Aug 13, 2013

Rodney Versus Death

What do you do in the face of a monstrous disease with a 100% fatality rate? In this short, a Milwaukee doctor tries to knock death incarnate off its throne.

In the fall of 2004, Jeanna Giese checked into the Children's Hospital of Wisconsin with a set of puzzling symptoms ... and her condition was deteriorating fast. By the time Dr. Rodney Willoughby saw her, he only knew one thing for sure: if Jeanna's disturbing breakdown turned out to be rabies, she was doomed to die.

What happened next seemed like a medical impossibility. Producer Tim Howard tells Jeanna's story and talks to authors Monica Murphy and Bill Wasik, and scientists Amy Gilbert and Sergio Recuenco, while trying to unravel the mystery of an unusual patient, and a doctor who dared to take on certain death.

Read more:

Rabid: A Cultural History of the World's Most Diabolical Virus, by Bill Wasik and Monica Murphy

"Undead: The Rabies Virus Remains a Medical Mystery," Wired article by Monica Murphy and Bill Wasik

"Bats Incredible: The Mystery of Rabies Survivorship Deepens," Wired article by Monica Murphy and Bill Wasik

"Study Detects Rabies Immune Response in Amazon Populations," the CDC's page on Amy Gilbert and Sergio Recuenco's work (inc. photos from Peru)

"Selection Criteria for Milwaukee Protocol," when to try the Milwaukee Protocol

Jeanna Giese's website

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JAD ABUMRAD:                    Hey, this Jad. Radiolab is supported by Rocket Mortgage by Quicken Loans. Home plays a big role in your life. That is why Quicken Loans created Rocket Mortgage. It lets you apply for a mortgage simply, and understand the entire process fully, so you can be confident that you're getting the right mortgage for you. To get started, go to

MULTIPLE VOICES:             Wait, wait, you're listening...
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You're listening to Radiolab…
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And NPR.

JAD ABUMRAD:                    Hey, I'm Jad Abumrad.

ROBERT KRULWICH:         I'm Robert Krulwich.

JAD ABUMRAD:                    This is Radiolab…

ROBERT KRULWICH:         The podcast.

JAD ABUMRAD:                    And today on the podcast, a story about death incarnate. Incarnate?

ROBERT KRULWICH:         Incarnate, I think.

TIM HOWARD:                      I think “incarnate.”

ROBERT KRULWICH:         Incarnate. That was Tim Howard, our producer.

TIM HOWARD:                      Oh, I'm sorry, am I in here?

ROBERT KRULWICH:         No, you're not supposed to be in yet wait.

JAD ABUMRAD:                    Yeah, just wait, you're coming, you're coming.

ROBERT KRULWICH:         Just wait.

JAD ABUMRAD:                    A story about death incarnate.

ROBERT KRULWICH:         And the man who… well, who thought he could beat death.

JAD ABUMRAD:                    Yeah.

(knocking on door)

TIM HOWARD:                      Are you Ann?

ANN GIESE:                             Yeah.

TIM HOWARD:                      Nice to meet you.  I'm Tim.

ANN GIESE:                             Nice to meet you, Tim.

JAD ABUMRAD:                    Comes from our producer Tim Howard, but you're already here, so just start.

TIM HOWARD:                      Okay. So late last year, I took a trip out to Wisconsin.

ANN GIESE:                             Test one, two.

TIM HOWARD:                      It was like that first weekend of November when we were out there for the live show. And I met this woman.

ANN GIESE:                             Ann Giese.

TIM HOWARD:                      To talk about her daughter, Jeanna.

                                                      Do you mind telling me just like where you're sitting, what room?

TIM HOWARD:                      Crazy story.

ANN GIESE:                             I am sitting in the kitchen of my home in Fond du Lac, Wisconsin.

TIM HOWARD:                      Alright.

                                                      So anyway, back in 2004 in September of 2004, her daughter Jeanna was 15, a sophomore.

ANN GIESE:                             I remember it was homecoming week, so they had all activities each day and dress up days and…

TIM HOWARD:                      Jeanna's a volleyball player and one morning, she just starts to feel kind of crappy.

ANN GIESE:                             She started getting a tingling in her left arm.  We thought maybe she had a pinched nerve or something, thought nothing of it.

TIM HOWARD:                      Then, she goes to the volleyball game, somebody I guess sets the ball to her to spike and she looks up and she sees two of them and she doesn't know which is the volleyball.

ROBERT KRULWICH:         Double vision?

TIM HOWARD:                      Yeah.

ANN GIESE:                             About a week later, she started getting flu-like symptoms.

TIM HOWARD:                      She has headaches and she feels really sluggish.

ANN GIESE:                             Each day, she just got more tired.

