Get out of the kitchen?

March 5, 2015 – 99 degrees today. I went in in the afternoon and after about 45 minutes began to feel anxious – a kind of panicky feeling, like I won’t be able to handle…something. I and a colleague were working on a particular project: Cleaning up and ordering all the medical supplies in all the rooms. You can perhaps imagine how they become a complete mess: People going in can’t check what is already in a given room (after all, you can’t go into the room unless you’re in full PPE). So we bring things we think we might need – IV tubing, “flush” syringes, IV fluid, needles, oral rehydration solution. When we get into the room, we put what we’ve brought down on a bed, but usually – since we are always being better-safe-than-sorry – we don’t use it all. Most of the time, we’re working pretty hard in there, so we don’t take the time to consolidate whatever we’re not using with whatever is already in the room. So, over the course of many shifts, little piles of miscellaneous, mixed equipment collect all over unused beds. It’s a complete mess – and beyond making things hard to find, it’s just depressing – makes it feel like things are out of control, which you’re already close enough to feeling during those busy, limited sessions in the unit anyway.

We had gotten all the “suspect” rooms organized in the morning, but my colleague was handling a torn plastic pill package that cut through both her gloves, so we had to leave before we’d done much with “confirmed.” So, in the afternoon, we started there – only to realize the rooms were such a mess that each was going to take maybe 30 minutes to organize.

Anyway, I breathed through the anxious feeling – a little difficult since the only masks we have available are the ones affectionately referred to as the “waterboarding” masks. They are soft paper/fabric, and as you sweat they gradually get saturated and collapse, till you’re trying to breath through what amounts to a wet towel millimeters from your face. Periodically the anxiety would rise, periodically I would breathe it down – I really, really wanted to get the rooms cleaned! Over the next half hour, I noticed my heart rate rising, my breathing rate rising, my head beginning to pound, my concentration beginning to unravel, and always the anxiety…. In the last room, I got the medication box organized and most of the supplies consolidated, and then my colleague (who is probably 25 years younger, but was also hurting) and I kind of shoved it all into a more-or-less rational pattern and got out.

Definitely the worst PPE session to date. I took my temperature (100.3 on a thermometer which usually clocks me around 97.9), downed a couple of liters of water and ORS, and, interestingly, gobbled down some cold French fries – maybe craving the salt? Now, two and a half hours later, I feel more or less okay – sleepy – tired – but okay.

Meanwhile – remember that time I told you that no one had died in the confirmed ward for a week? Well, I’m pretty sure that, over this past week, no one there has survived. I remember a fellow student in medical school who lamented – “Whether I study or don’t study, I still get the same grade on every test!” It’s beginning to feel that way here – we do what we do, fine-tuning it, “improving” it week to week, but whatever we do, half the patients die. It’s the same dispiriting picture as when I first got here….

I actually think we are delivering GOOD care. That is, given the limits of what we can do here (and of what we know – it’s incredible how much about the basics of just what happens to your body when you have Ebola no one knows), I think we are doing what we can. We’re giving each patient personal attention; we are treating every problem of theirs we find that we can treat; we are giving them medications to suppress other infections that might add insupportably to the strain on their bodies. There is nothing obvious we could be doing that we’re not. And yet we’re still nowhere near the survival rates achieved in the West. Maybe you just simply need more and more sensitive monitors, a wider range of life-support techniques, and more continuous (i.e., not just 15 or 20 minutes six times a day) care to dependably survive.