8
PURGATORY
For reasons which can certainly use close psychological inquiry the West seems to suffer deep anxieties about the precariousness of its civilization and to have a need for constant reassurance by comparison with Africa. If Europe, advancing in civilization, could cast a backward glance periodically at Africa trapped in primordial barbarity it could say with faith and feeling: There go I but for the grace of God.
—Chinua Achebe, “An Image of Africa: Racism in Conrad’s Heart of Darkness”
I left the Bong ETU for Monrovia late in the morning the first Thursday in November, dropping by one last time to say my good-byes both to patients and staff. In a preview of coming attractions, during the morning staff meeting I was given a few minutes for a valedictory speech where my voice quavered over three octaves while I praised the nurses in particular and spoke of the honor I had in working with the national staff.
Tears flowed easily for me as others looked on, not altogether comfortably, for the staff meeting was a place to get business done. As we wrapped up, people moved about quickly in anticipation of the myriad activities that were required to keep the place running. There was, after all, a catastrophic outbreak still going on, and the virus wasn’t pausing to dry its eyes after my address. Nor were the patients, who would die over the next few days and likewise wouldn’t be comforted by my words. I dabbed my face with the industrial-grade toilet paper that served as our Kleenex and strode to the men’s locker area for one last change into scrubs, and then PPE, to make my last rounds, at least for this deployment.
I especially wanted to see what had become of the Kollie family—the entire family, all of whom were now in the firm grasp of the virus. Their story had begun in a remote village a few hours walk from Ganta, the capital of neighboring Nimba County. There, a few weeks before, the patriarch of the family, a man named Jeremiah, had helped his friend and neighbor Matthew carry Matthew’s wife to a clinic several miles distant. A second man had also helped, and they took turns carrying the frail woman to the clinic. She died not long after reaching medical attention. Having done what he could, Jeremiah had returned to his wife and three children.
Matthew was the first of this sad group to arrive in Bong County after the eight-hour journey from his home. He had arrived a few days before I started working the night shift, and this was the story as we knew it upon his arrival. By the time I had returned to working days, he had weathered Ebola’s storm and was now, like so many of the other survivors, pacing the halls, bored stiff. But as I neared the end of my time in the ETU, we admitted a woman and her three children to the suspect ward, and they all looked ill. By then we had the clinical instincts to guess with reasonable accuracy which patients had Ebola and which did not even before we drew their blood, and it looked like all of them were infected. As we gathered the story from the mother, she said that she had come from this village, and that there was a man here whose wife had died. We realized that she was speaking about Matthew and that this was Jeremiah Kollie’s wife, Lorpu. “Where is Jeremiah?” we asked. And then, almost as soon as the question left our lips, we wished we hadn’t. Not only had Jeremiah died but so had the other man. These two men, in turn, had transmitted the infection to each of their families. The Kollie family was now before us; the other family had been taken to a different ETU, to what fate I would never know.
I cannot imagine what must have gone through Matthew’s mind at the sight of Lorpu Kollie accompanying her three young children to the confirmed ward. I cannot imagine anyone imagining this. But I can try to provide words, feeble though they are, to at least approach his state of mind in that terrible moment, words like anguish, remorse, horror, guilt, and fury. This man had loved his wife and only asked his neighbors a simple favor to help restore her to health. Now that decision had ended up killing them. This simple and touching gesture of assistance, a deed of kindness and solidarity that requires no prolonged explanation of particular cultural mores, was now threatening the lives of anyone associated with this universally compassionate act. And now, he had to face the woman who never had a say in what had happened but was now feeling its brunt. Can you imagine what might have going through her mind at the sight of a recovering Matthew? All words fail. There is an empty, dark, dreadful nothing to summarize that moment. I was glad I wasn’t there when it happened.