TIM HOWARD:                      One of those days, she does go to school, take the PSATs. But then, the next day, she can't even get out of bed to go to the doctor and he says…

ANN GIESE:                             "Well--"

TIM HOWARD:                      "It's not the flu."

ANN GIESE:                             So we went home and then she just kept getting worse. Her arm started to involuntarily jerk, her speech started becoming real slurred, her body kind of stiffened up. Like we'd get her up to go to the bathroom and she just... It was just really scary, weird, how her body was just stiffening up.

TIM HOWARD:                      Ann and her husband, John, took her to a neurologist for some tests.

ANN GIESE:                             Just trying to get down to the bottom of this, you know? And what is going on with her because the meningitis came back negative, everything else they were testing for came back negative.

TIM HOWARD:                      Were they running out of things to test for?

ANN GIESE:                             Yeah. They pretty much didn't know what else to do and…

TIM HOWARD:                      A day later on a Saturday, Jeanna's hospitalized. And then, on Monday, when her pediatrician, who had seen her on Friday came in, and saw her.

ANN GIESE:                             And saw how much worse she was.

TIM HOWARD:                      In just two days.

ANN GIESE:                             He was, like, frazzled.  Like, “What is going on here?” And then, something just made me tell him about the bat.


TIM HOWARD:                      Yeah. So this was a month earlier. Jeanna and her family, they were at mass.

ANN GIESE:                             It was St Patrick's Catholic Church, you know, old big church.

TIM HOWARD:                      And a bat was flying around and it was just kind of bothering everybody.

ANN GIESE:                             It would just land on behind the alter, the stained glass windows up high. It just seemed like it wanted to get outside. And there were open windows.  It's like, “Go!” (laughing) “They're right there, go.” But it just-- and then, it would swoop down and it started getting lower to the people's heads and stuff, and there was an usher, he hit it to the floor, I don't know what he used but Jeanna kept looking back at it and, being the animal lover she is, she thought she had to help it.

TIM HOWARD:                      And so, she jumps up, runs over to the bat, grabs it by the wings and takes it outside. And as she does, the bat bites her on the index finger of her left hand.

ROBERT KRULWICH:         So it breaks the skin?

TIM HOWARD:                      Yeah. They washed it and then thought nothing of it. But when Ann told the pediatrician about this…

ANN GIESE:                             His face turned white. He walked out of that room and he says, "I'll be right back." But he never told us what it was.

TIM HOWARD:                      They immediately rush her to Milwaukee, to this other hospital.

RODNEY WILLOUGHBY:  Children's hospital, Wisconsin.

TIM HOWARD:                      To be treated by this guy.

RODNEY WILLOUGHBY:  I'm Rodney Willoughby. I'm an infectious disease consultant.

TIM HOWARD:                      And at the point when Rodney met Jeanna…

RODNEY WILLOUGHBY:  She was what we call “stuporous.”

JAD ABUMRAD:                    You mean, like, she couldn't talk?

TIM HOWARD:                      She could, but barely.

RODNEY WILLOUGHBY:  She was talking only single sentences, could only follow a one-step command.

TIM HOWARD:                      She was in a wheelchair.

RODNEY WILLOUGHBY:  Because she couldn't physically stand.

TIM HOWARD:                      Her left arm would twitch and spasm.

RODNEY WILLOUGHBY:  She would apologize, say, "Sorry." And then try and get back into position for the exam.

TIM HOWARD:                      And she was literally getting worse by the minute.

RODNEY WILLOUGHBY:  Within two or three hours, she had to have a breathing tube put in. She was essentially becoming comatose. The way she looked, I wasn't sure she was going to survive. And of course, if she had rabies, I pretty much she wasn't going to survive.

JAD ABUMRAD:                    Rabies?

TIM HOWARD:                      Yeah.

ROBERT KRULWICH:         But if you are diagnosed with rabies, then what do you do?

TIM HOWARD:                      You die, basically.

ROBERT KRULWICH:         You die?

TIM HOWARD:                      Yeah.

ROBERT KRULWICH:         Well, what, all of the time? Some of the time?

TIM HOWARD:                      All of the time.

MONICA MURPHY:             It's a really deadly disease.

BILL WASIK:                           In terms of the percentage of people who come down with the symptoms of rabies, who die, it is the deadliest disease in the world.

JAD ABUMRAD:                    The deadliest?

TIM HOWARD:                      Yeah. Here's the bottom line…

MONICA MURPHY:             If we say there are 55,000 cases of rabies a year, then you also have 55,000 rabies deaths a year.

ROBERT KRULWICH:         Meaning it's 100% fatal.

TIM HOWARD:                      Yeah, and by the way, this is Monica.

