Ebola: One nurses journey facing a killer virus in the ER

Ebola: One nurses journey facing a killer virus in the ER

10/17/14
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It was the beginning of my shift in a rural Emergency Room. It was starting out in the usual fashion with the run of the mill abdominal pain, the headache, the car wreck, a stroke, a heart attack, you know the every day stuff, then the “Ebola patient!”

Yes, the Ebola patient. 

That statement alone caused a subtle panic that rose to fear as thoughts raced into my head. Ebola in America, and Ebola in my ER and Ebola in my room?  My day couldn’t get better. Geesh!

In my 27 years of nursing daily I have faced many potential death causing organisms that could cause me great harm. In my world yesterday I had at least an antibiotic or a medication I could take “just in case” I was overcome with a deadly bacteria to restore my health. Today, right now, to treat Ebola, very few options, no meds, no vaccine, naddah! I get it, go ahead and place me in the morgue, career over.

My dilemma today, this shift, this hour, I am having a showdown with the most virulent manmade virus on earth. It has the strength few have experienced and if I am overcome with this virus I may not see next week or live through the quarantine. My mind is in overload. I know this going in.

The thoughts of not hearing my children’s or wifes voice again are more than I can stand. My next birthday, weddings, my grandchildren being born, I have more life to live.

In a rush, my head begins to fill with memories, past vacations, Christmas mornings or just the kids filing into my bed on a weekend morning chuckling at my messed up hair or waving their hand at my morning breath. It’s sounds a bit silly but it came to me.

I like many others chose my profession. I feel it is a valiant one. I have cared for enemy soldiers on a battlefield, I have held new born babies in my hands and have clutched the hand of a sweet grandmother taking her last breath. I have heard the weep and wail of a mother or the deep baritone wail of a father losing his son or daughter whose life was cut short. There is no experience like it. I dont like it or feel like tending to it every day but
I do it, we do it, it’s our job. Its passion on display that often leads to empty reservoirs needing a refill that more often than not are not replenished. 

This grind leads to a damaged being but yet we sleep, we work, we sleep and we return to work. To understand the spirit of a nurse you must walk in our shoes, otherwise if would be mute of you to try and understand. Today, it’s about me and my patient and I hope the visualization is understood. I don’t need you to feel sorry for me, just listen to me.

I say that to say this. Despite the unpleasantries of my “job” or “calling” I feel a need to help others and pour my body, spirit and soul into my work and I really do love it, i just have to realize and absorb that it comes with very few tangible earthly rewards or accolades. My profession is inundated with many that feel this way, it’s how we roll.

Our jobs are thankless at times. We accept it and go on. We often leave our day with a heavy burden that must be shed daily or it eats away at our inner being. The Nurses head at times is overwhelmed with clutter that only a nurse would know. Serving others often leaves self denied.

Pity I am not seeking, perhaps a little empathy? For today I am facing my greatest challenge, soon to be my greatest fear, my own mortality. I am not alone. We all are facing this dilemma, this just happens to be my story, my first encounter with it.

It was real early into the shift about 8 pm. The flow of patients was churning as usual and sick patients were entering and leaving. The call comes out. Possible Ebola patient in the lobby. I recall just the day before two potential Ebola patients were whisked right by my facility to a level one trauma center. The subtle angst is there, the fear is lingering. This moment had been rehearsed for at least 24 hours in my mind. I knew it was coming eventually. I am left to enter this arena like a gladiator.

I had just watched the evening news and a Nurse inTexas had already contracted the virus and many more were being quarantined. The images and my plan for safety had already been rehearsed in my head. I am now part of kindred group and we face this as we always have. After all the best way to eat an elephant starts with that first bite.

I had fortunately in the days prior been updated and drilled on the usual universal and contact procedures and had them fresh in my mind, but was the knowledge refreshed enough to protect me. Was the equipment that really hasn’t changed in my near 30 years of nursing adequate. Was I gonna be protected when I faced the most virulent and feared virus of all time?

My thoughts ran and I even contemplated running to the nearest exit. My own anxiety and assimilation of fear had peaked, I was teetering, I was dangling on an edge that I had not been to frequently and avoiding this type moment had been purposeful throughout my career.

I could not run. I was stuck between reality and the fantasy of me developing wings and flying away.  

I soon put on my big nurse panties and began to reason over and through my situation. I am a Nurse warrior and my life calling is to save lives and make others feel better, not run right? But who was concerned about me in this moment. I’m not supposed to die for my calling, am I? I guess we find out.

My family miles away and unaware I was facing my own mortality and potential separation from them forever. A call to them would only perpetuate a bad situation and make it worse, they would surely want to assist me or convince me not to enter that room.

