FINALE

It was too good to be true.  SDA Cooper is the only hospital in Monrovia to be
open during the whole Ebola epidemic thus far.  And we were the only hospital
without Ebola casualties among its staff.

This morning, I get called into a meeting in Mrs. Carter’s office.  Dr. Martin,
Dr. Sonii, Steve, Gillian, the Chaplain and Mrs. Carter are all there.

I find out that Arabi, the ER nurse’s aide who took herself to JFK Hospital last
week to get tested for Ebola has been confirmed as positive.  She has had early
treatment, but the ongoing treatment is dependent on Steve taking money,
medicines and supplies over there every day and bribing the hospital staff to
take care of Arabi.  She’s conscious, but has bloody diarrhea.

No one has heard from Aaron either.  He’s one of the cleaning guys.  He’s been
sick for over a week, taking malaria medicines at home and refusing to come in,
go get tested for Ebola or even let anyone see him.  He’s been having rectal
bleeding which he’s been claiming is his hemorrhoids, but he won’t let anyone
examine him.  He lives by himself.  Steve went to visit him yesterday and the
door was locked and no one answered his loud banging.  Gillian had told me
earlier that the rumor is circulating that someone found him dead with his
pupils fixed and dilated.  This apparently hasn’t been confirmed.

As a result, yesterday, no midwives or nurses showed up during the day and only
one nurse at night.  Today, there’s one nurse and one midwife on as well as the
Outpatient Department staff.  Steve confirms that many nurses and midwives have
called him to say they’re not coming in, they’re too afraid.  Many of them had
contact with Arabi or with the same patients she did and so they are frightened
and don’t want to come in.  Steve recommends that we temporarily close the
hospital.  Everyone seems to be in agreement and after a brief discussion, we
decide to close for three weeks, as a sort of quarantine since that is the
incubation period for Ebola.

As of tomorrow, we aren’t seeing patients.  If you’re pregnant and need to
deliver?  Malaria, anemic and need a blood transfusion?  Surgical emergency?
Sorry, find someplace else…if you can.  Gillian and I and whatever nurses are
willing to help will take care of the inpatients until they are discharged.  We
only have six left after Gillian discharged many today.  Tomorrow, we’ll do the
last operation on Titus to close his colostomy and then he’ll go home in 2-3
days.  By Friday, the SDA Cooper Hospital will be closed.


Meanwhile, later in the morning, Bendu calls me to go see Mr. Wennie.  Mrs.
Wennie is helping him stumble into his office.  I follow them and see Mr. Wennie
sitting in a chair.  He has an obvious right facial droop and is complaining of
his left arm “not feeling raht.”

“His preshuh 150 ower 100, doctuh,” says Bendu.

“Did he take his pressure medicine this morning?” I ask Mrs. Wennie.

“No, he did uhnt take it.”

I have her bring his meds and we give them to him along with four baby aspirins.
He can barely swallow, on pill rests on his outer lip and he chokes on the
water.  All signs of a stroke.  I go get a thing of yoghurt from my fridge and
bring it to him.  He swallows that fine with the rest of his tablets.  We lay
him down on a mattress behind his desk.  I call for oxygen.  We’ll see what
happens.

Mrs. Wennie comes back a half hour later to tell me Mr. Wennie has refused his
oxygen. I go into his office.  His facial droop is gone and he’s sitting at his
desk without oxygen.  He’s talking better but says his left arm still doesn’t
feel right. I speak firmly with him about the need for oxygen and he finally
lays down again and lets us put the oxygen on.

I go back to my office.

I get a call to come see another “emuhguhncy in de cah’.”  A woman with a stroke
three weeks ago who went to a clinic, was diagnosed with “presshuh” and given a
water tablet which she took for a few days and stopped.  Then she went to a
Chinese medical clinic.  She shows me a bag filled with bottles labeled in
Chinese and baggies of black pellets.  Now since yesterday evening she has been
having right sided seizures.  I tell them there’s nothing we can really do and
except comfort care so I send them home with some meds.


As I take off my gloves and wash my hands in chlorine water before going back
into the hospital, a man comes up holding sick seven year old girl in his arms.
She is semi-conscious, but otherwise looks healthy.  Her temperature is normal.
The man explains that she had a headache last night with fever and then
convulsed this morning.  I admit her for treatment of cerebral malaria.

I realize suddenly, this may be the last patient I ever admit here in Liberia…I
can’t tell if I’m relieved or sad...

ANOTHER STORY

No sewing lately so I will just post an email that I received from a friend serving in Liberia...


Once again I find myself ignoring my initial instinct and letting myself be convinced by a good story.

As usual, the security guard calls me outside.  “Emergency in de car,” he says.  I walk outside, pulling on gloves with a snap as I go.  The woman is lying in the back seat of a beat up yellow taxi with 5-6 family members crowded around all eager to tell me the “story.”  I glance in and see a very critically ill patient with labored breathing and semi-conscious, her head flopped back on the seat being held by a female relative.

