Diary Prequel Package — page 434

will not hesitate to dialyze him. Also, he has some strange neurologic manifestations with an atypical tonic/clonic movements, but no other manifestations of brain or cord disease. There is a whole new chapter of Ebola disease manifestations to be written now that we can keep people alive who otherwise would have died days ago if there were in a Unit in West Africa without the equipment and manpower that we have. Last night there were 6 of us in the room with him. The good news is that his AST is starting to come down and the best news is that his CT value is now 29.96, which means to me that his immune system is starting to control the virus replication. If the downward trend of his virus continues and we can just keep him stable for the next 4 or 5 days, I believe and hope that we can get him through this. Meeting more ICU docs including Parker Ruhl from NHLBI. She is on call tonight and checked with her at 10:00 PM by phone. Also, am doing nightly e-mail reports to Paul Farmer who is in Peru with his daughter Catherine. March 19, 2015 - All non-renal numbers going in the right direction. Still in acute renal failure; however, the rise in creatinine is perhaps a bit less "steep" - creatinine 5.9 and BUN 111. We may well have to start dialysis today. Decision to be made mid-day today. His cycle (CT) is now up to 31.5 and so his immune system is certainly clearing the virus. Persistent fever prompting broad antibiotic coverage. Had a scary episode last night. As we were tapering him off heavy sedation it appeared that he was calm and doing well with the taper. However with two nurses in the room and the rest of us (physicians, nurses, WatSans, et al) taking evening report, he abruptly woke up in a delirium flailing his arms and legs despite soft restraints (he is 6'2" and very strong). He pulled out his PIC line and pulled out the tubing to his endotracheal tube. It was a nightmare for the 2 nurses in the room who had to simultaneously press down with a towel on the bleeding PIC line site, bag him through the endotracheal tube, hold him down and try to get Versed into him. We all got up and scrambled to Don but this took (even going at light speed) about 5 minutes leaving the 2 nurses in the room with 5 minutes of terror. Dan Chertow, Rick Davey and Tara Palmore went in and Bob Danner and I manned the nurses station and read the monitor to the people in the room. We decided that it would ne dangerous and non-productive to have everyone in the room. Real scare came when Neil (head nurse on that shift), who was one of the 2 nurses with Kim, doffed, he noticed when he took off his inner glove that his hand was bleeding. As you can imagine, the trauma of the prior 5 minutes and now a bloody hand brought us all, particularly Neil, over the top. Luckily, the blood was his (injured his hand against bed rail when holding down patient) and his gloves were intact. Tara Palmore checked his gloves by filling them with water and there were no leaks. We soon got everything under control and he is now the same as pre-event, only now under heavy sedation, which we would have had to do anyway if we ultimately decide to dialyze him. PIC line was replaced by VAT (Vascular access Team). March 20, 2015 - Patient stable this AM. First day of Spring today and we have snow in DC. What a winter - Ugh! Went in again today to go over patient with Dan Chertow. In for about 65 minutes. Making morning (8:00 AM) and evening (6:30 PM) report now every day with the Unit staff.