MONICA MURPHY:             Monica Murphy. I'm a public health veterinarian.

TIM HOWARD:                      And this is Bill.

BILL WASIK:                           Bill Wasik. I'm a senior editor at “Wired” magazine.

TIM HOWARD:                      And they wrote a book called “Rabid,” where they trace the history of rabies all the way back to the beginning.

BILL WASIK:                           There are references to rabies going back as far as we have human writing. In the Sumerian literature, in the Acadian literature.

TIM HOWARD:                      For thousands of years, we have been throwing everything and anything we can think of at this disease, and failing.

BILL WASIK:                           One like real--

TIM HOWARD:                      I mean, from the start--

BILL WASIK:                           You see these very, very weird cures.

TIM HOWARD:                      Desperate. For example, in Roman and Greek times, if you're Jeanna and you got bit by a bat, you might have tried…

BILL WASIK:                           Eating a cock's brain. Goose grease mixed with honey. The flesh of a mad dog, salted. The skin or old sluff of a serpent. A clod from a swallow's nest applied with vinegar. And then, we have the dung of red poultry, provided it is of a red color is very useful.

TIM HOWARD:                      If those didn't work, you could…

BILL WASIK:                           Pull out the feathers from around a live rooster's anus, and apply the anus to the bite wound, on the theory that said anus would suck the poison up out of the wound.

JAD ABUMRAD:                    Wait a second. How would a rooster's anus cure ever catch on in the first place? I mean, it wouldn't work.

TIM HOWARD:                      Well, yeah, but if you think about it, not every rabid dog or bat bite is actually going to transfer the virus.

BILL WASIK:                           In the sense that, you know, the saliva will just fail to get the virus where it needs to be.

TIM HOWARD:                      So every so often, the healer's gonna come along with his rooster's anus and, you know, put it on your wound and--

BILL WASIK:                           Sure enough--

TIM HOWARD:                      It works.

BILL WASIK:                           Case closed.  We have our rabies cure.

ROBERT KRULWICH:         So you're saying that Pliny’s list is a lot of lucky accidents by sorcerers.

TIM HOWARD:                      Yeah, I think that lucky accidents were kind of probably what kept some of these things kicking around long enough to become accepted.

JAD ABUMRAD:                    What do we know about rabies for real? I mean, what do we actually know about the disease?

TIM HOWARD:                      I mean, not much. We know it's a very unusual virus.

MONICA MURPHY:             Yeah. The way a typical virus travels is it has a port of entry, it replicates locally, it makes it into the bloodstream, it circulates widely, it finds its target tissues, and then it replicates there.

TIM HOWARD:                      Right, exactly.

So you get a wound, it gets infected, that goes into the blood. But rabies?

MONICA MURPHY:             It enters the body at the bite wound site.

TIM HOWARD:                      So in Jeanna's case, the tip of her finger.

MONICA MURPHY:             It binds to a nerve right there.

BILL WASIK:                           To a particular receptor.

MONICA MURPHY:             And then, crawls its way up the nervous system.

BILL WASIK:                           One to two centimeters per day.

MONICA MURPHY:             I think that's right. To attack the brain.

JAD ABUMRAD:                    It literally grabs onto the nerve and climbs up?

TIM HOWARD:                      It's like hand over hand. It might take a few days to go the length of a finger, maybe three weeks to go the length of an entire arm.

MONICA MURPHY:             It's during that slow climb that we could administer a vaccine and help the body mount an immune response.

TIM HOWARD:                      If you give a person the vaccine before they see symptoms, while the virus is still climbing its way up to the brain, they should be okay.

BILL WASIK:                           But once the infection has taken root in the brain… then it's too late for vaccination.

TIM HOWARD:                      The moment you have a twitchy finger, the moment you have like the slightest little flu-like symptom, which will later progress into rabies, that's the moment that you know you're going to die of that disease.

JAD ABUMRAD:                    Well, what does the virus do when it gets to the brain?

TIM HOWARD:                      Well, it's very much not known, specifically, what happens in the brain. It might start shutting parts of your brain down.  In about 30% of the cases, the muscles might start to kind of get paralyzed. It's called “paralytic rabies.” Eventually, their entire body will get paralyzed and they might just slump into a coma. Or more often, it's that cliché of the rabies death is what actually happens, where people have these like spasms of rage.

(audio recording of person screaming wildly)

There are videos online where you can see people in this state.

MONICA MURPHY:             Yeah, YouTube.

TIM HOWARD:                      I find them impossible to watch.

(audio recording of person screaming wildly)

People, you know, just screaming and writhing in convulsions.

