Notes From Ebola Dallas

Like many in Dallas, I was confronted Sunday morning by a reality that I and many around me had hoped we would not have to face. A second Ebola infection, this time of a health worker at Presbyterian Hospital (locally known as Presby). This is the first time the disease has been contracted in the US (others were infected in Africa and subsequently traveled to the US).

A few notes and thoughts to consider as you read/watch media coverage:

  1. Presby is not an out of the way place, nor is it the “gunshot hospital” that so many people in large cities will be familiar with. This is one of the major hospitals where everyone goes for everything, from standard doctor appointments (my doctor and my kids’ pediatricians are in one of the Professional buildings there) to child births (two of my three kids were born there). It is convenient to most of the residents north of downtown and has a massive extended physician infrastructure that underlies the healthcare program for many people here.
  2. Dallas is similar to San Francisco in that it is the financial, business, and nightlife hub of a huge metro area (DFW and the Bay area are approx. 6–7 million people each), however both Dallas and SF are themselves relatively small geographically and only +-1 million people live in the city limits of each. So when you talk about “Dallas” and you mean DFW thats an ocean. When you talk about “Dallas” and you mean the City of Dallas, thats more of a lake. This Ebola thing is happening in the lake, and in a very small corner of that lake just on the east side of US-75 (known locally as Central).
  3. Dallas is a city of massive mental-geography barriers. The city itself has no real barriers in the way that the Bay physically separates SF and Oakland. But what it lacks physically it makes up for mentally. Life here is defined in terms like South of i-30 v. North of I-30; North of 635 or “inside the Loop”; East of Central or West of Central… In this case, the west side of Central is (generally speaking) the wealthier part of town and includes the fabulously wealthy Highland Park, University Park, and Preston Hollow, while the east side (with some exceptions) is mostly older neighborhoods of working class and younger, upwardly-mobile families. For most people in Dallas this mental barrier is large and has been ingrained over many generations. This is one of the reasons that probably the biggest controversy in this entire mess is the visits Judge Clay Jenkins (See NYT coverage here) made to the Ebola patient’s family without protective gear. The controversy is partially to do with his political grandstanding and the inherent foolishness of the act(s), but there is no doubt that as a resident of Highland Park he was the first to break this mental barrier and bring the reality of Ebola contact across the Central divide. In the week or so after the initial diagnosis many people west of Central felt (rightly or wrongly) insulated from it all, but as the NYT points out Armstrong Elementary (in Highland Park which Jenkins’ kids attend) saw a 10x increase in student absences after Jenkins made his visits. This is a three week saga for many people here, but it has only been in the last week that the West of Central populace has gotten edgy.
  4. The most pervasive thoughts this morning among people I have spoken to are (a) the nurse (now identified as Nina Pham) is a hero who was put in the terrible position of having to care for an Ebola patient and without exception everyone I have spoken with has offered thoughts and prayers for her, (b) what the hell were we doing risking the lives of our health workers in order to give kidney dialysis to someone who was many days into a losing fight and who brought this disease to our city and country under somewhat dubious circumstances in the first place? (c) Why not send him in the first flying ambulance Gulfstream you can find to Emory and the CDC who can handle not only the physical strain of a case like this but the perception implications as well. Presby is one of our main hospitals and it is not only bearing the heavy burden of risking its workers in the front line of the US fight against Ebola, but also bearing a massive future financial risk that the people of Dallas move their healthcare elsewhere temporarily and never return. Anecdotal evidence indicates that since the initial diagnosis the number of surgeries performed at Presby have fallen to basically zero causing financial strain on the system. Ebola is a nasty disease but it is highly possible that the main long-term casualty here might be the health of one of Dallas’ best institutions.