A few days ago, two coworkers and I were discussing how many different kinds of people you meet doing international work. "You definitely meet all kinds..." I said. In light of the President's Day weekend activities at home, one of them asked if we use every part of the pig when we butcher. (I did give the correct response, but then one of them asked what the squeal was.) "What about the ears?" the other asked, "What do you do with those, wear them?" she laughed. And after I had to respond, "So, funny story...", I realized that I am actually the "all kinds."
We haven't yet discovered what makes our newest nurse unusual. He spent a few weeks working in Liberia last Fall, so his training here is a bit abbreviated. But as seems to have become the custom, I take the new person into the ward for his first admission. And it always seems to be a clown ambulance... So the other day, the new nurse joined me and my national nurse for the admission. Per the training director's orders, he was still only allowed to observe, he couldn't touch any patients.
It was a bit of a fiasco trying to triage these three patients. It seemed like they had collaborated on the ambulance ride to come up with a story. We already knew they were from a quarantined home, and the ambulance nurse told us that it was because someone died. The patients were a brother and sister and their nephew. All three looked at us with their bloodshot eyes and denied contact with any sick person. We would try to ask the child questions and the uncle would jump in and answer. "Have you had hiccups?" we asked him. He shook his head no and then hiccuped. Eventually it came out that their mother had been in another ETC and survived. Carrie was on the other side of the plexiglass and finally said, "We know someone died. Who died?!" Their father.
We walked all three patients into Suspect. We had to draw blood on all three and start lines in two of them. When we were in triage, I had washed my hands and somehow poked a hole in my outer glove when turning off the faucet on the bucket. If something happens to the outer glove but the first is still intact, you can just put a new glove on over the second. So someone threw me another pack of surgical gloves. So now we had three bloods to draw and two lines to start and I'm wearing three gloves on my dominant hand. Luckily they all had pretty good veins and my local nurse could do IVs. Our new nurse, who works in the ER at home, was still watching, much to all of our frustration.
I drew the first patient's labs and then moved on to the woman who needed labs and a line. The local nurse was going to work on her. I put the tourniquet on just to look. The patient had nice veins in her AC, so I grabbed the nurse two 18 gauges. I went to the patient's other side and told her she could squeeze my hand if she wanted to. I wasn't sure how much English she understood, but I talk to my patients anyway. (I mean, I have full conversations with Bud...) Then the nurse stuck her and I discovered that she had definitely understood me. She almost broke my hand. And that's when I looked at my nurse and saw that she had stuck the patient in the hand with my 18 gauge. "The veins are too small for this needle," she told me. Right...that's why I was aiming much higher in the arm... So we had to do the whole sticking/hand in the vice grip thing again. The nurse got the access and we drew the lab, then we started taping down the IV. Apparently "let go" was not in the patient's vocabulary, so I was reaching across the bed and trying to put the tegaderm on with one hand. The nurses here aren't experienced with tegaderms. While I was trying to be helpful, I ended up getting one of the strips on the back of the teg stuck across my three middle fingers. Really stuck. I tried to carefully pull it off, but I knew my glove would rip and there was no way I was getting a fourth glove on (oh, I mentioned that this was also on my right hand?). I soaked my hand in a bucket of 0.5% chlorine. Props to the adhesive manufacturers. And, of course, the one pair of scissors we keep in the ward was nowhere to be found. Oh hey, then we somehow lost the line. After we came out, it was pretty funny that I had taped three of my fingers together, but when my goggles were fogging and there was no end or success in sight (no pun intended), I wasn't as amused.
The next day when we finally got labs back (because it's back to taking 12-36 hours), they were all positive. A few hours ago when I was in the ward, we moved the the brother and nephew into a different pod so they wouldn't have to watch the woman die.
I had another new experience this week. While I was on R&R, a group from a University in the States stopped by to discuss a study they're doing. As a parting gift, they left us two cool vests. I finally got to wear one. We had a mandatory training this week and sent most of our nurses during the afternoon shift, so Carrie and I took the vests and went in to do afternoon meds. I've heard that it's below zero at home. Here the ambient temperature is 94. Then put on full PPE and go inside an unventilated tent. Vest with five giant ice packs in? Yes please. It was a bit unpleasant when putting it on in the pharmacy, and it's a little weird to have spots on your body that almost hurt from cold when you can feel sweat on other parts of your body.
We had fluids in two different wards, and we figured we would spend about an hour in each ward. And then two of our suspect patients pulled out their lines. At the same time. (Yes, one was the kid from the day before.) When we were getting ready to restart the first line, Carrie was inspecting my face and said my corners were getting close (you have to see all four corners of your hood/mask inside your goggles). In my frustration, I must've opened my mouth too wide a few too many times, because after I blew two of his veins, Carrie said she couldn't see my bottom corners and I had to leave.
So I only got to spend an hour in the cool vest, which was kind of pointless because I didn't even get to take advantage of the vest's purpose. However, I did notice that I did not get out of breath at all while inside, and that was really nice. I'm told that March is the hottest time of the year here, so I'm sure there will be more opportunities to use them. I hope everyone at home is enjoying the 100 degree difference.
Sunday, February 15, 2015
Sunday, February 8, 2015
There and Back Again
It's not that I love (or really even like) to fly, but sometimes I feel relieved to be back on an airplane. Like a third home, if you will. Which is why not being able to get on that airplane is so anxiety-provoking. The end of January was my R&R time, and I was really excited about it. There are two airlines flying into Sierra Leone right now, and the one I was on flies on Sundays and Wednesdays. I arrived at the airport with more time than I would have needed, in spite of having to get out of my car at the entrance, walk in, wash my hands, get my temperature checked, get back in the car, drive 60 feet, get out, wash hands, get my temperature checked... Anyways, I had plenty of time, and then the flight was delayed getting in. By two hours. Despite the fact that the plane actually stops 100 yards from the airport, they still loaded us all onto a bus where we sat for almost an hour.
When we finally landed in Brussels, I had 45 minutes until my next flight. We all had to stand in line and get our temperature checked. And then I took off sprinting through the airport. (Is there a Guinness record for number of airports you've run in?) I am weaving in and out of people on the moving sidewalk, huffing and puffing with my two backpacks stuffed full because I refuse to check a bag. And after 10-15 minutes of that, I come to find myself in line at passport control. Stupid European Union. Stamping your passport at the first point of entry rather than your final destination.
Made my way to the airline service desk to try to rebook my flight. Ended up having to buy a whole new ticket. And that's why I don't check bags, folks! My luggage would still be lost somewhere in Singapore. Even the ticket agent was relieved. Anyways, because I had to buy a new ticket, I technically had to leave the airport and come back in, which meant they stamped my passport AGAIN. I was already nervous about running out of pages because they used three whole pages for my SL visa. By the end of this story, I'll have 4 more stamps.
I did finally make it to Croatia, and I was only three hours later than my original arrival time. I was spending the week with two of my friends from Haiti. A car from the hotel was supposed to meet us at the airport earlier (Becky and I were supposed to be on the same flight from Munich), but now I figured I'd just take a taxi. I exchanged some money and was looking for signs when I suddenly got hugged. My first human contact in six weeks (other than the accidental high-five with Carrie)! Becky had talked the hotel into driving back to the airport to get me.