(audio recording of person screaming wildly)

And from the virus' perspective, it's trying to drive its host to be more aggressive, so that it bites somebody else and spreads more virus. The other thing that is I find really perverse… is that they will get this fear of water, a really powerful fear of water.

MONICA MURPHY:             The human victim of rabies tries to drink, wants to drink.

BILL WASIK:                           But then, they'll bring the cup to their hands and it'll just shake and overflow.

TIM HOWARD:                      The muscles in their throat seize up.

MONICA MURPHY:             The gag reflex.

TIM HOWARD:                      And they can't.

JAD ABUMRAD:                    They can't drink water?

MONICA MURPHY:             Yeah, you can imagine, though, again, from the virus' perspective why that would be advantageous. You are trying to transmit virus through biting, so an animal who can't swallow his virus-filled saliva.

JAD ABUMRAD:                    They're gonna be like a loaded gun.

MONICA MURPHY:             Right.

TIM HOWARD:                      And eventually, after a few days in these late stages, a person might lapse into a coma, have a heart attack. There's really any number of ways they could die.

JAD ABUMRAD:                    That sounds awful.

TIM HOWARD:                      And so… when the official results came back, and Rodney took Jeanna's mom and dad, Ann and John Giese, into a room and told them.

ANN GIESE:                             “We're sorry but she has rabies.”

TIM HOWARD:                      And it's definitely too late for the vaccine.

ANN GIESE:                             John and I both started crying. You know, “Was there anything that could be done?” And one of the doctors said, there's nothing we can do. We can either put her in a dark room and let her die, you can take her home and let her die. And we're just… “This can't be happening.”

RODNEY WILLOUGHBY:  They said, “What else do you got?”

And they said, “Well, we can do standard intensive care.”

“Well, does that work?”

“Well, no.”

“What else do you have?”

ANN GIESE:                             And then, Doctor Willoughby said…


ANN GIESE:                             “Well, I do have an idea. I'd like to try this…” I don't even know what he called it.

TIM HOWARD:                      Okay, so the night before, while they were waiting for the test results, hoping it wasn't rabies, Rodney started calling around.

RODNEY WILLOUGHBY:  You know, I actually called the CDC, asking if there's anything that was unpublished but promising.

TIM HOWARD:                      They say, “No.”

RODNEY WILLOUGHBY:  And then, I essentially headed to the library. What I did is I pulled-- I don't know-- about 20 years’ worth of case reports.

TIM HOWARD:                      Started reading.

RODNEY WILLOUGHBY:  Sounded pretty hopeless. But--

TIM HOWARD:                      But he does notice one thing. He sees mention in this one kind of obscure paper.

RODNEY WILLOUGHBY:  I read one article, they said, "Well, this might be this sort of nerve transmission."

TIM HOWARD:                      That maybe what's happening in the brain during rabies is something called “excitotoxicity.” Excitotoxicity.

ROBERT KRULWICH:         Excitotoxicity.

TIM HOWARD:                      Yeah.

JAD ABUMRAD:                    Sounds exciting and maybe toxic. What is it?

MONICA MURPHY:             Well, excitotoxicity-- and this is tricky stuff, and it's controversial.

TIM HOWARD:                      Yeah, this is the kind of thing that actually makes rabies researchers at conferences get into fights with each other. Here's a basic idea. You might think that a brain infection just physically destroys the brain. But under this theory, the brain isn't physically destroyed. It's just that the neurons themselves are getting overstimulated, overexcited, and then that part of the brain is disrupted, and it all just kind of shuts down.

MONICA MURPHY:             Just making impossible for the brain to function properly, and so the sort of life-sustaining functions of the brain, like…

BILL WASIK:                           Breathing and circulating blood.

TIM HOWARD:                      They stop working because the neurons that control them are just overwhelmed.

MONICA MURPHY:             Right.

TIM HOWARD:                      In other words…

BILL WASIK:                           Rabies doesn't destroy the brain, it disrupts the brain.

MONICA MURPHY:             The brain itself is spared.

JAD ABUMRAD:                    So it's like a software problem, not a hardware problem.

TIM HOWARD:                      Yeah, and what Rodney read is that people had died of rabies, and in the autopsy, their brains looked totally fine.

RODNEY WILLOUGHBY:  Entirely normal.

TIM HOWARD:                      Moreover…

RODNEY WILLOUGHBY:  The virus was gone.

TIM HOWARD:                      You couldn't even detect the rabies virus in their brain.

RODNEY WILLOUGHBY:  The brain no longer had rabies in it.

ROBERT KRULWICH:         Really?

TIM HOWARD:                      Yeah, it was like there was no weapon at the scene of the crime.

RODNEY WILLOUGHBY:  So that was my clue.

