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What’s in a mosquito bite? 

Unlike Eastern equine encephalitis, the viral strain that sickened people in Massachusetts and New York in August 2024, Western equine encephalitis seems to have gone dormant in the United States. Data from the Centers for Disease Control and Prevention (CDC) show that between 1964, when rigorous data collection began, and 1999, when the last human case was reported, there were only 639 confirmed cases. Most cases occurred in California, Colorado, North Dakota, and Texas between 1964 and 1970. 

My sister was one of them. All because of a mosquito bite.

Western equine viral encephalitis. The tentative diagnosis—forever tentative—arrived at our California home in a plain manila envelope months after what would have been her fourth birthday. Coming home from eighth grade that afternoon, I saw the sealed envelope on the kitchen table. By dinner, her autopsy report had disappeared.

She’d been born perfect. When my brother was ten and I eight, she came home swaddled in a receiving blanket, her gray eyes studying us intently. She was an easy baby, quick to sleep through the night. Even when she was only a few months old, Mom and Dad would attend dinner parties and leave her in our care. I’d change her cloth diapers, poking diaper pins into an unwrapped bar of Ivory soap so they’d glide through the cotton fabric. I’d push her pram to the grocery store, irritated when people would coo indulgently at me, “Ooh, you have a baby!” 

“Yes, I do,” I’d say matter-of-factly, rocking the buggy gently to rouse her. 

When she’d cry out they’d gasp and peek in. “Oh! You really do have a baby in there!” they’d exclaim. I’d roll my eyes and think, What idiots! Didn’t I just say so? Pretending to have a baby, playing with dolls, seemed juvenile and pointless. I loved feeling capable, being responsible. I was eager to teach her things that had confounded me. How to tie shoes the right way. How to use chopsticks the right way. How to understand Mom.

When she was two-and-a-half, she got sick.

Equine encephalitis. Her epidemiological puzzle, pieced from physical findings from her autopsy, consultations with other doctors, and my parents’ recollections, held little comfort. Tracing backward from her sudden torpor, her days of endless sleep, followed by days—no, months—of raging behavior, led the pathologist to this tentative conclusion. As I furtively read the autopsy report I knew I’d find hidden in Mom’s desk, I locked onto this detail. Horses! The only time in her abbreviated life that she’d seen a horse was slightly less than two years prior, on Easter Sunday, 1967. 

It had been a typical California day, warm and sunny, a perfect day for a Sunday drive. After church, we’d headed to a holiday picnic in the Pleasanton hills where the grass blanketing the hills was already the color of straw. Narrow paths clung to the contours of the steep slopes. “Those are cow trails,” my brother explained, helpful for once. He glanced down at the directions he’d jotted on a sheet of paper and directed us up a rutted dirt road. We parked under an old California live oak that spread its long heavy limbs over several more cars and stepped out into the dust.

I was surprised when my parents introduced themselves to the hosts. My brother was the only one with a connection, however slight. He’d recently met the daughter, who’d invited him to a family picnic to show off their two new horses, just arrived from Washington state. 

I imagine that Mom carried my sister to the corral and perched her tiny feet on the fence rail, holding her from behind so she could see the horses. The horses, prancing and whinnying after their long journey, would have made her giggle with delight. After a while, Mom might have put her down so she could scuff in the tall grass in her black patent leather Mary Jane shoes. Whatever they were doing, I was preoccupied. Waiting in a clearing outside the corral, I wondered if anyone would notice that I was the only kid who hadn’t yet had a turn? Finally, I was boosted onto the horse’s broad bare back, instructed to grip his shoulders tight between my knees and twine my fingers in his mane. All I fully remember is my body-drenched delight, the horse’s silky neck, my hair blowing free.

Weeks later, on a weekend trip to Morro Bay, my sister spiked a fever. She was constantly drowsy and irritable when roused. Mom and Dad traded off, carrying her past Hearst Castle’s Greek columns and elegant fountains. They seemed more annoyed than concerned. Maybe she just had the flu. Once home, she slept twenty hours a day.

After a month, her normal sleep habits returned. Summer was coming, and we breathed a collective sigh of relief. But then her little body started twitching out of control. Even Dad, a doctor, couldn’t correctly diagnose the problem. Much later, the autopsy report confirmed our worst fear: she had begun having seizures.