We spent that evening walking around Split. We walked a bit more than we intended to, since we didn't take the map with us and we ended up getting lost. Luckily we found a coffee shop where some guy called his friend to ask for directions and then drew us a map on his receipt. By the time we got back to our hotel, we were too famished to put any effort into finding a restaurant. Plus it was really cold. So we asked the manager if there was anywhere that delivered pizza. He called some people and then ended up buying the pizza for us.
Alex finally joined us on Wednesday, and the three of us had the evening together before Becky had to head back to Germany on Thursday. After we dropped her off at the airport, we rented a car and set off on an adventure trying to find this national park. I just knew there were waterfalls and that's what I wanted to see. We had the route on Alex's phone, but the blue dot didn't move, so figuring out where we were was a little difficult sometimes. The closer we got, the lower the temperature got, until we were finally in a Croatian winter wonderland. I had packed my chacos for the hiking, but luckily I had decided to wear closed-toed shoes. I also had my mittens. Yes, I brought mittens to Africa.
We paid our entrance fee, got the map, and our hot chocolate, and cheerily set out walking through the snow. We found the waterfalls within 10 minutes. And then we probably could've turned around and gone back to our car and been perfectly content. But we kept walking. I was okay until we got to the pavilion where we were waiting for the ferry. The windy pavilion. My shoes and socks were wet by then. The Korean woman we had picked up along the way (because I need an Asian wherever I go), thought it would be appropriate to play songs from the Frozen soundtrack on her phone. The ferry finally came a half hour later, and we took what I'm sure is a lovely ride up the river when it's green and 70 degrees. Then we hiked from the dock up to the shuttle area. I was so thrilled to get on the shuttle. Until it took us back to Station #1, where we had to get back out and hike the 20 minutes back to the park.
Friday we checked out of our hotel and drove to Dubrovnik. I can't believe our tiny car didn't blow off the roads in the monsoon we were driving in. I am also thankful that they did not stamp my passport when we drove through Bosnia. We had the same trouble with the blue dot and finding our apartment and ended up driving in a circle three times. But then we found that that's because our apartment wasn't on a street. In Split and Dubrovnik (and I'm sure numerous other places I haven't been), there are mini towns inside old palace walls. There are just walking roads, but they all have names. Names that show up on google maps and make you think you can drive there. But we finally found it, then an hour later found the person to let us inside, and then we could go get pizza and more salad. (I ate salad and doughnuts on R&R like it was my job.) It kept raining on Friday, and Alex had to leave very early on Saturday morning for her flight, so we didn't do much exploring. I walked around inside the castle walls some on Saturday before I set off on my trek to the airport shuttle. I would definitely go back to Dubrovnik and spend more time being touristy.
And now I'm back in Lunsar and it feels like R&R was a nice malaria med dream I had. The next wave of patients came, and our confirmed ward is almost full again. But full of peds this time. We have a whole bunch of teeny tiny babies, like six months and under. And then we have a bunch between 8-13. A lot of them are from the same families. Four patients were from the same quarantined house. They got sick on day 18 of their quarantine. This morning a nurse and I were feeding and changing one of our 10 year olds, and I was encouraged that she was sitting up and chatting. And then I asked my nurse what she said. Apparently, our patient had rambled on and on about how someone had stolen her orange this morning. Encephalopathy is never a good sign in our ward. So we'll see.
When we finally landed in Brussels, I had 45 minutes until my next flight. We all had to stand in line and get our temperature checked. And then I took off sprinting through the airport. (Is there a Guinness record for number of airports you've run in?) I am weaving in and out of people on the moving sidewalk, huffing and puffing with my two backpacks stuffed full because I refuse to check a bag. And after 10-15 minutes of that, I come to find myself in line at passport control. Stupid European Union. Stamping your passport at the first point of entry rather than your final destination.
Made my way to the airline service desk to try to rebook my flight. Ended up having to buy a whole new ticket. And that's why I don't check bags, folks! My luggage would still be lost somewhere in Singapore. Even the ticket agent was relieved. Anyways, because I had to buy a new ticket, I technically had to leave the airport and come back in, which meant they stamped my passport AGAIN. I was already nervous about running out of pages because they used three whole pages for my SL visa. By the end of this story, I'll have 4 more stamps.
I did finally make it to Croatia, and I was only three hours later than my original arrival time. I was spending the week with two of my friends from Haiti. A car from the hotel was supposed to meet us at the airport earlier (Becky and I were supposed to be on the same flight from Munich), but now I figured I'd just take a taxi. I exchanged some money and was looking for signs when I suddenly got hugged. My first human contact in six weeks (other than the accidental high-five with Carrie)! Becky had talked the hotel into driving back to the airport to get me.
We spent that evening walking around Split. We walked a bit more than we intended to, since we didn't take the map with us and we ended up getting lost. Luckily we found a coffee shop where some guy called his friend to ask for directions and then drew us a map on his receipt. By the time we got back to our hotel, we were too famished to put any effort into finding a restaurant. Plus it was really cold. So we asked the manager if there was anywhere that delivered pizza. He called some people and then ended up buying the pizza for us.
Alex finally joined us on Wednesday, and the three of us had the evening together before Becky had to head back to Germany on Thursday. After we dropped her off at the airport, we rented a car and set off on an adventure trying to find this national park. I just knew there were waterfalls and that's what I wanted to see. We had the route on Alex's phone, but the blue dot didn't move, so figuring out where we were was a little difficult sometimes. The closer we got, the lower the temperature got, until we were finally in a Croatian winter wonderland. I had packed my chacos for the hiking, but luckily I had decided to wear closed-toed shoes. I also had my mittens. Yes, I brought mittens to Africa.
We paid our entrance fee, got the map, and our hot chocolate, and cheerily set out walking through the snow. We found the waterfalls within 10 minutes. And then we probably could've turned around and gone back to our car and been perfectly content. But we kept walking. I was okay until we got to the pavilion where we were waiting for the ferry. The windy pavilion. My shoes and socks were wet by then. The Korean woman we had picked up along the way (because I need an Asian wherever I go), thought it would be appropriate to play songs from the Frozen soundtrack on her phone. The ferry finally came a half hour later, and we took what I'm sure is a lovely ride up the river when it's green and 70 degrees. Then we hiked from the dock up to the shuttle area. I was so thrilled to get on the shuttle. Until it took us back to Station #1, where we had to get back out and hike the 20 minutes back to the park.
Friday we checked out of our hotel and drove to Dubrovnik. I can't believe our tiny car didn't blow off the roads in the monsoon we were driving in. I am also thankful that they did not stamp my passport when we drove through Bosnia. We had the same trouble with the blue dot and finding our apartment and ended up driving in a circle three times. But then we found that that's because our apartment wasn't on a street. In Split and Dubrovnik (and I'm sure numerous other places I haven't been), there are mini towns inside old palace walls. There are just walking roads, but they all have names. Names that show up on google maps and make you think you can drive there. But we finally found it, then an hour later found the person to let us inside, and then we could go get pizza and more salad. (I ate salad and doughnuts on R&R like it was my job.) It kept raining on Friday, and Alex had to leave very early on Saturday morning for her flight, so we didn't do much exploring. I walked around inside the castle walls some on Saturday before I set off on my trek to the airport shuttle. I would definitely go back to Dubrovnik and spend more time being touristy.
