Sunset

I entered the ETU this afternoon to start an IV on a young woman who had just arrived by ambulance. As her IV fluids ran in, I quietly blessed the language barrier between us. She was unable to ask me where her mother was, and thus I did not have to tell her that when a second ambulance arrived not ten minutes later, her mother’s lifeless body had been pulled from the back.

I stepped out of the ward, the hot afternoon sun glaring through my face shield and making me squint to see. I checked in my with my sprayer and my national nurse, making sure they were OK to stay in PPE a little longer. Suddenly, from another ward came a shout, “Sprayer! Sprayer! SPRAYER!”

Members of our wash team circulate through the ETU, sometimes as part of a clinician team to help us decontaminate our hands and PPE as we work, and sometimes as a janitorial team. It’s not uncommon for someone to call “Sprayer!” into the yard, to indicate the need for a decon.

But this call was tinged with urgency, and with fear.

We turned to see a member of the wash team gripping the doorframe of a ward, his spray hose forgotten at his side. “My mask,” he called frantically, “my mask!”

Under our face shield we wear an N95 mask, held against our heads by two tight elastic bands. Everyone finds a way to position the bands as comfortably as possible, and for some people that way is to have both bands above the ears, crossed over each other. The danger with this positioning – as opposed to having the bottom band worn below the ears and behind the neck, as I wear it – is that if the mask suddenly slips, it is pulled upwards, and over the eyes.

You can be working along, comfortable as can be, and less than a second later the mask slips, and you cannot see. It’s called a “whiteout.” And you cannot do anything to fix it, for to touch your mask with your hands is to breach your PPE. And thus, you are blind and helpless in an ETU.

My sprayer and I called that we were coming, and walked over to him, calling reassurances every step of the way. Another clinician took his chlorine spray tank from him, and I positioned him standing behind me, and placed his right hand on my right shoulder. My sprayer put his left hand on the man’s shoulder from behind, and in this terrible conga line we walked slowly to the doffing area.

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The decon team took over, and the wash team member was safely deconned and able to to leave the ETU. But his arrival caused a backup at the doffing area, as his blindness meant he was brought to the front of the line ahead of other workers. The second clinician and I looked at each other, shrugged, and headed into the closest ward, figuring that if we were going to wait around for doffing to get “decongested,” we might as well get some work done.

We went bed to bed, cajoling people to sit up and drink ORS, feeding some other patients, giving anti-emetics and anti-pyretics to those who could keep them down. And then we came to our Box Baby, and we stopped.

Box Baby was named because for his first few days in the ETU, he lived in a box. He and his critically ill mother had arrived together, and she had died within hours. Lacking cribs, but in possession of a great number of empty supply boxes, we tucked him in a box, and our staff took turns working an informal night shift, feeding him with a syringe every four hours around the clock, and hoping against hopelessness that his PCR for Ebola would be negative.

Infants who are exposed to their Ebola-positive mothers are almost universally infected by them. There is constant skin-to-skin contact, and breastmilk is full of the virus.

The “Zaire” strain of Ebola that is currently wreaking havoc on Sierra Leone is fatal in 60% of cases. But for pregnant women, and for children under the age of five, the fatality rate is nearly 100%.

Box Baby’s PCR came back positive. We picked up his box and moved him to the Confirmed Ward.

We asked amongst the recovering women there in Confirmed to see if any of them would be willing to care for him. Several were still too weak to do it, and others refused for reasons deep and personal and fear-based. We didn’t push it. Night shift continued, and over three days he declined slowly but steadily. We’d arrived that morning to hear from night shift that he was no longer eating, that his arms and legs were moving sporadically, that his gaze was unfocused and distant. The seizures were starting.

And so, when we arrived this afternoon to Box Baby’s bed while waiting for doffing to decongest, we were startled to see he was still alive. But even more startling was the fact that he was out of his box, on a mattress on the floor, and a young woman was curled up next to him. Not yet twenty, unrelated to the baby in any way, and still weak and lethargic in her slow recovery, she lay on her side facing him. She opened her eyes at our approach, met our gaze, and then let hers drift over the infant next to her. She closed her eyes again.

She never touched him, but as his own sunset neared she lay close enough that he could sense her presence, feel her breath on his face, and maybe, possibly, along the vinyl coating of the mattress, hear the beat of her heart.

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