Experimental drugs and special care helped make Nina Pham Ebola free. But today she fears she may never escape the deadly disease.
The 26-year-old nurse says she has nightmares, body aches and insomnia as a result of contracting the disease from a patient she cared for last fall at Texas Health Presbyterian Hospital Dallas.
She says the hospital and its parent company, Texas Health Resources, failed her and her colleagues who cared for Thomas Eric Duncan, the first person in the United States diagnosed with Ebola.
“I wanted to believe that they would have my back and take care of me, but they just haven’t risen to the occasion,” Pham told The Dallas Morning News last week in an exclusive interview.
Pham says she will file a lawsuit Monday in Dallas County against Texas Health Resources alleging that while she became the American face of the fight against the disease, the hospital’s lack of training and proper equipment and violations of her privacy made her “a symbol of corporate neglect — a casualty of a hospital system’s failure to prepare for a known and impending medical crisis.”
She says that Texas Health Resources was negligent because it failed to develop policies and train its staff for treating Ebola patients. She says Texas Health Resources did not have proper protective gear for those who treated Duncan.
Texas Health Resources responded Friday with a statement from spokesman Wendell Watson.
“Nina Pham bravely served Texas Health Dallas during a most difficult time. We continue to support and wish the best for her, and we remain optimistic that constructive dialogue can resolve this matter.”
Watson declined to address the specifics of Pham’s allegations.
Pham wants unspecified damages for physical pain and mental anguish, medical expenses and loss of future earnings. But she said that she wants to “make hospitals and big corporations realize that nurses and health care workers, especially frontline people, are important. And we don’t want nurses to start turning into patients.”
In her 90-minute interview, Pham described working in chaotic surroundings at the hospital with ill-prepared nurses who received little guidance on how to treat Ebola and protect themselves. She talked about her life since her diagnosis and recovery, as well as her anxiety about the future.
Pham occasionally twisted a ring on her finger or slid a finger inside the cuff of her shirt and nervously tapped her wrist. She kept her composure except when she recalled the nurses who became “like family” to her when they cared for Duncan together and later risked their lives to treat her and Amber Vinson, another nurse at the hospital who contracted the disease from Duncan.
“Iwas proud of us. We fought in the trenches together, the frontline health care workers. That’s what nursing is about: putting the patient first. We did what we had to do,” Pham said.
She remembers spending hours alone with Duncan cleaning up his bodily fluids, monitoring his vital signs and reassuring him that everything would be OK. Pham said Duncan was in a great deal of pain and frightened but always polite. He told her “he felt very isolated.” She held his hand and told him she would pray for him.
But when Duncan tested positive for Ebola, it sent panic and fear throughout Presbyterian — and the nation. Pham, too, was frightened.
“I was the last person besides Mr. Duncan to find out he was positive,” she said. “You’d think the primary nurse would be the first to know. … I broke down and cried, not because I thought I had it but just because it was a big ‘whoa, this is really happening’ moment.”
Thomas Eric Duncan died at Texas Health Presbyterian Hospital on Oct. 8, 2014, 11 days after he was first admitted with Ebola. Three days after Duncan’s death, Pham tested positive for Ebola as well. (The Associated Press)
Duncan, who contracted the disease in his native Liberia, died Oct. 8. A few days later, Pham tested positive for the disease. She was initially treated at Presbyterian and then the National Institutes of Health in Maryland with a series of experimental drugs and plasma from Dr. Kent Brantly, an Ebola survivor.
She says that Texas Health Resources violated her privacy while she was a patient at Presbyterian by ignoring her request that “no information” be released about her. She said a doctor recorded her on video in her hospital room and released it to the public without her permission.
Charla Aldous, Pham’s attorney, put it more simply: Texas Health Resources “used Nina as a PR pawn.”
Pham said she considered not going back to care for Duncan after his diagnosis. Her colleagues said they wouldn’t blame her for not returning to her job where normal 12-hour shifts had stretched to 14 or 15. Even her mother said she didn’t care if Pham lost her job.
Pham said that while she did not volunteer to care for Duncan, she felt that she couldn’t say no.
“I had a duty to take care of him,” she said. “It’s not in my nature to refuse.”
RELYING ON PRINTOUT
She said the extent of her Ebola training was a printout of guidelines that her supervisor found on the Web.
“The only thing I knew about Ebola, I learned in nursing school” six years earlier, she said.
Dr. Daniel Varga, chief clinical officer for Texas Health Resources, testified at a congressional hearing in October that the company shared an Ebola advisory it received from the Centers for Disease Control and Prevention before Duncan arrived with its personnel and said the Presbyterian staff was trained to manage Ebola.