And now I'm back in Lunsar and it feels like R&R was a nice malaria med dream I had. The next wave of patients came, and our confirmed ward is almost full again. But full of peds this time. We have a whole bunch of teeny tiny babies, like six months and under. And then we have a bunch between 8-13. A lot of them are from the same families. Four patients were from the same quarantined house. They got sick on day 18 of their quarantine. This morning a nurse and I were feeding and changing one of our 10 year olds, and I was encouraged that she was sitting up and chatting. And then I asked my nurse what she said. Apparently, our patient had rambled on and on about how someone had stolen her orange this morning. Encephalopathy is never a good sign in our ward. So we'll see.
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| Walking in Split |
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| Inside Diocletian's Palace |
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| Random apartments inside the palace walls |
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| Inside the site of my first salad. Lots of people were sitting outside, but we opted for indoors. It's hard to control utensils while wearing mittens. |
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| We paid the $3 to walk around in the "catacombs" under the palace. January definitely isn't tourist season (someone in a restaurant asked us why we were even in Croatia), so we were the only ones there. |
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| Plitvicka Jezera - the national park. I'm quite sure that Slavic languages would not be my thing. |
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| I think you can see our little ferry in there somewhere |
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| The Before picture. There is no After. |
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| Our apartment in Dubrovnik up there on the right. Just 65 steps or so with our bags. |
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| Inside the castle in Dubrovnik. Alex was gone by then, and I'm a terrible lone tourist, so I don't know what it's called. |
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| I may have gotten lost while trying to find the path to walk around the top of the castle walls. So I toured some apartments inside the castle until I found my way back out. |
Friday, January 23, 2015
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.
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.
Tuesday, January 13, 2015
Mythbuster
Sometimes we sit at the ETC and muse about what we'll tell our families about that particular day or week. As in, "What's the good, vague part of the last few days that won't freak anybody out?" (Just kidding...) And sometimes our epidemiologist sits at her desk listening to us talk and laments over how she would love to write down some of the things we say, but no one else would understand. Medical humor, I suppose. This is my lead-in to how I don't know what to post again, but I sometimes get panicky texts/emails/whats app messages if I go too long without writing.
We had a bit of a theme over the last few days: pregnant patients. Ebola is somewhat famous for it's treatment of this type of patient. I tested a story out on a friend the other morning, and we determined it wouldn't do for the blog. So in honor of said friend's love of psychology, and in honor of the abundance of social workers in my life, I dedicate this post to our Psychosocial department.
If you were to visit our ETC, you'd see Psychosocial around, but you'd only be able to pick them out because they have weird scrubs (think 60s...). I've often said that my housemate, Anna, is the most overworked and under-appreciated person at the ETC. As a nurse, I have the glamorous job (so to speak...as some may not consider stepping in 4-5 different body fluids simultaneously glamorous). The medical team gets the most credit. We'll put it that way. But a few days ago, I got to do something new. Anna came into the medical tent looking for a specific chart. The family of a deceased patient was in her tent, and Psychosocial likes to give the family some specifics about the patient's treatment. Since I happened to know the patient's ID number off the top of my head (only because we thought we had a screw up with lab results) and there weren't any doctors around, she asked if I would come speak to the family. I was less than thrilled, but I agreed.
There are a lot of myths and uncertainties surrounding Ebola and treatment centers. Our local doctors were telling us that some Sierra Leoneans still don't believe Ebola is a real thing. Others think that Westerners are at treatment centers poisoning patients. There was one village here where a whole bunch of sick people were just rounded up and taken off to holding centers. Their families didn't hear from them again. Some of these patients ended up at our facility. Two were cured, and on the day of their discharge, Anna went back with them to their village. Basically, she had to read a list of deceased patients while families gathered around to hear if she had any news about their loved one. Her retelling of it reminded me of Gone with the Wind. Anyways, for these reasons and a few more, Psychosocial likes to have one of the medical personnel speak with the family. It kind of helps if the family can see someone who took care of their family member.
As we clunked across the rocks from the medical tent to the family tent, Anna told me what to say. I wasn't sure how much information/detail to give. For this patient in particular, I figured it wouldn't be helpful to say, "Yes, we knew she was pretty sick, but we were all still quite surprised when she died." So, I told them what her symptoms were and how we tried to treat them. Then they asked about this patient's brother-in-law. I remembered the patient, but didn't know that the two had been related. They said that he was the strongest person in their family and they didn't understand how he could have died. I agreed, he was quite strong. That's why he hung on for so long it was almost painful to watch. You knew that he knew he was going to die. I explained how sometimes some patients start bleeding and then there's not much we can do, and I also had to tell them that their brother began refusing to eat. Anna asked them if they had any questions about anything. They said they had two other family members who were sick but didn't come to our ETC and they lived. That makes you feel awesome. But Anna did her thing and explained how there's still a lot people don't know about Ebola, so we do our best but sometimes who lives and who dies just feels like luck. Amen, sister.
As we walked back to the medical tent, I thought to myself how glad I was that I don't have Psychosocial's job. I have to talk to the patients' families for 5 minutes a week. I don't have to tell them that we can't unzip the body bag to let them see their family member one last time (or simply to convince them that it really is their family member). I don't have to tell the lone survivor of a family unit, "I'm so sorry for your loss. Here's a bag of rice." I don't usually see the family once the patient leaves (unless they come back as patients...that was a first last week). So here's to the people in the funny scrubs. Quietly taking care of people. Unless, of course, we're discharging a cured patient. Then they break out the instruments and dance.
On a completely unrelated note, I finally had time to take a few pictures (/steal a few pictures from another nurse). Hopefully this will satisfy some curiosities.
We had a bit of a theme over the last few days: pregnant patients. Ebola is somewhat famous for it's treatment of this type of patient. I tested a story out on a friend the other morning, and we determined it wouldn't do for the blog. So in honor of said friend's love of psychology, and in honor of the abundance of social workers in my life, I dedicate this post to our Psychosocial department.
If you were to visit our ETC, you'd see Psychosocial around, but you'd only be able to pick them out because they have weird scrubs (think 60s...). I've often said that my housemate, Anna, is the most overworked and under-appreciated person at the ETC. As a nurse, I have the glamorous job (so to speak...as some may not consider stepping in 4-5 different body fluids simultaneously glamorous). The medical team gets the most credit. We'll put it that way. But a few days ago, I got to do something new. Anna came into the medical tent looking for a specific chart. The family of a deceased patient was in her tent, and Psychosocial likes to give the family some specifics about the patient's treatment. Since I happened to know the patient's ID number off the top of my head (only because we thought we had a screw up with lab results) and there weren't any doctors around, she asked if I would come speak to the family. I was less than thrilled, but I agreed.
There are a lot of myths and uncertainties surrounding Ebola and treatment centers. Our local doctors were telling us that some Sierra Leoneans still don't believe Ebola is a real thing. Others think that Westerners are at treatment centers poisoning patients. There was one village here where a whole bunch of sick people were just rounded up and taken off to holding centers. Their families didn't hear from them again. Some of these patients ended up at our facility. Two were cured, and on the day of their discharge, Anna went back with them to their village. Basically, she had to read a list of deceased patients while families gathered around to hear if she had any news about their loved one. Her retelling of it reminded me of Gone with the Wind. Anyways, for these reasons and a few more, Psychosocial likes to have one of the medical personnel speak with the family. It kind of helps if the family can see someone who took care of their family member.