TIM HOWARD:                      What that suggested to Rodney is that the immune system does eventually turn on.

ROBERT KRULWICH:         Right.

TIM HOWARD:                      And it kicks in, and it starts fighting the disease, but it just gets there too late.

RODNEY WILLOUGHBY:  So the immune system had all the tools, but essentially this virus beats your immune system to the punch. It would kill you faster than your immune response could eradicate it.

ROBERT KRULWICH:         ‘Cause the virus moves, what, more quickly than the immune system?

TIM HOWARD:                      Way faster.

RODNEY WILLOUGHBY:  And to me, it was like, “Well, you know, the solution there is obvious.”

TIM HOWARD:                      If you could buy Jeanna's immune system some time.

RODNEY WILLOUGHBY:  Enough time, you could clear the brain, and the brain would not be damaged.

TIM HOWARD:                      She might survive. So what he suggested to Ann is that he put Jeanna into a coma.

RODNEY WILLOUGHBY:  Put her into a coma…

ANN GIESE:                             Induce a coma, and if an anesthesiologist is controlling routine brain stem activities like…

TIM HOWARD:                      Breathing, circulation…

ANN GIESE:                             Then…

TIM HOWARD:                      No matter what the virus is actually doing inside her brain, he might be able to keep her alive.

RODNEY WILLOUGHBY:  Long enough for the immune system to make a response, which would take normally about seven to ten days.

TIM HOWARD:                      And this is still kind of a guess?

RODNEY WILLOUGHBY:  This is entirely improvised, yeah, and lots of things can go wrong and when they go wrong, they typically go wrong badly.

TIM HOWARD:                      He knows there's a huge risk that she's gonna end up being brain-dead or maybe locked in.

RODNEY WILLOUGHBY:  And that's worse than death, I think, in everybody's eyes.

TIM HOWARD:                      Were you nervous about the possibility-- like he said, she could end up being a vegetable just like she'd survive but not--

ANN GIESE:                             I don't think I thought that far ahead. I thought more of… “Let's just keep her alive, get the disease out of her.”

TIM HOWARD:                      So they put Jeanna into a coma. Rodney figures, “We'll give her a week and then we'll check to see if she has an immune response.”

ANN GIESE:                             And once they had her hooked up with the coma, she had the pole with all the IV stuff on and the different medications and stuff.

TIM HOWARD:                      Ann stays with Jeanna in the hospital room and spends her time…

ANN GIESE:                             Praying and calling people and asking them to pray and…

TIM HOWARD:                      She repeated this one prayer…

ANN GIESE:                             Psalm 91.

TIM HOWARD:                      Over and over again.

ANN GIESE:                             It talks about, basically, the devil not getting a hold of you.

TIM HOWARD:                      “He is my refuge and my fortress, my God in whom I trust. Surely He will save you from the fowler's snare and from the deadly pestilence.”

RODNEY WILLOUGHBY:  And so, we were just waiting.                                        

TIM HOWARD:                      “He will cover you with his feathers.”


TIM HOWARD:                      “And under His wings, you will find refuge.”

RODNEY WILLOUGHBY:  It was probably the most uncomfortable feeling I've ever had in medicine.

TIM HOWARD:                      Seven days in, they sample her spinal fluid, send it in for testing, and then they get the results, which say...

RODNEY WILLOUGHBY:  Her antivirus response is in and going up.

TIM HOWARD:                      So her immune system is working?

RODNEY WILLOUGHBY:  Yeah, it was working and, in fact, we now had rabies antibody and we had a fair amount of it and it was in the spinal fluid, meaning it was around the brain. And so, essentially, the plan worked. So we said, "Well, okay, let's start waking her up."

TIM HOWARD:                      But as they're waking her up, she has a fever.

ANN GIESE:                             And they couldn't figure out what was causing the fever.

TIM HOWARD:                      So they put her back under for another week. And then, finally, they start to wake her up again.

ANN GIESE:                             And she gradually, you know, woke up.

RODNEY WILLOUGHBY:  Her brain activity looked great and she had nice pupils, but physically, she did not move a muscle.

TIM HOWARD:                      They pinch her, they poke her.

RODNEY WILLOUGHBY:  She had no movement anywhere other than her pupils.

TIM HOWARD:                      So she was responding to light, and that's it?

RODNEY WILLOUGHBY:  Light, that's it.

TIM HOWARD:                      And this was the one thing that Rodney was most afraid of. That Jeanna was…

RODNEY WILLOUGHBY:  A lock-in. Essentially, locked inside this box of a body. And it was the worst day of my life. Because it looked like she probably would survive and we'd actually done worse than death.

TIM HOWARD:                      And as Rodney drove back and forth from work, he kept repeating this one prayer.