Where are they now
The aftermath of last fall’s emergency is still playing out across Dallas. Ebola has turned hazmat workers into heroes, brought fame and infamy to survivors, and could reshape the government that scrambled to fight it. Click each individual below to learn more about how they have fared in the wake of the Ebola crisis:
While Duncan’s fiancee and son grieved in near-solitude, out-of-state relatives found the limelight.
Duncan’s nephew, Josephus Weeks, toured Dallas with civil rights leader Jesse Jackson and Duncan’s mother at his side. On CNN, Weeks accused the hospital of letting Duncan die because he was black. And he hinted at a lawsuit.
Weeks went quiet in November, after the hospital paid Duncan’s parents and children an undisclosed cash settlement. He’s been out of the media since then, and didn’t return a reporter’s call.
“A lot is being said about what may or may not have occurred to cause Ms. Pham to contract Ebola. She is known as an extremely skilled nurse, and she was using full protective measures under the CDC protocols, so we don’t yet know precisely how or when she was infected,” Varga said in written testimony. “But it’s clear there was an exposure somewhere, sometime. We are poring over records and observations, and doing all we can to find the answers.”
Varga also acknowledged that the communication wasn’t enough and that Texas Health Resources needed “more proactive, intensive and focused training for the frontline responders” to Ebola. He also said the hospital followed CDC and state guidelines.
Aldous alleges that Varga misrepresented the information that the hospital system shared with its employees about Ebola and the type of protective gear Pham and others wore.
The day Duncan moved to ICU, Pham said, she and the charge nurse went in with double gloves taped to double gowns and wore double booties and a face shield. The hospital did not have hazmat-type suits, and Pham said her neck was always exposed.
“We’ve had nurses that I’ve worked with that worked in other states, and they worked in hazmat suits for flu and H1N1,” Pham said. “Why aren’t we wearing hazmat suits for Ebola?”
After days of asking, Pham said, the nurses were given hazmat suits. She said all the decisions to upgrade the protective gear and precautions were made by the nurses “on the fly.”
Meanwhile, the nurses devised their own hazardous waste area. In a room adjacent to Duncan’s, the nurses set up a place to take off their protective gear and shower after caring for him. In another nearby room, they placed bags of dirty linens, towels and other soiled items.
The nurses and respiratory therapists poured bleach into every bag, zip-tied them and placed them in cardboard containers. Pham estimated that the waste filled half a patient room.
No one would collect the waste or clean up, Pham said. At one point, the toilet the staff used stopped working and no one came to fix it.
“We were mopping floors with bleach and doing janitorial work and dealing with hazardous, lethal waste,” Pham said. “It was very physically and emotionally draining.”
Because of their long shifts, Pham took four days off. When she returned, she said, Duncan was “so very sick.”
By then, four nurses were assigned to Duncan each shift, Pham said: two inside his room and two outside. They traded places every two hours.
Pham was outside watching Duncan’s monitors when his heart rate plummeted.
“It was over in minutes,” Pham said. “It was very, very hard and devastating for all of us to have to go through all of that, to risk our lives and then we lose this patient.”
Texas Health Resources reached a settlement in November with Duncan’s family. The company apologized for not properly diagnosing Duncan with Ebola until he returned to the hospital for a second time. The company paid an undisclosed sum to Duncan’s parents and four children.
DEEMED ‘NO RISK’
The day after Duncan died, Pham said she met with someone from the CDC and the hospital’s employee health manager to walk through her care of Duncan and how she protected herself.
“They deemed me no risk,” she said.
She went home and later had a fever of “99-point- something,” about 2 degrees above her normal temperature. Pham said she called the hospital and the Dallas County health department, and was told to monitor her temperature. But unless her temperature reached 100.4, they told her, she should not be concerned.
Attorney Charla Aldous, who is representing Pham, says that Texas Health Resources “used Pham as a PR pawn.”
She woke up early Oct. 10 with a temperature of 100.6. Pham said she called the Presbyterian emergency room and told them who she was and that she was coming to the hospital. She drove to the hospital, where she was put in isolation. Her boyfriend at the time was quarantined but remained Ebola-free. They stopped seeing each other soon after, and Pham is currently not dating anyone.
When she was admitted to Presbyterian, Pham said, she made it clear that she did not want any information released about her medical condition.
“I wanted to protect my privacy, and I asked several times … to put be as ‘no info’ or at least change my name to Jane Doe,” Pham said. “I don’t think that ever happened.”
When a test confirmed that she did have Ebola, “I broke down crying” and was in disbelief.