As we clunked across the rocks from the medical tent to the family tent, Anna told me what to say. I wasn't sure how much information/detail to give. For this patient in particular, I figured it wouldn't be helpful to say, "Yes, we knew she was pretty sick, but we were all still quite surprised when she died." So, I told them what her symptoms were and how we tried to treat them. Then they asked about this patient's brother-in-law. I remembered the patient, but didn't know that the two had been related. They said that he was the strongest person in their family and they didn't understand how he could have died. I agreed, he was quite strong. That's why he hung on for so long it was almost painful to watch. You knew that he knew he was going to die. I explained how sometimes some patients start bleeding and then there's not much we can do, and I also had to tell them that their brother began refusing to eat. Anna asked them if they had any questions about anything. They said they had two other family members who were sick but didn't come to our ETC and they lived. That makes you feel awesome. But Anna did her thing and explained how there's still a lot people don't know about Ebola, so we do our best but sometimes who lives and who dies just feels like luck. Amen, sister.
As we walked back to the medical tent, I thought to myself how glad I was that I don't have Psychosocial's job. I have to talk to the patients' families for 5 minutes a week. I don't have to tell them that we can't unzip the body bag to let them see their family member one last time (or simply to convince them that it really is their family member). I don't have to tell the lone survivor of a family unit, "I'm so sorry for your loss. Here's a bag of rice." I don't usually see the family once the patient leaves (unless they come back as patients...that was a first last week). So here's to the people in the funny scrubs. Quietly taking care of people. Unless, of course, we're discharging a cured patient. Then they break out the instruments and dance.
On a completely unrelated note, I finally had time to take a few pictures (/steal a few pictures from another nurse). Hopefully this will satisfy some curiosities.
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| My house! |
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| The main walkway. Triage and wards to the left, "offices", pharmacy, kitchen to the right |
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| The medical tent |
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| Doffing area |
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| Donning |
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| Meds waiting to be passed from low to high risk |
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| Because we can't take pictures in the wards...here's the next best thing to seeing the inside |
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| Two nurses calling the vital signs over the fence to the scribe |
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| Carrie and I wanted to take pictures on our night shift. We can't touch, so this is our Awkward [Ebola] Family Photo |
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| Correction: You are allowed to bump elbows with people. But no high fives, handshakes, or any other touching |
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| Donning in the early morning |
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| Tearing the hole in my hood before the dresser gets to me because I don't like the way they do it |
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| The dresser asked my name, said, "Oh, that's my wife's name!" and then proceeded to spell it incorrectly on my head |
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| The nurse Carrie made responsible for taking pictures was a bit overzealous in his duties and wouldn't let us doff until he got pictures |
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| Sunset outside the Lunsar ETC |
Friday, January 2, 2015
A Day in the Life
My dilemma is that I feel like I need to write a post before we inevitably lose internet for days again, but I don't have anything really exciting to write about. So on the advice of a friend, I am taking you through a typical day.
Every day I cry a little bit when my alarm goes off at 6:20. Not because I don't want to go to work, but because waking up is hard. So I hit snooze for the next 20 minutes or so and then hope I'm not late for breakfast.
We take a van to the site, hoping all the way that we beat the bus full of national staff. If we get there at the same time, there's no room to change and no hope of finding scrubs that fit. Yesterday, a man without pants handed me my boots.
At 8am, all the nurses and doctors gather around the whiteboards (because no disaster response is complete without whiteboards) to get handover from the night shift. We're still working on how to do a proper handover (i.e. not just reading out loud everything on the board about every patient). We have plenty of handover opportunities to practice. While all the international nurses do 12 hour shifts, the local nurses (and the international doctors...) are split into 3 shifts: 2 6's during the day and a 12 overnight (during which they usually sleep).
We make several passes through the wards on each shift, so after handover, we have to make assignments. There's usually plenty of chiming in about who wants to do what, or who just did that job yesterday, or who can't go in because they picked open a zit on their face (you can't enter the hot zone with an open cut). The first pass is for patient care (feeding those who need help feeding, changing those who need changed, etc). In the morning we also have a phlebotomy pass to draw labs on patients and start or restart IVs. Not many nurses here have those skills. Or, I get put on phlebotomy with one of our four "lab techs" only to find that he thinks it's acceptable to try to draw blood on a 4-month-old with an 18 gauge needle. We've since introduced him to the butterfly needle.
Our second pass is always medications and vital signs (called TPR here, for Temp, Pulse, Respirations). Let me tell you, it is a real treat to try and get heart rate and respirations with goggles. I'm not sure who, but someone thought it would be a good idea to clean all of our goggles with some sort of scratchy device. It doesn't even matter anymore if you put the anti-fog spray on them, because you can't see a thing through all the scratches as soon as you put the goggles on your face. Sometimes if you tilt your head just right, you can see out the top or bottom. But you have to find a clock that's working first. Yesterday, I was helping with medications and I was doing the TPR so the national nurses would have time to hang all the IVs (we can't leave them attached when we aren't in the ward, so we do a 500mL bolus - or whatever can go in - before we have to leave). We got a new expat nurse in a few days ago, so she was following me around. It was her first time in the ward, so she wasn't touching patients, just getting a feel for things. She volunteered to watch the time so (theoretically), we could get TPR done faster and then help with the rest of the drips and meds. As we were in the middle of getting a pulse on one woman, the clock died. Second hand just stopped moving.
With so many fluids, the med pass often takes at least 90 minutes. Then there's yesterday when the national nurses saved the two hardest patients for last (I assume hoping that I would do them), and then they told me that they just couldn't give meds to those patients because they wouldn't cooperate. These women are laying on the floor and I think they ignore us sometimes, but I really didn't have much trouble hooking up their lines. But then I just had to wait another half hour until they were finished.
Anything that goes into the ward can't come out again. So we have to call all of our vitals (and doctor assessments) over the fence to the person posted outside. When the med pass goes really long, it's hard to leave the ward and then know you have another 10 minutes of shouting and enunciating to do while you can feel all the sweat inside your suit ("Bed C7." "C7." "Temperature 38.2" "38.2" "Pulse 130." "113?" "130. One. Three. Zero." "One three zero."). I'm always so thankful when the person outside isn't one who wants to double check every patient after we finish.
The doctors make a round through the ward once a shift with a nurse who speaks Temne. Often they come in during the med pass, tell us to hang another bag on a patient, and then get to leave before us. Something we're going to discuss at our meeting in an hour. Most of them are really good at helping out, though. ("Everyone does nursing care during Ebola!")
Our last pass of the shift is patient care again, which includes passing the next meal. Then we have change of shift and handover, and we do it all again with the afternoon shift.
We may also have admissions and discharges. If possible, we try to clump the discharges in with another pass. That might mean that psychosocial comes and says that the discharge is ready from their end, so you yell over the fence to whoever is in the ward and say, "Hey, get so-and-so ready to go and send them to the shower!" But sometimes it's a bit more organized than that. Admissions can be a bit trickier, depending on the number of patients and their conditions. If the first patient you triage isn't ambulatory or they're wet (vomiting and/or diarrhea), they go right to Probable. Then if the next patient is better, you have to send someone else in for them because you can't go backwards to Suspect.
