Diary Prequel Package — page 432

did not see any droplets coming out of his mouth as he coughed; however, I remember thinking thank goodness for the PPE. This experience brought into sharp relief for me the reason for the high case fatality of Ebola and why so many HCWs get infected. If were in West Africa, would be dead and Rick, Anthony and I would have gotten infected taking care of him if we did not have the state-of-the-art PPE. After an hour and 45 min. we doffed and waited for his parents. They came with Bible in hand to visit their son. Rick Davey, Cliff Lane, and I spent well over an hour with them explaining the situation and the seriousness of it. We then brought them into the nurse's station where they were able to speak with their son through video link. They could see him but he could not see them. Of note before we brought them into the nurse's station to see him through the video, we mentioned to that we were going to bring them into the room. He got very concerned that he wanted to get cleaned up from the diarrhea that soiled his bed and was over parts of his leg. In addition, his PIC line was bleeding around site and so that needed to be cleaned up. It took the nurses about 45 min. to an hour to get him perfectly clean so that he could feel comfortable talking to his parents even though his parents would not be able to see any of the soiled linen or pajamas from the distance that they were at the video link. It was a very moving conversation between the parents and ended up the conversation by reading a passage from the Old Testament. And then he turned to us in the room and said "what a wonderful country we live in that would put so much effort into the saving the life of one person - our son. There was not a dry eye in the room. I went home that night completely exhausted and went with Christine to Bourbon Steak bar and restaurant at the Four Seasons Hotel in Georgetown to unwind. March 15, 2015. Came into work again today which is Sunday. The day has turned into a very bright sunny day with a brisk wind. Again, I went to the SCSU and Rick Davey and I went in together to take care of . Some lab parameters are better and some are worse. The most worrisome of all is his respiratory situation. We have corrected what we believe is over hydration by cutting down on his fluids and giving him a diuretic. However his temperature is still 39 and he is still breathing at 35 to 40 breaths per minute. Of particular concern is the fact that on 2 L/min of nasal oxygen, his oxygen saturation is still only about 88%. Also, on call is Bob Danner from the ICU. Bob increased the nasal oxygen to 4 L/min and we had a discussion about the possibility that we might need to intubate the patient since he will likely soon get soon very tired from breathing at 35 to 40 breaths per minute. Cliff Lane was on a phone conversation with the people from Emory and Nebraska and they mentioned that even when they thought that they had very good control of intake and output of fluids, around day 8 to 10 of illness, patients often had unexplained accelerated respiratory difficulty requiring prolonged intubation. I hope that it does not come to that with however, it is entirely conceivable that it will. I will go over to the SCSU again tonight for a conference with all of the team to make these decisions. Drama tonight in the SCSU. Some change in status. All metabolic numbers, BP and cardiovascular, kidneys etc. were fine and even improving. However,