Inferno

by Steven Hatch, M. D.

  Three of the IMC staff were headed back Stateside: Zach Ilan Page, a full-time IMC employee who had come for about two weeks to supervise the security of the ETU; Stu Sia, our communications expert who was taking a ten-day R & R break before another tour; and me. After a small comedy of errors in which our drivers belatedly realized they didn’t have enough gas for the trip, leading to a breakneck scramble to find another car, we set off for Roberts airport with about ninety minutes to spare. Somehow we avoided the worst of the outbound traffic, making it to Roberts with a little more than a half hour before boarding time, tapping our fingers in the tiny airport lounge as we waited for the Brussels Air flight to take us away. I made my way over to the Liberian tchotchkeria and bought a few trinkets for my family. I hadn’t even left the ground, and I was already assuming my previous identity of American tourist.

  The plane out was nearly empty, and the flight uneventful. We got into the Brussels airport early in the morning with several hours to wait, and the three of us took up residence in a booth in a café, checking e-mail and browsing Facebook. I found the synagogue chapel, where I sat alone and wept again for good measure, apparently engaging in this rite on every continent available to me on my way back. Being liberal in my ecumenicism, I stopped to visit all the chapels before boarding, but the only place I shed my tears was in the small room where my people gathered as they shuffled from one country to the next.

  We landed at Washington Dulles airport at about four on Saturday afternoon, and as we made our way through the maze of concourses that would take us to Immigration and Customs, I knew I had about a five-and-a-half-hour layover, which seemed like more than enough time to grab my baggage and get to the next part of the airport. I knew that I was probably going to be asked a few questions about my work in some special screening area for West African travelers, but I didn’t think that should take more than an hour. As I got to the head of the line at Immigration, I decided to try a line that Colin Bucks had said he used when he returned two weeks before. I presented my passport to the officer.

  “Are you traveling from any of the following countries: Guinea, Sierra Leone, or Liberia?” he asked.

  “Um, I’m the guy you’re looking for,” I replied.

  He looked up. “Sorry?”

  “I’m the one you’re looking for,” I repeated. “I’m going to light up like a Christmas tree on all these questions.”

  Silence.

  “You a doc?”

  “Yep.”

  “You worked with patients?”

  “Yyyyep.”

  “With Ebola?”

  “Yyyyyyyep.”

  And then, something shocking: A smile flashed across his face. He was as entertained by this as I was, and thank goodness for that. He explained that he had screened a few people like me since the hubbub had gone into full swing, during which time he heard several explanations of the risks of Ebola transmission, so he was far less anxious than many of his fellow workers. “Okay, doc,” he said. “I think you know what comes next.”

  “A visit to our friends at the CDC?”

  “Yyyyyyyep.”

  Consistent with being a federal government operation, the CDC’s screening process was not a model of efficiency. Tasked with having to invent a process by which to screen travelers out of the affected countries and set up a system of risk based on the types of exposures they had encountered during their travel, and then coordinate with health officials in each of the fifty states, each with its own particular policies, the CDC had a huge number of logistical hurdles to overcome in a compressed time frame. I understood all of that; the only question was how long the process would take. I also had figured that I was a pretty easy case: I had been working in an ETU directly with patients, after all, which should theoretically put me in the highest-risk category. Someone like Stu or Zach would be harder to triage, since they did work in an ETU—harder to get any closer to the virus than that, after all—but they never had any contact with anyone while there, which from a scientific standpoint means that they’re about as much of a risk as someone who just came back from a little vacay in Zurich. I thought that Stu and Zach would be the ones that would hold me up, but since mine was the last flight out (Zach actually disembarked in Washington), I didn’t think my having to wait for them would pose problems.

  Because we sat toward the head of the plane, we disembarked first and were first in line, and therefore were among the first to be screened, ushered into a cramped room near the baggage claim as we waited our turn. Disembarking early proved to be advantageous because while we waited to be called, more than a dozen others, mainly Liberian expats, came to wait their turn as well. After maybe a half hour the CDC guys performed the initial screen, then ushered Stu and me into an office down the hall while they processed everyone else (as Zach had already left). “We just need to check a few things,” said the man in charge of the screening. “We’re really sorry to make you wait.” “Nah, no, that’s okay,” Stu and I both said. “We think you guys are great. We really appreciate what you’re doing.”

  “Well, you guys are heroes,” he said.

  “No, you guys are heroes,” came our reply. It was a warm and fuzzy moment.

  An hour and a half later, the warmth was starting to fade—almost literally because the office temperature was about sixty degrees and I was wearing clothing suited for the heat of Monrovia rather than a chilly office in Washington, D.C., in November. About that time our luggage arrived, along with the screener, who once again apologized, with the no, you guys are great exchange, which was beginning to feel obligatory rather than genuine. At least I could put on a fleece.

  We sat there idly checking e-mail and texting people as we waited. We chatted intermittently; although Stu and I had always had great conversations in the ETU and I had come to savor his company, by that point both of us were ready to move on to the next chapter in this saga, and each of us served as a reminder to the other that we hadn’t yet finished the current one. Stu, in fact, could have left, for we found out the holdup was me. But he stood fast, going above and beyond the call of duty in an act of kindness for which I will ever be thankful.

