On Death and the Fear Within Us

In February 2015, I met MK, a young man who fell ill with Ebola in Sierra Leone. I served as one of his physicians in an Ebola Treatment Center (ETC), and his powerful story is one that continues to leave a deep impression on me as a care provider
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In February 2015, I met MK, a young man who fell ill with Ebola in Sierra Leone. I served as one of his physicians in an Ebola Treatment Center (ETC), and his powerful story is one that continues to leave a deep impression on me as a care provider

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MK was scared. In fact, he was terrified. He had made the decision to do what so many others had done in the past few months in West Africa, often with deadly consequences: answer the call of a sick friend to drive him to an ETC.

Even though MK felt fine over the next several days, his mind kept racing. Did he have Ebola? Was he going to be ok? He was pretty sure he hadn't touched his friend too much, and had tried to wash his hands after, but he couldn't remember all of the details.

He had seen Ebola spread throughout Freetown, and had heard about the thousands that had died. He had seen up close some of his family and friends fall ill, and his fear grew to a fevered pitch when he woke up one morning with red eyes, as he knew that was one of the signs of infection with Ebola. He immediately went to the nearest ETC for evaluation.

When he arrived at the ETC, the conversation with our staff at triage was brief. Other than his red eyes, MK told them he mostly felt fine, but had some loss of appetite and very mild diarrhea. We debated briefly--he looked so well that some suggested he be sent home -- but he met the criteria for admission, and was taken back to the suspect ward to be tested for Ebola. He looked so well compared to the other patients that were diagnosed that one doctor's note read: "Not likely to be Ebola! Anxiety."

The next day, the blood test came back positive for Ebola, and MK was moved from the suspect ward to the confirmed ward. Initially, despite his diagnosis, MK felt well. He was worried, but his spirits were up and he was talkative. However, soon he developed vomiting and diarrhea. Then came the unrelenting fevers to 104 degrees Fahrenheit, joint pain and excruciating abdominal pain. We chased his fluid losses with bags upon bags of intravenous fluid and gave him medicine for pain and nausea.

None of it seemed to help, and his condition worsened daily.

On the sixth day of his hospitalization, the bleeding started. It was mild at first, just a little bleeding from his IV site. However, soon he started bleeding from other sites as well. Although we were able to arrest the bleeding for several hours with a transfusion of blood plasma, we knew it was only a matter of time before it started again.

On the morning of Day 7, he became confused, and you could see the fear in his eyes. "Am I going to live? Will I be ok?" he asked. Reassuring him with pleasantries, we knew the odds for survival were incredibly remote.

A team of clinicians evaluated him at 2:30p.m. and he was no longer responsive, though he was still breathing. They changed his IV catheter, gave more intravenous fluids and injected more antibiotics. At 3:30p.m., I went into the treatment ward with several colleagues. It had only been 15 minutes since the last team of clinicians had seen him.

MK was dead.

The other patients in the ward -- most of whom were doing well -- were terrified, bearing witness to the grim reality of Ebola and wondering if they were next.

His death shook the medical team deeply. We had all expected -- or rather, hoped -- that because he came in so early he would do well and survive. We felt we had done everything possible in our limited toolkit: aggressive hydration, antibiotics, clotting factors and transfusions that should have kept him alive. Despite our best efforts, he slipped away.

Back at the nursing station, I sat in silence thinking about his death. Why did MK's death have a disproportionate effect on the entire team, different from the many others who had succumbed to Ebola? I have come to believe it affected us differently because he reminded us so much of ourselves. He came in looking healthy, with no telltale signs of illness. In that normalcy, the façade of well-being, he reminded us of our own fragility and our own mortality. We had seen hundreds of Ebola patients come through the ETC, and more often than not they looked sick when they arrived, often gravely ill. MK, however, appeared fine -- and because he came in so early, we just knew we could get ahead of the illness and have him walk out of the ETC looking as well as he had when he walked in.

As clinicians none of us are immune from the fear of Ebola, and the fear is compounded by seeing the effects of Ebola play out daily in the hospital ward. It's often not at the forefront of our minds, but the risk is always somewhere in our thoughts -- as we put in an IV or doff our personal protective equipment. However, the fear protects us - complacency, even for a moment, can mean the difference between a high-risk exposure and an uneventful patient encounter.