Walking into the first room of the Confirmed Ward for the first time two days ago, we found eight-year-old Ryan lying on his side, neck extended and face uplifted. My partner felt a pulse but it was only his own heartbeat. Ryan’s chest remained still, no brachial pulse. The lighting was not good enough to see his pupils. My first instinct was to shield the youngster lying in bed across from him who had been staring, heavens know for how long, and witnessing his cousin’s fate with death. On the hard cement floor was Ryan’s seven-year-old sister, curled up sleeping. She shared a bed with her brother. No one knew whether she crawled out of bed out of distress while her brother struggled and breathed his last. She was picked up, pants soaking wet with watery stool. If there were a time when children needed their parents most; this would be one of them. But Ebola is unforgiving, without PPE they would surely become infected. No one could don PPE for an extended period of time in this heat and humidity.
Last night I was asked to do the night shift, I joined an ER doctor from California and a nurse from Kenya with our entourage of local nurses and a physician assistant. The last time I did an overnight shift was during my residency years. The evening staff started by singing and saying a prayer asking for God's protection. There were only 2 suspected and 15 confirmed patients. Many of the confirmed patients were not doing well and would require IV fluids.
Even in the evening, the donning process brought out a profuse sweat. My goggles fogged up. I reapplied the defogger to my goggles asking the monitor to let it air-dry which seemed to work better before launching into the Suspected Ward. An elderly unresponsive woman had weakness on the left side; we were unsure whether it was an old stroke. She died later in the early morning hours.
Then it was a flurry of activity of hanging IV fluids and ORS to catch up on the losses. Fever and diarrhea in a 5-year-old boy prompted more IV fluid. He was luckier than Ryan, his sister, Christine and cousin, Solomon; he had his father who recovered from Ebola to care for him. Solomon remained wide-eyed and silent, refusing to drink, his food piled up by the end of his bed while Christine slept curled up. Touchingly and lovingly, a nurse sang a lullaby to her.
Heavy rain came pelting down beating mercilessly on the tinned roof, it would be impossible to hear one speak in the wards. We made our second round at 2:30 am. Many patients had diarrhea and were soaking wet and cold. Another round of fluids and medications. Varney’s gums were bleeding. He could be awakened; evening report said he was semi-conscious.
The sprayer cleaned the ward as we made our round, chlorine fumes filled the air. Big flying insects fell into the bucket of chlorine, struggling to get out. Gigantic butterflies fluttered on the chlorine-soaked floors, desperately trying to get unglued. Giant rhinoceros beetles with menacing horns crawled around especially around the footbaths. In the evening they flew into the air in droning vertical flight and then suddenly dive-bombed kamikaze fashion on some unfortunate souls below.
During doffing, there were two instances which caused me some concern: while peeling off one layer of my gloves with my goggles already off my face, I felt drops of fluid flew into my eye and when the sprayer sprayed chlorine onto my Tyvek, wetness seeped into my scrubs. True breaches or not, I have to live with anxiety that understandably lurks at the back of my mind. Despite the cooler night, I still sweated through my scrubs during my hour and half inside the ETU for each of the rounding.
One happy piece of news was Fatu’s Ebola test was finally negative after 23 days. She beat Ebola and would return home in the morning triumphant.
The 12-hour shift actually turned out to be more like 14 after all the administrative meeting.
Dawn came. The eastern sky brightened. My energy level all of a sudden plummeted. I was ready to go to bed.