Over the past three weeks we have seen record highs and record lows in patient numbers. Our record high number of patients began shortly after a young man — infected with Ebola — fled from Monrovia. Due to being in the city, Ebola units in Monrovia must utilize cremation rather than burial after a patient passes away. The young man fled when he learned this reality. He hid in a village called Taylor Town, where family took him in and cared for him until he died. Then the inevitable began to happen- first one, then two, then 10 people began experiencing Ebola symptoms. Before long, our unit was bursting at the seams due to the Taylor Town and Gbarpolu outbreaks.
Ambulances arrived with new patients multiple times each day, rounds took over 2 hours each, mothers and their children shared beds, patient belongings had to be moved to the hallway to make room for more beds, mattresses began littering the floors after the last extra bed was occupied, and the idea of turning the morgue into a temporary confirmed unit was unwillingly considered. Most of the patients were critically ill and many of them didn’t survive. Regardless, the unit continued to accept new patients. The vastly increased stress and workload was better than the alternative — leaving these individuals in the community to infect more people.
During this time, a 22 year old woman named Victoria arrived to the ETU. Victoria was stable when she was admitted, but developed more severe symptoms within a few days. For almost two weeks, the medical staff watched helplessly as her physical condition deteriorated. Victoria, a beautiful and vivacious young woman, quickly became bedridden, became too weak to lift a small bottle of water, and began experiencing intermittent seizures. As with every patient, every effort was made to give her a fighting chance and to keep her comfortable — even devising a system of modified IV tubing and water bottles to give her the ability to drink fluids without assistance and without the need to expend any strength. Regardless of the efforts, Victoria didn’t seem to be getting any better. She was no longer speaking, her joints became stiff and her body became edematous. We prepared for what seemed to be inevitable — her death.
Then Victoria surprised us all. We walked into the confirmed unit for morning rounds a few days ago to find Victoria sitting up in bed. The first thing she wished to communicate in near weeks — the knowledge that she has a two year old daughter named Felicia. I imagine that thought is exactly what gave her the strength to accomplish what so many are not able to do — stare death in the face and refuse to give in. Since that day, Victoria has improved gradually. She needs assistance walking as her joints are painful and swollen- but she refuses to stay in bed. She needs to be encouraged to drink fluids- but she has the strength to lift a water bottle on her own. She still doesn’t eat much- but she insisted on eating the Pringles and candy her father brought her yesterday. There are so many we can’t save and even the strongest among us feels that burden. In finding the strength to survive, she has returned the strength we tried to give her. Victoria’s survival gives us all hope and strength in this continued war against Ebola.
Similar to Gbarpolu and Taylor Town, we are learning many outlying villages are infected, but are unable to get to the ETU due to location. Only the stronger Ebola patients are able to make the journey to the ETU from these outlying villages; those most critical must be left behind. Recently, we received a patient from one of these areas. His name is Emmanuel. When he walked into the triage room, it was obvious that he had been carrying a very heavy burden. He is young and strong, but his broad shoulders were hunched as if they were attempting — and faltering at — carrying the weight of the world. The story began to pour out immediately. Emmanuel’s wife, Mary, began experiencing Ebola symptoms three weeks ago. Two week later, Emmanuel’s seven month old daughter, Felicia, also became ill. Despite Emmanuel’s attentive care, Felicia passed away. A day after her funeral, Emmanuel began experiencing the same symptoms as his wife and daughter. Knowing that he couldn’t take care of his wife if he was sick, Emmanuel left and made the journey to the ETU. The following day Emmanuel’s blood test came back positive for Ebola. Upon hearing this news, Emmanuel began to cry and asked, “Will I ever be able to go home again”? A few days after he moved over to the confirmed unit, we received word from Emmanuel’s village — Mary had also passed away. Emmanuel spends most of his time sleeping or sitting with his head bowed and resting in his hands. He has lost nearly everything — not even his home is a guarantee anymore, as many villages are refusing to let survivors return to their homes. I can’t even begin to fathom the extent of this man’s suffering.
While we now have a record low number of patients, we are all holding our breath. Even one case has the potential to spread the virus to another individual and another village. Despite the low census, even the smallest of numbers and the smallest of outbreaks can carry a magnitude of devastation. A few weeks ago a young woman named Korto arrived to the ETU with her three month old daughter, Josephine. The baby tested negative, but Korto tested positive. Josephine was placed in a special isolation center for high risk children while Korto remained at the ETU. She was a breath of fresh air in the confirmed unit- always smiling, laughing and dancing. Every time I entered the unit, Korto would grab my arms and dance me in circles down the hallway. One day, I brought newly donated walkers for elderly patients into the unit. Within minutes, Korto and our 17-year-old survivor/employee, Bendu, were running them up and down the hallway and acting like, “crazy old ladies” — much to the rest of the unit’s entertainment.
Two days ago Korto became one of our survivors. She left the unit dancing and went straight to collect her daughter. The next morning, Korto and Josephine returned to the unit by ambulance; Josephine had developed vomiting, diarrhea and a fever hours after returning home. The Korto that left was a light-hearted child, celebrating survival and life. The Korto that returned was a worried mother, crushed by helplessness and fear. Josephine tested positive for Ebola and is now in the confirmed unit fighting for her life. While we are all praying and hoping- reality cannot be dismissed. A baby has never survived Ebola.
For the past seven weeks, the ETU has also been a training site for newly arrived staff. These staff members are from many different organizations and will be working in new Ebola treatment units across Liberia. On the first day of training, they are taken on an in depth tour of the ETU- which includes a short hike into the forest to the burial site. With each passing week, there are more grave markers and with each trip into the forest, the scene is a little more sobering. While it is heartbreaking and overwhelming to see how many have died at our ETU alone, I am also overcome with a sense of gratitude. So many beautiful souls now sleep in peace in that serene niche of forest. I am so grateful to have been part their lives- their joys, their suffering, triumphs and their sorrows. It has been a painful but wonderful gift to accompany each of them on this part of their journey in life- they have taught me so much and I will forever be a better person because of them.