I feel like I got sucked into a vortex at the end of June and I just recently emerged. My closest ebola friend went home for a few weeks, leaving me to do the nursing schedule. Which I would normally enjoy because it's like a puzzle. My grandma had this puzzle that was all Dalmatians. The whole thing was just spots. This schedule was like a 1,000 piece puzzle of that. And pretend 30 pieces have been eaten by a goat. Several days after I inherited this task, I got called to a meeting. This is the gist: Ramadan starts in two days, during Ramadan Muslims don't eat or drink anything during daylight, and therefore anyone fasting cannot go into high risk. Two weeks later, we had staff cutbacks and said goodbye to half of our nurses.
Meanwhile, we were starting to work in several local clinics, training them to screen patients in a way that will alert them to any possible ebola cases, donning and doffing, making and using chlorine, etc. With all of this going on, I had nurses calling me at all hours of the day and night. One time a nurse called while I was sleeping (my shift starts at 8am, please don't expect me to be conscious at 5:30), and despite speaking to her, I had to go to work and say, "I know we talked this morning, but I have no idea what about."
But anyway, Ramadan eventually ended, our patient load decreased, and we got into a routine with the clinics. On my first day at my clinic, I was paired with one of our nurses from the ETC. He showed me around, introduced me to the staff, and then we went into the triage area to oversee the screening process. At first it's kind of like fishing. They ask the patients all the questions and you find a patient who meets case definition and it's like, "Yay, we found one!" But after a few days, you find yourself thinking, "Please don't have three symptoms, please don't meet case definition" on a fairly regular basis.
One day during our triage, we got a woman who was in labor. All deliveries have to be done in full ppe, just in case. We are in the clinics to oversee and guide the screening and infection prevention and control, so I asked the nurse if it would be okay if I just observed. I put on my partial ppe and stood in the postpartum room with the traditional birth attendants (TBAs). The delivery room is turned into the red zone when there is a laboring patient, so we just watched through the door. The TBAs were using all the face shields, so I had to use goggles instead. There is no anti-fog spray at the clinics. Within minutes, I was down to just a small circle on the top right corner of the goggles. Ten minutes after that, the baby was born.
He came out and didn't make any noise. And then I thought to myself, "Oh my word, I never really considered that this kid might not be alive." This country does, after all, have a terrible infant mortality rate. The nurse cut the cord and brought the baby out onto the "resuscitation table." She rubbed and rubbed the little guy and he still wasn't crying. Or breathing. So now I have actually seen someone pick a baby up by the ankles and hang it upside down. No effect. She then pulled the manual suction out of a bag in the corner (no bulb suction here). She and the TBAs fumbled around a bit trying to put it together. Finally the nurse said, "Please help us!"
After we suctioned the kid, he still didn't breathe. The nurse did more rubbing. Then she tilted his head back. I think I could teach CPR upside down and backwards, in my sleep, in two languages (not one they speak here of course), so I recognized this (albeit incorrect) maneuver. "Does he have a pulse?" I asked the nurse. "Do you feel the cord pulsing?" she asked me in response. Well, I'm not actually supposed to touch this kid, but here we go. No, I do not feel the cord pulsating. She wrapped her hands around him and started trying to do compressions. "You're going to have to push harder," I told her. She didn't. So I started doing compressions. Eventually, the baby moved a little. Then he opened his eyes. Finally, the cheese-covered little bugger started to cry. So whether we actually resuscitated him or we just agitated him enough that he decided to make a life-sustaining effort, I don't know. Either way, I was relieved.
"They will call the baby Sarah," the TBAs told me. "But it's a boy!" I said. "Yes, but he is your color," they laughed, referencing how pale he was from the lack of circulating blood.
These days at the ETC, we are quite slow. We actually had a 24-hour period where we had zero patients. It was strange. But that has left me some time to do a few things before I make my exit on Sunday. The other evening, a friend and I were able to visit two of the ebola cemeteries in our district. It's impossible to describe unless you've seen it. But it was nice to find our patients and remember them for a bit.
