Into the Hot Zone

The first time I stepped into the donning room I was pretty nervous. Alright, that’s a bit of a an understatement, my stomach was in my shoes, and each step of donning felt slower and slower.

We had some patients who were just getting admitted from triage, we were gonna draw blood and  check on some other patients.

Slowly, over the course of ten minutes, you put on your gear, it’s called Personal Protective Equipment, but we just call it PPE for short.

Each step is checked and double checked to make sure its on right. There’s always a couple nationals in there to help you tie your hood, defog your goggles, tie your apron and hood. It’s oddly reminiscent of Knights suiting up for battle.  You stand their and look at yourself in the mirror as layer and layer of protection is applied and checked by the nationals.

You cease being who you are as an individual and become an Ebola Storm Trooper. The uniform of mad men and women either brave or foolish enough to work here.  The nationals  write our names on our foreheads so we can tell each other apart.  They also write the time we went in on our arms. They do this so someone coming in can tell if you’ve been in to long and need to go out. It’s sometimes easy to lose track of how long you’ve been working.

This is also the only place in the whole of Liberia where you can shake hands and touch other. Once you go inside, you cant due to the  risk of putting Ebola on someone, the same outside, but for those few minutes you can shake hands, hug, whatever you want. You’re pretty well protected in your full body condom.

Your senses are dulled as the suit goes on. You are suddenly aware of how heavy your feet are, where the straps touch your head – the placement of the mask on your nose – if the mask is high too high, if its too low.

You have to fix all these things before you cross over. If your mask slips, if something is wrong and uncomfortable – you can’t adjust it. You can not ever ever touch your face once you cross that line. I made the mistake of having my mask to low one day, and couldn’t breath through my nose for over an hour. You only do that once.

Finally, as the sweat starts to come out, and you feel like an Asthmatic astronaut you cross the red line into the Hot Zone.

I took a deep breath before crossing that line. Here it was, the whole reason I had came to Liberia, and volunteered for this mission. All the worries and doubts and questions rose up and I anxiety coursed through my body. Man didn’t go to the moon to sit in the Lunar Module and wait did? Not after the journey he took, no he took those steps and did his job.

Standing in my own space suit, I crossed that line. All the self doubt and worry disappeared.

It was replaced with a very itchy nose.

The first day I was working with two other Nurses, a nurse practitioner who is our charge nurse, and another nurse who came up with me.

We only went into Suspect that first day. The building itself is Spartan, constantly wet concrete floors – your boots splash in small pools that gather throughout the building. The building is separated into individual patient rooms. On the confirmed side you can have three or four to a room, in Suspect you don’t want someone who might have Ebola to be in the same room with someone who might not.

The walls are are blue tarp, and the wooden framing is exposed, there are nails jutting out from the walls near the beds (for IV’s to hang from)

The patients each have a plastic mattress, and paper sheets as well an outlet for a cell phone to be charged. There’s  a bucket to urinate/vomit/defaecate into. If they feel healthy enough there are tables and chairs outside for them to gather at. The insects that can fly buzz around above, any unfortunate to be caught in a chlorine sprayers path lay dead on the floor.

There’s a light bulb in every room that’s always on. They have no pillows,  the bed rails can not be lowered  or the beds adjusted.  I imagine the smell of chlorine is nearly palpable.
We had a patient in Suspect that we would later admit, the Nurse practitioner went for a blood draw and missed, then she asked if the two of us would want to give it a try.

I nodded and said sure. He wasn’t a hard stick, but drawing blood from someone with Ebola was particularly nerve racking. One slip, one second of distraction and I could infect myself.  I had drawn blood on maybe a thousand people in the past, but none of them ever had Ebola.  I took a second to settle myself and got the stick.

Remember I said you can’t touch your face? For the first ten minutes I’m in the ward I have an incredible urge to scratch my face or adjust my mask or something. You just have to ignore it and focus on a task,  it does go away after awhile. However, the intense awareness of anything and everything on or around your face doesn’t. Even after your out of PPE, you’re hyper aware of anything touching you or near your face.

The amount of care we can offer is pretty limited. It is in my mind at least comparable to a battalion aid station in the army:

We Give IV’s (A lot of them)
We draw blood
We give IV Meds (Cipro, Flagyl, Ceftriaxone)
IV Pushs (Metrocploromide, Haldol, Valium)
PO Meds
Cleaning patients
Changing beds

That’s really… about it. They’re were two occasions where Foley’s catheters were put in, but they’re really quite rare.  The actual scope of nursing care is pretty limited.

It’s the conditions that make everything a challenge. The suit narrows your field of vision, your hearing is dulled slightly from the hood.  You can’t listen to a stethoscope . We can’t use a BP for a blood pressure. Even palpating for puncture sites is difficult with three pairs of gloves on.

Supplies are an issue as well, if you don’t have supplies in the suspected ward, you just can’t walk out to the supply room and grab them. You yell over a fence until hopefully someone pays attention to you, you stand and wait for five minutes while they go get it, They then throw it over two layers of waist high fencing to get to you. Hopefully they have a good arm, or you wait all over again.