RODNEY WILLOUGHBY:  “Jesus Christ, Son of God, have mercy on me, a poor sinner. Jesus Christ, Son of God, have mercy on me, a poor sinner. Jesus Christ, Son of God, have mercy on me, a poor sinner.” And then, about two days later…

TIM HOWARD:                      Rodney's in the hospital, he's looking over Jeanna's charts.

RODNEY WILLOUGHBY:  Just checking her exam and…

TIM HOWARD:                      Another doctor was finishing up her shift and she comes over to Rodney.

RODNEY WILLOUGHBY:  Said, "Oh, did you know that she had reflexes today?" And I said, "No!"

TIM HOWARD:                      Rodney grabs reflex hammer…

RODNEY WILLOUGHBY:  And then, sure enough, she had knee reflexes.

TIM HOWARD:                      Next day…

RODNEY WILLOUGHBY:  Her eyes started fluttering a little bit.

TIM HOWARD:                      Within a week…

ANN GIESE:                             She was back.

JEANNA GIESE:                      For a couple of weeks after I woke up, I still had no memory.

TIM HOWARD:                      This is Jeanna Giese, the first person to survive rabies without the vaccine.

JEANNA GIESE:                      My first memory was actually Thanksgiving Day…

TIM HOWARD:                      A couple weeks after she woke up from the coma.

JEANNA GIESE:                      Back in 2004. I just remember being with my family, and playing board games with my brothers, and just them being there, and then going down to the cafeteria for dinner. Having fish. I remember we had fish.

JAD ABUMRAD:                    How long was she in the hospital for?

TIM HOWARD:                      About two months.

JEANNA GIESE:                      I had to learn how to stand, and then to walk, to turn around, to move my toes. I was really, after rabies, you know, a new-born baby who couldn't do anything, and then I had relearn that all.

TIM HOWARD:                      Do you remember that? Do you remember that feeling?

JEANNA GIESE:                      Yeah, I-- mentally, I was there, you know? Mentally, I knew how to do stuff but my body wouldn't cooperate with what I wanted it to do, and it was frustrating, and it definitely took a toll on me psychologically. You know, I'm still recovering, I'm not completely back. Stuff like balance, and I can't run normally.

TIM HOWARD:                      She can't play volleyball anymore, but she finished high school, went to college.

JEANNA GIESE:                      I graduated with a degree in just General Biology.

TIM HOWARD:                      And now, Jeanna is really into bats.

ROBERT KRULWICH:         She's a bat-lover?

TIM HOWARD:                      Yeah.

JEANNA GIESE:                      If I ever go down to the zoo, you know, they always-- the let me go behind and in with the bats, and I can pet them and stuff.

TIM HOWARD:                      Really?

JEANNA GIESE:                      Yeah. I'll feed them, I'll pet them. I've been going to bat festivals here in Wisconsin, so I have no fear of bats.

JAD ABUMRAD:                    That would be the last person I would expect to go to a bat festival.

ROBERT KRULWICH:         Oh, this girl is a saint, that's all.

TIM HOWARD:                      She is the poster child for what became known as the “Milwaukee protocol.”

JAD ABUMRAD:                    That's the name of Rodney's thing that he did with her?

TIM HOWARD:                      Yeah.

ROBERT KRULWICH:         You mean, this has been tried again?

TIM HOWARD:                      This has been tried all around the world by different people and different versions of it, but it's been tried around 30 times.

ROBERT KRULWICH:         With what result?

TIM HOWARD:                      So everything I'm about to say forward, there's debate about every single little bit of it, but he says five survivors.

ROBERT KRULWICH:         Five survivors?

TIM HOWARD:                      Yeah.

ROBERT KRULWICH:         Out of how many people?

TIM HOWARD:                      Out of about 30 people. Which on the one hand, is-- that seems like a terrible percentage for a treatment for a disease-- 5 out of 30. But on the other hand, this is rabies and, for all of human history, it was zero out of 30.

ROBERT KRULWICH:         Was there anything about the five that separates them from the others?

TIM HOWARD:                      Well, this brings us to the really murky territory.

AMY GILBERT:                       You know, rabies has been one of those just really interesting pathogens to me. The more you think you know about it, the more you don't know about it. (chuckling)

TIM HOWARD:                      This is Amy.

AMY GILBERT:                       Dr. Amy Gilbert. I'm a research biologist at the National Wildlife Research Center here in Fort Collins.

TIM HOWARD:                      So this gets to your question, Robert. A couple years ago, Amy actually went to study rabies in Peru. With this guy.

SERGIO RECUENCO:           I am Sergio Recuenco. I'm a physician by profession.

