Records chronicle Duncan's decline

Despite five days of intensive treatment, Thomas Eric Duncan's condition was deteriorating.

Then, suddenly 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 saltine crackers and some Sprite.

Six days later, Duncan was gone. The first person to be diagnosed with the dreaded Ebola virus on United States soil was the first in this country to die of it.

Grieving and angry family members wonder whether the man they called Eric might have survived had health care workers not sent him home when he first presented himself at the hospital Sept. 25 and whether doctors did everything in their power to save him.

Hundreds of pages of medical records provided to The Associated Press chart the disease's march through Duncan's body. And they provide an unprecedented look at how Ebola killed despite the aggressive efforts doctors made to save him.

First arrival

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, and he was in pain.

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. His temperature was 103.1 degrees.

This time, the nurse's notes made it clear 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 diarrhea, abdominal pain, nausea and projectile vomiting. Efforts to bring down his fever failed.

Because Duncan recently had 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. Sept. 30, doctors received the confirmation all 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 his abdominal pain had lessened. He said he was "trying to keep up good spirits and 'stay strong."'

But there was 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 of Sprite.

By Oct. 3, the situation had turned dire.

Physicians contacted Chimerix, a small pharmaceutical research firm based in Durham, 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 organ failure. By morning, a shipment of brincidofovir arrived, and Duncan got the first dose.

Too late

Monday morning, Duncan's nephew, Josephus Weeks, was going across Louisiana in a hailstorm. 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 north of Charlotte, 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 it was in life, Duncan's body was cremated.

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Breed and Schmall reported from Kannapolis, North Carolina, and Neergaard from Washington.