So to answer those who have asked what I do when I'm not in the suit: I help to make all of the above things happen! There is a lot of organizing and coordinating that goes on outside the ward, between medical and WASH and/or psychosocial. We have to make sure the labs get collected out of the hot zone, disinfected, and sent to the lab. We have to sign off meds in charts, sign off lab draws, and make sure the local nurses sign off their charts. We also always have a person posted outside each ward that has people in it in case they need something (i.e. "Hey, C16 is vomiting! Get the doctor to write for zofran and then bring it to me." or "So-and-so needs another blanket!").
It all depends on the number of patients and their conditions and the number of staff. Yesterday was so slow. We had so many national staff on in the evening that I didn't need to go in a second time. I ended up folding and organizing all the clothes in the psychosocial tent. I had gone in there to ask for long sleeves and long pants for our patient who also has TB. We had to put her in the convalescent tent all by herself so she wouldn't infect any of the other confirmed patients.
This woman really amuses me. She speaks English really well, and I saw her very soon after she got admitted, so she has started calling me "My Friend." Any time she sees me (in PPE), she says, "It's my friend! You're my friend!" However, the other day I went to talk to her through the fence when I wasn't in the ward. I said my name so she would know who I was (name is always written on my head, remember), and she said, "Nice to meet you." ... So she recognizes me in the PPE, but not as a regular person. Guess that answers my question about whether or not it's possible to connect with a patient when you just look like a marshmallow with goggles.
Thursday, December 25, 2014
Christmas in Ebola
Last night at supper, our site manager was pretending to make a phone call to someone (I can't remember all the details of the joke, but imagine her speaking with a Scottish accent), and she started out by saying, "Yes, hello! We're here in Ebola!..."
While it was just really funny at the time, it's true that "Ebola" has truly become the identity of this place. I was talking with one of the local nurses today while we were posted outside the Suspect tent, and she was telling me how all of life in Sierra Leone has stopped because of Ebola. Schools have been closed since May, hospitals are closed, stores are closed. Literally everything revolves around Ebola. Even Christmas, which was "cancelled" by order of the President.
While Sierra Leoneans were not able to participate in their usual Christmas traditions, we had a few small treats at our ETC. Special meals for the staff and patients, a movie for patients who were well enough to venture outside the tent to watch, and some Christmas music. (You would think that people would be able to remember all the gifts in the 12 Days of Christmas by the third time through the song in it's entirety, but you would be wrong.)
Despite the efforts, much of the day was just the same as any other. While drinking my coffee this morning (and wondering not for the first time if the staff is secretly putting out decaf...), I thought of an episode of MASH where they try to keep a soldier alive until after midnight so his family doesn't have to think of Christmas as the day he died. I told the people at my table that I hoped no one dies today. Obviously, I hope this every day, but I was sharing in the sentiment of my fictitious fellow medical professionals.
Unlike every one of my previous Christmases, this one was exceptionally hot. I was on for admissions today, and the admissions usually come between noon and 2pm, when the heat is getting most intense. Our first ambulance arrived shortly after noon. Heather (a nurse I actually worked with at Medishare in Haiti...small world) and I went in with our Temne speaking nurse to do the triage. There were two patients in the ambulance, and the triage process followed by moving them into the Probable ward took probably half an hour. It seems so much hotter when you're not moving because you can feel how much you're sweating. If you're doing things, you don't think about it. For this reason, people sometimes pace if there's a line to doff. Triage is a lot of standing and waiting while we ask the patient questions. The area isn't that big, and there's plexi-glass to separate the low-risk and high-risk zones. Plus, when you have a suspect patient that you're moving, you have to have a WASH sprayer follow behind you, spraying where you've walked. The point being that it's hard to pace in triage. So while there have been times that I've been in for two hours and been fine, after 20 minutes today I could tell that my moisture-wicking socks were putting forth their best effort to save me from trench foot.
We were moving our two patients into Probable when the second ambulance came. We gave them their admission packets from the Psychosocial department and some water and told them we'd be back to draw their blood. We were hoping that the next patient would be Probable, because if he or she was Suspect, someone else would have to take them in. In the unit, you can only move from low to high risk. Suspect is lower risk than Probable, and we'd already entered the Probable ward so we couldn't go into Suspect. Complicated, yes? And PPE is around $100/suit. But as it happened, we could label the patient as Probable with one look at her. Really we could have labeled her Confirmed, but technically that requires a blood test. Thankfully, our nurse manager had donned and come in for some reason, so she could be our fourth person to carry the stretcher (WASH was busy spraying everything in sight). You're technically not supposed to get into an ambulance to get a patient out, but since they haven't invented the Ebola ambulance yet to eject the patients automatically, Heather got in. We take turns breaking that rule.
Anyways, a bit of background: There are holding centers set up at various points throughout the country. From my understanding, they do blood tests to confirm Ebola. However, they are mostly just to quarantine the sick and keep the disease from spreading. They don't provide treatment. After we got this woman out and got a look at her, we just couldn't help but wonder what in the world these holding center people were thinking in keeping her there that long. If we had gotten her earlier, we might have been able to give her a fighting chance. As it was, she was practically dead. She seized on the way into the ward and then died about 10 minutes later. But at the very least, the Psychosocial department can tell her family (once they find them) that she didn't die alone and that she was with people who did their best to make her comfortable.
The point of this post wasn't meant to be about that patient. I was aiming more for the lighthearted aspect coming up next, but I got carried away (according to The Cousins, this is a Grosh sibling trait). The real point is that I now understand what "Get out 10 to 15 minutes before you start to feel sick" actually means. As I said previously, it was really hot today. I felt hot 20 minutes into my In time. The Suspect ambulance bay doesn't have a canopy over it, so we were in full sun when getting the stretcher out. And then we had to carry the stretcher down to Probable, stepping in like 40 foot baths on the way there. (40 is probably an exaggeration.) Once you lose your breath in the PPE, it's pretty difficult to get it back. I am out of shape, and I was definitely out of breath by the time we got this woman into a bed. We did the other two blood draws, then we came back to this woman. Even though she passed, we still have to draw blood for various statistical and tracking reasons. But my blood draw partner was being very slow. I started pacing around the ward. My goggles seemed like they were getting really tight on my head and I was starting to get a headache. Once you're dressed, you're not allowed to adjust anything you're wearing. The goggles sometimes sit funny on my nose and my nose was getting really stuffed up but my face was simultaneously dripping sweat (I do, in fact, understand how unattractive this sounds, in case you wondered). So all you can think about is touching your face. Thankfully, Heather and I were in with other people, so when I said, "Hey, I have to go doff right now," she didn't have to come out with me (buddy system at all times).
I got out to the doff station and it seemed to take the sprayers an exceptionally long time to put their gloves and shields on. I requested that they give me the quick version of the spraying, otherwise I promised to throw up on them. My sprayer was quite helpful, and he remained calm even when I got stuck in my suit. There's a big flap that's sticky and covers the zipper down the whole front of the suit. By the time you're opening the flap and zipper, the goggles are off, so you have to keep your face up in the air so no Ebola splashes into your eyes (though this is highly unlikely because you've already been sprayed with 0.5% chlorine 3 or 4 times). So you blindly fumble around feeling for the flap and/or zipper while someone who speaks English as a second language speaks to you through a mask and a shield. ("Move your hand over. No, the other way. Down. Okay.") In my frenzy, I ripped open the top of my suit instead of pulling the tab away from the zipper, so I couldn't actually get to the zipper to unzip it. Luckily, there was a person in line to doff behind me and he or she got me out (the sprayer can't touch me because he's in the low risk zone and I'm high risk). You would not believe how good it feels to take off the goggles and the mask and get a full breath of fresh [chlorinated] air. Once that happened, I no longer had to throw up. I just took my chlorine bath, then my fresh water bath, and then I got a drink. Or I went to change into new scrubs because mine were dripping with sweat.
