February 20, 2015 - An active day. We discharged something
like 10 “suspect” cases (see the post about how the ETU runs, if this doesn’t
make sense to you) who came back with negative PCR tests. Unfortunately, we
also moved 5 or 6 people into "confirmed" whose tests were positive. And,
overnight – a child died. Gravely ill children are just so fragile (at least,
to this non-pediatrician they seem so) – they have little bodies and thus high
surface-area-to-volume ratios, which means they probably lose more fluid by
sweating (proportionally speaking) than adults (and as I’ve said so many times,
fluid is key). And they simply contain less fluid than an adult, so really bad
diarrhea can dangerously drain them faster than it does us. And – I don’t know
– they just seem fragile – they have a reputation for “going south” incredibly
rapidly when things go seriously wrong, in the States as well. Anecdotally,
I’ve been told that the mortality rate for young children in the ETU is very
high, significantly higher than for adults.
However, since making some modifications to our treatment
regimen, our “record” is six survivors, just one death (the child). We remain hopeful. And (more of the good news I hinted at a couple of posts ago),
one of the VERY sick men that we’ve been taking care of for a week or so, whom
we’ve seen at a really low point, pouring out diarrhea and/or vomit, seemingly
psychologically disoriented – he’s been looking better and better, and today
his repeat PCR came back negative!!! There were cheers in the office when this
was announced, I can tell you. (He’s still very weak – I don’t know how soon
he’ll actually be able to go home. But, in theory, he is now no longer at risk
of Ebola.)
In the afternoon, there were only two people in suspect (as
recently as two days ago, there were maybe 16), so almost all of us went to
work in confirmed. And though there are some very sick people, the treatment
situation looks generally good – we have a good IV (and usually two) in
everyone, and have gotten 4 or 5 liters into most of the sick folks, with
evening and night shifts still to come. I felt like we “hit our marks.” In
fact, I feel like I’m figuring out, more and more, how to do this. (A lot of it, frankly, is organization and
time management – feeling our way into how to get the really important stuff
done every time we go in, in the limited time available.)
I’m also realizing one of the things I contribute. Oddly
enough (because I am VERY disorganized, as a person), it is thoroughness. I think,
in fact, that BECAUSE I’m disorganized, I’ve developed the habit of going over
things again and again, which adds up in the end to being thorough - ! I think
that, more than some (not all) of the clinicians, I notice when, for example,
our system of administering malaria medications (which need to be given twice a
day for 3 days) is allowing people to fall through the cracks and risk missing
doses – or when we court danger by not sufficiently emphasizing when a patient
has gotten a recent dose of Tylenol (if you overdose this, as you probably
know, you can cause serious liver damage, which would be a hideous thing to do
to a patient who has come in expecting we’ll take care of him/her). And I do
this little obsessive thing quite naturally – I don’t have to “whip myself into
shape” to make this particular contribution. Everyone here, no doubt, has
something like this that they bring. So often, I equate “work,” or “doing
something worth doing” with grinding, bitter effort. Which I’m sure it is
sometimes (ask a teenager practicing the piano!). But when it’s more “in the
zone,” more “flow” – it’s nice.
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