A sample of Nurse Lucy’s blood was sent to the Hot Lab to be tested. By the next day, Nadia Wauquier and Augustine Goba had confirmed that Lucy May had Ebola. Her blood showed a high positive—she already had a heavy concentration of virus particles in her bloodstream. It meant that her and her baby’s chances of death were close to one hundred percent. Lucy May was transferred to the Ebola ward, where she came under the care of Auntie Mbalu Fonnie.
RESCUING LUCY MAY
July 3
When Lucy May was admitted to the Ebola ward, Mbalu Fonnie, Humarr Khan, and the Ebola nurses decided that she should not be placed among the other patients. The ward was a horror. They found a small space for Nurse Lucy in the little nook at the end of the corridor in the red zone. They moved a cot into the nook and put Lucy on it, in order to give her some privacy and to spare her from seeing the ward. At night, a senior Ebola nurse named Alex Moigboi took over Lucy’s care. He was working twelve-hour night shifts in the Ebola ward while wearing PPE, tending around thirty Ebola patients. Nurse Alex did what he could for Lucy, visiting her often and tending her needs, and trying to give her some company so that she wouldn’t feel alone. He set up an IV for her and gave her a saline drip, to make sure she didn’t get dehydrated.
Lassa and Ebola produce similar effects in pregnant women: profuse hemorrhaging, death of the baby, death of the mother. Both viruses are nearly always lethal to the baby and typically lethal to the mother. Nevertheless, over the years, Auntie Mbalu Fonnie had rescued a number of hemorrhaging pregnant mothers who seemed doomed. Auntie’s rescue technique was to remove the fetus from the mother as quickly as possible, by abortion or induced delivery, and then she would give the mother a dilation and curettage. Often the virus killed the fetus and triggered a miscarriage, though at times a Lassa-infected baby would be born alive, though it rarely survived for very long. After the baby was removed through abortion or was born naturally, the D&C procedure was used to scrape out any remaining placental or fetal tissue from the inner wall of the uterus.
For reasons that aren’t clear, the Lassa rescue procedure seems to increase a Lassa-infected pregnant mother’s chances of survival dramatically—giving her perhaps as much as a fifty-fifty chance at survival. Auntie wondered if the Lassa rescue procedure would work with pregnant woman infected with Ebola. Could the procedure save Lucy May? Auntie had reason to think it might work. In fact, she had already seen an Ebola-infected pregnant woman survive her ordeal, even though the evidence predicted she would die. The survivor was Victoria Yilliah, twenty, the first confirmed Ebola patient discovered at the Kenema hospital. Ms. Yilliah had lost a stillborn baby in a hemorrhagic miscarriage and had ended up in the Lassa ward under Auntie’s care. Auntie, mistakenly thinking that Ms. Yilliah had Lassa, had done a version of the Lassa rescue. Ms. Yilliah had already lost her baby, but Auntie had given her a dilation and curettage. Ms. Yilliah had been hemorrhaging at the time—and she had survived.
It seems crazy to scrape a woman’s uterus with a scalpel when she has Ebola and is hemorrhaging, but Ms. Yilliah gradually recovered after her D&C. In thinking about the previous experience with Victoria Yilliah, Auntie started considering trying to save Lucy May with a Lassa rescue. The question was timing. If she was going to try a rescue, when should she make the attempt? Lucy was at a late stage of her pregnancy. The baby could be born naturally, and it might have chance of survival. Auntie decided to wait, not make a decision yet. She would not abort Lucy May’s baby unless it died in the womb. She would let God make any decision to end the baby’s life. Fonnie monitored Lucy and her baby, directing the nurses at their tasks and sometimes putting on PPE and tending Lucy herself. At night, Nurse Alex Moigboi tended Lucy. Her face settled into an expressionless mask.
8 p.m., July 3
A nurse exited from the red zone and told Mbalu Fonnie that Lucy May was having a miscarriage. Fonnie dressed herself in PPE and entered the ward; she then went to Lucy’s bedside in the little nook at the back of the ward. She listened to Lucy’s abdomen and confirmed that her baby was dead.