Last night, some of my coworkers had a dinner for me, which was really sweet and unexpected. We laughed a lot and ate really good food. As one of our doctors once told me (at the end of an argument), "We have been here a long time. We are more than colleagues, we are like brothers and sisters." (My response to that statement: "Yes, who FIGHT.") And no, I don't know what's next, so I'm sticking with the story that I'm joining a band of gypsies in Romania. You never know.
Friday, August 14, 2015
Friday, June 19, 2015
Lottery
I am not wrong very often. But I was wrong this time. My last time in PPE was not my last time in PPE. Not only did we have confirmed patients when I returned, but we had a whole mess of them. (What do you call a group of patients, anyway? Flock? Herd? ... I really wanted to say "a murder of patients", but thought the joke might be in poor taste.) My first morning back at work, we had a traditional healer die. Then the second of at least three co-wives. All before I went inside. It was like December again, with med checks taking an hour and then the actual med pass taking three.
I should have prefaced that with what happened before I even got to work that Monday (to The Mamas and the Papas - never has anyone been so right). Mornings are hard to begin with. When you actually have to speak to people before being awake for an hour, it's even crueler. When you have to call a friend and say, "Can you please help me flush something out of my eye?" before you've been awake five minutes, it's utterly ridiculous. In the room I was put in when I first got back, the air conditioner was right above the bed. And the room was tiny so I couldn't move the bed anywhere. There were birds living in the air conditioner. Or maybe they weren't living there yet, they were just building and preparing to move in. Perhaps because they're African birds, they were using a lot of cement. Tiny pieces of which were falling out onto me and my bed all night long. There must have been some in my hair, and when I woke up, it went into my eye. Naturally, we had been cheated out of generator time so the power was already out and I had no luck flushing the building material out of my eye by myself. So put that one on the "Things I've Had in my Eyes" list, right under "piece of a piano key".
Back to the point. So, here we were, having a mini outbreak in the midst of the outbreak. Our probable and confirmed wards got fuller and fuller of people with the same address. Or people who shared a bathroom with the people from the same address. The problem was that a lot of the people in these few quarantined houses were very skeptical and insisted that they would just die in their homes. Our psychosocial team plus those from other NGOs plus WHO plus UNICEF were all visiting these homes trying to educate and convince people to come in when they got sick. So eventually they did start to send some of the children to us. Not quite a week later, a set of brothers who said they would die in their house sat in our triage with flaming red eyes.
So our team worked. And we worked hard. After two days I felt like I could barely walk from standing for 12 hours in gumboots I wasn't used to anymore. Even going to the bathroom isn't a break for your feet around here when you have to squat over a hole and try not to pee on your own clown-sized pants. Every pass lasted for hours, and during the day that meant getting so sweaty that my boots started filling up. And wet socks make me crazy. But I sloshed around the wards and then dumped a few cups of my own perspiration out into the gutter after I doffed. One day I was kneeling on the concrete next to one of our kids for about 20 minutes doing her IV meds, and when I finally stood up, there was a puddle on the ground. I had sweated through my tyvek suit and rubber apron. More than the average man, I tell you.
This little one was the sickest of our kids. Not that any of them were doing particularly well. When she was still fairly responsive, she would spit out all her oral meds at us and refuse to eat while her father yelled from over the fence in Probable for her to cooperate. One night while we were inside, she was mumbling and muttering things. I asked my nurse if she was making sense and if her responses were appropriate. She said no. Generally, once our patients get confused, they only have a few days left. But this kiddo was an ornery one, so rather than lay in bed and be confused, she wanted to get up and be confused. The end of that pass involved two caregivers chasing/holding her up, my nurse and I desperately trying to keep her close to her IV pole so she didn't rip the line out, and then my nurse yelling at me to be careful because I was kneeling in a puddle of diarrhea. Then the patient got an abscessed tooth and her face swelled up so much that her eyes swelled shut.
During all of this, we also have a trial going on. There are a few different trials going on at various treatment centers in the area. It's interesting and I'm happy to be a part of it, but it does mean some extra work for us. That coupled with our new policy/"safety feature" that mandates naked doffing if you accidentally touch your scrubs have added a bit of stress. (Well, to be fair, I think I'm the only one stressed about naked doffing.)
