Ventrilocricket

For about a week now, there has been a cricket in my bathroom. He goes on and on all night and I can't find him. At one point I thought he was hiding behind the toilet, so I sprayed a lot of deet back there. Quiet until the next night when he got more obnoxious just for revenge.

Our patients seem to come and go in waves. The number of cases in the country as a whole is going down, and the other ETCs in the area also have lower numbers now. We were quite full for the first month I was here. Then about 10 days ago we emptied out. One day last week, Carrie and I were training the two new nurses (one who grew up in Lancaster - it's so frustrating trying to play the Mennonite game with a Baptist), when the next wave came.

While all the international nurses work 12 hour shifts, the local nurses work 6s during the day. All of our admissions seem to come around change of shift. We knew 6 were coming. Two local nurses triaged the first two, and then the third ambulance came with four patients inside. They're really not supposed to do that, because one of the patients could be negative until you pile two positives in on top of them. That and it's a lot of work and coordination for one team to do that many at once. So Carrie and I each buddied with a new nurse and went in.

We were told two patients were ambulatory and two needed stretchers. Assuming the ambulatories were more likely to be suspects, we untangled them from the other two and brought them through first. The engineering team was doing something to the gate on the ambulance bay, making it impossible to hear, so we didn't get the most thorough triage. Enough to know they met criteria and put them in Suspect. The next two we managed to get out without stretchers, thankfully. As we were hobbling into triage with them, we were told from the low risk side (through the plexiglass) to just take them both straight to Probable. So off we went like a herd of turtles.

The one lady was quite sick. I kept sternal rubbing her and yelling at her to wake up. She perked up a bit after we gave her a liter of fluid. The other lady was older, but she seemed much better. She just sat there waiting patiently for us to draw her blood. She chowed down on the banana we gave her and she fussed with her head wrap.

We finished labs and lines and then doffed and went to the medical tent where we finally got the real stories on our admissions. If they had been truthful right away, all four would've gone to Probable. Apparently, they were all from the same village and had attended a funeral. When the village chief asked them about it, they told him that no one had died, he just wasn't around because he went to Guinea. Then they started to get sick. The chief called an ambulance, and after catching the one woman who tried to run away, all four were brought to us. The first woman who was admitted by the local nurse team had attended a birth and then gotten ill. The following day, the sickest funeral attendee's 1-year-old daughter was admitted.

I switched to nights the day after the women were admitted. We also had 6 or 7 come into suspect. After my first pass inside, our epidemiologist called me to give us lab results (a mere 32 hours later). "You have 5 positives and the rest are negative," she said. "I know which ones they are," I said. I listed the ID numbers for the five ladies, and she confirmed that I was correct. Carrie and I were on with just 3 local nurses that night, so we had to map out quite a plan to get them all moved to the confirmed tent. It only took a few hours. 

Our sickest lady was rapidly declining. She had progressed into respiratory distress. We sat with her for awhile, trying to make her comfortable. At one point, Carrie noted that the other four patients had fallen asleep while we sat there with one awake, and quite likely the next morning four would wake up and one would not. I was too tired to comprehend what she meant at first. It finally came to me when we were doffing later. When they fell asleep, their friend was alive, but the people in suits were putting things in her IV. They were obviously already suspicious of the whole ebola thing. Luckily, our lady was still somehow alive when we made our morning pass.

As we watched her struggle to breathe, I couldn't help but think what a high price she was paying for her insistence on participating in a funeral. She died later the next afternoon, and then another woman died each day subsequently. We have one left now, and I think she'll make it. Sometimes it's worse to know their story. The first woman's daughter miraculously had two negative tests and we discharged her a few days ago. She is cute as a button and was less than thrilled about the chlorine shower she had to take to get out of the ward.

I was on the other side of the plexiglass for another admission this week. We were going through the triage questions  and it seemed he would be probable (with diarrhea and hiccups). Then we got to the question about contact with a sick or dead person. He said his wife died. We asked his wife's name, and then we all groaned when he responded. His wife had been our patient. Our first pregnant patient. She died within 24 hours of being admitted. It was no surprise when I got his labs back last night. We moved him into confirmed this morning, bloody diarrhea, hiccups, and all.

On a lighter note, I think I should get some credit from the parents for how I eased them into me coming here. We all like to sit around and tell the stories of how our families took the news. One doctor told her parents the night before she was flying, and then her sister met her at the airport to try and talk her out of it. One of our Kenyan nurses has his parents thinking he's just doing education here. And one of our local nurses told her parents she works at a supermarket. She said that after it's all over, she'll tell them that the money that has been paying for their food is ebola money. She thinks it's hilarious. 

Two nights ago, I was in my room, fed up with the cricket. He sounds like he's everywhere. Finally, I thought he might be behind the sink. It took me an hour or so, but I eventually located him. With the deet. This morning after my night shift, I slept peacefully.