Today, as a timeline of fluid.
8:30 a.m., 0.5 litre consumed. Morning report. No one has died, although two are close. An admit is sitting on the bench outside the triage area, waiting for intake. Five patients have tested positive for Ebola. Three have tested negative. The rest are waiting for a lab test that currently takes 72 hours to result. Teams are assigned.
9:30 a.m., 1 litre consumed. First wave teams are in, passing meds, pushing ORS. I am on the second wave team, and thus am standing in the green zone outside the Suspect Ward, which is my perpetual project. A clinician comes to the fence. “There is a woman in Ward D. We found her on the floor beside her bed in a pool of her own blood.” I know exactly which patient. She is in the 20% of Ebola patients that actually hemorrhage and die, instead of seize and die. Her blood will no longer clot; she is bleeding from her nose, her gums, her eyes, her rectum.
I draw up IM diazepam; we have no pain medications stronger than Tramadol for the dying, so we give them diazepam to try to relieve their agony. I know it will not work.
I pass it over the fence to the clinician.
11:00 a.m., 1.5 litres consumed. I enter the donning area with five outstanding Sierra Leonian nurses. I am wearing scrubs, with the pants tucked into knee-high socks. I put on my Tyvek suit, my knee-high boots, my first pair of surgical gloves; I hook the finger-loop at the end of the sleeve over my middle finger from the back, and put on my second pair of surgical gloves. I pull on my N95, adjust the straps, pull up the hood of the suit; zip the suit, seal the adhesive flap over the zipper. I put on my apron; another nurse ties the straps up through the neck loop to pull the front of the apron higher to protect my chest and fully cover the zipper yet again. My name on the front in marker, a huge “N” above it to signify that I’m a nurse. Then the face shield on my head, adjusted in the front, and I am ready.
I gather my team around me in the cattle chute, the passageway between the donning area and the bolted door that leads to the red zone. I check every single person’s PPE. Then we start our wave with the same words, every time.
“Who is the most important person in the ETU?” I ask them.
They point to themselves. “We are,” they reply.
I point to each of them in turn. “You are, and you are, and you are, and you are, and you are. There is no emergency in Ebola. We do not run. We do not rush. We take our time, and we stay safe. We get out before we are tired.” And one final time: “There is no emergency in Ebola.”
And we walk through the gate, and into the red zone.
12 noon. My nurses have discharged all the people with negative tests. Suspect ward is the most dangerous place for patients in the ETU because most of the time you cannot tell who has Ebola, and who doesn’t. It is frighteningly easy for someone to catch Ebola during their stay in the ETU, and if I do not wash my hands with chlorine between each and every task, I could be the one to infect them. When someone has a negative PCR, we get them out. Fast.
I am crouching by a mattress on the floor in Ward D, where the woman is dying. The first wave team put her on the mattress, gave her the IM diazepam, and then, after nearly two hours in, had to leave the red zone. She is now bleeding from the injection site. But she is still alive. I hold her hand for a moment, and lay my hand on her head. Then I stand, leave the ward, go to the courtyard and have my sprayer disinfect my apron, legs, back, arms, and hands with chlorine.
I stop by Ward B to check on someone, and my eye is caught by the absence of movement in a corner. I walk to his bedside, and check a carotid pulse, and do not find it. I pull his lapa over his face. “May your soul find peace,” I murmur, and I walk to the fence by the green zone to tell them to call the corpse team in.
1:30 p.m., 2 litres consumed. I am out of the red zone, drenched in sweat, sitting in the nurses station, drinking ORS. It tastes like the ocean. It is not appealing. Many of my patients try to drink it, and immediately vomit. I empathize.
2:30 p.m., 2.5 litres consumed. The first afternoon wave of clinicians is in the ETU. I am back at the fence as a runner, my ORS in hand. A clinician approaches me. “Can you draw me up some IM diazepam? It’s for a patient in Ward D.” I am startled. “She’s still alive?” I ask, incredulously. I was certain she would not survive another hour. He nods. I draw up diazepam, and pass it over the fence.
An ambulance pulls up, and by ambulance I mean a Land Rover-esque vehicle with a fully enclosed back. The back doors are sprayed with chlorine, and opened. There are five miserable souls crammed in the back. The contact tracers have found an infected village. The admit team gets to work.
Another ambulance pulls up in front.
4:00 p.m. 3 litres consumed. A late lab result comes in. It is for a vibrant, ebullient woman in the Suspect area who likes to chat with us over the fence, and update us on the people in her ward. It is negative. We rush to the fence, screaming the news in delight. Inside the red zone, she begins to jump up and down, her arms over her head, victorious. She is going home.
We have admitted 14 patients so far throughout the day. Another ambulance is disgorging a family of five, with a tiny infant in his mother’s arms.
Two more ambulances are waiting at the side of the road for their turn.
5:30 p.m. 4 litres consumed. I am back in the donning area. I am heading in the with the first wave of the night nurses. I escort four more patients to Ward A. We have now admitted 22 patients. We have run out of admission packets, and admission medication packets, and toothbrushes, and soap, and buckets, and cups. We give them a wristband and a cheap synthetic lapa, and show them to the cholera beds where they will spend the next three days, or the remainder of their life, whichever comes first.
6:00 p.m. I go to Ward D. I have just enough light to see that she is still breathing. As they die Ebola patients contort themselves into a horrible tableau, back arched, legs bent, arms akimbo and above their head, neck extended, mouth open.
I can no longer lay my hand on her head, for it now lies in a pool of blood, and it is too dangerous.
6:30 p.m. I walk three people back to Ward A. We have now admitted 31 patients, with all four clinicians inside leading people to beds. Another clinician walks up to me. “If the generator doesn’t work tonight, we’ve got about ten minutes to get out of here.” I nod.
We push ORS for 9 minutes.
6:40 p.m. The generator works tonight. The lights come on. I look over to Ward D. It is dark in D, E, and F. The circuit in those buildings is blown.
Our last patient is carried in, wrapped in a lapa in the arms of a doctor. It is a feverish, limp four-year-old child. They give paracetamol, and help him drink. He vomits everywhere.
6:50 p.m. I go to the doorway of Ward D. It is pitch black inside. In the faint light from a small window, I can see her arm. I cannot see her chest. I do not know if she is alive.
7:00 p.m. The ambulance bay doors are closed, and locked. Our admit team leader sends us all to the doffing area immediately. “Get the fuck out of here. We are DONE.”
7:30 p.m. 5 litres consumed. We sit in silence in the command center, and stare at the patient board. There are 65 human souls enduring the unimaginable in our ETU. We admitted 32 patients, a new record. 15 of those admissions came in between 5:30pm and 7 p.m.
So for an hour and a half, we admitted someone every six minutes.
8:00 p.m. 6 litres consumed. I go to the bathroom.
I am dehydrated.