TIM HOWARD:                      Just so happens Sergio is also from Peru.

SERGIO RECUENCO:           I was born in Lima.

TIM HOWARD:                      And he now works as an epidemiologist at the CDC.

SERGIO RECUENCO:           So going to…

TIM HOWARD:                      But in 2010, they traveled deep into the Amazon jungle.

SERGIO RECUENCO:           First from Lima, we have to travel to Tarapoto, and from Tarapoto, we go…

TIM HOWARD:                      I mean, we're talking remote.

SERGIO RECUENCO:           Three hours from (indistinct) was the San Lorenzo….

JAD ABUMRAD:                    What were they looking for?

TIM HOWARD:                      Well, they were studying bat-borne diseases and, in that part of the world, people have a lot of contact with vampire bats.

SERGIO RECUENCO:           So we choose two towns.

AMY GILBERT:                       Truenococha and Santa Marta.

TIM HOWARD:                      So they arrive and…                

AMY GILBERT:                       Have a pretty lengthy discussion with the community leaders.

TIM HOWARD:                      They explain what they're up to, then go door to door.

AMY GILBERT:                       Household to household.

SERGIO RECUENCO:           We visit each house and talk with one member of the family.

TIM HOWARD:                      And they’d ask, you know, “Have you been bit by a vampire bat? Have you had any illnesses?” Then, they take a blood sample, and what they found is basically rabies front-page news.

AMY GILBERT:                       11% of the blood samples that were tested…

TIM HOWARD:                      7 people out of 63.

AMY GILBERT:                       Had what we call evidence of virus-neutralizing antibodies.

TIM HOWARD:                      They had rabies antibodies in their blood.

JAD ABUMRAD:                    Uh… okay?

TIM HOWARD:                      Well, you know how I mentioned that sometimes the body will mount a response to rabies but it's just too late?

JAD ABUMRAD:                    Yeah.

TIM HOWARD:                      So you might see those antibodies but only when somebody's dying. Right? And these people in Peru, they had the antibodies.

SERGIO RECUENCO:           But we didn't have any evidence there was any neurological disease in any of the cases.

TIM HOWARD:                      They didn't seem to have rabies.

SERGIO RECUENCO:           We were really, very surprised.

JAD ABUMRAD:                    I'm sorry, why?

TIM HOWARD:                      Well, think about it. The only way they could've gotten those antibodies in their blood was…

SERGIO RECUENCO:           By contact at some point with the virus.

TIM HOWARD:                      They’d come into contact with rabies, and yet, they were fine. It was almost as if they were immune to rabies.

JAD ABUMRAD:                    Huh.

AMY GILBERT:                       Well, I…

TIM HOWARD:                      But Amy won't use that word, “immune,” because…

AMY GILBERT:                       The data are sort of inconclusive as to whether there was any entry into the brain.

TIM HOWARD:                      Like, they didn't know if the virus made it all the way into these people's brains, and so did they come down with full-blown rabies or not, they don't know. But it's possible that these people are special. Some people even argue…

MONICA MURPHY:             That there are special individuals who are able to survive rabies.

TIM HOWARD:                      And not just in Peru. Monica told me about another case.

MONICA MURPHY:             The “Texas wild child.” Rabies case, laboratory-confirmed, in a girl in Texas.

TIM HOWARD:                      17-year-old girl.

MONICA MURPHY:             A runaway.

TIM HOWARD:                      She shows up in 2009 at a hospital in Houston. She has a headache, her neck hurts, and she's really agitated. They confirmed that it was rabies but she…

MONICA MURPHY:             Didn't receive the Milwaukee protocol or any critical care measures.

TIM HOWARD:                      As far as we know, they just figured she would die. But then, three weeks later, this girl…

MONICA MURPHY:             Went on to walk out of the hospital.

TIM HOWARD:                      She just got better.

JAD ABUMRAD:                    No drugs, no coma, nothing?

TIM HOWARD:                      On her own.

ROBERT KRULWICH:         Hmm. Wow.

TIM HOWARD:                      And this actually brings us back to Jeanna.

RODNEY WILLOUGHBY:  She's pretty close to normal.

TIM HOWARD:                      Because at the point when she arrived at the hospital to see Rodney…

RODNEY WILLOUGHBY:  She actually was diagnosed as having small amounts of antibody in her.

TIM HOWARD:                      She already had antibody in her blood, like those people in Peru?

MONICA MURPHY:             She did not have recoverable virus.

RODNEY WILLOUGHBY:  We could not isolate virus from her.

TIM HOWARD:                      Which is unusual.

MONICA MURPHY:             It does seem that she's immunologically special.

TIM HOWARD:                      In fact, if you look at all the people who have gotten the Milwaukee protocol and survived, they all have that profile.