“It was very scary,” she said. “My time at Presbyterian is a bit blurry just because I was in and out of having to take pain medications and just being very, very, very fatigued the whole time. One of the hardest things about having Ebola was the extreme amount of fatigue.”
Pham said she received three experimental drugs and “one glimmer of hope” when she found out that Brantly could give her plasma. Brantly, a doctor from Fort Worth, contracted Ebola in July while treating patients in Liberia. The plasma of Ebola survivors is helpful in the treatment of others fighting the disease.
Although Pham was always being watched and she talked with her family on the phone, she was lonely, she said.
“Just knowing the whole world’s watching but you’re so isolated and the people that are coming [in to care for me] are risking their lives,” Pham said. “Touching me is life-threatening. It’s very lonely.”
By the fifth day of isolation, Pham was sitting up in a chair. She thought she was doing better. But a doctor came in to talk about “end-of-life decisions” with her.
The day Pham was transferred to NIH, a notation was made in her medical file that “she does not have the mental capability to make end-of-life decisions,” Aldous said. But PR people from Texas Health were trying to talk to her for a media release “about how much she loves Presbyterian,” Aldous said.
Texas Health, with a PR firm’s help, developed a slogan — “Presby Proud” — aimed at restoring the community’s faith in the beleaguered hospital.
Before Pham’s flight to Maryland on Oct. 16, she said, a doctor wearing a video camera under his protective hood came into her room and said he was filming her for educational purposes. Pham said she did not give permission for the video, which was released to the media.
“Thanks for getting well. Thanks for being part of the volunteer team to take care of our first patient,” a man’s voice said in the video. “It means a lot. This has been a huge effort by all of you guys.”
Pham, still lying in her Dallas hospital bed, got teary-eyed and said, “Come to Maryland, everybody.”
Pham said she understands the reasons for making the video.
“They had just a PR nightmare with what happened with Mr. Duncan … and then us being infected with Ebola. Not just one nurse, but two,” Pham said. “People lost faith in them, especially after we got sick.”
Pham said that she was asked on video — although not on the part released publicly — whether she wanted to stay or go. Pham recalled that she was scared and knew nothing about NIH. She said if she was getting better, she would stay. But if the staff, which was low because some were quarantined, could not handle it, she would go. By this time, Vinson was sick, too.
“I could tell that they wanted me to stay just because they kind of knew, they could see I was getting better,” Pham said. “They wanted that ‘yes, we cured her’ kind of attitude. They wanted a win, especially after a loss.”
STRUGGLE TO RECOVERY
Before leaving NIH on Oct. 24, an Ebola-free Pham said, “Throughout this ordeal, I have put my trust in God and my medical team. I am on my way back to recovery, even as I reflect on how many others have not been so fortunate.”
Pham said she was met with “radio silence” from Texas Health Resources when she returned home. No one called to ask how she was doing or offered to bring food.
The people who cleaned her apartment to rid it of Ebola tossed her sheets but not the duvet cover on her bed. The rugs were gone but not the thermometer that she used to determine her temperature was in the Ebola danger zone.
Now there is no such thing as a typical day for Pham. Though she still gets a regular paycheck from Presbyterian, which she joined in July 2010, she isn’t working. She spends time with her family and her now-famous Cavalier King Charles spaniel, Bentley.
There’s also the social aspect of life that is different than before. When she meets someone, she wonders if that person knows who she is.
“I feel like I’ve been less social, in a way. Every time you’re in a social setting, especially now, Ebola always comes up,” Pham said. “It’s very hard to talk about it.”
Before getting sick, Pham, a Texas Christian University alum, considered graduate school to further her nursing studies.
“I’m still trying to figure out what I want to do next. It’s been such a life-changing experience, a traumatizing experience, too,” said Pham. “I don’t feel like I’m physically but mostly mentally prepared to go back into the ICU for right now.”
Last week, she was supposed to fly back to the NIH to donate her plasma for research. But the icy weather delayed the trip, so she plans to reschedule.
Pham said she has a lot of anxiety about the possible long-term effects of Ebola and the experimental drugs.
She’s been told to look out for possible sensory changes, vision loss and organ failure.
Pham previously had complications with high levels of enzymes in her liver, and she’s concerned the problem has reappeared. She said that she can’t even have a glass of wine with dinner now without getting sick.
Some of her hair has started to fall out. A doctor at NIH told her that was caused by Ebola, she said.
“I don’t know if having children could be affected by this, but that’s something I worry about,” Pham said. “Just the uncertainty of it all. And if I do have a health problem in the future, is it related to Ebola or is it something else? How do we know that? … That’s the scariest part — it’s the uncertainty.”
Follow Jennifer Emily on Twitter @dallascourts.