Updates: The Siblings. Early Sunday morning, the brother passed away. His sister followed the next afternoon. Sometimes you do your best and it isn't enough.
Highlights: Sometimes your best is good enough. My favorite little lady (did I mention previously that she spits like a camel?) got her second negative blood test back the other day, so we are hoping to discharge her tomorrow. Last night, she went out onto the back "patio" area behind the Confirmed ward to sit with a few other ladies. Anna, my housemate and one of the chief "Psychos", told me she was back there. You actually have to leave the unit and walk the whole way around the fence in the big rocks to get to that area, so it's a process. Anyways, I went out to see her. This was, of course, the first time she had actually seen me, even though I've been caring for her for 10 days. I tell the patients my name, but who knows if they hear and/or understand me. We also get our names written on our heads before we go in so our coworkers can identify us. But again, I'm not sure if patients are concerned with reading my head. The psychosocial people can't go into the ward, so this is where they always meet with patients and/or patient families. So a psychosocial guy was back there and translated for me. I told her my name and that I'm the one who steals her blanket and won't give it back until she eats her meal. She laughed. I just love her.
A 13-month-old was brought in yesterday. The mother is dead from Ebola, the father is supposedly in a holding center somewhere. Someone has to take care of this child in the ward, and it can't be a nurse because we can't let anyone sit in PPE continuously. Sometimes another patient can look after a child, but our only other patient in the Probable tent at that point was a 6 year old boy. The whole thing was a mess for a bit. But then Anna found a survivor who was willing to go in and take care of the child. They don't have to be PPE trained because, obviously, they've already had Ebola and they're immune. It was really special to see this lady taking care of the baby today. Not only is she a survivor, but she lost her own baby and husband to Ebola. For once, I don't have words to describe it. The baby is going to need every advantage she can get because her tests came back positive Ebola and positive malaria. Human contact is a good place to start.
Last night after we finally got back from the ETC, we sat around the supper table talking. (Well, some talking, some on the second round of the 12 Days of Christmas. Or the 6th chorus of Good King Wenceslas from the Europeans.) Someone asked where we all were last Christmas and we went around the table and shared. We're kind of like the band of misfits who have formed a little family. I hardly know most of these people, but we'll always share a connection from our time together here in Ebola.
While it was just really funny at the time, it's true that "Ebola" has truly become the identity of this place. I was talking with one of the local nurses today while we were posted outside the Suspect tent, and she was telling me how all of life in Sierra Leone has stopped because of Ebola. Schools have been closed since May, hospitals are closed, stores are closed. Literally everything revolves around Ebola. Even Christmas, which was "cancelled" by order of the President.
While Sierra Leoneans were not able to participate in their usual Christmas traditions, we had a few small treats at our ETC. Special meals for the staff and patients, a movie for patients who were well enough to venture outside the tent to watch, and some Christmas music. (You would think that people would be able to remember all the gifts in the 12 Days of Christmas by the third time through the song in it's entirety, but you would be wrong.)
Despite the efforts, much of the day was just the same as any other. While drinking my coffee this morning (and wondering not for the first time if the staff is secretly putting out decaf...), I thought of an episode of MASH where they try to keep a soldier alive until after midnight so his family doesn't have to think of Christmas as the day he died. I told the people at my table that I hoped no one dies today. Obviously, I hope this every day, but I was sharing in the sentiment of my fictitious fellow medical professionals.
Unlike every one of my previous Christmases, this one was exceptionally hot. I was on for admissions today, and the admissions usually come between noon and 2pm, when the heat is getting most intense. Our first ambulance arrived shortly after noon. Heather (a nurse I actually worked with at Medishare in Haiti...small world) and I went in with our Temne speaking nurse to do the triage. There were two patients in the ambulance, and the triage process followed by moving them into the Probable ward took probably half an hour. It seems so much hotter when you're not moving because you can feel how much you're sweating. If you're doing things, you don't think about it. For this reason, people sometimes pace if there's a line to doff. Triage is a lot of standing and waiting while we ask the patient questions. The area isn't that big, and there's plexi-glass to separate the low-risk and high-risk zones. Plus, when you have a suspect patient that you're moving, you have to have a WASH sprayer follow behind you, spraying where you've walked. The point being that it's hard to pace in triage. So while there have been times that I've been in for two hours and been fine, after 20 minutes today I could tell that my moisture-wicking socks were putting forth their best effort to save me from trench foot.
We were moving our two patients into Probable when the second ambulance came. We gave them their admission packets from the Psychosocial department and some water and told them we'd be back to draw their blood. We were hoping that the next patient would be Probable, because if he or she was Suspect, someone else would have to take them in. In the unit, you can only move from low to high risk. Suspect is lower risk than Probable, and we'd already entered the Probable ward so we couldn't go into Suspect. Complicated, yes? And PPE is around $100/suit. But as it happened, we could label the patient as Probable with one look at her. Really we could have labeled her Confirmed, but technically that requires a blood test. Thankfully, our nurse manager had donned and come in for some reason, so she could be our fourth person to carry the stretcher (WASH was busy spraying everything in sight). You're technically not supposed to get into an ambulance to get a patient out, but since they haven't invented the Ebola ambulance yet to eject the patients automatically, Heather got in. We take turns breaking that rule.
Anyways, a bit of background: There are holding centers set up at various points throughout the country. From my understanding, they do blood tests to confirm Ebola. However, they are mostly just to quarantine the sick and keep the disease from spreading. They don't provide treatment. After we got this woman out and got a look at her, we just couldn't help but wonder what in the world these holding center people were thinking in keeping her there that long. If we had gotten her earlier, we might have been able to give her a fighting chance. As it was, she was practically dead. She seized on the way into the ward and then died about 10 minutes later. But at the very least, the Psychosocial department can tell her family (once they find them) that she didn't die alone and that she was with people who did their best to make her comfortable.
The point of this post wasn't meant to be about that patient. I was aiming more for the lighthearted aspect coming up next, but I got carried away (according to The Cousins, this is a Grosh sibling trait). The real point is that I now understand what "Get out 10 to 15 minutes before you start to feel sick" actually means. As I said previously, it was really hot today. I felt hot 20 minutes into my In time. The Suspect ambulance bay doesn't have a canopy over it, so we were in full sun when getting the stretcher out. And then we had to carry the stretcher down to Probable, stepping in like 40 foot baths on the way there. (40 is probably an exaggeration.) Once you lose your breath in the PPE, it's pretty difficult to get it back. I am out of shape, and I was definitely out of breath by the time we got this woman into a bed. We did the other two blood draws, then we came back to this woman. Even though she passed, we still have to draw blood for various statistical and tracking reasons. But my blood draw partner was being very slow. I started pacing around the ward. My goggles seemed like they were getting really tight on my head and I was starting to get a headache. Once you're dressed, you're not allowed to adjust anything you're wearing. The goggles sometimes sit funny on my nose and my nose was getting really stuffed up but my face was simultaneously dripping sweat (I do, in fact, understand how unattractive this sounds, in case you wondered). So all you can think about is touching your face. Thankfully, Heather and I were in with other people, so when I said, "Hey, I have to go doff right now," she didn't have to come out with me (buddy system at all times).
