News 8s Medical Reporter Janet St. James sat down with Dr. Gary Weinstein with Texas Health Presbyterian Hospital Friday and they had a wide-ranging discussion about the Ebola virus in Dallas and the hospital and health officials response to the crisis. Dr. Weinstein was at the heart of the care team at Presbyterian and treated all three Ebola patients who contracted the virus in the U.S., Thomas Eric Duncan, Nina Pham, and Amber Vinson. _________ Watch the full interview here or read the transcript below. Here is a transcript of the majority of the 45-minute interview with some personal details of the patients removed: St. James: How do you feel? Dr. Weinstein: I feel well. I feel rested and well. Totally without symptoms. St. James: People will be worried that Im sitting here with you. Whats your temperature? Dr. Weinstein: Well, I have taken it four times today, and the most recent one is 97.2, and I have been afebrile [not feverish]. St. James: So are we safe to be this close to you? Dr. Weinstein: Totally. Totally safe. Im not ill. Theres no risk. _________ St. James: What has your role been? Dr. Weinstein: I have been participating in the care of all three patients that weve had with Ebola virus disease. Im part of the team. Im one of the main doctors. St. James: What risk category do you think youre in? Dr. Weinstein: I think I would be […] according to their stratification, I think I would be low-to-no apparent risk. I think Im no apparent risk because Ive had exposure to the patients, but I have not had any exposures to bodily fluids when I have not been completely, completely covered. St. James: I think the public would dispute that. Should you not be high risk? Dr. Weinstein: My only interactions with any of these patients have been in completely covered respirators, no skin showing to the outside world. The exact same personal protection equipment [PPE] that theyre using today at the NIH and at Emory Hospital. St. James: So, you consider yourself to be low risk. Dr. Weinstein: At most. I think Im no risk. _________ St. James: Where were you and what was your reaction when you heard there was a probable Ebola patient? Dr. Weinstein: Its somewhat of a blur. I really dont remember where I was. I think I was in the intensive care unit and was told of that by one of our nursing supervisors. [I had] Lots of reactions initially. Its, That cant be. I think the same reactions most people would have. That cant be right. Doesnt seem right, thats not likely, find out what the real story is. I think those were my initial thoughts. St. James: Tell me about the first time you saw Thomas Duncan [the first Ebola patient in Dallas]. Dr. Weinstein: I saw Mr. Duncan on the day after he developed respiratory failure and was sedated and comfortable... [He was] deeply sedated, on a ventilator breathing for him, and on a dialysis machine. This was – I believe – he had been in the hospital for a few days. It was not right at the beginning. He came in and was not unstable when he first came. He was sick, but not unstable, and then he deteriorated over the weekend. St. James: Were other patients in the ICU when they brought him in? Dr. Weinstein: No, everyone was moved. He was not moved to the ICU until the ICU had been cleared of other patients and set up so that we could do the things we needed to do, as far as putting on and taking off personal protection equipment in the ICU. So […] there was no one in the unit when he came. St. James: Were you assigned, or did you volunteer? Dr. Weinstein: I was on. No different than if you came in ill. It was... This is what I do. I was on and it was my job to care for him. And thats what I did. St. James: What about the nurses? St. James: Why did they volunteer? Dr. Weinstein: Nobody questioned it. Its been so heartwarming. This kind of illness, this process that weve been through, this is the essence of nursing. This is the epitome of health care. Somebody is sick and needs help, and we provided the help that they needed. This is what we do. Nobody said no. St. James: What did Thomas Duncan look and seem like? Dr. Weinstein: When I began my involvement in his care, he was completely sedated and comfortable and not moving, because of the medications that we were giving him. He had... His body fluids were being controlled. They were being collected and controlled. So he had a tube in his nostril to drain the stomach contents, so there was no vomiting. A catheter in his bladder to collect his urine, so there was no … urine. And the same thing for his stool. St. James: There were reports that there was extreme amounts of waste on the floor. Dr. Weinstein: Again, from the point of my involvement […] he had already deteriorated significantly, was critically ill, and was on a ventilator, asleep, pharmacologically - medically - in a coma. St. James: Why did they not collect the body fluids like that from the beginning? Dr. Weinstein: The collection of bodily fluids was done as soon as it could be done, and to put somebody into a pharmacological coma itself has risks. We dont do those things in any patient unless its medically indicated. So we wouldnt put a patient on a ventilator willy nilly... Collecting the body fluids was, in fact, done as soon as it could be done. When he developed significant diarrhea, a tube was placed to collect the diarrhea. But I dont know off the top of my head exactly the date that it was put in. READ: Timeline details missteps with Ebola patient who died St. James: So, you didnt see - essentially - Armageddon in the room? Dr. Weinstein: Correct. Thats correct. St. James: Were you scared? Dr. Weinstein: I dont think I would say I was scared. I was cautious. I think all of us who were involved in his care were... cautious and deliberate in our actions and making sure that we put on our PPE carefully and took it off carefully. Certainly, we understood that there were risks, but I didnt lay awake and think about it. Again, this was – we see patients who have hepatitis, who have HIV, who have tuberculosis. St. James: But this is Ebola. Dr. Weinstein: Theyre all communicable diseases. They all could be passed to the caregivers. […]We take care of the patients. This is a patient in need. This is a man who was ill, who presented to our doorsteps and we took care of him. St. James: Were you not thinking, putting [your] life on the line, [and that Duncan was] engaged to be married? Dr. Weinstein: I did not have those thoughts. I thought about the things that I needed to do and that the team needed to do. And it would come as no surprise that there were lots and lots and lots of things to do. St. James: Tell me about the team of physicians. Dr. Weinstein: Theres an internal medicine physician, infectious disease, pulmonary critical care. That was our team […] when he came into the ICU. Dr. Weinstein: I did not. St. James: When were you brought in and why? Dr. Weinstein: Well, I was brought in because my partners were seeing Mr. Duncan, and it was my day to be on call. And for the next two weeks, I was assigned to the medical ICU and thats […] so that was my duty. He was a critical man who needed help, and if it wasnt me, it would have been one of my partners. St. James: Why was Thomas Duncan intubated? Dr. Weinstein: The simple answer is because he had respiratory failure and he had kidney failure. He wasnt making urine [… he] needed dialysis. St. James: Had anyone ever tried that? Did you look it up on Google? Dr. Weinstein: Certainly not. We - from day one - we had daily conferences with the physicians from the CDC, as well as physicians from Emory, Nebraska […] we presented what was going on. There was in fact a patient from Emory who had been intubated, ventilator, dialysis. St. James: Did it stabilize him? Dr. Weinstein: Yes it did. It certainly did. St. James: Why werent experimental medications and a possible blood donation from the two known Ebola survivors in the [United] States considered early on? Dr. Weinstein: Those things were considered right off the bat. Again, we had at least once-daily conversations with the CDC, who were on site, as well as by phone and physicians from Emory. […]And the convalescent serum, the blood donation, as its been termed in the media, could not be done because he did not have a blood type that matched the two known donors. It has to be type-specific. So the blood type has to match. When it doesnt match, its not an option. Theres only two known donors in the United States and they were not his blood type. St. James: Some in the public doubt thats true. Dr. Weinstein: Well, they can be as skeptical as they would like, but that is, in fact, the case. The most common blood type in the United States, I believe, is A. And there was an A donor and there was an O donor . So patients who get Ebola who have A blood type and O blood type, potentially could get convalescent serum from one of the known donors, if they havent donated too recently to do it again. The other thing thats important to know is that all of these treatments are experimental. Theres no known benefit to any of them. Lots of studies... St. James: Why was experimental medication considered so late? Dr. Weinstein: Well, some of the medicines were felt not to be recommended. Again, [we were in] consultation with our colleagues who have dealt with this, because it can make you really sick. And the experience with one of the patients […] they felt like [an experimental medication] made the patient pretty sick, and they recommended that we not do that. They thought it could potentially make him more ill, not less. All of the possible therapies were discussed literally every day. And […] convalescent serum was not an option. One of the medications was thought to be too risky. One of the medications was - we were told by everyone - was nonexistent. ZMapp: Unavailable. And the last one had to be located, you have to get permission from the FDA, get permission from the IRB [institutional review board]... Theres a lot of hoops and paperwork and email and consents that had to be done. And all that was done as quickly as it could be done. And the medication isnt at the CVS – it had to be located. Its an experimental medicine thats not in great supply, because its just being used in studies. Dr. Weinstein: I dont know how you can speed it up... It doesnt make sense to me to speed up if youre talking about the approval process […] without any knowledge of whether its beneficial or not. The process moved – considering all the agencies – really moved amazingly fast. St. James: Many people have said Thomas Duncan was not treated as well as he should have been because he was black and uninsured. Dr. Weinstein: I find that remarkably insulting. I dont know how better to describe that. The team here worked their tails off trying to save his life. St. James: Do you think you tried everything you could? Dr. Weinstein: Yes. St. James: Do you think he could not be saved? Dr. Weinstein: Yes, he was too sick. St. James: What was your reaction? Did you know he was dying? Dr. Weinstein: It was very, very quick. He was critically ill and unstable, and over a period of minutes, he lost his pulse and was dead. St. James: Had he spoken to anyone about resuscitation? Dr. Weinstein: Yes, he had. He spoke to one of my partners, and he did not want chest compressions, did not want to be shocked, he was willing to be on a ventilator, he was willing to have dialysis... He was coherent, he understood, he had an informed conversation with my partner. He asked questions. He knew he had a bad problem. And he knew from his experience in Africa what happens to people with Ebola. And I presume that all of that factored into his decision. Im told […] that he was a thoughtful, intelligent, kind man. The nurses spent a lot of time speaking with him and trying to comfort him. _________ St. James: What sort of protective gear were you wearing? Dr. Weinstein: When I was involved, everyone on the team was doing the same exact thing. Everyone had on full protective gear, so you had on multiple sets of gloves, impermeable, water-impervious zippered jumpsuit, […] gloves taped to the sleeves, […] multiple pairs of liquid-impervious booties, […]masks, and a full, completely-covered headgear that had a source of air that you wore on a belt thats behind you, thats filtered. Nothing exposed. Completely covered. St. James: Did you ever hear any complaints from nurses about adequate protection? Dr. Weinstein: [I] did not. What we asked for, we got. We had complete support. And again, I think were learning about this. This is the first time in this country that a patient with Ebola has presented to an emergency room to be diagnosed. And theres a big difference between a patient with a known diagnoses, and people coming to the door of our emergency room who are ill, who might have Ebola. St. James: Did you feel like you had all the equipment you needed? Dr. Weinstein: Again, I would say yes. And everything that we asked for that the CDC said, You know, I think we ought to do this. We got it. READ: Ambulance service takes special care with Ebola patients St. James: Did you feel like you had the expertise to handle it? Dr. Weinstein: To handle the illness? The illness requires supportive care. There is no treatment – no known treatment – for Ebola. Treating Ebola requires supportive care, IV fluids, hydration, keeping people from getting dehydrated when they get diarrhea. St. James: Did you ever ask for help? Dr. Weinstein: All the help we asked for, we got. I mean, we didnt need – we had plenty of nurses volunteering […] we had physicians, we had equipment. We had help from advice from people who had taken care of Ebola […] from day one. Listening to the experience. We had the things that we thought that we needed. And when the recommendations changed and it was recommended that we do other things, we had those. We got those. St. James: What was your reaction when you find out about when Nina Pham was coming in? Dr. Weinstein: What did I hope it was? I hoped it was a cold, sinus infection, the flu. I felt sunken. I felt horrible for her. She was scared. It was scary. She risked her life to care for a patient, and now she was afraid for her life. St. James: You couldnt even give her a hug. Dr. Weinstein: Certainly not. Certainly not like youd want a hug. A hug through a couple layers of plastic is probably not as comforting as she needed. St. James: Did you do that? Dr. Weinstein: You bet I did. She did remarkably well, emotionally. I think once she got over the initial fear and concern and was surrounded by her friends and colleagues, that she knew would care for her so well – just like shed cared for Mr. Duncan. That was comforting and reassuring. READ: Pham