My heart was racing the night before our patient arrived. Richard Sacra was flying in from Liberia, the third American to be evacuated from the country after contracting Ebola. Emory University had successfully treated the first two. Now it was our turn in the hot seat, battling the virus that was spreading devastation across West Africa and fear across the United States.
Our team at the Nebraska Biocontainment Unit, where I am assistant medical director, had been training for this for years – executing drills on admitting highly infectious patients, reviewing detailed procedures for safe treatment and memorizing what gear should be used for which diseases. But this was the first time we would be putting all that training to use since the NBU opened in 2005. There was no way to fully prepare for the pressure, the national focus, the immensity of being responsible for curing a patient whose deadly disease was at the center of global debate.
The challenges associated with caring for patients with communicable diseases, and specifically deadly diseases like Ebola, had always fascinated me. With these patients, you can’t rely on hand-to-skin contact to assess their condition, and you can’t bond by pulling up a chair and chatting about their personal lives. While in the isolation unit, all this patient, Rick, knew about me was the color of my eyes and the typed biography given to him when he was admitted. Still, this was an experience I had anticipated since I was a student. After all, reading about the famed virus hunters investigating the first Ebola outbreaks in Africa influenced my decision to attend medical school and eventually pursue my chosen career path as a specialist in infectious diseases. The presence of the NBU at the University of Nebraska Medical Center was one of the reasons I left my home state of Texas and moved to Nebraska.
As I mentally prepared for Rick’s arrival, I contemplated how my life could change over the next few weeks. I thought about how my husband and young children would be affected, and how other families in our community would react. Would their classmates make mean comments? Would I be able to go to the grocery store without being criticized for bringing Ebola to Omaha? I sat down with my kids and discussed this with them in words they could understand. We talked about my work at the hospital, and I told them that if anyone said anything unkind to them about what I was doing, they should proudly reply, “My mommy is a doctor and she takes care of sick people.” I gave them extra hugs and kisses as I tucked them into bed that night, unsure of what the next day would bring.
The constant flow of adrenaline coursing through my body made me feel like an athlete before a big game. Ebola is like the Super Bowl of infectious diseases, a deadly virus with no known vaccine or therapy. My anxiety, magnified by darkness, made sleep impossible that night.
I arrived at the hospital on that rainy morning to find our team of 40 doctors, nurses, respiratory therapists and technicians preparing for the patient’s arrival. We all shared the same emotions — the air was filled with a palpable mix of excitement and anxiety. I carefully dressed in scrubs and covered them with bulky protective equipment, mentally noting the importance of each layer of plastic that would cover every part of my body for the next three weeks. When our patient entered the unit – traveling by ambulance from an Air Force base where he had landed outside of Omaha — we were ready.
My partner is Dr. Philip Smith, another infectious diseases specialist and director of the NBU. He recruited me to Nebraska in 2009 and is my mentor and my friend. As we stood side by side that morning, we decided that it would be ideal for only one of us to go into the exam room for now, to minimize unnecessary contact with the patient. The other would observe via two-way video and document the patient’s history and exam findings in the electronic medical record. Phil informed me he would examine the patient and that I should do the documentation. He said he was being “chivalrous” and we joked about who had the easier job, since writing notes and orders in an electronic medical record can be a formidable task.
The first few days after our patient arrived were incredibly taxing. I was working about 14 hours a day struggling to solve a puzzle that had no definitive solution. We tried several treatments, giving him an experimental drug and blood transfusions from Kent Brantly, a doctor who had recovered from Ebola weeks earlier. My stress level rose and fell with Rick’s condition. Meanwhile, we were inundated with media requests. In between shifts in the NBU, we worked with our public relations team to respond to hundreds of media questions and requests for on-camera interviews.
For a week, I only communicated with Rick through a screen. When it came time to meet him in person, I was anxious. But as I entered his room for the first time, I forgot about all of the extra protective gear I was wearing and focused on him. I put my gloved hand in his and shook it. I asked how his night had been, performed an exam and discussed his plan of care, just as I would with any other patient. At that moment I knew that we were doing the right thing by caring for this patient who needed us, and I was not afraid.
About a week after he arrived, Rick began to improve. He became more alert, interacting with our staff and speaking to relatives via video conferencing. He joked with us about baseball – he’s a Red Sox fan and Phil roots for the Yankees. On the day he rode an exercise bike in his room for the first time, I was so overcome with joy that I began to cry right there in the middle of the nurses’ station. There is absolutely nothing more rewarding to a health-care worker than seeing a sick patient begin to recover.
Three weeks after he was admitted, Rick tested negative for the virus. Interacting with him for the first time without our protective gear was a poignant moment. Through the computer screens, glass windows and layers of plastic protective gear, we had formed a bond as tight as any patient and medical team. Together, we had beaten Ebola — a ravenous virus that, just a month earlier, had never existed in our country. Discharge day was emotional for everyone, with plenty of tears and hugs. All involved showed extraordinary bravery, dedication, tirelessness and compassion.
The experience is indelibly etched in my memory. It has been incredibly challenging, but so rewarding. Would I do it all again? Certainly. In fact, as I write this, we are preparing to receive our second Ebola patient in the Nebraska Biocontainment Unit. I am sure there will be additional hurdles ahead, but we are here for the purpose of helping patients in need, and that is exactly what we will do. After all, just like I told my children: I am a doctor and I take care of sick people.
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