Dallas Ebola Victim’s Medical Records Detail Decline in Final Days
FROM WIRE REPORTS
11 October 2014 11:51 PM
Despite five days of intensive treatment, Thomas Eric Duncan’s condition was deteriorating.
Then, suddenly on the afternoon of Oct. 2, came a hopeful sign. Duncan was hungry.
Nurses at Texas Health Presbyterian Hospital Dallas helped the 45-year-old welder from Liberia into a sitting position and gave him saltine crackers and Sprite.
Six days later, Duncan was gone. The first person ever to be diagnosed with the dreaded Ebola virus in the U.S. was the first in this country to die of it.
Grieving and angry relatives wonder whether the man they called Eric might have survived had health care workers not sent him home on Sept. 25, when he first went to the hospital emergency room.
Now, state officials say they may investigate how the hospital handled the case. Presbyterian has said it has “made changes” to its intake process and is reviewing the “chain of events” related to Duncan’s diagnosis.
Here, culled from medical records Duncan’s family in North Carolina provided to The Associated Press, is a recap of his last days:
Sept. 28: Returning to Presbyterian
When Duncan first went to the hospital, he was complaining of a headache and abdominal pain. His temperature spiked to 103 at one point, and on a scale of one to 10, he rated his pain as an eight.
Doctors ran tests, decided it must be sinusitis, sent him home with antibiotics and told him to follow up with a doctor the next day.
A nurse’s note said Duncan told her he recently had arrived from Africa. That info did not make it to the attending physician.
Now, Duncan was back. His symptoms included vomiting and diarrhea. His temperature was 103.1 degrees.
This time, the nurse’s notes made it clear he had “just moved here from Liberia.” This time, the doctor got the message.
“I followed strict CDC protocol,” wrote Dr. Otto Javier Marquez-Kerguelen, referring to the Centers for Disease Control and Prevention guidelines for treating potentially infectious patients. Wearing a mask, gloves and full gown, he began his exam and took a history.
“Pt states he has not been to any rural areas or funerals recently,” he noted. “Pt denies any sick contacts. Pt denies chills. The pt does not do [sic] any other associated signs of sx [symptoms] at this time.”
Among the possible diagnoses: malaria, gastroenteritis, influenza and Ebola.
Duncan was put into isolation. The nurses notified county officials. The doctor called the CDC.
By evening, he was suffering from explosive diarrhea, abdominal pain, nausea and projectile vomiting. Efforts to bring down his fever failed.
Because he recently had been in Liberia, Dr. Gebre Kidan Tseggay noted, “Ebola virus disease should be high on the list” of differential diagnoses.
Duncan had traveled to Dallas to visit relatives. His neighbors in Monrovia, Liberia, have said he likely was exposed while assisting a pregnant 19-year-old who later died of the disease.
Sept. 29: Feeling ‘miserable’
Shortly before noon, Duncan asked the nurse to put him in a diaper “because he feels too tired to keep getting up to the bedside commode.” His fever spiked again to 103, and he was wracked with chills.
“Pt said he just doesn’t feel good and doesn’t want to stay in the hospital and expressed concern that the doctor had not been here to tell him what was going on,” a nurse wrote.
Blood tests showing damage to the liver and kidneys, and fluctuating blood sugar levels kept doctors scrambling.
“Feels miserable. Says he is suffering,” Dr. Oghenetega Abraham Badidi wrote. “The patient seems to be deteriorating.”
Sept. 30: Ebola confirmed
At 2 p.m., doctors received the confirmation: “Patient has tested positive for Ebola.”
Duncan tried to remain upbeat. “Pt requested to watch an action movie,” a doctor said the next day. “States he is feeling better.”
Duncan told his nurse he wanted to try solid food, then refused his lunch tray.
Sepsis had set in. Doctors ordered aggressive IV care in hopes of preventing kidney and liver failure.
Oct. 2: Hopeful signs
Duncan told his attendants his abdominal pain had lessened. He said he was “trying to keep up good spirits and ‘stay strong.’”
But there was blood in his urine. Worried about lung function, doctors added advanced antibiotics to his medication.
