Life on inside of Emory’s Ebola unit

Georgia team’s success eases fears of dreaded disease nationwide.

People took it as a good sign when Kent Brantly, his body teeming with Ebola virus, walked into Emory University Hospital under his own power.

Inside the hospital’s isolation unit, however, Brantly told his doctor the truth. Those few steps had taken everything he had. His body was terribly weakened —- indeed, he was near death —- losing a battle against a virus attacking virtually every organ.

His spirits were just as low. A doctor himself, Brantly was infected after treating about 50 Ebola victims in West Africa. He told the doctor that 49 out of 50 died.

“He was resigned, ” said Dr. Bruce Ribner, chief of the isolation unit.

Less than a month later, Brantly walked out of Emory on Aug. 21, free of the virus. So did Emory’s next Ebola patient, and the third, and, on Tuesday, the fourth.

The accomplishments of Emory’s isolation team are nothing less than historic, said Dr. Stephen S. Morse, professor of epidemiology at Columbia University. The team of 21 nurses and five doctors treated the first patients ever for Ebola in the United States. They helped advance the perception of Ebola as a treatable disease rather than a death sentence. In the process, they may have eased some of the anxiety sweeping the country.

“For the first time, Ebola can now be thought of as a manageable disease, ” Morse said. “We can’t guarantee the result. People do still die. But the majority of people here have survived.”

‘About the sickest

we’ve taken care of’

Ribner and two nurses recently described life inside the isolation unit for The Atlanta Journal-Constitution. They talked about big moments, such as when they placed patients on ventilators and dialysis. Previously, physicians didn’t employ such aggressive treatments for Ebola. An Ebola patient whose kidneys or lungs were failing was beyond hope.

“I think we have shown our colleagues in the U.S. and elsewhere that is certainly not the case, ” Ribner said.

They also talked about small moments inside the air-controlled unit, where they interacted with patients through full-body protection suits. Ribner found it difficult to hear Brantly’s heartbeat through a stethoscope while wearing the protective hood.

The staff, in general, had to come to terms with extraordinary quantities of vomit and diarrhea —- a patient in the worst stages produces five to 10 quarts, or up to 2 1/2 gallons, of infected bodily fluids a day. Ebola essentially drains a person down to death, and the Emory unit was running not one but two intravenous lines into patients to replace those fluids. It also was disposing of as many as 40 trash bags of medical waste a day.

“These patients were about the sickest we’ve ever taken care of, ” Ribner said.

The physician didn’t offer Brantly any false hopes.

“I told him he had a better chance of survival here than in Africa, ” he said.

‘We know we have

each other’s backs’

When medical teams work around one of the deadliest bugs on the planet, every procedure has a strict protocol to ensure safety. Some members of the unit had trained for this kind of situation for 12 years, donning and doffing protective gear and drilling on protocols three times a year. Now that Ebola was here, nurses skipped vacation to be part of the fight.

“You’re working with an infectious disease that nobody else has worked with” in the U.S., said Carolyn Hill, the unit’s nursing director. “You’re an innovator, a trailblazer.”

Every morning, the team huddled to review the patients’ condition, prepare for the work ahead and go over any protocol mistakes from the day before. It was Hill’s job to observe the workers putting on the protective suits, which included two pairs of rubber gloves, and taking them off, considered one of the most dangerous moments for a caregiver.

“We know we have each other’s backs, ” she said.

She spent as many as 3 1/2 hours in the suit at a time, much of that time in a special anteroom where she grabbed thermometers, catheters and medications for the staff. The suits are especially warm, so the showers afterward were welcome.

Brantly got worse

before he got better

Brantly was the country’s first Ebola patient, and many in the public reacted with fear and anger to his arrival. So when the 33-year-old medical missionary entered the isolation unit, the nurses wrote a big message on a board: Welcome Back To Atlanta. Welcome Home.

At first, his condition deteriorated. The medical staff was on edge every hour. Brantly had a high fever, weakness and irregular heart rhythms. He was hemorrhaging from the eyes and developed small red and purple spots, caused by broken blood vessels, all over his body. He had to hold onto a nurse even to raise himself a bit from the bed, according to an account published in Emory Magazine.

Days after his arrival, another Ebola patient, Nancy Writebol, came in on a stretcher. She was equally despondent. She felt, she told them, she was coming home to die.

Ebola, with a death rate of 40 percent to 90 percent, has killed nearly 5,000 people in West Africa. The key, doctors have found, is keeping a patient alive long enough for their body to successfully fight off the infection.

After about a week of treatment, the patients started to improve. One by one their organs started to operate properly.

Brantly told Hill, the nursing director, “If I didn’t come here, I would have died in one more day.”

Then he hugged her.

Nerf basketball, and walking over the ‘red line’

The patients watched the outside world on a television and tablet computers. One nurse prayed with them. Several set up a “spa day” for Writebol, replete with a pedicure and lipstick, according to Emory Magazine.

When Brantly rallied, they put up a Nerf basketball set for him.

“It provided some physical and occupational therapy for hand-eye coordination, ” said Nancye Feistritzer, Emory’s chief nursing officer.

When Brantly was well enough to step over the “red line” and depart the unit, the entire team formed a line, and he thanked each of them. Hill said she felt “excited, proud, emotional.”

On the other side of the line waited Brantly’s wife, Amber. The staff had seen her every day, looking into the window of his room, often holding a Bible.

Brantly stepped up to his wife. They reached out to each other.

“It was a look, a kiss and a big hug, ” Hill said.

Then Amber Brantly slipped her husband’s wedding ring onto his left hand. They walked away, happy as newlyweds.

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