The patient was led into his room, his wife in tow. The Triage Nurse was finishing up her assessment in her full PPE regalia. As she exited the room ridding her self of a flimsy gown, an N95 mask, rubber gloves and a pair of goggles my heart began to race. “You’re  up”, she quipped! Obviously her faith in the equipment was more than mine. I remained child like in my approach, inquisitive yet trusting, I think. 

Regardless, after a detailed report telling me the patient had recently been in contact with someone overseas, was having flu like symptoms, had diarrhea and a slight fever. Yep, enough questions answered to warrant an Ebola quarantine. My turn was up.

I paced the hallway in front of the closed and isolated room. The other nurses were concerned at my dilemma but were busy with their own and this was the hand I was dealt. This was my problem.

Seek and destroy was my military credo, it didn’t always fit being a nurse on the battlefield but it was my mentality and I was facing an enemy that needed annihilation or at least protection from it. I beat on my chest for a moment, then flashbacks of me running to my mom as a child after a nightmare and her comforting me. I debated sticking my thumb in my mouth but doing so would “breech protocol”, so I resisted the urge.

Sure, I felt I was being dramatic. After all I am a caregiver and I took an oath and besides that I’m just a good and caring kinda guy, it’s what I chose to do? Right? The drama was substantiated but our collective shortcomings and distrust in our PPE, Personal Protective Equipment was overwhelming me, I couldn’t stop rehearsing worst case scenario in my head.

I whispered a prayer while walking to the table set out in the hallway to don my equipment. I peered over my shoulder and saw orange cones to deter others from the one bathroom on that end of the hall. A security guard posted to not allow entry or exit from this isolation room. Construction paper taped neatly to the floor in front of the room to assist our exit. The flimsy gown, the goggles, much like the kind I used in the yard while weed eating, I donned. I placed my hair bonnet and boots over my thin protective pants. I tied my own gown around my neck, placed three pairs of gloves on and I began to sweat. I was ready to face the greatest threat to my health to date.

Again those darn self limiting thoughts of doubt began to trickle in and out of my brain and it began to warn my body. My fight or flight response was taking over. Running at this point would appear cowardly, so I stood still. A slight tremble to my hands was noticeable.

My hair and neck were beginning to collect beads of perspiration that were turning to streams and culminating in the small of my back saturating my clothing. I couldn’t shut the emotion off. I was in it’s throes and there was no backing away.

I again began to pace and I could feel the cool air in the hallway cooling my neck, my face and my back. I am a mess and I was alone.

Keeping my emotions in check and taking a short inventory before I entered the room. I quickly realized I was not covered even with the best we had to protect us. I had skin exposed, I was vulnerable, I was overrun with questions and no quick answers. So I proceeded for some reason despite my reservations.

Is it airborne? Is it not? Droplets? Will the patient sneeze? Will I accidentally wipe my forehead after touching the patient? Will I begin my rapid death today?

Was I being overly cautious? Was I making a big deal out of nothing or was I to believe that the “best we got to protect me going to actually protect me?” After all, I had been using that same type equipment for 30 years with no real harm done? Right? After all, I am a nurse, I don’t need nobody taking care of me, I take care of others. I began to growl and soon stopped making me realize that doing so made me look unstable and I didn’t need a trip to the local psychiatric facility so I digressed.

I looked downward, then side to side watching others as if I was entering a patients room for the last time and I was about to start the clock on the last five days I will spend on earth. 

Honestly, I was scared. Not of what may happen to me after death but to die this way, doing what I love, it’s not supposed to be this way. I would have allowed anger to ensue at the total lack of preparedness for a situation like this but I had no vacancy in my mind for another emotion, so I left it where it originated, I’m choosing my battle.

My movement had slowed to a pace slower than real time. I realized now I was in what people talk about as the fear zone. I’ve been there a few times before and it was starkly familiar. A very interesting place.

Everything is clear, it’s slow and deliberate. Its oddly comfortable. With several of these under my belt I began to savor this rare emotion where few have gone hoping it wouldn’t return but enjoying the out of body experience. This sudden fear of death has caused me to feel incredibly alive. It’s really odd. The endorphin kick had entered my body, much like a runners high. I’m strangely aware. Everything is very clear, voices and sounds are amplified and I have gained cat like vision. I’m bullet proof.

I press the door handle down to enter and even though no one else heard it, the door creaked as I opened it. I was hyper aware of the threat I faced, done the research and I was on it’s door step. The temperature of the room was cool, the air at my vantage point was filled with the aroma of Ebola and I was stepping into its lair, it’s grasp and I was in the zone. 

I had overridden my fear with reasoning and deduction with a smattering of hormones to face this demon. After all, at this moment I was feeling fully alive not dead or diseased. Is this all you got?

I entered and saw the sweetest couple. Middle aged, well dressed and the nicest folks I had met in a long time. I was feeling oddly comfortable and my heart was returning to my normal beats per minute. I was settling in to this whole taking care of Ebola patient thing.

