How do you tell family members you are treating a patient with Ebola?
What kind of reaction would you get?
AFTER EBOLA is a special reporting project of NET News.
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Part 4: Rural Hospitals Prepare
The staff of the Nebraska Biocontainment Unit (BCU) found out exactly how their family members felt. Fear, curiosity, support and unease. It was all there to see and hear.
During interviews for the NET News documentary “After Ebola: Nebraska and the Next Pandemic,” we asked doctors and nurses what they heard from family and friends in the closing months of 2014. They were responsible for treating three patients infected with the Ebola virus, rushed to Nebraska from the center of the plague in West Africa. The biocontainment unit, where they volunteer when the facility activates, is designed to safely contain the most dangerous diseases on the planet while treating the patients inside.
The team knew they might be called on to treat Ebola patients. The news was filled with stories of thousands dying in Liberia, Sierra Leone and Guinea. The U.S. government started transporting Americans infected with the hemorrhagic fever to one of the three U.S. hospitals able to handle highly infectious diseases.
Angela Vasa, now the lead nurse at the BCU, remembers getting the text in that first week in September declaring “NBU activation. This is not a drill.”
“So, I read it and I read it again,” Vasa recalled.
She remembers thinking “Is this really happening? Excitement. Like I can’t believe we are really going to do this, then the overwhelming sense of responsibility. It is our team. We are it.”
The staff had been training for years and felt confident about taking on the responsibility for the patient while protecting their own health and the safety of family and friends in the community.
The BCU had been set up for this very purpose 10 years earlier, yet this was the first patient to be treated here. The occurrences of highly infectious diseases were that rare. Even while families understood the nature of the work, it was still a shock to know husbands, wives and partners faced some genuine risk.
The first concern for nurse Morgan Shrader was arranging for her four children to stay with their grandmother. Her mother’s reaction was unexpected.
“My mother probably in the half-an-hour conversation told me I was going to die at least 20 times,” Shrader recalled. “She was dead serious and my dad was like, ‘As long as you believe in what you are doing I support you 100 percent.’”
For nurse Betsy Flood, the conversation that evening was short and to the point.
“It was a non-discussion at my house,” according to Flood. “My husband just didn’t want to talk about it and he didn’t want me telling anybody and he didn’t tell anybody, which was perfectly fine by me.”
There was a much different sort of discussion between Angela Vasa and her two sisters, who were also trained nurses. "We talked openly about it,” she said. One had also volunteered to work in the BCU.
"There was a little bit of hesitation on their part like, ‘Are you sure that you want to stay on the team?’” But Vasa says she never felt ostracized or restricted in making the choice and had the support of her family.
“I was very fortunate in that regard,” she said.
When she ended her first shift with the Ebola patient, she did take one conscious, if mostly symbolic step to reassure her partner at home. Although everyone showers before leaving the unit, sometimes multiple times, Vasa also showered again once she got home.
“To just to give my significant other that peace of mind,” she explained. “Just as those things to make your family and your significant other feel comfortable.”
There was just a hint of uneasiness shown by Frank Freihaut’s wife, Shelly.
Discussing the risk with her husband, “she said as long as you are keeping yourself safe.”
He was surprised to learn later “she had changed her towels to white towels (so) she could easily bleach the towels” if Freihaut used them after a shift with the Ebola patients.
“So, there was a little more fear I didn’t realize.”
Fear was more likely to show up when members of the medical team encountered neighbors unfamiliar with the training and protections the unit had in place.
“When we were active with the first (Ebola patient) we had some of our staff whose kids were uninvited to birthday parties or uninvited to Thanksgiving,” Shrader said. “We ended up being the support system for each other in that regard.”
Clinical care physician Dan Johnson heard the suspicions creep into conversations at social events.
"They made comments like, ‘Now, you haven't had anything to do with Ebola, right?’” Johnson just shook his head.
“They were having fears. They have children. They were worried that I was going to be able to transmit the disease to their kids, I suppose.”
While Johnson was recruited for the BCU at the last minute, his research gave him full confidence that he was never at risk.
The symptoms of Ebola, primarily a fever that doesn’t go away, can be latent for up to 21 days. That became the magic number for anyone on the medical team. It was a benchmark when Johnson and the others knew they were safe from the virus.
“There was no possible way I could transmit the Ebola virus disease to another human being without any symptoms,” Johnson said.
Talking to children about their parent’s hazardous duty posed different concerns. It was impossible to keep it from the kids when Ebola fears and its Omaha connection were all over the news and social media.
“I know that they were worried about me,” said the BCU’s director of research, John Lowe. He made it a teaching moment.
“I was working through with them what we were doing here and why we were doing it here,” Lowe explained. “I think in doing that, it instilled a lot of confidence in them that they were safe.” Nurse Morgan Shrader agrees with that approach. “I think it’s very valid and important to just be open and honest with what we are doing every day.”
All the media attention earned her something of a rock-star status with her own children. “My kids think the unit now is very, very cool,” she said, with a huge smile.
There was also a moment in all the anxiety and unease of bringing Ebola to Omaha that brought comfort to Lowe.
Late in October, shortly after the second patient had been released healthy and safe, Lowe and BCU medical director Angela Hewlett went to the Halloween party at their children's elementary school. In addition to traditional monsters and clowns, “we saw kids running around in yellow suits that mimicked our EMS providers and our healthcare providers and I had a kid in my son's fourth grade class run by me and say, ‘Dr. Lowe, I'm you.’”
The story still makes him laugh.
The University of Nebraska Medical Center provided mental health professionals to give the team a chance to talk through the high stress environment.
By the end of 2014 most of the drama had subsided. Two patients were sent home free of the Ebola virus. One succumbed to the disease. The staff at the biocontainment unit are quick to point out, they all remained healthy and that means they also kept their family and their neighbors safe as well.
They are also prepared to do it all over again when the next dangerous and contagious disease shows up somewhere in the world.