The Kollie children did not fare well. On my penultimate day in the unit, I came in to find Peter, Lorpu’s middle child at two years old, lying on the cot. She must have known, for she had left the room by the time we arrived and he was alone, not in rigor but clearly dead. I quickly found Fredericka Feuchte, the head of the psychosocial team who happened to be rounding in the confirmed ward that day, and asked her to relay the news. I took what seemed like the much easier job of preparing little Peter’s body for burial. Bridget Mulrooney, the nurse working that shift, had gone to retrieve the spray contraption, which she hoisted on her back, spraying down the child along with all the surfaces he had touched, while I went to get the body bags from the storage room. I was unaware that there were special, smaller body bags for children, so when I arrived with these huge, adult-sized bags, Bridget took the opportunity to mirthlessly tease me for a few moments. Neither of us laughed, but the insertion of something that could at least pass for a kind of humor helped us move through the grim business that was upon us. After I sealed the second bag, I didn’t need to find a stretcher, and I gathered the child in my arms to carry him to the morgue. Carrying children was one of my favorite things to do in the unit, for it provided the joy of human contact, something strictly forbidden outside the Hot Zone. Every few days I would look for some excuse to pick up one of the kids and twirl them around, to their happiness as well. Peter would be the last child I would carry in the ETU.
So that following day I needed to see the other two children for myself. Though ill, they still lived, while Lorpu Kollie maintained a mask of flat affect that didn’t even hint at the suffering that she must have felt. I moved on to see other patients and bid my farewells, especially to those who had been there for weeks and were waiting around for their ticket to freedom to be punched, which they knew would come eventually.
*
I climbed into the SUV and headed down the long dirt road, unsure whether I would ever see this place again. Similar to the biblical Lot, I didn’t look back. We were at my flat at Cuttington within ten minutes, where I retrieved my luggage, and before I knew it I was on the road to Monrovia. We made a stop halfway there just outside the town of Kakata to drop off some supplies and documents at the next ETU that IMC was building. Because they hadn’t yet finished construction—it was due to open in mid-November—I was able to walk around without having to suit up.
If the Bong ETU was a blue world, then the Kakata ETU was most definitely a white world. Compared to the hastily constructed facility in Bong, the Kakata ETU was a massive complex whose structural advantages were immediately evident. Unlike our hilly ETU, the ground here was even so the risks of stumbling or falling were minimized. It was obviously designed to accommodate many more patients, easily twice as many, yet there was plenty of space for workers to maneuver. Both the suspect and confirmed wards were massive, about one hundred feet in length, each with a steel-ribbed skeleton that rose twenty feet into the air to form a pitched roof. Exhaust fans with the circumference of a truck tire were placed at each end of the building, just below the roof peak, to keep the air circulating and the temperature at least reasonably cool, in marked contrast to snug ovens that characterized the interiors of the wards in Bong County. The advantages for patient and health-care worker alike were clear, but I couldn’t help but think, as I watched the makeshift yurts of our ETU transform into semipermanent buildings of Kakata, that we were witnessing the industrialization of the virus. The epidemic had gone on so long and had infected so many that frantic improvisation had yielded to careful and deliberate planning, a mixed blessing if ever there was one.
But as w
e left Kakata for the final two-hour push into Monrovia, my mind turned to what awaited me in the next few days, and far from feeling a sense of euphoria or relief from having made it through the experience, at best I felt anxiety and at worst dread. For although I had not become infected, I could still be incubating the virus and wouldn’t know that I was truly in the clear until I had been away from the patients at the ETU for twenty-one consecutive days. The clock was starting to run, but the next few weeks were likely going to be a trying time rather than a triumphant return. That was largely due to events that had taken place in New York City only two weeks before.
On Thursday, October 23, a doctor named Craig Spencer started to run a fever. Spencer had just returned the week before from Sierra Leone after working a six-week stint for MSF in one of their ETUs doing pretty much the same thing that I had been doing. According to later reports, he started to feel fatigued a day or two earlier, but on Thursday his thermometer read 100.3 degrees Fahrenheit, and he immediately isolated himself and called the local public health authorities. The next day, in full Biosafety Level 4 isolation and with obvious signs of illness, his blood test was positive for Ebola.
