requires a sophisticated system to be sure for anyone bitten there is complete confirmation that the animal has a current rabies vaccination. The Seneca county animal control officer, who the deputy sheriff brought back with him, also checked the inoculations. As the dog was located in Ithaca, (watch out!) the Seneca County Health Department transferred the case to Tompkins. They quarantined the dog with the owner for ten days to make sure rabies symptoms didn’t show up even though it was inoculated. If there was any uncertainty the animal control officer here has the power to impound the animal for up to six months to make sure it wasn’t rabid. They take no chances. If effective vaccination could not be confirmed, then I would have to go through rabies shots, and pretty quickly. They are expensive, but the health department would pay for it for me.

One thing I realize about this is that sitting here, healing up slowly from the attack, the very most serious risk is something that I don’t have to think about at all. That is because the county government, backed up by state and federal programs, is worrying about this risk for me. I don’t even need to go to my doctor. If I need rabies shots, I can rest my life on the caring functions of government: that the Tompkins County Health Department has got my back.

It has been politically popular for some years to say that government is the problem; that it should be “drowned in the bathtub.” Government workers can be characterized as lazy and unmotivated. The reality of the rabies prevention system shows that this is not true. In this, every medical person who treats a dog bite, every policeman who responds to a call, and the key people in the health department must function without flaw. Government is often criticized for inefficiency. So how efficient are counties in preventing the dreaded rabies? The answer surprised me: it is 100%. With one exception, there has been no case of rabies in New York State in the past fifty years. That is how effective this small function of government is: completely.

Systems are operated by people. It made me realize just how many generations of county Health Department staff have, without fail, chased down every animal bite. How many activities in any sphere attain 100% reliability? Without any fanfare, they do.

Just how far the health departments will go is illustrated by the case of the only person to die of rabies in New York State in the last half-century. It was the tragic case of a girl in the Catskills in 1993. No hospital could save her, and she died. It was only upon autopsy that it was discovered that she had died of rabies. But how? There was no bite.

That’s when the pathologists and scientists at the state health department lab stepped in. After advanced RNA analysis, they determined that the rabies had come from a bat. It had been an invisible wound. Why did these scientists go so far to pinpoint the cause? I read the research findings, and their analysis was worthy of the Cornell vet school. Maybe they learned it there.

Why did these “state workers” go to such an effort? You could say that it was simply their job. But I think that there was something else. If one person got rabies, there was a possibility that there was some kind of gap in their system, that they had missed something. I imagine that they were quite relieved to discover that this case came from something that they couldn’t possibly have prevented. That’s how important keeping the citizens of New York State from getting rabies is to them.

From my own years in state government (Pennsylvania) I know that most of government at any level consists of groups of people in offices that do the routine work of ensuring the health and safety of its citizens. They are often unglamorous, invisible but crucial jobs. Although it became visible to me after being bitten, usually the only way these functions become apparent is when they are eliminated. When politicians talk about government as the enemy, they are including the functions of government that make it possible for me to not have to worry that I have contracted rabies. They do this for me: my tax money at work.

I am a fortunate citizen because of these people. The only thing I have to deal with is the effect of having been attacked by an animal intent on killing me. In the early history of mankind, this must not have been an unusual experience. (Most of it was big cats, a predator of humans.) As someone with long clinical experience in the treatment of trauma, I have the unusual experience of observing the way the body and mind react to my own trauma. I am at the stage of repeated images coming up to me again and again, with decreasing intensity. The images are detailed, fixed pictures of that dog’s teeth, lurching at me. In the treatment of child trauma, you always find such stored detailed “photographic” images. While you may never know the exact stories, such images might as well be taken with your film camera; there is no fantasy or imagination in it. It is neurological proof that you were there. I already have mine.

This will fade, unless re-triggered by another dog attack. (I have made a new personal policy of never being around any dog that was bred to fight to the death.) The shock, the high blood pressure, the startling images, will fade in time. I will not suffer nightmares over this forever. I will recover. But if the season for government-as-enemy continues, someday some politician may cut the modest funding to pay for the people who keep us safe. Should that day come, rabies will come back. That will be the real nightmare.

I know it’s generally unpopular to say in America right now, but two cheers for government workers. Especially, in this case, the county Health department. If I missed checking the need for rabies vaccinations like I have missed deadlines for car inspections and registration, I’d have had rabies three or four times now, and it only takes once. With something this crucial I would be foolish to trust myself. Fortunately, I’m saved by the county. They keep track. They are looking out for me better than I could do it myself. I remember this again when the phone rings. It’s Cynthia Mosher, the lead person for rabies prevention in the Tompkins county health department. She is calling me to tell me that the dog has cleared quarantine, which means I am in the clear too. They are satisfied that I am at no risk of getting rabies. Thanks, Cynthia.

Our public health director is Frank Krupa, MPA; the medical director is Dr. William Klepack. The department also runs animal vaccination clinics, their first line of rabies defense.

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David B. Schwartz, Ph.D. lives and practices psychotherapy in Fall Creek. www.sidewalkpsychotherapist.com