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October 17, 2014: Suakoko, First Day at the ETU
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In the midst of this flurry of activity, a recently arrived patient in triage met the criteria for suspected Ebola, so I went with another nurse to fetch him. Either he was too weak to get up to walk or he was absolutely petrified at the sight of all of us in space suits. Outside, rainclouds hung low in the sky. He sat, seemingly frozen in his chair, staring blankly at what must have looked like hovering ghosts. Eventually we were able to help him into the Suspected Ward. His pants were soiled with loose stool, so we changed and cleaned him. He was breathing fast and looked dehydrated, and there was a definite glint of fear in his eyes. We had no oxygen to ease his laborious breathing, but we gave him a bottle of oral rehydration solution (ORS) and instructed him to drink. The night shift would start an IV. I wondered what it was like to be cared for by strangers dressed in Hazmat suits without the comfort of human touch.
As we departed, the rain came pelting down loudly on the tin roof, offering little solace to this lonely man covered by a white sheet, left in a strange, Spartan room lit by a spiral, energy-saving bulb. In my heart I feared the worst for him.
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October 18, 2014: A Lonely Death in the ETU
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John, the petrified patient whom we helped into the Suspected Ward at the end of the day yesterday, lived through the night, but was still struggling to breathe. His IV line had stopped working. I made him a straw out of some IV tubing and sat him up so he could sip his ORS before a new line could be placed. He eagerly drank about ten ounces of fluid in between gasps but eventually slumped down in bed, exhausted. I stuck around as much as I could, rubbed his back, and squeezed his shoulders to convey the message that he was not alone. I have always felt the need for human touch when I am sick. In the U.S. on more than one occasion I have hugged my most distraught patients. How profound must have been this man’s loneliness, how tremendous his fear as he fought for his life in an alien place with no family members by his side! ...
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In the afternoon, we learned that John had passed away. His Ebola sample had been missed by the morning pick-up and was still sitting in the fridge. He was forty-two years old.
Some recovering patients were sitting outside as the sun set in hues of yellow, orange, red, blue, and purple. John will never have another chance to see this scene, I thought: the life of the first patient I had helped into the Suspected Ward of the ETU had been snuffed out. In his dying hours, he was all alone.
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November 11, 2014: A Birth in the ETU
Before we started our rounds, someone called out from the confirmed ward that Watta M. had just aborted her pregnancy. We hurried off to the donning room to put on PPE. By the time we got in, Watta M. was sitting calmly at the end of her bed in her room. No baby and no sign of anything else: she was even wearing a clean sarong.
A patient yelled to get our attention and pointed out back, behind the ward. Watta M’s room was the last one on the left-hand side of the confirmed ward overlooking the outhouses and the patients’ shower rooms. We found the baby on the harsh, sloping ground next to the fence, not too far from the latrine, cord coiled loosely around its neck, placenta attached. The baby was lying on its side, headfirst down the slope, waving its right arm aimlessly in the air. It was crying and breathing well, despite such a rude entry into the world. Trailing from it were cloth wrappers stained with blood. Watta M. must have given birth to her baby in the backyard, somehow also delivered the placenta by herself, and walked away, abandoning her child.
We knew we had to cut the cord, but how? Calmly I walked back into the confirmed ward and all the way down to the other end, where the supply room was, to look for string and a pair of scissors. I found a bungee cord, but it was too slippery to be of any use. Finally I found a neon-orange shoestring. By then a midwife who had put on PPE had made her way into the backyard. Her heavy-duty gloves decreased her
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dexterity in tying knots on the shoestring before she finally was able to cut the cord with the scissors. She picked up the baby. The left side of its face was covered with bits of gravel that left imprints on the tender skin after being brushed off. The midwife instinctively looked between its legs: it was a baby boy. Someone came with a red hazard waste bag for the afterbirth, the rest of the stained clothing, the scissors, and remnants of shoestring. All would brought to the morgue.
The baby was just about three of my palm lengths and as light as a feather. He had perfect little toes and fingers and looked surprisingly pink. The midwife estimated the preemie’s age as about twenty-four weeks. He was covered with a towel and brought to his mom, who by then was eating breakfast. We were fully aware that the baby’s chances of survival were slim. Still, we felt blessed to see a birth in the ETU.
To my surprise the midwife did not follow us into Watta M.’s room, instead heading to the doffing area without giving us any instructions. But on reflection I understood her fear; earlier on during the Ebola outbreak, many of her colleagues died from the infection after unknowingly taking care of Ebola patients without protection. It exacted a tremendous toll on their numbers.
Watta M. was lying in bed, expressionless. She did not reach out for the baby, and when we placed him
next to her, she just lay there stiffly. He made feeble attempts to suckle at her nipple. ...
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By late afternoon the baby was reported to be gasping. The nurse who went in to see her reported that Watta M. had requested that the baby be taken away. I remembered how Krubo had kept herself far away from baby Moses when he was in a coma, as though terrified to touch him. Perhaps it was a mother’s defensive instinct not to become attached to a child who would not survive. Still, I could not understand Watta M.’s repulsion toward her own baby. ...
Ironically, while Watta M. brought a life into the world, if only briefly, across the hall Magbla was found in her bed, stiff and cold, life snuffed out like a candle. And Carr, the lone patient in the suspected ward, also lost her battle to Ebola shortly after daybreak.
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Tonight, though, my thoughts returned to the little baby that started our long day—a miracle in the ETU.
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October 31, 2014: The Crow on the Roof and the Dancing Boys
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At noon a crow stood on the roof of the morgue, cawing ominously. When I was young and growing up in Malaysia, my mother used to say that when a crow settled on the roof of a house, a death would soon follow. Last night we had one death, and in the morning we had another two. One was Dorcas, Patience’s sister, who like her sibling had had one of the highest Ebola titers in the Bong ETU. She had gallantly kept herself clean daily despite profuse diarrhea and weakness. I rooted hard for her two days ago when she was cleaned by an aide and helped into a sundress, after which she dragged her small frame outside in front of the ward to join the other patients. Sadly, she had lost her battle.
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Back in the confirmed ward, the day was coming to a close. Despite the tragedies, Solomon and Joe had been performing a dance they created for anyone who would watch. They turned up the radio to full blast and gyrated here and there on the gravel. They gave a particularly exuberant performance this afternoon when the navy lab man, who had children the same age, came personally to tell them their Ebola tests were negative. In unison they shouted, “I am free of Ebola!”
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November 7, 2014: Time Will Heal
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It was a bittersweet day for Christine, the little girl who climbed out of the bed she shared with her brother, Ryan, when he died. Day twenty-two of her stay in the ETU and—her Ebola test having turned negative—she was finally going home. Her short life had been a tough one, losing both her mother and brother. She had been here almost as long as I had and had won over many hearts. In the morning, she sat on the white plastic chair at the devotional service. Deep lines of sorrow were carved into her young face. When I held her for the last time, she managed a sad little smile.
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AFTERWORD
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... the stories of Ebola-affected victims should be told and remembered. As Individuals we should not turn away from uncomfortable horrors, but summon the courage to heal with our hearts those we cannot touch with our hands. The Ebola outbreak took an immense toll. Many who perished were buried graveyards with temporary markers that will invariably erode in the harsh tropical climate, leaving no trace. We must remember both those who died and the frontline Ebola fighters who perished while caring for them. The graves do not contain a nameless or faceless mass, but people who in the not so distant past once loved and were loved.