And that Friday the 24th, we all sat in front of our laptops at the ETU and watched America become totally unhinged, even worse than when Thomas Eric Duncan had died in Dallas the month before. Every detail of Spencer’s life since his arrival became known and dissected by the media in short order. He went running. He went bowling. He had eaten with his fiancée at an Italian restaurant. The twenty-four-hour network news channels had turned Spencer’s infection into wall-to-wall coverage.
A responsible version of the story would look something like this: He was a threat to no one before his fever, he’s isolated now, a few people in close contact need to take some special precautions, but otherwise it wasn’t a big deal from a public health standpoint. It was obviously a big deal for Craig Spencer himself. But Fox News and CNN among others couldn’t resist the lure, Fox especially, given its advanced training in fearology. Just because of the sheer volume of coverage devoted to the most idiotic minutiae of Spencer’s recent life—he had taken the subway, crowded with people, for goodness sake!—there was no way a layperson could conclude anything other than that an act of biological terrorism had just been committed on American soil, and for the second time in two months.
Yet it was that other act that should have given Americans some sense that Ebola wasn’t quite the public health calamity that its portrayal suggested. Thomas Eric Duncan’s story was instructive. Everything that could have gone wrong with his initial evaluation and subsequent care did go wrong. The screening questions designed to identify potential Ebola patients somehow failed to pick him up, so he remained out in the community for three extra days. The isolation procedures were hastily and incorrectly performed. The PPE wasn’t adequate. The Dallas situation was, in short, fubar—the word that GIs from World War II had invented to describe a mess like this: fucked up beyond all recognition. By the time he died, the Texas Department of Public Health identified 168 people requiring careful monitoring, of which 120 were exposed at the hospital, while the other 48 were personal or professional contacts that Duncan had made before his hospitalization.
After this mostly man-made disaster played out, how many people did he infect?
Two.
Even though the people that Duncan had exposed were still a moving target by the time that Craig Spencer had become infected and it would not be known for many weeks that the outbreak that he caused really would stop at two, it should have been apparent by the end of October that there weren’t dozens of Ebola patients suddenly cropping up in the Dallas area. If the members of the media so breathlessly pursuing every detail of Spencer’s life had stopped to think about this, they might have concluded that Stateside Ebola was certainly something to cause concern but not perhaps alarm, much less panic. But the exercise in sophistry that constitutes television news makes no allowance for turning the temperature down or helping to calm the populace, so the idea that Spencer’s infection was going to be met with a measured response by the news media was placing hope far above experience.
Given the timbre of the news reports about Spencer, the political reaction was swift and severe. Within hours, governors of various states were cobbling together hastily considered policies for what to do with anyone returning from the three affected countries, and they were either doing this without the input of their own public health experts or were ignoring them altogether. Quarantine became the watchword. It didn’t help that the state in which Spencer resided was being governed by Andrew Cuomo, who was eyeballing a run for the White House, depending on the political fortunes of the early prohibitive nominee, Hillary Clinton. For Cuomo, the chance to look statesmanlike, especially on an issue concerning international policy, could be an unexpected gift if he was going to make the argument that he was as qualified to be commander in chief as someone who had served as secretary of state.
But Cuomo wasn’t the biggest beneficiary of Craig Spencer’s rising temperature. The real political windfall came to New Jersey’s governor Chris Christie, who could distinguish himself by appearing tough and competent within what was looking to be a crowded field for the Republican presidential race by isolating the African hordes in whatever way possible. Given that Newark airport was the entry point for many such returning travelers, he would almost immediately get his wish, for within twenty-four hours of the news of Spencer’s infection a woman named Kaci Hickox, herself also returning from Sierra Leone, had been pulled aside by New Jersey authorities when she mentioned that she had been working with Ebola patients. Hickox was using Newark only as a transit point to return to her home state of Maine, but suddenly found herself as Exhibit A in Christie’s tough-guy agenda.
