“I did what?!”
“Steven, I hope you don’t mind my asking, but did you … hug somebody on Monday morning? In a public place?”
“Oh my goodness.” I suddenly pictured the following morning’s above-the-fold headline in forty-point lettering: “Ebola Hugging Doctor Wreaks Havoc at University Campus.”
“Well, apparently several employees called this reporter and they have been reading the CDC guidelines, and they are under the impression that this violates the guidelines in a fairly dramatic fashion,” she said. She went on to say that they were currently trying to find out what they could and that she would let me know anything, especially if they wanted to ask me any questions before going to press.
But there I was in a hotel room, suddenly feeling like a sitting duck, wondering what would happen over the next several hours. Would the T&G, as it is known locally, want to keep the Ebola-Hugging Doctor story to itself as a scoop, or would it try to notify a TV station who could show up at the front desk asking questions anytime between now and tomorrow morning? After I hung up the phone with Jen, I broke into a cold sweat, called Miriam, and told her that I would be home within the hour. If a reporter showed up at our house, at least I could hunker down and weather the storm in my own bed. We were going to have to roll the dice with the kids and how they would be received at school. I gathered up my belongings, throwing them into the car as quickly as possible, and drove home, about seventy-two hours after I had arrived.
The next morning it was time to read up on the CDC guidelines. The source of the misunderstanding became immediately apparent and revolved around the concept of what constituted high risk. Normally a health-care worker in the United States would consider direct contact with a patient who had a serious communicable disease to be a high-risk situation. But the CDC guidelines regarded people who had known direct contact with Ebola without protective gear to be high risk, while anyone who had known contact with Ebola patients while wearing PPE to be at some risk, and even a casual reading made clear that I fell into this category. Whoever had been calling the T&G reporter hadn’t bothered to read the criteria carefully and instead went directly to the recommendations on what to do with these people, having placed me in the wrong category.
No article appeared in that morning’s edition, and I spent much of the day—now safely tucked away in a new office in a research building, far from the corridors of the hospital, as I had been explicitly enjoined from venturing there—reviewing drafts of press releases by both the school and the hospital about my return, as both institutions felt compelled to make some announcement so as to get ahead of the story. Why there needed to be a “story” at all, of course, was a question only I was turning over in my mind. Or at least it felt that way; everyone else was in damage-control mode, and I was a radioactive particle that someone needed to demonstrate UMass was taking care to seal in a lead-lined chamber for the next three weeks.
It wasn’t that people from within the institution, even at the highest levels, weren’t proud of what I had done and wanted to support me. My boss, Bob Finberg, had given me a temporary posh parking spot adjacent to the building of my temporary office (which had the added advantage of preventing me from walking the quarter mile to the building and randomly hugging whomever I happened to encounter at a given moment) and had indicated he would support any ongoing work I would do while the outbreak continued. Katherine Luzuriaga’s group, which had received the funding from the Paul G. Allen Family Foundation, was prepared to sketch out what role I might play in their grant. And various colleagues dropped by to make sure I was being fed, since I wasn’t allowed to go to the cafeteria. They also came to ask about my experiences, about which I both desperately wanted to talk, and felt guilt for talking about at all.
On the following day, while driving into Worcester from the Boston suburbs, my cell phone rang. I answered through the car speaker system and heard a voice saying, “Doctor Hatch? The chancellor would like to speak with you. Can you please hold for a second?” And then, the chancellor’s voice.
“Listen, Steven, I know this must be a very stressful time with all of this paranoia,” he said. “I can’t believe what’s been going on with a news story about you being dangerous by hugging people. So I want to make an offer. Why don’t you come in here to my office today, and we’ll get our photographer to come by, and I can give you a hug, and we can put that picture up on the school’s website so that everyone knows you’re perfectly safe to be around?”
This from a man I’ve not only never met, but never even conceived of meeting. “Well, thank you, chancellor, that’s a very kind offer,” I said. “I think at the moment I’m going to take a pass only because I’d like to keep my face out of public view.”
One brief pause, exquisitely timed to convey total disbelief, followed by his reply, “It’s an interesting policy for someone who was just featured on a 60 Minutes story that was seen by thirteen million people.”
I had no snappy comeback for that except that my concerns were local: The UMass employees that I was most concerned about probably hadn’t seen me on 60 Minutes, which I was on for a scant twenty seconds anyway, and weren’t likely to see it either. So I could still move about the campus as a reasonably anonymous figure. Not that I was really moving anywhere at all; I went to my office and stayed there most of the day before going home. But if we posted a photograph of me on the school website, whatever anonymity I still possessed would vanish, and from my point of view, that was just begging for trouble.
That afternoon both the school and the hospital issued a press release, saying that I was a doctor who had been to Liberia to work with Ebola patients and had now returned, and that I wouldn’t be seeing any patients or come anywhere near the hospital in the immediate aftermath of my return. You could hear the press release practically shout this last point. The Ebola Hugging Doctor story never materialized, and a different reporter from T&G followed up on the press release in a story that would run the following morning.