The other day one of my newer coworkers was saying how this is the greatest job. And I agree. But for people who don't think like us, the million dollar question is, "Why in the world do you do this?" And there were times back in December/January when we had two separate 24-hour periods where six patients died that I wondered the same thing. But we had a discharge this morning, two of our little ones left the ETC cured. Their ornery sister was cured and discharged earlier this week. That means that 8 of the 9 positive patients we've had in the last 19 days have been or will soon be cured. So to answer the question "why in the world do we do this" is pretty simple. Because sometimes you win the lottery.
I should have prefaced that with what happened before I even got to work that Monday (to The Mamas and the Papas - never has anyone been so right). Mornings are hard to begin with. When you actually have to speak to people before being awake for an hour, it's even crueler. When you have to call a friend and say, "Can you please help me flush something out of my eye?" before you've been awake five minutes, it's utterly ridiculous. In the room I was put in when I first got back, the air conditioner was right above the bed. And the room was tiny so I couldn't move the bed anywhere. There were birds living in the air conditioner. Or maybe they weren't living there yet, they were just building and preparing to move in. Perhaps because they're African birds, they were using a lot of cement. Tiny pieces of which were falling out onto me and my bed all night long. There must have been some in my hair, and when I woke up, it went into my eye. Naturally, we had been cheated out of generator time so the power was already out and I had no luck flushing the building material out of my eye by myself. So put that one on the "Things I've Had in my Eyes" list, right under "piece of a piano key".
Back to the point. So, here we were, having a mini outbreak in the midst of the outbreak. Our probable and confirmed wards got fuller and fuller of people with the same address. Or people who shared a bathroom with the people from the same address. The problem was that a lot of the people in these few quarantined houses were very skeptical and insisted that they would just die in their homes. Our psychosocial team plus those from other NGOs plus WHO plus UNICEF were all visiting these homes trying to educate and convince people to come in when they got sick. So eventually they did start to send some of the children to us. Not quite a week later, a set of brothers who said they would die in their house sat in our triage with flaming red eyes.
So our team worked. And we worked hard. After two days I felt like I could barely walk from standing for 12 hours in gumboots I wasn't used to anymore. Even going to the bathroom isn't a break for your feet around here when you have to squat over a hole and try not to pee on your own clown-sized pants. Every pass lasted for hours, and during the day that meant getting so sweaty that my boots started filling up. And wet socks make me crazy. But I sloshed around the wards and then dumped a few cups of my own perspiration out into the gutter after I doffed. One day I was kneeling on the concrete next to one of our kids for about 20 minutes doing her IV meds, and when I finally stood up, there was a puddle on the ground. I had sweated through my tyvek suit and rubber apron. More than the average man, I tell you.
This little one was the sickest of our kids. Not that any of them were doing particularly well. When she was still fairly responsive, she would spit out all her oral meds at us and refuse to eat while her father yelled from over the fence in Probable for her to cooperate. One night while we were inside, she was mumbling and muttering things. I asked my nurse if she was making sense and if her responses were appropriate. She said no. Generally, once our patients get confused, they only have a few days left. But this kiddo was an ornery one, so rather than lay in bed and be confused, she wanted to get up and be confused. The end of that pass involved two caregivers chasing/holding her up, my nurse and I desperately trying to keep her close to her IV pole so she didn't rip the line out, and then my nurse yelling at me to be careful because I was kneeling in a puddle of diarrhea. Then the patient got an abscessed tooth and her face swelled up so much that her eyes swelled shut.
During all of this, we also have a trial going on. There are a few different trials going on at various treatment centers in the area. It's interesting and I'm happy to be a part of it, but it does mean some extra work for us. That coupled with our new policy/"safety feature" that mandates naked doffing if you accidentally touch your scrubs have added a bit of stress. (Well, to be fair, I think I'm the only one stressed about naked doffing.)