As I piece together the story from the different people all trying to talk at once she had malaria 10 days ago which was treated with a  three day course of Artemether/Lumafantrine, a common first-line therapy.  Then four days ago she had a miscarriage and bled heavily that evening.  Yesterday, she went into the Benson Hospital where a doctor told them she needed an emergency D&C.  The father paid the $US 200 and the procedure was done.  She stopped bleeding afterwards.  Today, however, her breathing got heavier and she started to fade in and out of consciousness.  They were told by the doctor she needed a blood transfusion and that their lab couldn’t do it and they needed to come to Cooper SDA Hospital.

In the back of my mind a still small voice is trying to whisper “where’s the referral slip?” but that quickly gets suppressed by the good story I’ve just heard.  How could they make all that up?  I ask the typical screening questions about vomiting, fever, diarrhea, etc. and they all adamantly shake their heads “No, she doesn’t have any of that.”  So I motion them to bring her in.  She kind of stumbles up the steps, supported between two relatives.  I have her wash her hands and I see her kind of slump as they now drag her through the door, past the benches in the waiting room and into the first exam room on the left.

As they lay her on the exam table, she starts to seize and then stops breathing.  The family starts to wail immediately and I roughly push them away shouting “Let me do my job, will you?” and I start doing CPR, half-heartedly I admit.  But I then stop and check and she does have a pulse, albeit a weak one.  So I keep pushing on her chest to force air in and out of her lungs.  Not deep and rapid like compressions of the heart, but enough to get some air movement.  I start calling for nursing help and they struggle to get an IV.  I figure if we can just get some IV fluids in her and then some blood maybe we can save her.

All along her arms are deep purple bruises.  It wants to set off some alarm bells in my head, but I quickly silence them and keep up the resuscitation efforts.  We pull the bed away from the table so the nurses can look for IVs on both arms.  I then have one of them take over chest compressions while I search for a femoral vein.  I find it but have to hold it specifically in position or it stops.  I get a dose of adrenaline in and then it moves and stops working.  But her heart is better now and she’s having some sketchy spontaneous breathing efforts.

I’m calling for oxygen.  At some point, Gillian shows up after finishing an appendectomy upstairs.  The oxygen tank is missing the handle to open it.  They run to get another one.  A nurse’s aide, Habakuk, finally finds a small IV and we start running in some fluids.  The lab tech has now arrived and there are two new nurses as we have passed change of shift.  I think maybe she’s still bleeding from her miscarriage so I order some oxytocin to be given intramuscularly.  We’ve finally got oxygen going and she’s breathing on her own with a good pulse.  Two bags of blood are available and the first one is almost in.

“Bring in a family member,” I ask a nurse.  Just as the sister walks in the door the patient seizes again and stops breathing.  “Get her out of here!” I point to the sister and we restart our efforts.  Finally, we succeed in getting her breathing and oxygenating well with a strong heartbeat and pulses.  I call in the father.  He is overjoyed and thanks us profusely.  I’m happy.  This is why we still do this CPR stuff, because sometimes it actually works.  The second bag of blood is in, a recheck of her hemoglobin finds a stable 9 g/dl.  We’ve been working on her for two hours. The sister comes back in.  We start talking.  I ask some more questions.  Suddenly, she starts talking about how she’s been vomiting and having watery diarrhea and fevers at home.  I nervously look at the patients arms with the huge bruises and then notice all the IV puncture sites still oozing.  I pick her her wrap and see that there’s oozing from where we gave her the shot.

I go ballistic. “What are you trying to do, get us all killed?” I scream.  “Lies, all lies!  Why didn’t you tell us the truth.”

The sister and father weakly try to give excuses “We didn’t know, I wasn’t there, etc.” 

“Everyone was there when you were denying vomiting, diarrhea, and fever…don’t lie!  It won’t help you or her!  Take her out now!”  I’m sure she has Ebola!  I’m starting to freak.  I’m exhausted and feel like I’ve now put how many staff at risk?  How could I ignore my instinct?  If a staff member dies of Ebola, I’m responsible.  I feel like for the first time I’ve had a serious exposure and my stomach is in knots.  I rush home, take a shower and soak my scrubs in a red, hospital smelling disinfectant I find on a shelf in the shower.

The patient dies almost immediately on being carried out the hospital doors.  The father comes back to the steel bars now keeping him out.

“You did your best.  I’ll come back tomorrow to settle accounts on our deposit.”

I want to scream, “Is that all you can say after lying and exposing us all to a deadly plague!”

My sleep is troubled by fearful dreams and I wake up with my heart beating out of my chest and it still dark outside.  I kneel with my face to the floor and sob out as I cry to God for mercy, mostly for the staff and also that he will spare my life.