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.      

Merry Christmas to all, and to all a good night! Much love