She was whisked out of the airport against her will and stuck in a makeshift tent set up in one of the parking lots on the campus of University Hospital Newark a few miles away. The news of Hickox’s detention spread quickly, and the story went international within hours. Christie’s office tweeted that she had a fever and was “being evaluated” that evening. But Hickox was for the moment without recourse, and instead of starting a quiet weekend at her home in Maine where she could begin to unwind and process a difficult experience, she had become a captive of the State of New Jersey.
It’s not hard to see the appeal of Christie’s gamble: If she got sick, he would not only get to claim that his administration was not merely more competent but less reckless than the one in Washington, and he could use New York’s alleged mishandling of Spencer as a perfect counterexample of how the overly sensitive limousine liberals of the Democratic Party could threaten the populace with their bleeding-heart policies. And this would all be happening when the largest number of registered voters was paying attention to the issue.
Even Bobby Jindal, the governor of Louisiana and also a White House hopeful, tried to use the outbreak to muscle his way to some free publicity. Since Jindal didn’t have the benefit of an international airport to use as a prop, he had to wait his turn until the following week, when he vowed not to let in anyone from West Africa to the meeting of the American Society of Tropical Medicine and Hygiene in New Orleans. The conference annually hosts more than 3,500 attendees from more than a hundred countries, many from sub-Saharan Africa. You couldn’t have found a better place to concentrate some of the most important minds currently working on Ebola in order to hash out a coherent strategy for what could be done moving forward, but Jindal, not surprisingly, couldn’t see beyond his own narrow interests. By that point, however, the quarantine story was starting to fade from the front page, and the only people who were paying close attention to the outrage of the ASTMH convention freezeout were the very public health experts to whom few politicians were listening.
If Chris Christie was right and Kaci Hickox had Ebola, he might be able to leverage the whole affair to upgrade his candidacy for president; if he was wrong and she didn’t, he still had a decent c
hance of using the event to his own political advantage by showing he was a Serious Man, willing to take swift action when called for. Needless to say, I’m not a political strategist, but I wouldn’t be surprised if someone in his inner sanctum opined early on that, whatever happened to her, it was a win-win situation.
But in his bungling lust for power, Christie overreached. At best, what could be said about her physiologic state was that the forehead thermometer used to check her temperature did indeed register a fever, while the more accurate oral thermometer that was used simultaneously clocked in at a pedestrian 98.6 (Hickox claimed that the discrepancy was due to her being flushed because she was upset). Christie’s team, however, selectively interpreted the data, expanding the errant measurement into full-blown illness. The following day, Christie doubled down on his bet at a campaign stop in Iowa. “When I left this morning she still had a fever and she’s being tested for other illnesses after the Ebola test came back negative,” he said. “There’s no question that the woman is ill, the question is what is her illness” (my emphasis). This kind of pronouncement came in spite of his receiving status updates from physicians and nurses charged with her care, who saw nothing of the sort.
Hickox swiftly proved to be ready and willing to tangle with the governor on the biggest of stages. Despite being exhausted, scared, cold, and unwashed, she channeled her rage and eloquence into an op-ed that ran in the Dallas Morning News that Saturday morning, and she gave an interview to Candy Crowley of CNN the following day. She portrayed herself, accurately, as a clean-as-a-whistle professional—who had, after all, just returned from some incredibly dangerous volunteer work for which the word “heroic” might not have seemed out of place—yet was being treated little better than a felon by the governor. She also had a quick comeback to Governor Christie’s inflated assessment of her “obvious” illness. “First of all, I don’t think he’s a doctor; secondly, he’s never laid eyes on me; and thirdly, I’ve been asymptomatic since I’ve been here,” she said.
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