My Evening as an Ebola Patient

With the recent outbreak of enterohemorrhagic E. coli in romaine lettuce (don’t buy any for the time being!), I’m reminded of the Ebola outbreak earlier this decade. During the height of the “scare”, I was an emergency department volunteer at Mount Sinai Beth Israel Medical Center in New York. My duties included assisting patients to their rooms, running samples and medications around the hospital, and ensuring that patients felt as though they were being properly cared for. One evening, though, I arrived to be assigned to a different task. As part of the hospital’s efforts to ensure that they were prepared for an infected person to walk into the ED, they were conducting random, surprise drills in which somebody would enter the department as a patient and display all of the signs and symptoms of an Ebola patient. I’d like to briefly relay my experience as that patient both because I found it very interesting and because it illustrates a truth about medicine that I’ll discuss later.
Although most of the medical staff in the emergency department knew who I was, the security guard who screened patients at the entrance for recent foreign travel as well as much of the crisis response team didn’t know that I was a volunteer. And although the hospital had already conducted several drills that year, a real Ebola patient had recently been admitted to Bellevue hospital just up the road. I was instructed to tell the medical staff that I had recently returned from Sierra Leone, where I had served on a medical mission. I was also supposed to say that I had experienced a sudden onset of fever, diarrhea, and weakness. So out the back door I went, ready to enter the front door of the hospital and set alarm bells off across the building.
When I walked into the ED entrance and was asked by the security guard if I had experienced any fever accompanied by diarrhea or fatigue. I answered yes. When he asked if I had traveled to West Africa within the past several weeks, I again answered yes. He replied, “Really?” I answered that I had just returned from Sierra Leone and was worried that these symptoms may indicate an Ebola infection. I was surprised with the efficiency of the hospital staff’s response from that point forward. The security guard asked a group of people standing in the entrance hall to move into the next room (the ED waiting room). He then asked me to stay right where I stood and wait for a nurse to come get me. He then disappeared into the hospital, closing the door behind him. I hadn’t been briefed on what the hospital would actually do when confronted by my case, but I certainly wasn’t expecting what happened next.
A side door to the emergency department opened, and a single nursed dressed in a head-to-toe clean suit stepped into the entrance hall. It was at this point that I realized that tonight’s volunteer shift would be particularly memorable. I should also note that a recent Ebola patient in Dallas had infected two nurses, so I think a large part of this drill was ensuring that the medical staff maintained proper protocols for PPE (personal protective equipment). She had a mask, face shield, and gloves for me to put on; I put my belongings in a plastic bag. She repeated the questions that the security guard asked me, and at this point I think she probably realized that this case was part of a drill. But the drill wasn’t even close to being complete, so I was led through the side door into a hallway that had been draped entirely in clear plastic. The plastic hallway led into a private exam room that I hadn’t seen used in the past. My vitals were checked by the nurse and then I was instructed to stay in the room. About five minutes later, a physician, also dressed in full PPE, entered, introduced herself, and asked me the at this point standard questions about my symptoms and history. After a brief physical exam, the physician left the room and the head nurse (who gave me the assignment) came in and told me that the drill was over. The entire thing lasted about thirty minutes.
Knowing what I know now about how physicians think about a disease diagnosis, in a non-simulated patient of the same type the physician would likely be skeptical of a diagnosis of Ebola. One of my favorite medical school idioms thus far is that “common things are common.” When you add in the fact that it is rather difficult to transmit Ebola anyway, the precautions taken and the repeated drills may start to seem unnecessary. But unnecessary precautions speak to a truth, I think, about medicine in general. It is important to treat unlikely cases as if they are confirmed until proven otherwise because the one case out of 1000 that does exist is as important to catch as a much more common diagnosis. In the emergency department, the basic job of a physician is to rule out those disease etiologies, or causes, that are life-threatening in the short term. They know that, for example, high fevers in infants are much more common and benign than most people think. As good providers, though, they are likely to still do a full workup to rule out anything dangerous that could possibly cause a high fever in an infant no matter how unlikely. This kind of thinking is repeated throughout every health field. When you begin to recognize this, the repeated questionnaires and seemingly excessive and wide-ranging assessments that physicians put us through begin to make a lot more sense. When you add in the consideration that Ebola is incredibly deadly and has the potential in this case to spread to a new continent, the precautions make even more sense. Ebola or not, in medicine the stakes are often too high to act as though rare diseases are nonexistent. Just ask the staff at Bellevue!