Bleeding from the birth canal had begun. This indicated that Lucy had gone into disseminated intravascular coagulation, or DIC. Tiny clots had appeared in her bloodstream, and they had lodged everywhere in small vessels, and her blood had lost its ability to clot, and was running out. The bleeding could be coming from the walls of the uterus or the placenta.
Fonnie called three nurses to the ward and informed them that Lucy’s baby was gone. She asked the nurses if they would join her in an attempt to save Lucy’s life. Fonnie was going to induce childbirth and try to get the deceased fetus out of its mother as quickly as possible. The procedure had to be done immediately. Lucy May was bleeding, and she could die at any time.
The three nurses were absolutely terrified, but they agreed to help Fonnie because Lucy was a fellow nurse. The three nurses suited up in the cargo container. An extreme shortage of disposable biohazard suits had developed. The nurses were reusing their suits, spraying them with bleach, or not spraying them, then taking them off and putting them back on the next time they went into the red zone.
After the nurses had suited up, they came to Lucy’s bedside. One of the nurses was Princess Gborie, the nurse who had tended to ambulance driver Sahr Nyokor just after he had died. Auntie had recently called Princess Gborie into the Ebola ward and trained her in the wearing of PPE. Princess was not experienced, and had only worn bio-hazmat gear for a few days. The other two nurses were women named Sia Mabay and Fatima Kamara. They had suited up and gone into the red zone because Lucy May was their friend and colleague. The three nurses were beyond frightened.
At about 8:10 p.m. Fonnie instructed the nurses to set up an IV drip of Pitocin, a drug that induces birth contractions. Lucy was conscious and in extreme pain. There was no anesthetic available. The ward had run out of many basic supplies.
The drug was infused into her quickly. Auntie wanted to get the baby out as fast as possible, because for every minute the baby stayed inside Lucy her risk of death went up. Soon Lucy’s contractions began. The pain must have been unimaginable and unendurable, since the contractions of childbirth were occurring in tissues that were saturated with Ebola particles and packed with blood vessels, and the vessels were breaking down and leaking large amounts of blood. She was hemorrhaging from the birth canal. Her blood wouldn’t coagulate. The bleeding increased as labor began. There was blood in the cot. They held her knees, talked to her, swabbed her with towels or pads. They held her hands. They spoke to God. Lucy went into a luminous bleedout in the cot. The nurses’ gloves got bloody. There was blood on the sleeves of their suits. They tried to keep themselves calm for the sake of Lucy. There were no blood supplies in the ward. There was no possibility of giving her a blood transfusion.
Fonnie ran her hand through the birth canal to the cervix and felt the cervix and estimated its dilation. Since the baby was no longer alive, she would remove it quickly in a breech birth position, feet first. She wouldn’t wait for the cervix to dilate fully, she would pull the baby out as soon as possible. She would not use sharp instruments to cut into the deceased baby or try to break up the tissues of the baby, since there would be a risk that Lucy herself could be cut by an instrument, and Lucy couldn’t afford an injury like that. As Auntie worked, she got blood on her gloves and on the sleeves of her protective suit. Pinpoints of splashed blood may have appeared on her transparent surgical face shield, and on her breathing mask, and blood drops may have landed on a small area of bare, exposed skin on her throat below the HEPA mask that covered her nose and mouth.
Auntie got her hand through the cervix and pulled the baby out. It emerged in a gush of fluid and blood. Fonnie pulled out the placenta, which seemed to be the main source of hemorrhaging, and she cut the umbilical cord away from the deceased child.
At the sight of the stillborn child and the blood and fluids in the cot and all over themselves, the three n
urses would have received visual confirmation of their fears that they themselves would get infected by this procedure. There was too much fluid and blood, the virus was everywhere, all over them, all over Lucy, coming out along with the child.
We cannot know what went through Auntie Mbalu Fonnie’s mind when she saw Lucy’s child, or when she perceived how wet her suit was. Maybe Auntie was too tired to think much about herself or what could happen to her. She was a widow, she missed her husband, her ward had been destroyed by Ebola. It seems possible that she thought to herself, or whispered, “God will drive this.”
