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.