The local anxieties were addressed in a headline that must have been music to the ears of the hospital administrators: “Back from Liberia, UMass Memorial Doctor Will Not Treat Patients for 21 Days.” You could almost hear someone in an office in the hospital add, See? It’s still okay to come to our medical center! The picture that ran was one of me from the ETU in full gear, my face covered in a mask, and that was music to my ears, so to speak. Anyone wishing to recognize me on campus was going to have to go to the trouble of an Internet search. Moreover, no story materialized in the Boston area, and no neighbors or parents of my children’s classmates seemed to be assembling outside my doorstep bearing pitchforks and torches. It looked like I would get through the monitoring phase without a major event, provided I didn’t come down with Ebola.
The three weeks of pseudo-isolation, and the daily tension that came along with each new development, served the purpose of keeping me mentally and emotionally occupied. My daily temperature had to be taken in front of a public health official to prove that I was not running a fever, and after several days I learned to my surprise just how low I could run, with the thermometer consistently hitting 35.5 degrees (or just about 96 degrees Fahrenheit). Neither the official nor I believed it initially, but repeated measurements with different thermometers seemed to confirm it. The lowest I ran was an astonishing 35.3 degrees Celsius, or 95.5 degrees Fahrenheit. That was more than a curiosity, since low body temperatures are also associated with severe infections just as much as a fever, and again I fretted about what might happen if a reporter got hold of these numbers.
Then there was my left elbow, which presented an entirely new dilemma. Five straight weeks of wearing PPE had been brutal on my skin, especially my legs and arms. In my final week at the ETU, my skin had become so raw on that part of my body that I was forced to raid the supply closet so that I could wrap my elbows in gauze bandages. More than a week later, the left elbow was getting red and sore. I knew that it was, at worst, bursitis, an
annoying but not deadly problem.
But what would happen if I got a fever, which could easily happen in a bad case of bursitis? Normally I’d just call a colleague and ask for a prescription of antibiotics, and when I warned the weekend on-call ID physician about my situation, that’s exactly what he offered to do. I pointed out that if I was given medical help without a formal evaluation, there would be many questions asked in retrospect that might prove to be thoroughly unpleasant for both of us if I did develop Ebola. But getting a formal evaluation for a fairly trivial matter was asking for a different kind of trouble, since the evaluation would by necessity require Biosafety Level 4 procedures, and rumors of the Ebola doctor requiring medical attention would become almost instantaneously exaggerated. Even mentioning the matter to my colleague put us both at risk. This kind of second-guessing activity kept me busy for hours at a stretch.
Sooner or later, though, I knew that the excitement would abate and that I was going to need to process what I had just lived through and, given that I had now become enmeshed with the outbreak, figure out what my next move would be. I could not simply walk away from it until it was over, but I wasn’t sure what I was going to do.
9
MAWAH
Community leaders needed to be convinced that the disease was real. During the current Ebola epidemic, earning community trust and confidence in response efforts has at times been challenging. In Mawah, community members might only have been willing to accept the proposed quarantine after witnessing the devastating effect Ebola had on the village.… [T]he appropriate isolation of sick persons and comprehensive contact tracing remain essential components of an Ebola response, irrespective of decisions on community quarantine.
—Centers for Disease Control, “Morbidity and Mortality Weekly Report,” February 27, 2015
While I fretted about my elbow in mid-November 2014, Dr. Trish Henwood had shifted her work from the IMC ambulance service to the wards. By that point, a crush of patients from Gbarpolu County had been absorbed. Gbarpolu, which lies to the northwest of Bong County, is Liberia’s most remote area, with essentially two roads into its interior. The limited access proved a valuable asset in keeping Ebola at bay, since it was difficult for an infected person to bring the disease into such an isolated area. The WHO situation reports would show a map of Liberia, shading the counties that had seen Ebola cases. Nearly every county in Sierra Leone and Liberia was colored, although Gbarpolu remained pristine white until October 8, when it finally saw its first case. Once Ebola came to Gbarpolu, however, that inaccessibility served as a trap, and bringing patients to ETUs became a dangerous and demanding exercise. It was not unusual for the ambulance team to have to drive three hours, then get in a canoe for another hour, and walk on foot for another still in order to retrieve patients. Then there was the trip back.
The Gbarpolu patients practically overran the ETU. Our confirmed ward had been designed to hold, at its maximum, forty-five patients. While I worked there, we came within range of that number only rarely. But combined with the influx of patients who were still coming in from Bong and Nimba counties, the Gbarpolu bolus stretched the ETU beyond capacity. On the confirmed side, there weren’t enough beds, and patients had to sleep on the floor. To make matters worse, the Gbarpolu patients had one other unusual feature: They bled. For the first time in the Bong County ETU, patients began to present just like Richard Preston had described them. Trish said that their clinical behavior was different, the bleeding out of proportion to anything we had seen before. She wondered whether generations of isolation led to small genetic changes that could account for the differences she and the rest of the staff were observing. It would be a question that could be answered with only speculation, for the outbreak was still on and that level of scientific research would have to wait.