That afternoon, he ate crackers and drank less than 2 ounces of Sprite.
“Patient states that he is ‘happy right now,’” the nurse wrote.
Oct. 3: Turn for the worse
In the morning note, a nurse-practitioner wondered, “concern for liver failure?”
A nutritionist wanted to start a kind of IV feeding used in the severely ill, and the doctors sought advice from the CDC.
That afternoon, a doctor’s note declared Duncan’s kidney function “much worse.”
Physicians contacted Chimerix, a pharmaceutical research firm in Durham, N.C. They wanted to try the firm’s experimental antiviral drug, brincidofovir.
Oct. 4: Tapping new drug
Just after midnight, nurses said “patient is restless. Coughing.” His oxygen levels were dropping, and he went into multiple organ failure.
They placed a tube in Duncan’s airway to help him breathe.
By morning, a shipment of brincidofovir arrived. Duncan got the first dose.
Oct. 5: Reaching out
Doctors consulted with Emory University in Atlanta. It had cared for three Ebola-stricken aid workers airlifted there from West Africa. Two had recovered and the other was stable.
One of those survivors, Dr. Kent Brantly, had donated blood for other patients, in hopes his antibodies might fend off the virus. But his blood was not a match for Duncan’s.
Oct. 6: Family visit
As doctors increased Duncan’s dialysis, his nephew, Josephus Weeks, was driving to Dallas from his home north of Charlotte, N.C. With him was Duncan’s mother, Nowai Korkoyah.
That evening, hospital staff escorted the family members to a room where they could see Duncan via closed-circuit TV.
“My son is dead!” Korkoyah cried out when she saw him. To Weeks, the immobile, expressionless face was “like a mask.”
Oct. 8: Beyond help
That morning, nurses found Duncan’s heart rate had dropped into the 40s.
They administered several rounds of atropine and epinephrine, but it didn’t help.
“No palpable pulse,” they noted. “Time of death called.” It was 7:51 a.m.
As infectious in death as he was in life, Duncan’s body later was cremated.
 |
| Thomas Eric Duncan died of Ebola Virus Disease in Dallas on Oct. 8, 2014. |
11 October 2014 11:51 PM
Despite five days of intensive treatment, Thomas Eric Duncan’s condition was deteriorating.
Then, suddenly on the afternoon of Oct. 2, came a hopeful sign. Duncan was hungry.
Nurses at Texas Health Presbyterian Hospital Dallas helped the 45-year-old welder from Liberia into a sitting position and gave him saltine crackers and Sprite.
Six days later, Duncan was gone. The first person ever to be diagnosed with the dreaded Ebola virus in the U.S. was the first in this country to die of it.
Grieving and angry relatives wonder whether the man they called Eric might have survived had health care workers not sent him home on Sept. 25, when he first went to the hospital emergency room.
Now, state officials say they may investigate how the hospital handled the case. Presbyterian has said it has “made changes” to its intake process and is reviewing the “chain of events” related to Duncan’s diagnosis.
Here, culled from medical records Duncan’s family in North Carolina provided to The Associated Press, is a recap of his last days:
Sept. 28: Returning to Presbyterian
When Duncan first went to the hospital, he was complaining of a headache and abdominal pain. His temperature spiked to 103 at one point, and on a scale of one to 10, he rated his pain as an eight.
Doctors ran tests, decided it must be sinusitis, sent him home with antibiotics and told him to follow up with a doctor the next day.
A nurse’s note said Duncan told her he recently had arrived from Africa. That info did not make it to the attending physician.
Now, Duncan was back. His symptoms included vomiting and diarrhea. His temperature was 103.1 degrees.
This time, the nurse’s notes made it clear he had “just moved here from Liberia.” This time, the doctor got the message.
“I followed strict CDC protocol,” wrote Dr. Otto Javier Marquez-Kerguelen, referring to the Centers for Disease Control and Prevention guidelines for treating potentially infectious patients. Wearing a mask, gloves and full gown, he began his exam and took a history.