I got out to the doff station and it seemed to take the sprayers an exceptionally long time to put their gloves and shields on. I requested that they give me the quick version of the spraying, otherwise I promised to throw up on them. My sprayer was quite helpful, and he remained calm even when I got stuck in my suit. There's a big flap that's sticky and covers the zipper down the whole front of the suit. By the time you're opening the flap and zipper, the goggles are off, so you have to keep your face up in the air so no Ebola splashes into your eyes (though this is highly unlikely because you've already been sprayed with 0.5% chlorine 3 or 4 times). So you blindly fumble around feeling for the flap and/or zipper while someone who speaks English as a second language speaks to you through a mask and a shield. ("Move your hand over. No, the other way. Down. Okay.") In my frenzy, I ripped open the top of my suit instead of pulling the tab away from the zipper, so I couldn't actually get to the zipper to unzip it. Luckily, there was a person in line to doff behind me and he or she got me out (the sprayer can't touch me because he's in the low risk zone and I'm high risk). You would not believe how good it feels to take off the goggles and the mask and get a full breath of fresh [chlorinated] air. Once that happened, I no longer had to throw up. I just took my chlorine bath, then my fresh water bath, and then I got a drink. Or I went to change into new scrubs because mine were dripping with sweat.
Updates: The Siblings. Early Sunday morning, the brother passed away. His sister followed the next afternoon. Sometimes you do your best and it isn't enough.
Highlights: Sometimes your best is good enough. My favorite little lady (did I mention previously that she spits like a camel?) got her second negative blood test back the other day, so we are hoping to discharge her tomorrow. Last night, she went out onto the back "patio" area behind the Confirmed ward to sit with a few other ladies. Anna, my housemate and one of the chief "Psychos", told me she was back there. You actually have to leave the unit and walk the whole way around the fence in the big rocks to get to that area, so it's a process. Anyways, I went out to see her. This was, of course, the first time she had actually seen me, even though I've been caring for her for 10 days. I tell the patients my name, but who knows if they hear and/or understand me. We also get our names written on our heads before we go in so our coworkers can identify us. But again, I'm not sure if patients are concerned with reading my head. The psychosocial people can't go into the ward, so this is where they always meet with patients and/or patient families. So a psychosocial guy was back there and translated for me. I told her my name and that I'm the one who steals her blanket and won't give it back until she eats her meal. She laughed. I just love her.
A 13-month-old was brought in yesterday. The mother is dead from Ebola, the father is supposedly in a holding center somewhere. Someone has to take care of this child in the ward, and it can't be a nurse because we can't let anyone sit in PPE continuously. Sometimes another patient can look after a child, but our only other patient in the Probable tent at that point was a 6 year old boy. The whole thing was a mess for a bit. But then Anna found a survivor who was willing to go in and take care of the child. They don't have to be PPE trained because, obviously, they've already had Ebola and they're immune. It was really special to see this lady taking care of the baby today. Not only is she a survivor, but she lost her own baby and husband to Ebola. For once, I don't have words to describe it. The baby is going to need every advantage she can get because her tests came back positive Ebola and positive malaria. Human contact is a good place to start.
Last night after we finally got back from the ETC, we sat around the supper table talking. (Well, some talking, some on the second round of the 12 Days of Christmas. Or the 6th chorus of Good King Wenceslas from the Europeans.) Someone asked where we all were last Christmas and we went around the table and shared. We're kind of like the band of misfits who have formed a little family. I hardly know most of these people, but we'll always share a connection from our time together here in Ebola.
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| Merry Christmas to all, and to all a good night! Much love |
Saturday, December 20, 2014
I Wonder As I Wander
I figured that tonight I could stay up late and write an update since I probably won't be sleeping anyways. Tonight I am thankful for my Australian housemate who removed the giant spider from my bedroom wall. And when I say 'giant', I mean, this was either the biggest spider I've ever seen or it was second only to that one tarantula in Haiti. This after I reached into a box in the pharmacy for an IV catheter and grabbed some sort of praying mantis-like bug instead, which caused me to scream and throw the whole box of IV caths onto the floor. And there are real praying mantises (manti?) in the wards. Too many bugs in Africa (but no leopards yet...).
Moving on. My donning/doffing training was now a week ago, but it feels like a lifetime. Last Sunday, Tim and I went to the ETC, put on the suits and walked around outside a few times to get used to it. (Basically, the little Romanian doctor watched us put them on and then said, "Okay, walk around. I come back for you in 45 minutes.") Monday we had a few more lectures, and then Tuesday we shadowed in the wards. From Wednesday on, we worked.
When I got here, the ETC had been open for about 10 days, and we were only receiving confirmed patients. There were seven. Sometime this week (though I couldn't tell you when) we opened our suspect and probable wards as well. So the work has tripled. Our ETC is staffed largely by local staff. It's similar to Haiti in that they have some trouble with critical thinking and problem solving. Some of them, I've found, don't know how to take a pulse, but they do work hard in other areas (like feeding and changing patients). But sometimes it's just like herding cats.
Four paragraphs in, I still haven't figured out exactly what I want to write in this post. My feet hurt. The Mennonite in me was too strong when I was shopping, and I didn't buy those inserts. Tim brought inserts, but forgot to take them out of his boots the first day and lost them. I comfort myself with that. My big toes are actually still numb, four hours after taking the boots off. We all get a slight cough at night. For some reason, the chlorine concentration seems a lot higher in the evenings, so if I come out right before the shift change, it's really overpowering when I'm being sprayed down. Kind of like suffocating in a swimming pool. It's been dubbed the Chlorine Cough. One size does not fit all. I could put at least one other person in my scrubs with me.
A girl I know from Haiti has been working with IMC in an ETC in Liberia. Before I came to Sierra Leone, I would read her facebook notes about her experience. I remember one post where she described Ebola as mean. I think that sums it up pretty well. Sometimes there doesn't seem to be a rhyme or reason to what it does. Or, rather, we can't figure out everything that's going on with a patient because we don't have _______ (fill in the blank with "equipment", "lab capabilities", etc). It's just a bunch of doctors and nurses (and logistics and sanitation people) who get in a huddle every day and say, "Okay, how do we keep this person alive today?" Sometimes it works, sometimes it doesn't. Yesterday we discharged two patients cured, and today we sent three to the morgue before supper was passed.
I wonder sometimes what the patients think of us. Can they tell us apart? Or are we just giant white blobs with eyes? Do they become familiar with our voices? There is one WASH (it's a UN/WHO grouping for things that fall into one of the Water, Sanitation, or Hygiene categories) guy who makes me feel safest when he's doffing me, and I have no idea who he is (I am trying to learn the names of like 100 people who all wear masks and hoods), but I recognize his voice. When I hear that voice say, "Wash your hands," I feel like, "Oh good, this guy knows what's going on and is going to take care of me." I wonder if it's like that for the patients? Do they feel any connection to the caregivers? Does physical touch help as much when it's with hands wearing multiple gloves?
