Shift Change

A thick haze hung in the air this morning as I got up at 5:30 to go for a run.  The morning sky arrived for her shift early before the night sky was done with his restorative duties.  The result was a smoky, seemingly benign but somehow foreboding reaction in the air.  Like a wall of e-cigarette vapor.  I greeted Shakira and used my mini-mag lite to cut a beam through it and started my morning routine.

When I arrived at our Ebola Treatment Center (ETC), I changed into scrubs and put on my rubber boots and prepared for shift change.  The medical tent at this time is full of nurses and doctors ready to go home from working the night shift and abuzz with the uproaring chatter of the new staff  greeting them.  It is crowded, loud and animated.  Everyone in dark blue scrubs and ink black rubber boots.  Imagine a throng of car wash workers.  Then I noticed the master board with a list of all our patients.  I scrolled down to see "RIP" next to a patient named Mohammed we admitted two days ago with pulmonary tuberculosis and possible Ebola.  He had been on TB medications for 5 months now and came in complaining that he never really improved and now had continued shortness of breath, at rest and walking.  He was found dead with his prayer book on his chest and the radio still playing early this AM.  There are expected deaths and unexpected deaths.  He was more in the latter category. 42 years old.

The average life expectancy for a male in Sierra Leone is approximately 48 years, one of the lowest in the world. Infant mortality is equally as abysmal.  The public health infrastructure prior to Ebola was terribly inadequate but since Ebola arrived here in December, 2013, the whole healthcare delivery mechanism has seized like an old transmission.  Routine medical care for non-Ebola patients has disappeared.  Patients come to our treatment center even if they don't have Ebola symptoms just in order to receive some medical care.  Unfortunately, we are not resourced to provide much else beyond Ebola care, which in and of itself is supportive for the most part.

As the morning sun chased away the haze, I went into the treatment unit to check on Sarah, a 40 year old pregnant woman who presented yesterday with Ebola symptoms.  Her 16 week fetus was halfway expulsed yesterday when I saw her, a purple flesh balloon sticking out from her vagina.  We have strict protocols here about not doing any extractions or vaginal exams in pregnant patients given the high risk for bleeding and exposure to our healthcare workers to massive amounts of Ebola virus.  So we gave her medications and hoped she would pass it on her own.  Given her risk of infection, we put her on antibiotics as well.  When I rounded on her today she had passed the fetus but was in a lot of pain and began to show signs of bleeding and shock.  We attempted to put in another IV as her first one was blown but she had the all-too-familiar sunken veins of dehydration.  She died one hour later.

When a patient is actively dying their eyes have a wide glossy shine.  Their last light  burns out like a ship's lantern as the ship bobs and sinks completely into the sea at night.   A wild calm.  We are trained to "pronounce" people after they die by listening over their heart to make sure there is no audible beating.  And watch for the rise and fall of the chest for respirations. To feel for a pulse.  But I cannot help but always start with the eyes.  They speak of mysterious passages in a language of salt and electricity.

Fatmata, a 25 year old woman with agricultural biceps and a wide, lean torso was admitted about 4 days ago.  She knew our treatment center because her baby died here on Christmas Eve.  She went back to her village and started showing symptoms of Ebola and was finally returned to us.  Too late.  She developed massive diarrhea and started bleeding from her gums.  She eventually became disoriented.  When I rounded on her yesterday she thought she was back in her village.  I imagined her drifting in and out of consciousness thinking about holding her baby in her arms and slicing potatoes with her sisters and laughing as they sat in the open air kitchen by the fire on wooden stumps.  I pronounced her dead today at 1:50 PM and we put up a small blue partition so the patient next to her would not see what she already knows.

The afternoon steam intensified even outside the tents and my black boots felt like bird shaped tires.  I was finishing up for the day. And I was finished.  The treatment center noise seemed far away, punchless.  I wanted to stay forever.  I wanted to leave forever.  I wanted to call my son and hear about red power rangers.

Just as I was about to catch the minivan back to my room I heard some clapping coming from the showers outside the confirmed tent.  Then some laughing.  The sound of hands striking drums shot through our compound and I knew at once it was the discharge celebration for a patient named Yakadiatu who had outrun Ebola and was now free!  The chants and percussion then became a small parade to walk her out, feet dancing as she weakly left, the wicks of her eyes awash in holy, wet light.

 I went back to my room, took off my shirt and my shoes, and closed my eyes and waited for sleep.