“Pt states he has not been to any rural areas or funerals recently,” he noted. “Pt denies any sick contacts. Pt denies chills. The pt does not do [sic] any other associated signs of sx [symptoms] at this time.”
Among the possible diagnoses: malaria, gastroenteritis, influenza and Ebola.
Duncan was put into isolation. The nurses notified county officials. The doctor called the CDC.
By evening, he was suffering from explosive diarrhea, abdominal pain, nausea and projectile vomiting. Efforts to bring down his fever failed.
Because he recently had been in Liberia, Dr. Gebre Kidan Tseggay noted, “Ebola virus disease should be high on the list” of differential diagnoses.
Duncan had traveled to Dallas to visit relatives. His neighbors in Monrovia, Liberia, have said he likely was exposed while assisting a pregnant 19-year-old who later died of the disease.
Sept. 29: Feeling ‘miserable’
Shortly before noon, Duncan asked the nurse to put him in a diaper “because he feels too tired to keep getting up to the bedside commode.” His fever spiked again to 103, and he was wracked with chills.
“Pt said he just doesn’t feel good and doesn’t want to stay in the hospital and expressed concern that the doctor had not been here to tell him what was going on,” a nurse wrote.
Blood tests showing damage to the liver and kidneys, and fluctuating blood sugar levels kept doctors scrambling.
“Feels miserable. Says he is suffering,” Dr. Oghenetega Abraham Badidi wrote. “The patient seems to be deteriorating.”
Sept. 30: Ebola confirmed
At 2 p.m., doctors received the confirmation: “Patient has tested positive for Ebola.”
Duncan tried to remain upbeat. “Pt requested to watch an action movie,” a doctor said the next day. “States he is feeling better.”
Duncan told his nurse he wanted to try solid food, then refused his lunch tray.
Sepsis had set in. Doctors ordered aggressive IV care in hopes of preventing kidney and liver failure.
Oct. 2: Hopeful signs
Duncan told his attendants his abdominal pain had lessened. He said he was “trying to keep up good spirits and ‘stay strong.’”
But there was blood in his urine. Worried about lung function, doctors added advanced antibiotics to his medication.
That afternoon, he ate crackers and drank less than 2 ounces of Sprite.
“Patient states that he is ‘happy right now,’” the nurse wrote.
Oct. 3: Turn for the worse
In the morning note, a nurse-practitioner wondered, “concern for liver failure?”
A nutritionist wanted to start a kind of IV feeding used in the severely ill, and the doctors sought advice from the CDC.
That afternoon, a doctor’s note declared Duncan’s kidney function “much worse.”
Physicians contacted Chimerix, a pharmaceutical research firm in Durham, N.C. They wanted to try the firm’s experimental antiviral drug, brincidofovir.
Oct. 4: Tapping new drug
Just after midnight, nurses said “patient is restless. Coughing.” His oxygen levels were dropping, and he went into multiple organ failure.
They placed a tube in Duncan’s airway to help him breathe.
By morning, a shipment of brincidofovir arrived. Duncan got the first dose.
Oct. 5: Reaching out
Doctors consulted with Emory University in Atlanta. It had cared for three Ebola-stricken aid workers airlifted there from West Africa. Two had recovered and the other was stable.
One of those survivors, Dr. Kent Brantly, had donated blood for other patients, in hopes his antibodies might fend off the virus. But his blood was not a match for Duncan’s.
Oct. 6: Family visit
As doctors increased Duncan’s dialysis, his nephew, Josephus Weeks, was driving to Dallas from his home north of Charlotte, N.C. With him was Duncan’s mother, Nowai Korkoyah.
That evening, hospital staff escorted the family members to a room where they could see Duncan via closed-circuit TV.
“My son is dead!” Korkoyah cried out when she saw him. To Weeks, the immobile, expressionless face was “like a mask.”
Oct. 8: Beyond help
That morning, nurses found Duncan’s heart rate had dropped into the 40s.
They administered several rounds of atropine and epinephrine, but it didn’t help.
“No palpable pulse,” they noted. “Time of death called.” It was 7:51 a.m.
As infectious in death as he was in life, Duncan’s body later was cremated.
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