The other day one of my newer coworkers was saying how this is the greatest job. And I agree. But for people who don't think like us, the million dollar question is, "Why in the world do you do this?" And there were times back in December/January when we had two separate 24-hour periods where six patients died that I wondered the same thing. But we had a discharge this morning, two of our little ones left the ETC cured. Their ornery sister was cured and discharged earlier this week. That means that 8 of the 9 positive patients we've had in the last 19 days have been or will soon be cured. So to answer the question "why in the world do we do this" is pretty simple. Because sometimes you win the lottery.
Wednesday, April 29, 2015
Bedtime Stories and Songs
Even though I struggled greatly trying to think up an introduction for this post (when I considered saying something about June Cleaver, I gave up), my real life introduction to this, my last night shift (for now), was quite nice. I was treated to a lovely dinner from our favorite (and only) gas station. One of the doctors went to pick up food after evening report and asked if I had any requests. Frozen yogurt, of course. It makes me think of the beach. Probably because it tastes like sunscreen. When he said, "This is what you want for your dinner?" I said I wasn't sure how that was any worse than the time we ate it for breakfast. So I got frozen yogurt and some sort of something else. It was spicy and I think it was red meat. I'm not sure that I've eaten red meat this year, so it was delicious.
It's quiet in our ETC these days. Quiet in regards to patient numbers, not necessarily in relation to the events. As I typed that sentence, our power went out. Hopefully that doesn't cause our young suspect patient to stir. I remember babysitting a whole slew of children who found it impossible to stay in their beds all night after I turned out the lights and shut the bedroom door. Universal phenomenon. But when this patient gets up, we can't actually get to her, and we have to make sure she stays contained within the fences and ropes. Yelling through the donning area, "Go lay down, we'll see you in the morning!" doesn't have quite the same therapeutic effect as tucking a kid back in. During med rounds, the patient kept telling one of my nurses, "Auntie, please, come sleep beside me."
Our only confirmed patient, on the other hand, is resting quite comfortably. Just waiting for her second negative result to come back. Then our confirmed ward will be empty. It would appear that ebola is finally slowing down. Schools are opening. Lockdowns are cancelled. We will probably continue to have patients cycle through our suspect ward for a while. Even though I will be back here in a month (there it is!), I am expecting that this will be my last time with confirmed patients. Maybe in PPE! I might actually have to relearn how to have good bedside manner. Right now no one can tell if I'm gagging because it is too early in the morning for the smells coming from my patient or if I'm laughing really, really hard because a patient just peed in my coworker's face while I chased him so I could hang onto the IV we hadn't yet taped down to his arm. (Don't worry, I paid for all the laughter later when I couldn't properly oxygenate myself and I was crouching in the doffing area sucking my mask into my mouth while trying to get a breath. My doffer just shook his head, "Too long. You spend too much time inside today." Even though I hadn't, I didn't argue that time. Sometimes I fight with them when I'm hungry. Then a doctor gives me his protein bar. Oops. But I digress. "Yes, whatever you say, just get me to the part where I get to take all this stuff off my face.")
Since I embarked on this rabbit trail, I might as well share one of my favorite PPE stories. A friend and I were doing meds late one night, and our patient was sleeping while her liter of fluid begrudgingly infused. Rather than disturb her with our talking, we went out the back of the tent to the little patio area and sat down. It turned into one of those moments where you realize that what you've come to think of as normal is actually pretty absurd. I am sitting here having a serious conversation with you, and you look like a duck wearing goggles.
Normal or absurd, it has been a privilege to share in this experience. I don't know exactly what my job will look like when I come back in a few weeks, but that's part of the adventure I guess. In the meantime, my next adventure is quarantine. I imagine it will be exciting for six hours or so. Be nice to me or I will sneak into your house and lick all your spoons. Just kidding...
Someone tell Brad and Carrie I'm opening my own chapter of the "Feisty Little Nurses Association. "
It's quiet in our ETC these days. Quiet in regards to patient numbers, not necessarily in relation to the events. As I typed that sentence, our power went out. Hopefully that doesn't cause our young suspect patient to stir. I remember babysitting a whole slew of children who found it impossible to stay in their beds all night after I turned out the lights and shut the bedroom door. Universal phenomenon. But when this patient gets up, we can't actually get to her, and we have to make sure she stays contained within the fences and ropes. Yelling through the donning area, "Go lay down, we'll see you in the morning!" doesn't have quite the same therapeutic effect as tucking a kid back in. During med rounds, the patient kept telling one of my nurses, "Auntie, please, come sleep beside me."