My patient and his spouse had been briefed about our protocols and they obliged every inconvenience with ease. Quite frankly I didn’t care if they were mad or not about being quarantined. It was our situation and we were dealing with it. After all they came to me I didn’t wrangle or hog tie them to seek medical care. 

My patients first words were “are you scared?” I reached for a proper response and only replied with a “yes, yes I am!” “Are you” , he replied  “Yes I am and this is some scary stuff, isn’t it?” That realization and mutual confirmation of our reality eased me somewhat and made my assessment easier.

I applied my stethoscope to his chest, lungs clear. BP, pulse, respiratory rate ok and in range.

This is not so bad. I got this. 

My patient then said I recognize you, you have taken care of me before. Harmless question huh?

My anxiety returned and my heart rate bounced upwards again. That sentence hit me like a sledge hammer. Besides my voice he recognized features that recalled me in his memory. I was visible enough for him to know me and remember me. I’m in the zone and clicking on all four cylinders. I’m hyper aware and realistically am one with the Ebola virus at this moment. If he can see me, I am disease accessible.

If he “sees” me then that air he is breathing sees me also. Good Lord in heaven, please take me now. I don’t wanna go in a hurry, in a weakened state and expelling bloody diarrhea from my butt to my death. Not this week.I got things I wanna do.

He saw my demeanor change and sensed it, realizing that potentially we were all three were dying in this moment. I was vulnerable and I am not comfortable inside this precarious time frame. I’m looking for a door and a quick exit. I can’t just run out, I’ll expose everyone. I can’t be careless.

I scurried to finish my assessment, little else was said and I shed my outer protective gear and my initial and perhaps final assessment had been done. I now have to process this event and ponder my next move.

Standing in the hallway, I gathered I huddled with our ER Doctor outside the room and he offered these words of comfort. Donning his equipment for his assessment he says “it’s gonna be ok” , “we will get through this”, “this is only a thing!”

As he walked away I heard the whistling in the background like an old Clint Eastwood movie where he rides off into the sunset. He comforted me with his gentle wisdom and appropriate words.

Just as before I look around the ER. As the doctor is doing his assessment I am worrying for his health. I knew by seeing clearly in that moment, facing that disease I was not protected, our infection control protocol had holes in it.

I was seeing those images on TV where the CDC Doctors and  scientists were  wearing the Tyvek suits complete with it’s air filtration packs and full hoods with drapes down to mid chest and no skin showing and they were not easily identifiable. Where was mine? I rehearsed the nightly news casts in my head and I recalled the talking heads stating this latest spread of the disease may be due to the nurses error, she “breeched protocol.” 

Then it appeared to me. I felt betrayed. I felt expendable. I had just tested the inadequate equipment and saw it’s faults and it failed me miserably and it was allowed.

Between the three medical personnel that were exposed we represented nearly 100 years of valuable care experience and in that moment we were just a loss prevention statistic waiting to be analyzed and the cost was being projected for our loss.

My forehead, my cheeks, my neck, eyes, wrists and back were vulnerable this day and quite frankly I deserved better. 

Where is the standard with this new disease. Why aren’t protocols being instituted? Can we not meet the need with better equipment? Why are nurses and caregivers less equipped than our sanitation workers? Where is our representation? Where is our voice?

The doctor removes his “protective” gear with my assist and he states “based on my assessment and several other questions asked I have ruled out he has been exposed to Ebola, his threat level is zero now.”

Based on his decision to clear the patient my anxiety should have subsided. After all, he doesn’t have Ebola or does he? At the point of care we have no ability to test the patient and cant make a definitive diagnosis at the bedside or within three days, even though the technology exists to do so. 

As I roll home in my car, enter my house and grab my children, hug my wife, the thoughts are still entering my head. What if this Doctor were wrong in his assessment? What if he misread his diagnosis? Didnt ask the right questions? It happens every day. It’s not all cut and dry. There are margins of error and at one percent I am still uncomfortable.

Oh well, I resort back to my private life, I have a day off or two. Lingering at least the next 22 days my health could deteriorate. I’ll just dismiss the remote possibility that I could be carrying Ebola and spreading it around. I am confident this time the Doctor was right and I agreed with his diagnosis. It’s the best our system is allowed to be.

I know when I return to another shift there will be another encounter. Another day, another potential Ebola patient. These worrisome times are upon us.

I continue to pray for all caregivers out there on the front lines. We are in this together. Demand better equipment and shift the thinking to elevate out profession beyond expendable. 

Many more battles are in our future, be safe and love to you all. 

Peace!

Disclaimer: 
Although I use humor in my writing it does not lessen my sincerity for this dilemma we are facing. I know it is a very serious threat to us. I take it very seriously. 

Healthcare workers, nurses and etc are extremely  vulnerable right now. We have holes in our system. We can fix it but we must be heard. My hats are off to all! 

Much respect.