We finally took her to the doctor after she deliberately ran herself into a jagged rock wall at the Fremont Hub shopping center.

That day had begun as summer days often did, an idle weaving of chores, with Mom needing something at Longs Drugs, then suggesting we’d check out the sale at Mervyn’s before heading to Winchell’s Donuts for a fresh baker’s dozen. We stepped into the mall and my sister ran off, shrieking in glee, daring me to chase her. I whooped and followed. She raced toward the rock wall—its lava-like surface a common 1960s architectural motif in shopping malls—and I hung back, expecting her to veer off at the last moment. She didn’t. Shock turned to horror as I watched her hit the wall and crumple to the ground. Hadn’t she seen it? When I picked her up, her forehead was bleeding. As I set her on her feet and tried to get a better look at her injury, she ripped out of my arms and ran directly into the wall again. 

Soon there were tests. Her pediatrician referred her to Stanford University Hospital, across San Francisco Bay, for a neurological exam. They found nothing abnormal in her EEG, nothing abnormal in her reflexes. There was nothing to explain her raging intent, the onset of her screaming fits, her self-harm, her violent lashing out. It was as if a demon had overtaken her. 

No one could come over to our house.

I couldn’t know how wretched it was for Mom. I’d come home from school, see Mom in the kitchen and my sister on the floor, and head to our shared bedroom to do homework. But after a ghastly year of seizures and cloth ankle restraints, in May 1968, my parents got her admitted to The Stanford Home for Convalescent Children. Nestled in a eucalyptus grove close to the Stanford campus, the residential hospital was well known for caring for children with asthma and other chronic diseases. Although her illness was yet unidentified, she was admitted as an inpatient with a chronic disease, one of the last children admitted under the auspices of the original mission. 

I have no memory of our family talking about it. I was shocked when I was told she was going to live at a hospital. Who first suggested that she go there? Did Mom or Dad know how long she’d be gone? A month? A year? Until there was a diagnosis, a treatment plan? Did they have a plan for her to come home? Even basic questions felt accusatory, and I couldn’t bring myself to ask.

Suddenly my room was my own.

That summer, Mom and I visited her twice a week for an hour or so each time. I can still taste the bitter silence that always accompanied us to the hospital. Mom, engulfed by her Cadillac sedan, would slide on her huge-lensed sunglasses. We’d wind through the narrow streets of Newark, cross the railroad tracks, and pick up speed as we drove past the smoke-belching FMC plant. When the stink of the Leslie Salt evaporation ponds grew stronger, I’d drop the quarter and dime for the toll bridge into her open hand. As the two-lane road passed the KGO station house and approached the metal trusses of the old Dumbarton Bridge, I’d brace myself for the big bounce that marked the entry onto the bridge. Oncoming cars would whiz by close, their wheels almost touching the middle yellow line. When we’d park in the fragrant eucalyptus grove where acorns with tiny crosses littered the ground, Mom would keep her big sunglasses on until we got inside.

With the first whiff of antiseptic, I felt a chill of foreboding and excitement. How would she be feeling? Would she be happy to see me? 

But mostly I remember the relief. The guilty relief. 

Fall came. Then winter. As Christmas approached, Mom seemed a little lighter. She unpacked the fragile glass tree ornaments. She baked her favorite poppy seed cookies. She bought gifts. I hung ornaments, greased cookie sheets, and wrapped presents.

Two days before Christmas, just three weeks shy of her fourth birthday, my sister developed pneumonia. Mom and I rushed to see her. Our family tradition was to celebrate Christmas Eve with Dad’s extended family and Christmas Day with Mom’s, so we wouldn’t see her again for at least three days. I knew Mom wouldn’t change our plans. It was our turn to host Christmas Eve dinner at our house, and Mom was stubborn enough to believe that she’d lose face if she backed out. Immersing herself in the ensuing Christmas Day celebration with her six siblings and their families would, for Mom, be a welcome respite. 