Our only confirmed patient, on the other hand, is resting quite comfortably. Just waiting for her second negative result to come back. Then our confirmed ward will be empty. It would appear that ebola is finally slowing down. Schools are opening. Lockdowns are cancelled. We will probably continue to have patients cycle through our suspect ward for a while. Even though I will be back here in a month (there it is!), I am expecting that this will be my last time with confirmed patients. Maybe in PPE! I might actually have to relearn how to have good bedside manner. Right now no one can tell if I'm gagging because it is too early in the morning for the smells coming from my patient or if I'm laughing really, really hard because a patient just peed in my coworker's face while I chased him so I could hang onto the IV we hadn't yet taped down to his arm. (Don't worry, I paid for all the laughter later when I couldn't properly oxygenate myself and I was crouching in the doffing area sucking my mask into my mouth while trying to get a breath. My doffer just shook his head, "Too long. You spend too much time inside today." Even though I hadn't, I didn't argue that time. Sometimes I fight with them when I'm hungry. Then a doctor gives me his protein bar. Oops. But I digress. "Yes, whatever you say, just get me to the part where I get to take all this stuff off my face.")
Since I embarked on this rabbit trail, I might as well share one of my favorite PPE stories. A friend and I were doing meds late one night, and our patient was sleeping while her liter of fluid begrudgingly infused. Rather than disturb her with our talking, we went out the back of the tent to the little patio area and sat down. It turned into one of those moments where you realize that what you've come to think of as normal is actually pretty absurd. I am sitting here having a serious conversation with you, and you look like a duck wearing goggles.
Normal or absurd, it has been a privilege to share in this experience. I don't know exactly what my job will look like when I come back in a few weeks, but that's part of the adventure I guess. In the meantime, my next adventure is quarantine. I imagine it will be exciting for six hours or so. Be nice to me or I will sneak into your house and lick all your spoons. Just kidding...
Someone tell Brad and Carrie I'm opening my own chapter of the "Feisty Little Nurses Association. "
Friday, April 10, 2015
The Rain in Spain
I'm told that I don't take enough pictures. So when I went on my second R&R, a friend said I had to take 30 pictures a day and I had to be in at least 10 of them. Unfortunately, I am a bad tourist and was not prepared with my selfie stick. I hadn't ever seen one of these before, but in Barcelona, you couldn't swing a cat without hitting someone with a selfie stick. Nevertheless, here is Barcelona in pictures.
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| The Magic Fountain. It was pretty, but I've been more mesmerized by the fountain in Lancaster City. |
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| Parents on public transport. Madre only paid for her suitcase instead of herself once. |
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| For some reason, I am obsessed with cathedrals. |
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| And organs. (I didn't intend the pun/double meaning, but now that I've noticed it, I'm amused and leaving it.) |
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| Torre Agbar. We came, we saw...we left because there was nowhere around here to eat. |
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| La Sagrada Familia |
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| Park Guell |
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| Still don't know what this is, but everyone else was taking pictures of it. |
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| Two days later, we went back to Sagrada Familia and, like good tourists, had tickets to go inside. This is from the top of one of the towers. |
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| Technically this is not a cathedral, but I still have more pictures of this than anything else. |
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| Palau de la Musica. Mozart, Beethoven, and some other random guy. |
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| Cathedral and music - definitely my favorite day |
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| Christopher Columbus supposedly pointing at Algeria. While our tour guide was entertaining, we're not sure how accurate his information was. |
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| I knew ahead of time that the statues were real people. Did not expect them to reach out and grab people. I don't like costumed characters to begin with, so I was never in danger of being grabbed. |
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| This is for everyone who has heard me complain about wanting cheesecake over the last four months. |
Thursday, March 19, 2015
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.
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.
Monday, March 2, 2015
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]
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]
Sunday, February 15, 2015
Cool Factor
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.
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.
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