doing well in Bethesda; clinic humbled and fortunate St. James: What was Nina Phams initial symptom? Dr. Weinstein: Fever. St. James: Low grade? Dr. Weinstein: I dont remember exactly. I believe it was over 100.5, which is what brought her in. Because she was being monitored, taking her temperature. St. James: Rash? Dr. Weinstein: She developed a rash. I dont think she presented with a rash. St. James: Coherent? Dr. Weinstein: Totally. St. James: Was she in pain? Dr. Weinstein: She had some mild abdominal discomfort, initially. She got a little sicker, then she got better. READ: Video released of Ebola patient Nina Pham in hospital St. James: And when the second nurse, Amber Vinson was diagnosed. What did you think when you heard? Dr. Weinstein: I think I had the same emotions that everybody would. This is horrible and I hope that this is the last. How could this happen? Im just a normal guy. I have the same emotions that everybody else does. St. James: So how do you think [she was infected?] Dr. Weinstein: I think that these two nurses took care of a critically-ill patient at a time when he was not in control of his body fluids, and at a time when the recommendations from the CDC that we were following did not include the full respiratory mask. I dont know that. But thats what one person thinks – thats me. Thats not based in science, its not based on anything I saw. Its just trying to be thoughtful and think about the risks that we now know. St. James: Do you think there will be more [Ebola cases in Dallas?] Dr. Weinstein: I dont think so. I dont think so. I think its remarkable, and remarkably fortunate, that Mr. Duncans family has not gotten ill. St. James: Nurses often have to do some dirty work. What were they dealing with in there? Dr. Weinstein: Theyre all unbelievable heroes – the nurses, the respiratory therapists, the people who participated selflessly [with] these patients with a disease that is potentially deadly. St. James: Were they all scared? Dr. Weinstein: I suspect that, on some level, everybody was. St. James: Knowing what you know now, was the hospital ready? Dr. Weinstein: I think we were just as ready as every other hospital in this country, save the four who have level-four containment units. St. James: Are you ready now? Dr. Weinstein: I would say were more ready than any hospital in this country _________ St. James: Were you treating other patients [while you treated the Ebola patients?] If I thought for a moment that I was not safe, I wouldnt go home. Wouldnt come to work. I wouldnt see other patients. We were following the states guidelines and recommendations regarding contact. St. James: S hould you be in isolation? Dr. Weinstein: I am not quarantined. I have been asked not to go in public places, not to ride public transportation, not to go where the public congregates. Ill miss my sons last homecoming game as a senior, happening tonight. St. James: Is it unwise to travel? Anyone ever tell you before yesterday? Dr. Weinstein: Weve been monitoring our temperatures one time a day by someone from the county or the state. And the other times […] asked questions twice a day. But sometime in the last day or two is when Ive been given those instructions. READ: Travel ban for Texas health care workers in Ebola case St. James: Are you worried about infecting loved ones? Dr. Weinstein: No. St. James: Not at all? Dr. Weinstein: No. The public – this is difficult and I understand the publics concerns, because its scary. But I know about the disease, I know about what efforts were done for personal protection. And if I had any concerns, I sure as heck would not have gone out... St. James: B e safe for our sake. Dr. Weinstein: Well, again, I cant address all of the publics concerns, but I can feel confident that Im safe and protecting my family. Im not going to do anything that puts my family at risk, which means, in turn, that Im not putting the public at risk. St. James: Are you worried about the stigma? Dr. Weinstein: Its... I dont know whats going to happen. I think time will answer that question. I know that peoples lives are being affected. But the caregivers have had babysitters go home, people who wont go to their house – theres lots and lots of uninformed and irrational fears. But these people, these nurses, they are truly heroes. This has not happened before. And they selflessly gave of themselves to care for this patient. And they shouldnt be shunned. READ: Nurse sent home because daughter visited from Kenya St. James: What would you tell people afraid to go to Texas Health Presbyterian? Dr. Weinstein: This is a fantastic hospital that I wouldnt hesitate to go to. Theyre going to have to see – We will recover. We have a fantastic crew, and well recover. Hopefully, it wont take too much time. The community needs this hospital.
Posted on: Sat, 18 Oct 2014 14:12:43 +0000
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