When my sister saw us, she tore out of her hospital room barefoot, half-dressed in a T-shirt and underwear. “More clothes?” I blurted to the nurse, who shrugged and waved us on. I gave chase as she squealed down the hall, only catching up with her as she slowed for a corner. I followed her into the lunchroom, worrying about the cool linoleum chilling her bare toes. 

Sitting at a little table beside her, I felt her forehead. She was warm—not hot—to the touch. As she leapt up again and ran in circles, I watched carefully, willing her to stay in the middle of the room. But sometimes she still ran at things on purpose. The word Stop! caught like a bone in my throat. 

By the end of our visit, she’d exhausted herself. I caught her and kissed her goodbye, her cheek smooth and taut against my lips. For a blessed moment I thought that we should bring her home for Christmas. That impulse vanished as Mom turned to go. 

Mom wasn’t so abrupt as to be dismissive, but she also wasn’t trying to linger. Back then I thought it was Mom being practical, maybe beating the rush hour traffic. But as I—now also a mother—look back on that scene, I find my emotions on a knife edge, inhabiting an impossible moment. In the space between duty and love, if you linger, would it hurt too much to ever leave? If you leave, do you love any less?

The entire ride home I was obsessed with one image: my junior encyclopedia, those apple-red volumes shimmering with gold lettering. As soon as we arrived, I went straight to my room and shut the door.

Was pneumonia serious? Might she die? I felt guilty even imagining the possibility. I fingered the top of the spine of volume “P-Q” and tipped it out, fearing Mom’s quick steps down the hallway. I dropped the book on my bed, knelt on the floor, and flipped to “pneumonia.” As suspected, pneumonia had been a relentless killer up through 1935, when the first sulfa drug was invented. But throughout the 1940s and 1950s, rapid improvement in antibiotic discovery and therapy led to significantly better survival rates. By the 1960s, eighty percent of pneumonia cases were cured. The only sensitive populations remained the elderly, the very young, and the chronically ill. 

She was already at a hospital where world-renowned doctors had access to the best antibiotics. Almost four, she’d grown out of infancy and was not medically fragile. Relieved, I snapped the volume shut and slid it back on the shelf. She was safe.

As our clan gathered on Christmas Eve, I gathered coats and purses while my brother stashed the fancy wrapped gifts under our tinsel-strewn tree. My sister’s absence was noted, but briefly. Mom busied herself in the kitchen, stirring bacon bits and scallions into the mashed potatoes, unmolding the Jell-O salad and garnishing with maraschino cherries. I carried the finished dishes to the buffet table. As holiday lights blinked on the mantel and “O Come, All Ye Faithful” played in the background, the phone rang. Dad took the call in the bedroom. As he emerged, lips drawn in a thin line, he motioned to Mom. Dad’s oldest brother, seeing the hollow look in his eyes, followed too.

Even through the closed door, we heard Mom’s piercing wail. 

It was my uncle who came out first. He took my brother and me aside. In hushed tones he told us that our sister had died. 

In that instant I felt betrayed by my faith in the medical profession, in antibiotics being a sure cure. I wanted to scream at Dad, How could this happen? But her death had not come as a complete surprise. Under my grief lay a hidden pain. Was it my fault? Was I somehow complicit in her death by even letting the possibility cross my mind? 

That Christmas Eve, after all our relatives had left, our family, again now four, sat quietly at our kitchen table. Suddenly my brother began sobbing inconsolably. “It’s my fault, it’s my fault,” he moaned over and over until Dad stood and guided him back to his room. Mom and I sat silently, the blinking Christmas lights still glowing on the mantel. 

My sister became a ghost no one spoke of. 

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Turns out, the virus that causes Western equine encephalitis still lurks today in South America, waiting for the right opportunity, and a ready mosquito. On December 20, 2023, after a decades-long lull, Argentina notified the World Health Organization of a human case of Western equine encephalitis. When Argentine and Uruguayan health agencies looked in earnest, they found a major outbreak: 217 human cases, 12 fatal, and over 2,500 equine cases. By April 2024, the outbreak appeared to be over. Living in a world still reeling from the sudden rise of COVID-19, I felt relief mixed with terror. Why had this disease emerged now? When and where would be the next outbreak? Will mosquitoes proliferate in a warming climate, heightening the odds for contracting mosquito-borne diseases? How can we reduce the risk and protect ourselves?

