The response of the CDC earlier this week to the development of Ebola in a Dallas nurse illuminates another sad consequence of the rise of bureaucratic medicine. In their very disturbing response to this tragic incident, the CDC arrogantly announced—prior to any investigation and without adequate evidence–that the cause of the transmission of the Ebola virus to Nina Pham, the nurse involved in the care of Thomas Duncan, was a “breach in protocol.” Labelling it “unintentional” did little to soften the blow of their judgment.
The pages of medical history are filled with stories of heroic individuals who have sacrificed their lives in the provision of care to the sick and dying during times of plagues and epidemics. The fate of such caregivers has been viewed as a tragic end to the noble and heroic act of caring. But today, from our bureaucratic perspective, it is viewed as a “preventable error” with blame shifted from the bureaucracy toward the effected employee. Instead of honoring this nurse for her self-sacrificial care, the CDC portrayed her as a casualty resulting from careless compliance with their protocols, implicitly blaming her. This woman is no longer a hero who has risked her life for the care of another, but someone who, having done her job imperfectly, is suffering the consequences.
The presumption of the CDC is that their protocols are perfect and that by precisely following all protocols and procedures transmission of this virus will be prevented. Such a position assumes far too much. It assumes, first of all, that we have extensive and accurate knowledge of this organism and its virulent potentials; yet it appears that our knowledge is in fact inadequate—or even faulty–as we are daily bombarded by evidence contradicting what we were previously told. Second, it assumes the perfection of our protective procedures and protocols, which, if one checks the CDC website, do NOT include the use of impermeable Hazmat suits (as portrayed on television) or N95 head shields, but merely ordinary gowns, face masks, goggles, and gloves. This recommended protection provides less coverage than one has in the operating room, because it leaves one’s head, hair, and neck exposed to body fluids from projectile vomiting or explosive diarrhea. Alarmingly, the CDC’s recommendations for removal of the protective equipment is also contrary to that used by surgeons in the operating room for removing contaminated garments: the CDC’s protocol recommends removal of gloves FIRST, leaving ungloved hands vulnerable to contamination from removal of a body-fluid soaked gown; surgeons always remove gloves last. Third, it assumes that our equipment is flawless, that there are no holes or imperfections in our protective gear. How many times are surgical gloves donned only to find they have holes before they’ve been used? Finally, it assumes the impermeability of our protective gear to viral particles, and fails to acknowledge what we already know: that latex has pores that are small enough to adequately prevent bacterial penetration but are NOT small enough to perfectly prevent viral penetration: viral transmission is merely hampered, not prevented. Not surprisingly, this position is similar to the bureaucratic declaration that “safe sex” can be achieved through the use of condoms: condoms may prevent pregnancy and transmission of bacterial organisms but do not entirely prevent the transmission of viral particles and hence, are not entirely “safe.” And they break!
It is indeed vital that the CDC thoroughly investigate this incident, but by beginning with the assumption that their protocols and procedures are adequate, they are biasing their investigation and impeding the search for knowledge and truth. A more appropriate response would be to humbly acknowledge that we are fallen, fallible humans with imperfect procedures and flawed equipment, and then to look open-mindedly at the situation in an attempt to safeguard our caregivers and prevent the spread of this disease to the best of our corporate ability.
It is likely that the CDC has painted this picture with colors of blame in order to squelch fear-mongering among the population as well as to reassure health care providers that the protocols in place, when properly followed, provide adequate protection from this life-threatening disease. But in true utilitarian fashion, what they have essentially done is to throw this nurse “under the bus,” sacrificing her for the sake of the emotional reassurance of many others. From this perspective, there are no heroes. Therein lies the tragedy.