MONICA MURPHY:             Like the girl in Texas, like Precious Reynolds.

TIM HOWARD:                      That's another girl who got the Milwaukee protocol and survived.

MONICA MURPHY:             They have had similar labwork come back. Those patients have extraordinary labwork and extraordinary outcomes.

TIM HOWARD:                      And so, some researchers in Canada and Thailand have argued that Rodney's protocol actually had very little, if nothing, to do with Jeanna Giese surviving. They would say she survived…

MONICA MURPHY:             Despite Dr. Willoughby's treatment, rather than because of Dr. Willoughby's treatment.

JAD ABUMRAD:                    Oh, so they're accusing him of basically pulling a rooster's anus kind of number?

TIM HOWARD:                      I don't think they would really put it that way, exactly. (chuckling) They say that the Milwaukee protocol should be discontinued, and that we shouldn't be wasting time and money on it.

MONICA MURPHY:             You know, they-- in Bangkok-- are acutely aware of the fact that to do one Milwaukee protocol case, you could vaccinate I think it was all of the kids in Bangkok preventatively against rabies.

BILL WASIK:                           Tens of thousands of slum kids in Bangkok could be preventatively vaccinated against rabies.

TIM HOWARD:                      So these critics would say, you know, “Give people vaccines, but don't induce the coma and don't use these untested drugs that Rodney administers. And if somebody comes in with an advanced case of rabies, well, unless you have evidence that they're one of these immunologically special people, you just need to accept the fact that they're going to die.”

SERGIO RECUENCO:           I think no. Calling not to do anything, I would definitely disagree. We have to do something.

TIM HOWARD:                      According to Sergio, the idea that Rodney somehow just got incredibly lucky when he was treating Jeanna Giese...

SERGIO RECUENCO:           That's very unlikely.

TIM HOWARD:                      Jeanna was basically at death's door.

SERGIO RECUENCO:           So there are some things might not be fully understanding in Jeanna Giese's case, but it was obvious that if she was not given this alternative, she might not have survived.

TIM HOWARD:                      And you could argue that if Jeanna's part of this immunologically special group of people, who can just survive rabies without the vaccine, then how come nobody did before Rodney came along?

RODNEY WILLOUGHBY:  You know, this is really not science. This is, right now, storytelling. There's something right but we still don't know and we won't know until we figure out which parts work and don't work.

TIM HOWARD:                      You know, for now, Rodney's forced to evaluate and try to improve the protocol just one patient at a time, without the funding or research that he wants, so no clinical trials, no animal models.

RODNEY WILLOUGHBY:  So we're left learning the hard way, which is an awful way to learn.

TIM HOWARD:                      But he says you can't just give up hope. In the early days of cancer treatment, they weren't having any success, but they didn't just stop.

RODNEY WILLOUGHBY:  And I've seen treatments for cancer evolve over my professional career from being zero percent survival to being 85% survival.

TIM HOWARD:                      And now, he puts the success rate of his protocol at about 20%

RODNEY WILLOUGHBY:  That's a lot better than zero.

TIM HOWARD:                      And it could go up.

JAD ABUMRAD:                    Or it might not go up.

TIM HOWARD:                      It's true. So if you're a doctor now, though, and a kid comes into the hospital, hasn't had the vaccine, has a full-blown case of rabies, what do you do? Do you just throw up your hands, say, "Sorry, he's not gonna make it." Do you check and see if maybe he's immunologically special?

ROBERT KRULWICH:         Put him in a coma?

TIM HOWARD:                      Do you put him into a coma? That you don't know is gonna work. Whatever the case, you've actually gotta be glad that Rodney gave Jeanna a shot… because whether or not you think he saved her life or she saved her own life, the fact is that at least we know that rabies isn't quite the killer that we once thought it was. He took it off of its throne of death, even if just a little bit maybe.

MONICA MURPHY:             And when we say, you know, rabies is coming off its 100% throne, it's down to 99.999. You know, like it's…

JAD ABUMRAD:                    And it might be that it was never quite on that throne, exactly, ever.

MONICA MURPHY:             Yeah, right.

JAD ABUMRAD:                    Alright, well, we've certainly cleared things up.

(all chuckling)

Thank you, Tim.

ROBERT KRULWICH:         Thank you.

TIM HOWARD:                      Sure thing.

JAD ABUMRAD:                    Thanks also to Ashvin Shaw for research help, and to you guys for listening.

CLAIRE:                                     Hi, this is Claire calling from Beijing. Radiolab is supported in part by the National Science Foundation and by the Alfred P. Sloan Foundation, enhancing public understanding of science and technology in the modern world. More information about Sloan at