Here’s what the CDC tells us: horses are the primary target. The Western equine encephalitis virus (family Togaviridae, genus Alphavirus) was discovered and isolated from the brain of a horse in California in 1930. Small songbirds serve as natural reservoirs for the virus, and mosquitoes like Culex tarsalis, a species endemic to irrigated agriculture and stream drainage, spread disease by biting birds, horses, and humans. There’s no cure for Western equine encephalitis. Twenty to forty percent of horses that contract the disease will die. But for horses, there’s good news. There’s a vaccine, and horses are vaccinated annually to prevent disease. 

Not so for humans. For humans, there’s no cure, and no vaccine either. Even though the aftermath of the disease in humans can be horribly grim—mild to severe neurological defects in those who survive the acute “brain fever” stage, with worse outcomes in children—there aren’t enough cases to attract the interests of the big pharma companies to develop a vaccine. Our only protection is vigilance. Long sleeves. Ordinary mosquito repellent.

Some people rely on Jergens Cherry Almond lotion. I take no chances. I use DEET. The stronger, the better.

The mosquito that bit my sister was surely not the only virus carrier that day, so why didn’t Pleasanton become the locus of an encephalitis outbreak? If children are more vulnerable, why were my brother and I unaffected? What about the daughter who spent so much time with the horses in that virus-endemic environment? Viruses are opportunistic. Pleasanton residents had lifetimes of exposure ahead of them. But for my sister, a fateful two hours on Easter Sunday led to brain damage so profound that she became virtually unrecognizable. Even if she’d survived pneumonia, she would have been sentenced to a lifetime of rage with no hope of recovery. 

For over fifty years, she was a silent statistic, one of those 639 confirmed cases in humans. She exists in the pages of a long-forgotten autopsy report. Yet without that report, I would have no clue to her disappearance. My parents, now gone, never spoke her name again. 

Her name is Adrienne.

I’m still searching for Adrienne before, because the seared-in afterimages are too punishing to endure. In her early life, those eight-hundred-and-six before days, she must have eagerly leaned forward in her highchair as I spooned rice cereal into her open mouth. She must have clutched my index fingers for balance as we toddled around the living room. She must have brought me books to read and said things that made me laugh. She must have danced with abandon, a child in the thrall of a dizzying twirl, an airborne toss. She must have giggled at that weightless feeling of her body brimming with delight.

I desperately want to know that once, Adrienne was happy. 

But if I didn’t have a photo on my desk, taken on Christmas Day, 1966—one of the precious before days—with me, my brother, my aunts and uncles, all twenty-five of Mom’s relatives scrunched around the living room couch, logically, I’d know she must have been there but my memory could not confirm it. Yet there she is on the far right, a three-year-old sprite in a crimson corduroy dress, her black hair pulled up into a tiny topknot, cuddled in Dad’s arms. All these years, my cousins have been too afraid to ask, “What happened to Adrienne?” This near erasure saddens me. 

Only now can I tell them, unburdened by the guilt of betraying my parents’ pain.

What I have of her is this: a professional portrait of her at eighteen months, head turned, smiling at someone out of the frame to her right, someone who I like to imagine is me. A 24-karat gold baby bangle, heavy to the touch, worn only once. A scuffed pair of black patent leather Mary Janes. Two diaper pins, still sharp. 

 

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AMBER WONG(opens in new tab) is an environmental engineer and memoirist from Seattle who writes about hazardous waste, Chinese-American culture, rowing, and the perils of being a bad Chinese daughter. She received her MFA from Lesley University, her bachelor’s and master’s degrees from Stanford University, and rowing instruction from Pocock Rowing Club. Being a bad Chinese daughter came naturally. Her work has appeared in Under the Gum Tree, The Plentitudes, Pangyrus, Terrain.org, Solstice, CRAFT (Winner of the 2022 CRAFT Creative Nonfiction Award), Creative Nonfiction, and other literary journals and anthologies. Some of these essays have been adapted for use in her upcoming award-winning memoir, The Hierarchy of Soup (Trio House Press, expected publication date: October 2027). Find her on Facebook @amber.wong.129.

Featured image by Zhenzhong Liu, courtesy of Unsplash.