A Sense of Loss

Wednesday was a rough day on many levels. Per IMC policy, if you are doing a 3 month contract, you can have 9 days of r&r after 6 weeks. One of our nurses left Sunday & another left Wednesday night. While I am grateful that both individuals will have time away to relax and to spend with friends/family (although the us citizen can't actually go home because USA won't let her leave our country until the 21 days of quarantine are up, even to return to West Africa), I am also sad because I was close to both nurses, and now they are gone, albeit temporarily. And the goodbyes and the sense of their absence resonated deeply with me--because so many Sierra Leoneans, Liberians, and Guineans have said permanent goodbyes to loved ones over the past 14 months. Family and friends, whom, some of them, left their communities looking perfectly healthy...only to die of Ebola within two weeks or less.

Another reason it was rough--today was day 8 for the husband to be in the ward. If you can make it past day 7-8, you can usually beat Ebola. And he has been fighting, fighting, fighting, all the way. But 4 days ago he began to have visible signs of bleeding and spiking temperatures. One of our national doctors, a man who has been fighting Ebola since it began in Sierra Leone, said the other morning, "I have never seen a patient survive once he or she starts bleeding. But perhaps he will be the first, he is a fighter." And as days 6 and 7 passed, we all began to feel optimistic and wanted him to survive and recover. Not that we ever don't want patients to recover, we do, but we feel a special pull to him because his wife died---and circumstances surrounding her death will haunt my co-workers for some time. I am thankful I was not yet in Sierra Leone when she was in our ETC. For our staff, his surviving would be a bit of redemption since there was so little we could do for his spouse. He did not fare well through Tuesday night though, and when I saw him at noon he looked terrible and was no longer responsive, even to pain. The docs and I stayed with him at bedside as long as we could, perhaps 45 minutes. Then after shift change I went in again-because he is "actively dying" and I wanted to spend more time with him. Second time in high risk I was in close to two hours--and as WASH tends to fuss at medical for being in too long, I came out at two hours. (They are only trying to protect us, after all). He was still breathing but struggling to do so. We gave him morphine. The national staff is quite hesitant to give morphine because, from what they see of it, it causes death. (Cue Brian Regan: "Morphine?!! That's what they gave the guy in Saving Private Ryan right before he died!") We give it to the sickest patients, so it does kinda look like it causes death--but the whole palliative care modality doesn't exist here. And the ones who get morphine are usually "actively dying." I don't know if you have ever seen someone actively dying. It isn't easy to see--and there is no way to know how long the process will last. Humans are too different. I don't guess anymore because I am always wrong. I thought he would be dead at 3 pm; and he wasn't. I left him at 5 and came back at 6:30. His breathing was more shallow but his pulses remained strong even in his feet. (You can assess a person's blood pressure based on which pulses you can feel/no longer feel when you do not have a blood pressure cuff).

My supervisor and I left him at 7:35 because we needed to doff before shift change-the national staff has a bus to catch and we didn't want to delay them. It was so hard to leave him. I hate Ebola, and I hate that so many die alone, isolated from their loved ones.

Another reason today was hard--we had 4 admissions in 3 ambulances over several hours. My supervisor found out about the fourth pt, a pregnant lady, shortly after I left high risk for the second time. At this point in the day almost everyone had been in twice and a few three times. She graciously agreed to join me and I quickly gulped down O.R.S. (And yes, the taste is pretty terrible) and 2 liters of water. We were told we had 30 min to an hour before her arrival. They then updated us a few min later with "They are still thirty minutes out," only for us to hear the ambulance siren two minutes later. Time is relative here ;-)

We got our new patient settled and spent a little time with her then we moved on to the confirmed ward to check on our dying patient and to relieve the nurses who had passed dinner meals. They were giving iv fluid and couldn't leave because the pt receiving the iv fluids is not oriented and she has to be monitored while receiving fluids so she doesn't rip her iv out.

Several of our new patients are quite ill. And the one is an aunt & caretaker of one of our patients in the confirmed ward. When she goes outside her 8-yr-old niece sees her and cries incessantly because she wants her aunt--but her aunt is currently Ebola negative and cannot go to her niece without putting herself in great danger of contracting Ebola, something the 8-yr-old cannot comprehend. All she knows is her aunt won't come through the double fence to be with her.

We have a movie projector and we show films at night that the confirmed and probable patients can watch if they are well enough to go outside. I didn't recognize the film tonight but the patients seemed to enjoy it.

I can't help but wonder if the husband would have done okay if we could have given him a blood transfusion. He is such a fighter, but he has lost so much blood. The disparity in health care grieves me. If I were to contract Ebola, I would be air-lifted out, given interferon and transfusions, potentially blood products from survivors and would be given every thing we have tried thus far that could potentially help--because I am from a first world country. He isn't, so he is essentially on his own. We give iv fluids but no transfusions, not yet. We don't have interferon here. Today, praise God that you were born where you were and that you have had things like basic health care and nutrition from a young age. We lose so many kids to malnutrition here. And I am not saying poverty doesn't exist in the states, it does. But there are still hospitals and a working health care system, sure, it has flaws. But it is the grace of God that you were born where you were, that you are literate and able to even read these words, that you have electricity and clean drinking water from the tap and, for the most part, 3 meals a day. That are well-rounded meals, not just carbs because they are cheap and satisfy initially. But protein. And if your meals aren't well-rounded, it is usually within your means and ability to make well-rounded choices. Thank God for how He has blessed you. You could have been born in a time or place where maternal and pediatric health is low and lost your mother at childbirth and you could have died before age 5.