We don’t know if Auntie proceeded with a D&C afterward. She may have decided it was too risky to scrape the uterus with a scalpel if there was so much bleeding. After the procedure was finished, the nurses and Auntie cleaned Lucy, and prayed for her, and she rested quietly. At around nine o’clock that night her breathing became labored. There was no oxygen in the ward, no way to assist her breathing. At 9:15 p.m. Lucy lost arterial blood pressure and went into shock. Her blood pressure collapsed, her heartbeat became irregular, and at about 9:30 p.m. she had a cardiac arrest. The rescue of Lucy May had failed.
When it was clear that she had passed, the three attending nurses burst into screams, and their screams turned into roars of agony. The sounds came out of the Ebola ward and drifted across the hospital grounds in the darkness, frightening people all over the hospital. Fifty yards down the hill from the Ebola ward, Nadia Wauquier was working inside the Hot Lab in a moon suit. She heard the nurses’ cries and knew that something terrible had happened in the Ebola ward.
We can imagine that Auntie might have been somewhat stern with Princess Gborie, Sia Mabay, and Fatima Kamara. She might have asked the three nurses to quiet themselves. We can also imagine that she might have told them that this was God’s will. We can easily suppose that Auntie would have wept, too, joining her nurses’ tears.
Eventually Auntie went to the decon area and removed her bio-hazmat suit, which was smeared with birth fluids and blood. There was a bleach sprayer in the decon area. No one knows if it contained any bleach that night. The sprayer was often empty or not used, and a shortage of bleach had developed at the hospital. No one knows whether Auntie sprayed her suit before she took it off. Underneath she was wearing her usual starched white outfit, which was now completely soaked with sweat. Her brother, Mohamed Yillah, was waiting for her. He started his motorbike, and she climbed onto the seat behind him and wrapped her arms around him, and he drove her home. He caught it, too.
The next afternoon, Wahab the Visioner walked through the hospital gates and began shouting. He knew all about the death of Lucy May.
CANDLE FLAME
Afternoon, July 4
Wahab the Visioner walked swiftly around the hospital grounds, agitated and shouting, driven by a vision of the future that seemed to torment him like stinging flies. “Oh!” he cried in a piercing voice. “Oh! You did not make enough sacrifice! You did not make enough sacrifice!” The nurses’ ceremony had failed, he shouted. Lucy May had been one of the three nurses who had been fated to die. Now many more nurses were going to die. But there was still a chance that these many doomed nurses could save themselves. The future could still be changed. Wahab’s voice carried into the main wards of the hospital, and he may have gone inside the wards and prophesied directly at nurses and patients—those who were still left at the hospital. “For now,” he shouted, “you must sacrifice a candle. All living nurses must make this sacrifice. You must light candles all around the hospital compound. All the nurses must do this! If you don’t do this sacrifice a lot of nurses are going to die. Even an important doctor will die.” Abruptly the young man was gone.
After sunset, around fifty nurses gathered in front of the maternity ward. Many of them were wearing civilian clothes, because they had stopped working at the hospital. They lit candles and began walking quietly around the hospital grounds, singing gospel songs in Krio, in three-part harmony. Their voices were serene and gentle. More and more medical staff joined the crowd as it flowed around the hospital, and each person held a burning candle in hopes that the candle would be a suitable sacrifice, and that the holder of the candle would be spared. As nurses sang, they asked God to spare them and the hospital from more deaths.
“It was shocking, it was beautiful, and it was terribly, terribly sad,” Nadia Wauquier remembered.
