Maybe the best part of the day, though, had to do with the
two sick men. We managed to get 7 and 8 liters, respectively, into them during
the day shift, along with potassium and glucose. There are calculations that
someone with Ebola – vomiting and having diarrhea all day long – can lose 10 or
more liters of fluid a day, and the heat would, if anything, make it worse.
There are risks in trying to get this much fluid back into someone, especially
over a short period of time – in particular, the risk that you “flood” their
lungs and make it difficult for them to breathe – but we simply can’t give them
fluid 24 hours a day, and we’ve more or less concluded that for otherwise
healthy people, it’s more of a risk to leave them “dry” than it is to
over-hydrate them. The whole point of giving this much fluid is to keep their
organs functioning, and if their organs are functioning, they can probably pee
out the extra water.
By the end of the day, the five patients were doing
moderately to very well, the two sick patients were very well hydrated and
supplemented, everyone had gotten their relevant medications, and everyone had
at least one good IV (the sick ones had two good ones each). As a list, this
may not sound like much, but for us it is something like a home run. (Even more
so since we as a team only made “aggressive hydration,” if possible with two
IVs, an official goal as of this morning. It was good to feel we had risen to
the challenge.) I felt like laughing out loud as we were driving home.
Of course there are always life’s little dramas: After my
last time “in,” I discovered at the “doffing station” (where we take off the
PPE; there’s a mirror there) that I had some hair showing on the outside of my
suit (between my face shield and my hood). Ebola isn’t airborne, I’m a lot
taller than most of my patients (especially if they are lying in bed, and no
one was spitting at me or upchucking on me, so the chances of those strands of
hair having virus on them are small. But I did drench my head in 0.05% chlorine
when I was out of my suit! Then, an hour or so later as we were turning care
over to the evening team, a horsefly began biting me. I shooed it away almost
immediately, then – uncharacteristically for me but with delicious satisfaction
– smashed it into a pancake the next time it landed. When it fell to the
ground, I noticed that it made a little bloody spot on the floor. Now – who’s
blood do you suppose that was? It had only bitten me for a split second. Was
it, perhaps – an Ebola patient’s blood? And, if so, was it infectious? I’ve
never, ever heard of insect-borne Ebola, but – as with HIV and mosquitos 30
years ago (remember?), it makes you wonder! I washed my smashing hand (and
soaked the fly and the floor where it fell) as soon as I could.
In both of these cases – what are you going to do? What’s
done is done. We’ll see in the next 21 days!
And then I got home, where, standing talking to a
colleague, my left SI joint, irritated when I was carrying a patient several
days ago, flared into excruciating ache. One of my colleagues, who just happens
to be an acupuncturist and integrated-medicine practitioner as well as an ER
doc (!), gave me a lovely needle treatment after dinner. All my native
endorphins and enkephalins were activated, I was as happy as a clam, and I fell
into one of the best sleeps I’ve had since I got here. But I just woke up (10
pm) and – it still hurts!
To be continued….
No comments:
Post a Comment