  The problem on my end was that the CDC didn’t apparently have anyone they could get hold of from Mass DPH on a Saturday night. They said they couldn’t release me on that flight unless a health authority knew I would be arriving. By the time we understood that this was the problem, two and a half hours had passed, and I was starting to become concerned about making my connection. Once I understood this, I showed them the e-mails on my cell phone where I had been trying to tell them for days about my arrival date and asking what more I should do, along with their noncommittal replies. The DPH people had given phone numbers (“Please call us if you have any questions when you arrive”), and so the CDC officer called the number. He got a voice mail since he was calling on the weekend, and they hadn’t given an after-hours line even though I had told them I was coming in on a Saturday. I found myself gritting my teeth. I want to like the Mass DPH people, who are the good guys, I thought to myself, but rilly effing pissed at them right now.

  At any rate, I pointed out to the officer, they knew I was coming, and they knew when. Now could I please go? “We’ll get back to you,” came the reply.

  As we were approaching the end of our fourth hour, I had had enough and finally walked outside the office into the long hallway that ferried passengers to the main terminal, a place that had been emptied of people for two hours. One of the airport security officers saw me and, apparently thinking that someone was casually tossing polonium in her direction, got off her chair and started excitedly squawking like an enraged hen. “Sir, you are to return to that room right now!” she growled.

  “Officer, you will find someone from the CDC right now, or so help me God I will call the White House and ask why I am being detained!” I waved my phone. It was double bluff. First, I wasn’t going to do anything of the sort unless things got completely out of hand as opposed to m
erely annoying, and more importantly, I had no signal.

  “Get back in that room!”

  Then, deus ex machina, the gentleman from the CDC reappears, saying, “Thank you, you are free to leave.” Stu and I made our way through the baggage transfer. We zipped through the security screens since no one had been there for hours and we had a line of one, and within a few minutes we found ourselves truly back in the United States. We killed an hour over fast food and bade each other farewell as we walked to our gates that would whisk us home.

  I arrived a bit past midnight on Saturday night, headed for a hotel, woke up in the morning to drop by home to pick up some belongings to get me through the pseudo-quarantine. I still hadn’t heard anything explicit from the people at DPH concerning what the rules of engagement would be, so I drove out to the next hotel in the Worcester area, spent the afternoon taking a long walk, and finally heard from someone at DPH.

  Their game plan was mostly simple. They were going to follow the CDC guidelines: I would be required to check in with a DPH representative twice a day (once in person, once over the phone) and report my temperature; if I developed any symptoms, I would obviously need to take myself out of circulation and contact DPH immediately (and was given, this time, an after-hours cell phone to call); I was not allowed to cross state lines unless the authorities in the other state were aware of and approved my visit; and I was strongly encouraged to avoid being in crowded public areas like shops and restaurants. Except for the slightly fuzzy area about what constituted a “crowded” area—I was, after all, going to need to retrieve food for myself over the next three weeks—the guidelines seemed logical enough to me. I settled in for a night of long sleep before returning to the UMass campus on Monday morning.

  The following morning was mainly a blur. I went to the division office to find out whether my personal office had been moved during my absence as had been planned, which it had. I made a phone call to Ann Moorman, a researcher whose main work dealt with malaria and Burkitt’s lymphoma in Kenya, but because of the outbreak had been coordinating a huge effort by UMass to stabilize the laboratory infrastructure in Liberia. She was also working to create a personnel pipeline so that people like me could temporarily leave their positions at academic institutions and go work in the affected countries, and I called her to find out what work I would need to do for the Ebola crisis group. I looked for Rick Forster, the UMass internal medicine residency director, to see what help he could use, as our interview season for the new applicants was just under way.

  While wandering through the hallways I ran into a variety of people, and the reactions spanned a wide range from pleased to fearful, but no matter where on the spectrum it fell, I did become aware that eyes were upon me. In retrospect, I suppose that I should have seen it coming, but it was one in an ongoing series of surprises that showed no signs of abating. At the ETU, I was just another person; here, I had the sense that I would be an object of intense fascination and scrutiny for the next several weeks.

  When heading down one corridor, I noticed maybe a dozen or more people milling about. I heard my name called and turned to see a former student, Emily Bouley, dressed in a business suit, in the middle of a group of applicants for residency. “Bones!” I shouted. (Emily’s maiden name was McCoy. Since I thought she would be a future Doctor McCoy before she changed her name, from the moment I met her, I had always referred to her as Bones in homage to the Star Trek character.) She rushed at me and we hugged each other in the middle of the hallway, and I took great comfort in someone elated to see me and without any fear whatsoever of my touch. It wasn’t just the best moment of that day but would turn out to be among the best moments of the next month.

  But it came at a price.