While the Bong ETU was coping with this massive surge in its census, other ETUs were quietly continuing their steady decline. The article that Sheri Fink had written suggesting that the worst might be over was now starting to look like a real possibility. By the time that I completed my monitoring period, Liberia recorded only sixty-seven newly confirmed cases—a number that we wouldn’t have dared dream about while at Camp Ebola in mid-September. When combined with Sierra Leone and Guinea, the total number of new cases stood at six hundred. The trends looked encouraging, although this number from one single week in the West African outbreak was, all by itself, still substantially larger than what had previously been the second-largest Ebola outbreak, which had lasted more than an entire year.
*
As the initial excitement from all of the distractions of homecoming finally died down and my first month back gave way to the second, I finally let the tide of grief that I had tried to keep at bay overwhelm me. Mainly I sat in my office and stared out the window. Massachusetts in December is a depressing scene to begin with, as the hard frosts and bracing winds come along with a sun that almost testily insists on starting its decline not long after three o’clock. To match the outside weather, my mood willingly turned dark. I withdrew from people, wandered about in a daze, and avoided public gatherings. When I did venture out, I carried myself in a completely different manner than I had before in my life. As a friend remarked to Miriam after observing me at a luncheon, while I sat there quiet as a mouse, “It’s like he’s lost a layer of skin.”
That I was able to get up in the morning and eke out a day at work without raising too much alarm among my colleagues, including giving a reasonably decent Grand Rounds presentation on my experiences to my department, might have been the greatest trick I pulled off during this stretch. But I was reeling, and I couldn’t fully explain why that was so.
The simple explanation was that I had posttraumatic stress disorder, and a few people, including some whose job it is to make such diagnoses, thought this to be true. But that diagnosis rankled me on more than one level. For starters, I felt that showed incredible disrespect to the Afghanistan and Iraq War veterans who had genuine and unambiguous PTSD. I have seen some of those people in my work, and to compare my experience to theirs is to significantly discount their suffering or inflate my own. They were routinely jarred, without any warning whatsoever, by bombs, bullets, and flashes of all manner, often for months at a stretch, watching perhaps dozens of friends or civilians get blown up. What did I do? I went to work, slept in a comfortable bed, showered every day, and got an op-ed published in The New York Times. That’s hardly deserving of the word “trauma.”
Moreover, what everyone else thought so difficult—watching people die—is what I do in part for a living, and I had long acclimated to that aspect of my work. As Nahid Bhadelia, the doctor who had worked in even grimmer circumstances in Sierra Leone at the height of the outbreak, had noted, people who died of Ebola were just dying of sepsis brought on by a severe viral illness. About thirty-five people died on my watch while I worked in Bong County, which is a lot, but it was nothing compared to what the MSF doctors had seen in the huge Monrovia ETUs, where at its worst it wasn’t out of the question to witness that many die in a day. Of those thirty-five, I personally found about six or seven of those patients after they had died. None of them had died in an especially grisly manner, Richard Preston and his Hot Zone descriptions be damned.
True, it wasn’t a hell of a lot of fun to place a toddler in a body bag, especially with his mother a few rooms away. I could, however, recall the event in my mind without being emotionally overwhelmed, but also just as importantly I was able to still experience emotions about it, feeling appropriately somber. I just didn’t feel traumatized.
Nevertheless, I was in a state of turmoil, some of which had to do with the actual experience, but most of which involved the unfortunate mind-set by which I had launched myself into the epidemic a few months before. I had had many conversations with the other expats who made the decision to come over, and everyone talked about “making their peace.” That is, they knew that losing their lives in one form or another was a risk that they wer
e willing to take in the name of some higher purpose. I did something different: I just assumed I was a dead man walking and that I wasn’t coming out of Liberia alive.
I hadn’t formulated the idea fully as I was headed over there, but it became clear that’s how I viewed things when people back home were writing me and asking me about my fear, of which I had none at all. I offhandedly mentioned this to Sheri at one point, saying the reason I wasn’t scared was because I knew I was, in some important sense, already dead, so what was the point in having any fear? She rolled her eyes, having already grown a bit weary of some of my more melodramatic pronouncements.
What I did share with many other volunteers was a sense that I didn’t belong in the States, for the work in West Africa was far from over. I desperately wanted to return, and almost within days of coming home I was trying to figure out how I could get back to an ETU. What I missed was the profound sense of purpose that such work had provided, and I slowly realized why people talked of “missing the war,” a phrase that always seemed discordant to my ears. You miss being in the midst of senseless butchery? Great. But I belatedly realized it was that purposefulness, the sense that you were doing something that was deeply and truly meaningful, that drove people back to such unstable situations.
It was also during this time that I thought in a more organized way about why patients had died. I thought a lot about fluids—in particular, intravenous fluids. If, as my own two eyes had shown me, Ebola was a disease closer in appearance to severe gastroenteritis than it was to a river of blood being unleashed, then giving back as much fluid as possible might take a disease with a 50 to 70 percent mortality and turn it into one with a 10 to 20 percent mortality.
Inferno Page 27