AP Enterprise: Records chronicle Duncan’s decline
Despite five days of intensive treatment for Ebola, Thomas Eric Duncan’s condition was deteriorating.
Then, on the afternoon of Oct. 2, came a hopeful sign. Duncan was hungry.
Nurses at a Texas hospital raised the 45-year-old welder from Liberia into a sitting position and gave him a packet of crackers and some soda.
Six days later, the first person to be diagnosed with the dreaded Ebola virus in the United States was gone.
Grieving and angry family members wonder whether he might have survived had health care workers not sent him home when he first presented himself at the hospital on Sept. 25, and whether doctors really did everything in their power to save him.
Hundreds of pages of medical records provided to The Associated Press provide an unprecedented look at how Ebola killed Duncan despite the aggressive efforts doctors made to save him.
On Sept. 28, an ambulance carrying Duncan pulled into the emergency bay at Dallas’ Texas Health Presbyterian.
Not 55 hours earlier, Duncan had been at the hospital complaining of a headache and abdominal pain. His temperature spiked to 103 degrees Fahrenheit (39.5 degrees Celsius), 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 information did not make it to the attending physician.
Now, Duncan was back, only this time his symptoms included vomiting and diarrhea.
This time, the nurse’s notes made it clear that Duncan 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 U.S. Centers for Disease Control and Prevention guidelines for treating potentially infectious patients. Wearing a mask, gloves and full gown, Marquez-Kerguelen began his examination 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, Duncan was suffering from explosive diarrhea, abdominal pain, nausea and projectile vomiting. Efforts to bring down his fever failed.
Because Duncan had recently traveled from Liberia, Dr. Gebre Kidan Tseggay noted, “Ebola virus disease should be high on the list” of differential diagnoses.
Blood tests showing damage to the liver and kidneys, and fluctuating blood sugar levels, kept doctors scrambling. Tests ruled out influenza, hepatitis, parasites and C-diff, the germ notorious for spreading diarrhea in hospitals and nursing homes.
Finally, at 2 p.m. on Sept. 30, doctors received the confirmation that everyone had been dreading: “Patient has tested positive for Ebola ...”
By Oct. 1, sepsis had set in.
Duncan tried to remain upbeat.
“Pt requested to watch an action movie,” the doctor noted. “States he is feeling better.”
Duncan told his nurse he wanted to try solid food, then refused his lunch tray.
The next morning, Duncan told his attendants that his abdominal pain had lessened. He said he was “trying to keep up good spirits and ‘stay strong.’”
But there was now blood in his urine. Worried about his lung function, doctors added advanced antibiotics to Duncan’s medication.
That afternoon, he ate his crackers and drank less than 2 ounces (60 milliliters) of soda.
By Oct. 3, the situation had turned dire.
Physicians contacted Chimerix, a small pharmaceutical research firm based in North Carolina. They wanted to try the firm’s experimental antiviral drug, brincidofovir.
The Food and Drug Administration gave its blessing.
Just after midnight Oct. 4, Duncan went into multiple organ failure. By morning, a shipment of brincidofovir arrived and Duncan got the first dose.
The following day, Sunday, Oct. 5, the Texas doctors consulted with their colleagues at Emory University in Atlanta about additional options. Emory had cared for three Ebola-stricken American 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 that his antibodies might help them fend off the virus. But Brantly’s blood was not a match for Duncan’s. There would be no transfusion for the Liberian.
Monday morning, Duncan’s nephew, Josephus Weeks, was picking his way across Louisiana in a hail storm. Riding with him were his son, Josephus Jr., Duncan’s sister, Mai Wureh, and Duncan’s mother, Nowai Korkoyah.
After more than a week of listening to his uncle’s failing voice over the phone from his home in North Carolina, Weeks decided it was time to go to him.
That evening, hospital staff escorted the family members to a room in the basement of Texas Presbyterian. The only way they would be allowed to see Duncan was via closed-circuit television.
“My son is dead!” Korkoyah cried out when she saw him. To Weeks, the immobile, expressionless face was “like a mask.”
Wednesday morning, nurses found Duncan’s heart rate had dropped into the 40s.
They administered drugs, but he was beyond 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 was cremated.
Back in North Carolina, Weeks pored over the stacks of medical records — 1,400 pages in all. He has so many questions:
How could the hospital have sent Duncan home that first day? Why did it take so long to remove the other people from the Dallas apartment where Duncan had been staying when he got sick? Why was Duncan not given the same experimental treatments as Americans with Ebola?
“Four white people got it,” Weeks had said angrily as Duncan languished.
Compounding his grief, Weeks now finds himself having to defend his dead uncle from allegations that he lied to airport authorities about his exposure to the disease.
Duncan’s neighbors in Monrovia, Liberia, have said that he was likely exposed to the virus while assisting a pregnant 19-year-old who later died of the disease. But Weeks says his uncle told him he hadn’t helped the young woman.
“He would have never come (to the U.S.) if he knew there was even the slightest possibility that he had Ebola,” Weeks said.
In the living room of her extended family’s comfortable one-story home, Korkoyah weeps for her son. He was, she said, “so kind, so generous.”
“I know I can’t get my son back,” she said. “But I just pray God will give me the strength.”
Breed and Schmall reported from Kannapolis, North Carolina, and Neergaard from Washington.