The heat is another factor inside those suits.  During the afternoon shifts it can hit 93*, and with humidity it feels around 110. Walking around in that normally wouldn’t be fun, throw on tyvex or god forbid tychem suit and suddenly you’re facing 100% humidity.  Every activity you do is slower, every step you take has to be for a reason.

Rolling a patient to clean them? Subtract some time you can be in there.
IV? More time
Even handing out PO meds gets you after awhile.  I force myself to walk slow and plodding along like Darth Vader to conserve energy.

If you can be in there for ten minutes or three hours there’s never any judgement for “tapping out” and leaving early. Utmost care and attention is given to your own safety. What would happen if you pass out in the confirmed ward? How exactly do they get you out?  Luckily the situation has never happened, but the risk is always there.

It’s Always Sunny at the Ebola Treatment Unit

(Note: I’ll write about going in and working in the ETU in a little bit, but I thought I’d share this recent update with you)

I had just finished a 13 hour shift working at the ETU, we had given report and handed off all information to the incoming shift. Myself and another nurse were just waiting for a ride, and I (being in a post 13 hour shift gregarious state) start talking to one of the drivers.

He’s about 6’2 and built like a tank. Instantly I miss the gym, picking stuff up, and putting it down (repeat).  He’s friendly enough, he’s wearing a blue International Medical Corps shirt, with a IMC vest and sunglasses.

“What’s your name?” I ask

“Sunshine.” He replies.

“Sunshine?” I ask my head tilting like a three month old chocolate Lab.

“Yes,” He smiled, his hands waving in front of him, “Like the sun, it shines? My name is sunshine.”

He seems friendly enough, and my mind banks it with all the other meet and greets I’ve had recently. Sunshine only difference was the fact he was a tank, and since the end of the civil war – you don’t see a whole lot of tanks in Liberia.

He was also well liked, I remember hearing some jokes between Sunshine and our supply guy about having a pushup and pullup contest.

Well, let’s fast forward a few days. Our chief medical officer comes in one morning fuming.  He’s very upset, and talking more with his hands than he normally does.

It turns out our resident Sunshine was never in fact a driver for IMC. He had buffaloed his way into the job, he never had an interview, someone gave him the IMC shirt and gear, and he had just started driving people around. He had no license, and was a convicted felon in the United States who was deported back to his Native Liberia.

Well if this wasn’t enough, it turns out he had stolen an IMC car and crashed it into a tree.  (In my head, I like to imagine Rage Against the Machine playing while he does this).  He was hurt and sent to the hospital.

Where he proclaimed he would be suing IMC for the medical costs incurred upon him from the hospital.

Were all a bit stunned. He had been a pretty likeable guy, I wonder why he had done it?  It’s the main topic of discussion for a few hours, but slowly it fades into the past, another quirky news story at the ETU.

A couple days later I work a night shift, come home and sleep violently.  I’m awoken by two of our doctors coming into the guest house in scrubs and their gumboots.  I look at the clock, it’s only 3:00 PM, they’re supposed to be working till 7:00 at the earliest.

They sit us down and tell us what happened-

The story of Sunshines return to the ETU.

Apparently disgruntled at his prospects of a successful lawsuit against IMC for stealing one of their cars and wrecking it, he decides to return to the Ebola Treatment Unit.  In America in a situation like this, a disgruntled employee might go confront of his boss, or make a, “Whose coming with me man?! Whose coming with me?!” speech.

Not Sunshine, Sunshine has a better idea, Sunshine is going to take matters into his own hands.

He rushes the waist high orange fence in the Confirmed ward and leaps over it.

(Dramatic Reenactment)

Sunshine has just placed himself voluntarily into the confirmed ward of an Ebola Treatment unit.  All the staff start freaking out, and they pull everyone out of the unit, one of the Liberian PA’s inside draws up a syringe of Haldol to put Sunshine down if he assaults him, but the risk of getting your mask or suit torn during a confrontation with a angry Liberian tank and being exposed to Ebola is high, so he retreats with the rest.  The whole compound- save for 5-10 people are evacuated and sent home.

The police are called, but don’t have the training/refuse to don PPE and go into a confirmed Ebola Ward. I can’t say I blame them.  We send in our pyscho-social lady in to try to talk him out. She’s in full PPE -turns out he had laid down on one of the empty beds and taken a bit of a nap. The sleep- combined with her negotiating skills convinced him to take a chlorine shower, change clothes and give himself up.

The whole affair leads to afternoon fluids/meds for the patients being skipped, and we get to clean up all the mess during night shift.

They send sunshine to the hospital to be quarantined for a few days, and we all breath a sign of relief that its finally over.


The next day we get the news that Sunshine broke out of the hospital quarantine, and headed back to the College campus (Where we all live) Where he broke into his dorm room  and –

Took a nap for a couple hours.

He woke up, lazily stretched after his nap and took off, he was spotted later that day drinking a soda on a bench somewhere on campus. We currently don’t know where he is, if he’s infected,  or where he plans to nap next.