Survivors

Today was a bittersweet day of celebration at the ETC. Unfortunately, I was on a plane, train, or automobile for R&R and didn't get to participate in person. But I had requested pictures of the event so I could enjoy it from my couch (!) in Barcelona. Today, on his 21st day in our unit, we discharged a cured 4-year-old and his mother. He is our first child under age 5 to survive. And we all fought our hardest for him every one of those 21 days. At Tuesday morning handover, we all gave a little cheer when we heard that the results of his first test were negative. But it was a cautious and short celebration, just in case. A few months ago, we had a 3-year-old get a first negative and die the next day. Today, though, I am sure the drums, singing, and dancing were loud and enthusiastic.

Three weeks ago, this little guy was admitted with his mother, 2-year-old brother, and 5-month-old sister. The father and another sibling had already died of ebola. The baby sister followed shortly after. We were able to be more aggressive with the two boys than we had been for other patients. Unfortunately, we lost the 2-year-old on day 8.

One of the biggest reasons we were able to provide the type of treatment we did was because we have caregivers. These are selfless women who have survived ebola themselves and now work in our ETC. We often have children in our ward who come without a family member, or the family member dies, etc. It is believed that one cannot get ebola a second time (provided we only have one strain here), so the caregivers can stay in the ward without PPE. Many times the caregivers are better at getting the kids to take their meds than we are, so I have on occasion just handed them the bag of pills and watched. Our 4-year-old refused almost all PO meds and food and was terrified of those of us in PPE. It was like wrestling a small alligator to get a line or tube or anything in him. If you managed to get some meds into his mouth, he'd pocket them in his cheeks like a chipmunk. But after 10-12 days of taking nothing by mouth except water, the caregivers were able to get tiny amounts of food into him. If we dropped it off and slowly backed away, making no sudden movements. These women made sure he didn't pull out his IV [too often], changed him, washed him, and held him. They've done the same for quite a few other patients. Many of them have lost their own families to ebola. One of the caregivers is even a survivor of ours. I wonder sometimes what it must be like for her to work in the same tent where she was a patient.

We talk about our patients a lot here. It's not like we all go home to our own separate lives. We go home to our coworkers! I've found that we most often talk about the ones we lost, and it's sometimes harder to remember the names of ones who were negative or cured. It makes me think of a few lines from The Guardian:

J: What's your real number?
B: 22
J: 22? That's not bad. It's not 200, but...
B: 22 is the number of people I lost, Jake. The only number I keep track of.

Today, though...today we celebrate life. A 4-year-old, his mother, and the 9 women who helped take care of them.

Ward[robe]

Every once in a while, I have a chance to think about how strange this experience is. One such occasion was last week on a nightshift while my buddy and I were standing in Probable for 90 minutes waiting for our fluids to finish. The patients were sleeping in their beds and my partner was sleeping standing up, so I was left to entertain myself. The one perk of being an only child is that I've become very good at this. Maybe it's not always a perk...the other day I was in pharmacy and didn't realize I was singing out loud about Vitamin C until the pharmacist, the tech, and another nurse all looked at me and asked if I needed some. But I digress. Anyways, after I plotted my revenge on the doctor who ordered IV potassium for the patient who could swallow pills, I got to thinking about being inside the ward. I decided it's kind of like being in Narnia. After the dresser inspects you and salutes you, thanks you, or tells you to "walk safe", you pass through the rope and time kind of ceases to exist (except when you're yelled at by the people who are outside because they think you've been in too long). They write the time we enter high risk on our arm, and, in theory, we should be able to keep track inside the ward. But of the 8-10 clocks in each tent, usually one (sometimes none) are working. Or they work and all say different times. It's basically a surprise every time you get to doffing where there's a working clock. Lucky for me I like surprises. The wearing of goggles added to my Narnia train of thought. No matter how unfoggy or scratch-free the goggles are, it's still not like real sight. Kind of like being in a dream.

But unlike Narnia, we seem to have a shortage of miracles here. We continue to get waves of patients from quarantined homes. Several weeks ago, we had a DOA. We swabbed the body and she came back positive. Then six of her relatives showed up here. Yesterday morning, after 14 days in our unit, the last of the six died. Statistically speaking, it seemed like she would make it. We usually manage to keep one out of the group. But two nights before, she told one of our nurses that her relatives were talking to her and she couldn't sleep. We also have another pregnant woman in our Confirmed tent. Her first lab test was indeterminate and we had to draw her again. Her second test came back negative. So she was just hanging out in our Probable tent waiting for her second negative (we draw two tests 48 hours apart). Thursday morning, I saw her mother when she came to visit. "How is she doing?" she asked. "Oh, she's good! Just waiting for her lab results to come back. We expect her to be negative and be able to go home," I told her. The second lab was indeterminate, so the lab was going to run the sample again. Then it came back positive. We were all shocked. The lab told us that her results were right on the line between positive and negative, so we drew her again to double check. Positive again.

As I've mentioned before, ebola is pretty harsh on pregnant women and their babies. The viral load is sky high in the placenta, so the baby usually dies, and then mom dies from hemorrhaging during the miscarriage. Or mom reports decreased fetal movement and then she herself dies after breakfast. Prior to about three weeks ago, I know of two women who survived ebola while pregnant. Both came from a clinic run by MSF where they only care for pregnant survivors. I believe one was still pregnant. (But don't quote me on these facts.) Then we had a pregnant woman survive at our ETC. We had to have a case conference to decide what to do with her. If she miscarried (or miraculously made it to a delivery), she posed a huge risk to anyone who was around her or helping her. MSF recommends induction. There was a brief murmuring about if we should induce at our facility. Thankfully, it was decided we definitely wouldn't do that in our ward. But then what is there to be thankful for other than me avoiding an ethical dilemma? I didn't have to refuse to give the drugs, but the patient was still talked into having the induction done somewhere else. The patient was totally against it, so one of our managers spoke to her husband, who then talked her into it.

On Saturday, we had seven admissions. Five of them were kids age five and under. One mom and her 4-year-old, 2-year-old, and 5-month old all came back positive. But amid that gloom, a miracle showed up. A 16-year-old came in with her newborn baby brother. The sister didn't meet criteria for admission, so she was sent to a center to be monitored for 21 days, and we kept the baby. We were all a bit skeptical when we heard the history. Supposedly, mom was ebola positive and died of postpartum hemorrhage. How did we have a live 3-day-old baby if mom was positive? But we got confirmation that mom was swabbed and the swab was positive. We put the little bug in the capable hands of our survivor caregivers and waited for his results. Negative. What?! So we're all holding our breath that today's results will be negative as well. According to our nurse manager, there is one other documented baby who survived and was delivered, but died at 6 weeks. So maybe our little guy will be the first. Maybe there will be more hope for pregnant survivors so they can try to carry their babies to term. Maybe the springtime is on its way...

[“Wrong will be right, when Aslan comes in sight,
At the sound of his roar, sorrows will be no more,
When he bares his teeth, winter meets its death,
And when he shakes his mane, we shall have spring again.” 
― C.S. Lewis, The Lion, the Witch, and the Wardrobe]