The crowd grew to more than a hundred members of the medical staff, and eventually it stopped in front of the children’s ward. The children’s ward has a large open area covered by a protective roof, where parents and their children gather while they are waiting to see a doctor. The roof protects them from rain and sun. The crowd gathered under this roof in the waiting area and in the open air around the waiting area. The children’s waiting area and the walls of the children’s ward glowed with candlelight as the nurses sang. Wahab’s vision seemed to hang in the air in the darkness above the many small flickering glows of the candles and the faces of the medical staff. Wahab had predicted that if the sacrifice of their candles didn’t prove to be enough, many more would die, among them an important doctor would be among the dead. If Auntie Mbalu Fonnie couldn’t stop the virus no matter what risks she took, and if candle flames didn’t stop the virus, then there would be no way to stop it, no way at all.
PART THREE
THE ANCIENT RULE
JOURNEY TO KINSHASA
In order to have a clearer view of emerging viruses, we need to look back in time to the crisis of 1976, when Ebola first manifested itself at a remote Catholic mission in the lowland rain forest of north-central Zaire. If we look closely at this outbreak, the first outbreak of Ebola, we can learn things that may help us prepare for the next emerging virus, whatever it is and whenever it comes. It seems virtually certain that another Level 4 emerging virus, one that is perhaps far more contagious than Ebola, will cross from the virosphere into a person somewhere on earth. That person will pass the agent to someone else, and quickly the agent will move along airline routes, traveling inside air passengers, and it may be able to ignite spreading chains of infections in cities, as Ebola did. Since there will be no vaccine and no treatment for such an emerging virus, and because it may spread easily from person to person, the virus will be terrifying and will seem virtually unstoppable.
If we are going to stop the next virus, it pays to study history. There is much to be learned by looking at the people who engaged with Ebola during its first known encounter with the human species. We can study their lives and deaths, and we can watch what they did as they confronted the unknown. We can watch the moves they made as they engaged with the virus—and the moves the virus made in response. We can learn their secrets.
Ebola is an entity of a kind, though it is not a conscious thing. It was not even a thing, it is uncounted numbers of things, each one striving, in a biological sense, to survive and replicate. A growing swarm of Ebola particles has no awareness of itself as an entity. It has no memory of the past or ability to anticipate the future. The swarm has no emotions, no desires, no fear, no love, no hate, no pity, no plans, no such thing as hope. Yet, like all forms of life, each particle in the swarm possesses an unalterable biological will to copy itself and perpetuate its genetic code through time.
As we look at the crisis of 1976, we can see how something that seemed unstoppable was stopped, and we can see the spiritual and human cost to the people who faced Ebola and tried to stop it. If we can learn something from the events of 1976, it can sharpen our perceptions of the battle that was unfolding at Kenema Government Hospital in 2014 and, indeed, was expanding into the world. We can learn something about human character in moments of life-or-death crisis, and we can observe the dramatic interaction between the human species and nature, which has always been a subject of deep interest to this writer. The simple question faced by those who encountered the virus was how to kill it before it killed them.
SOMEWHERE
IN THE AIR ABOVE THE CONGO RIVER,
ÉQUATEUR PROVINCE, ZAIRE
About 9 p.m., September 26, 1976
Jean-Jacques Muyembé, MD, PhD, sat in a seat in a Fokker Friendship passenger aircraft, listening to the whining hum of the plane’s twin turboprops. It was dark outside the window. The plane was flying over a region of nearly unbroken rain forest, tracing the Congo River along its course upstream. There were no lights visible down below—no electricity and no towns, although there were villages here and there, nestled in small breaks in the forest canopy or hidden under the canopy. Some of the villages were inhabited by people who spoke Bantu languages, while other villages, and small camps, were occupied by Twa people, who are of very short stature, and are an ancient people who have lived in the central African rain forest for tens of thousands of years, far longer than any other group has lived there.
Muyembé was anxious to deliver his sick patients, Sister Myriam and Father Sleghers, to the best hospital in Kinshasa. Their illness, a polymorphic disease with puzzling features, was expected to progress rapidly and potentially be fatal. Muyembé also wanted to bring his samples of blood and liver back to his lab before they rotted in the tropical heat. By analyzing the samples in his lab, he hoped to identify the disease, and then, perhaps, find a way to stop it. He strongly suspected it was typhoid fever or yellow fever.
Crisis in the Red Zone Page 18