  A few hours later I got another call from my contact at DPH. This time I could sense some anxiety on the other end of the line. “Um, Steven, uh, so … you’re back at work?” was the opener, which came as a surprise since I had had this conversation less than twenty-four hours before with the same person.

  “Ummm … yeah, I am. As you know, I don’t have any more vacation time to take off.”

  “Well, do you have to be on the campus?”

  I had two instantaneous reactions. The first was emotional, deep within the reptilian portion of my brain, and was of pure rage: I didn’t like to be reminded that I was back at work only four days after putting a two-year-old into an oversized body bag and spraying him down with 0.5 percent chlorine bleach while his mother comforted her two remaining children a few rooms away, and I was expected to resume my duties as if I had been sipping mojitos on a Caribbean shore for the past several weeks. Did I have to be on campus? Well, in fact I did, as I had already stopped drawing a paycheck because my vacation time had run out. If DPH wanted to strongly suggest that it would be a great idea for me to be paid by the hospital while I did basket weaving, or became a basket case, in some hotel room, that would be fine with me. But I wasn’t about to initiate that conversation with them myself.

  My second reaction was one of mystification: Though subtle, his speech was pressured. He was nervous about something. I suddenly had an inkling that there was a series of frantic phone calls being made between UMass administrators and the DPH, and perhaps between the DPH and the governor’s office. I wondered if they were scrambling. But why? What had happened in the intervening twenty-four hours? I had, after all, given them a pretty decent lead time to think about this, reaching out to them even before Craig Spencer turned into, well, Craig Spencer. So what was up?

  I’ll probably never know this unless someone inside DPH or in the UMass administration spills the beans, but my guess is that my name became an item on the governor’s Monday morning agenda once people saw me prowling the halls of UMass—an action that I had thought of as this thing called “going to work.” I also wouldn’t be surprised if some senior staffer in Governor Patrick’s administration learned to his or her surprise that the Ebola volunteer about whom they had been hearing reports just made a brief appearance on 60 Minutes the night before and was identified as being from Massachusetts.

  If I were the governor, after watching what had just happened to Andrew Cuomo and Chris Christie, I would want to know more than just the whereabouts of the Ebola doctor and make damned sure he wasn’t running amok so that some political egg didn’t end up on my face. Especially if, just as an outside chance, I might be thinking about making a run for the presidency of the United States someday. It seems reasonable that lots of phone calls were made that morning, and possibly for the next few days afterward, while people in high places figured every angle in case damage control was necessary.

  This analysis could be paranoid: I have no idea whether Deval Patrick even wanted to return to political life once his two terms as governor were over. The analysis could be narcissistic: After all the media coverage, maybe I had acquired a warped perception of my own importance in the larger story. But it may, however, also have some validity. The phone call ended with the plan that DPH would talk to people at UMass, and they would try to find for me a temporary office as far away from the hospital as possible. It was repeated in a variety of guises a few times in this tense conversation: Just please stay away from the hospital, Steven.

  I puzzled over this for a time, for I had never drawn a sharp distinction between the hospital and the medical school. To me, they were always the same thing, sharing a large building, even if they had distinct wings. But in fact the two institutions have different missions. The school is broad in its focus and thinks about itself as a player on an international stage, while the hospital has a local mission, serving the needs of the people living within about a sixty-mile radius of Worcester.

  Those two separate sets of priorities normally don’t conflict with one another, but the Ebola outbreak posed some peculiar challenges. The school, because of its long-standing relationship with Liberia, had a vested interest in staking out a leadership position in the international aid effort. The Paul G. Allen Family Foun
dation had given UMass an $8 million grant to parlay our strengths based on our contacts and experience working there to assist the aid organizations and help rebuild the medical-scientific infrastructure of the country. Although I was only peripherally involved with the grant, as the group had begun its work while I was in Liberia, I was at least marginally publicly associated with the group’s work, and it would have seemed logical for the school to see me as an asset for public relations.

  The hospital, by contrast, saw me as a liability. That’s only my guess, but look at it from, say, a CEO’s perspective: The lifeblood of the hospital is patient volume. Any negative press coverage associating the UMass hospital with an Ebola scare could lead to a huge downturn in visits. At Dallas Presbyterian Hospital, where Thomas Eric Duncan had been seen, the total number of visits had declined by a significant percentage, as much as 60 to 70 percent in some divisions of the hospital. That could mean tens of millions of dollars of lost revenue in a worst-case scenario. If I turned into a bad story, even if I never developed Ebola, that was the kind of hazard the hospital faced.

  And unbeknownst to practically everybody, I was on the verge of turning into a bad story.

  The following evening, as I sat in my hotel room quietly trying to process all that had been going on over the past two months, my cell phone rang with a number I didn’t recognize. Normally I let these calls go to voice mail, but I had a premonition that something important was about to be said on the other end of that line, so I picked it up.

  “Steven, hi, I’m Jennifer Berryman,” the voice began. Jennifer was the head of the school’s communications division. She got straight to the point. “We need you to be aware that a writer from the Worcester Telegram & Gazette is writing a story about you, saying that you violated the CDC guidelines upon your return to campus.”