I wonder these things when dealing with a few patients in particular. There is one lady who is just the cutest. She always has her eyes closed, perhaps because she thinks people won't bother her. But I always wake her up so that she eats and drinks something. She waves me away and I keep poking her and talking. Then she usually sighs and sits up. She takes a few bites and then as soon as I move on to another patient, she lays back down. I figure she might think of me as the especially irritating one.
Then there are two who probably aren't thinking much of anything right now, just maybe feeling a little bit. Tim and I agree that we feel a bit more connected to these two patients because they were some of the first to come in when we started working. They were the first patients we really got to know. A brother and sister, brought in by their teacher. Ebola had already killed their parents, and she had been looking after them. The day before they were fine, and now they are laying in adjacent beds dying. I had asked a few people to pray for them because I can't see them living without a miracle. Ebola is a hemorrhagic disease, though only a small percentage of people actually bleed. These two are bleeding. For a few days, we were constantly changing the boy. His diarrhea has stopped now, at least, but he's still slowly bleeding from IV sites. She is bleeding at her sites and in her mouth. Ebola patients often get confused, and these two actually switched beds last night. I talk to them and rub their backs, and I try to keep her blanket tucked in around her because she always seems to want a blanket, and I wonder if they know I'm there. I wonder what, if anything, goes on in their minds. Do they feel like someone cares for them even if they don't know what's happening?
I have tomorrow off. I'll probably still go in, though, to see how the patients (mostly the kids) are doing and because Tim will be by himself. The other expat nurses (who serve as the team leads) either have off or will be coming off the night shift. And one is actually going back to the US tomorrow. So I'll probably go help out after I take advantage of the fact that I can sleep in.
In other news, I never was successful in getting my chair into the bathroom. It is just too wide for the door frame, no matter which way I turn it. However, I did determine that the sink was sturdy enough for me to stand on. It did take me a bit to figure it out, but, again, the dial was in Chinese, and I did ultimately succeed in getting hot water. 64 degrees Celsius is a bit hotter than I would've needed, but I can't complain. Except for tonight when I will not be showering before going to bed because I still have no lightbulb in my bathroom and I don't have any desire to accidentally happen upon any of the giant spider's friends.
Moving on. My donning/doffing training was now a week ago, but it feels like a lifetime. Last Sunday, Tim and I went to the ETC, put on the suits and walked around outside a few times to get used to it. (Basically, the little Romanian doctor watched us put them on and then said, "Okay, walk around. I come back for you in 45 minutes.") Monday we had a few more lectures, and then Tuesday we shadowed in the wards. From Wednesday on, we worked.
When I got here, the ETC had been open for about 10 days, and we were only receiving confirmed patients. There were seven. Sometime this week (though I couldn't tell you when) we opened our suspect and probable wards as well. So the work has tripled. Our ETC is staffed largely by local staff. It's similar to Haiti in that they have some trouble with critical thinking and problem solving. Some of them, I've found, don't know how to take a pulse, but they do work hard in other areas (like feeding and changing patients). But sometimes it's just like herding cats.
Four paragraphs in, I still haven't figured out exactly what I want to write in this post. My feet hurt. The Mennonite in me was too strong when I was shopping, and I didn't buy those inserts. Tim brought inserts, but forgot to take them out of his boots the first day and lost them. I comfort myself with that. My big toes are actually still numb, four hours after taking the boots off. We all get a slight cough at night. For some reason, the chlorine concentration seems a lot higher in the evenings, so if I come out right before the shift change, it's really overpowering when I'm being sprayed down. Kind of like suffocating in a swimming pool. It's been dubbed the Chlorine Cough. One size does not fit all. I could put at least one other person in my scrubs with me.
A girl I know from Haiti has been working with IMC in an ETC in Liberia. Before I came to Sierra Leone, I would read her facebook notes about her experience. I remember one post where she described Ebola as mean. I think that sums it up pretty well. Sometimes there doesn't seem to be a rhyme or reason to what it does. Or, rather, we can't figure out everything that's going on with a patient because we don't have _______ (fill in the blank with "equipment", "lab capabilities", etc). It's just a bunch of doctors and nurses (and logistics and sanitation people) who get in a huddle every day and say, "Okay, how do we keep this person alive today?" Sometimes it works, sometimes it doesn't. Yesterday we discharged two patients cured, and today we sent three to the morgue before supper was passed.
I wonder sometimes what the patients think of us. Can they tell us apart? Or are we just giant white blobs with eyes? Do they become familiar with our voices? There is one WASH (it's a UN/WHO grouping for things that fall into one of the Water, Sanitation, or Hygiene categories) guy who makes me feel safest when he's doffing me, and I have no idea who he is (I am trying to learn the names of like 100 people who all wear masks and hoods), but I recognize his voice. When I hear that voice say, "Wash your hands," I feel like, "Oh good, this guy knows what's going on and is going to take care of me." I wonder if it's like that for the patients? Do they feel any connection to the caregivers? Does physical touch help as much when it's with hands wearing multiple gloves?
I wonder these things when dealing with a few patients in particular. There is one lady who is just the cutest. She always has her eyes closed, perhaps because she thinks people won't bother her. But I always wake her up so that she eats and drinks something. She waves me away and I keep poking her and talking. Then she usually sighs and sits up. She takes a few bites and then as soon as I move on to another patient, she lays back down. I figure she might think of me as the especially irritating one.
Then there are two who probably aren't thinking much of anything right now, just maybe feeling a little bit. Tim and I agree that we feel a bit more connected to these two patients because they were some of the first to come in when we started working. They were the first patients we really got to know. A brother and sister, brought in by their teacher. Ebola had already killed their parents, and she had been looking after them. The day before they were fine, and now they are laying in adjacent beds dying. I had asked a few people to pray for them because I can't see them living without a miracle. Ebola is a hemorrhagic disease, though only a small percentage of people actually bleed. These two are bleeding. For a few days, we were constantly changing the boy. His diarrhea has stopped now, at least, but he's still slowly bleeding from IV sites. She is bleeding at her sites and in her mouth. Ebola patients often get confused, and these two actually switched beds last night. I talk to them and rub their backs, and I try to keep her blanket tucked in around her because she always seems to want a blanket, and I wonder if they know I'm there. I wonder what, if anything, goes on in their minds. Do they feel like someone cares for them even if they don't know what's happening?
I have tomorrow off. I'll probably still go in, though, to see how the patients (mostly the kids) are doing and because Tim will be by himself. The other expat nurses (who serve as the team leads) either have off or will be coming off the night shift. And one is actually going back to the US tomorrow. So I'll probably go help out after I take advantage of the fact that I can sleep in.
In other news, I never was successful in getting my chair into the bathroom. It is just too wide for the door frame, no matter which way I turn it. However, I did determine that the sink was sturdy enough for me to stand on. It did take me a bit to figure it out, but, again, the dial was in Chinese, and I did ultimately succeed in getting hot water. 64 degrees Celsius is a bit hotter than I would've needed, but I can't complain. Except for tonight when I will not be showering before going to bed because I still have no lightbulb in my bathroom and I don't have any desire to accidentally happen upon any of the giant spider's friends.
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