Genmedmom here.
Last week, a patient with risk factors for Ebola exposure, and who had medical issues, walked into our office.
Kudos to our N.P., who handled this very well. Upon learning of the potential exposure, she called infectious disease at our hospital, and they walked her through the appropriate screening interview questions. It took awhile, but she was able to determine that this patient was extremely low-risk for direct contact with the Ebola virus, and was not exhibiting any suspect symptoms. She was given the all-clear by infectious disease, and proceeded to take care of the patient.
Of course, this drove home very quickly the fact that any of us could be called upon to make a similar evaluation at amy time. I know I opened our hospital-issued Ebola risk stratification and action guidelines and read them over several times.
All day and on the long drive home, I imagined what I would do.
My first instinct was: Of course I would step in and help, no matter what any patient had or may have. I'm a healthcare provider. That's my job.
But.
There are now two nurses who contracted Ebola through caring for an infected patient in Dallas, despite knowing the diagnosis and wearing all the recommended protective gear. This is a virus with a 40 to 50% case fatality rate (now reported as closer to 70% in West Africa, due to lack of resources and care).
I'm a mother to two very special little kids. Could I justify knowingly exposing myself to a highly contagious virus with a grim fatality rate?
I went back and forth in my mind.
There are many healthcare workers in this country... But my kids only have one mom.
On the other hand, I do think that nurses and nurses' aides are at far greater risk of exposure, due to the inherent nature of their jobs and the mode of transmission of the virus. Now that I am an outpatient attending, I am rarely exposed to patients' body fluids.
But.
It only takes one, tiny exposure.
Of course, we have had a providers' meeting about this, and we did review our office protocol again. If needed, we have the "moon suits" and a designated isolation room. We have all the phone numbers to call to arrange transport of a suspected case. We have solid resources, so unlike our counterparts in West Africa. My heart goes out to them and to all the poor people suffering with this. We are lucky over here.
But.
I don't know much about donning layers of protective gear. I would likely screw it up. It only takes one, tiny exposure.
How would I then limit contact with my family, not get too close with my kids, for twenty-one days? I'm always clearing noses, changing diapers, wiping binkies... it would be near-impossible, and nerve-racking.
Ugh.
I don't know what I will do, given the choice.
I know that many hospitals are compiling lists of volunteers, staff who are willing to care for patients with Ebola, including aides, nurses, physicians.... I understand that most of these lists are pretty short. I have no idea what our hospitals' list looks like. I know I am not on it.
I am very curious what others have thought about this, especially the hospitalists and nurses out there, who would likely have more direct and frequent contact with a case should one come in.
Healthcare provider-moms, what are your thoughts?
And if you haven't thought about it, you should....
--Genmedmom, also at www.generallymedicine.com
I'm an ED attending and have thought a lot about this. I have a 3 year old daughter and I'm currently 30 weeks pregnant. It's definitely not a situation I want to be placed in. The health care workers who are volunteering to care for these patients deserve our utmost respect and support.
ReplyDeleteI don't know if we have a volunteer list, and as a hospice physician I'm unlikely to be called on. I haven't thought about it. Now I will. I don't know what I'd do. It's a very good question.
ReplyDeleteIf I got exposed accidentally in my line of work, that's something I would have to deal with. But no I wouldn't volunteer. I'm not scared about myself so much as the thought of exposing my children or being isolated from them. What if you volunteered your services, contracted ebola, survived, but your children got it from you and one or both of them died? I couldn't live with that.
ReplyDeleteI have also thought about this a lot. I have three children. If I encounter a patient with suspected Ebola, I willnot go home for 21 days (unless the test comes back negative, of course). It's the only possible thing I could see doing.
ReplyDeleteI also think it's so easy to contaminate yourself with the PPE, and I do not feel at all safe in my procedures.
When I think about the possibility of me contracting Ebola, I mostly think 1. How can I avoid giving this to my family and 2. How incredibly sad it makes me to think my children could be left without a Mom.
I'm glad you brought this up. I'm bringing an overnight bag to work.
You raise an excellent topic that needs to be considered. If it is not Ebola, it may be some other lethal infectious disease around the corner. Currently my clinical practice does not involve any hospital work and would not put me at high risk of being in the front lines of Ebola management. However, this made me think of a recent situation on a long flight from Maui. During the flight a man became severely ill and when the flight ended, Health Canada came on board before anyone could deplane. When we finally deplaned we passed him on a stretcher in the airport. No one had addressed the passengers during the flight for a doctor's assistance, but a nurse was involved. It made me wonder what I would have done. I was traveling with my husband and 2 children so thankfully I didn't get involved and potentially put them at risk.
ReplyDeleteAltruistically I wish I could say that I would present myself to help any medical situation. Realistically my family comes first so l would not knowingly be involved in a situation that could in turn put them at risk. My name would not appear on a hospital list such as yours either.
Thanks for sharing your thoughts!
My heart goes out to all the patient contact docs above. Times like these make me thankful to hide behind the microscope. We have been collecting PPE (personal protective equipment) for the lab and developing policies for the hospital - i.e. which room in ED devoted to suspected Ebola cases and which units in ICU would be reserved for confirmed and/or admitted waiting for testing results cases.
ReplyDeleteThe reality, as we have witnessed in Dallas news, is very different from the plan. Great post.