Inferno

by Steven Hatch, M. D.

  There are many people I met during my training at Fort McClellan in Anniston, Alabama, to whom I am indebted for their generosity of spirit. An abbreviated list includes Martha Mock, Tony Fiore, and Satish Pillai of the CDC; Rupa Narra of the CDC’s Epidemic Intelligence Service; Nahid Bhadelia of Boston University; Major Matthew Chambers of the U.S. Army; Emily Veltus of MSF; Commander James Lawler of the U.S. Navy; Lieutenant Colonel Tom Wilson and Lieutenant Colonel William E. Thoms of the U.S. Air Force; the PIH posse of Anany Prosper, Paul Pierre, and Joia Mukherjee; Dan Kelly of the University of California, San Francisco; Preetha Iyengar of Save the Children; and Pam Falk. Then there is the ultimate badass, Lieutenant Commander Elizabeth Lybarger DeGrange of the U.S. Public Health Service, without whom the experience of Camp Ebola would certainly have been less vivid.

  There is a long list of IMC staff who each have incredible stories; their dedication and spirit inspired and humbled me when I worked there in October and November 2014 and when I returned in February 2015. One group in particular merits special thanks: the expat nursing staff. The lion’s share of the work fell to the nurses, who not only risked their lives on a daily basis with frequent blood draws and IV line placements, but coordinated the work of the national staff nurses and nursing aides, all while tending to upwards of fifty patients, clad in full PPE, working in the searing heat for up to three hours a stretch. Thanks, therefore, to Rosa Nin-Gonzales, Pero Tabby, Patrick Githinji, Bridget Mulrooney, Audrey Rangel, Elvis Ogweno, Kelly Suter, Megan Vitek, Amaia Artázcoz, Rakel Vives Font, and a very special thanks to my guardian angel, Nora Hellman, whose timely words in a dimly lit office one morning at Cuttington University in February 2015 literally helped me cling to life when the darkness nearly consumed me.

  The remainder of the IMC crew with whom I had the honor of working will always hold a special place in my heart. Sean Casey and Pranav Shetty were all one could ask for as they ran the ETU. I came to think of Sean and Pranav as the Jordan-Pippen of international medical relief—though I won’t speculate, at least publicly, as to which was Jordan and which Pippen. Others on the IMC crew, all of whom deserve more than just being a name in a list, alas, include Hilarie Cranmer, Margaret Traub, Adam Levine, Colin Bucks, Trish Henwood, Steve Whiteley, Kwan Kew Lai, Stuart Sia, Fredericka Feuchte, Sambhavi Cheemalapati, Jean-Francois Baptiste, Yves-Pierre Beauchemin, Godfrey Oryem, Sam Siakor, Garmai Cyrus, “President” Thomas Jefferson, Vasco Wuokolo, A. Welehyou Duo, Amanda Karpeh, Julius Sevelee, Sophie Bellorh Jarpah, Yarmah Cooper, Love Fassama, Augustin Mulbah, Bendu Howard, Comfort Harris, Marco Morelli, Eoin “Sláinte” Ó Riain, Katie Mullins, Olivia Roberts, Simon Cowie, Maia Baldauf, Linda Shipton, Samer Attar, Paul Douglas Waggoner, Joshua Wilkie, David Imo Mwita, and last but not least, Dziwe Ntaba. As I write their names, I think of the stories they told me, of the horrors and the triumphs and the hilarities they encountered in their work, and it feels shameful just to list their names without telling readers more. My apologies to them all.

  Without the members of the U.S. Navy who had been deployed to Liberia, the entire experience of the Bong County ETU would have been remarkably more stressful. Because of their ferocious competence, a fast turnaround time that provided absolutely reliable results prevented many dilemmas from ever happening. Thanks go out to them and their leader, Lieutenant Commander Ben Espinosa. Talk about things I never thought I’d say, but what the hell: Go Navy!

  Others that were there along the way: Daniel Berehulak, whose genial nature never failed to make my soul feel lighter; Ben Solomon; Rick Kopelman; the amazing Ayan Zado; Cristina Santamaria and her always-buoyant missives; Karen Wong of the CDC; Rene Vega, a doctor who could not be better suited for a group named Heart to Heart; Gus Kuldau, for graciously tolerating my appallingly rude tantrum on Facebook; Nisha Makan, with whom I had conversations about infrastructure and development that were far too short; Jason Odhner; Laura Chambers-Kersh; Gregg Lucksinger; Laura Milligan; Lauren Sattely Snow; Hunter Keys; Jennifer Dienstag Levine; Marra Gad; Kidist Tarekegn; Ignace Nzayisenga; Sia Kamarra; and Roseda Marshall, the president of the Liberian College of Physicians and Surgeons. A special thanks to Sheri Fink for being there from nearly the beginning.

  Many people from my home institution of UMass deserve shout-outs. Most important is the Tackle Ebola group, whose work was funded by the Paul G. Allen Family Foundation and includes Trish McQuilkin, Ann Moorman, Jeff Bailey, Katherine Luzuriaga, Christine Wassuna, and Salimata Bangoura. Jennifer Berryman, the Vice Chancellor for Communications at the UMass Medical School, was incredibly kind throughout my many comings and goings. My department chair, Robert Finberg, along with Chancellor Michael Collins, gave real support after I had returned from my first stint. Deb Poliquin treated me with much-needed nonchalance at a time when a good many people thought of me as something akin to being radioactive. Rick Forster provided behind-the-scenes moral support in his typically levelheaded manner, proving his status as a man of exceptional quality. Nancy Skehan just sat and listened to me for a few hours one night as I tried to readjust to the reality of being back in Massachusetts days after I left the ETU. Jackie St. Martin gave me Saint Anthony to watch over me during the outbreak, and he watches over me still, though likely with reservations. Thanks to all of them.

  Likewise, I was blessed to have had a fantastic set of correspondents from UMass throughout my deployments in Liberia in 2014 and 2015. Their good cheer made e-mail a special treat and served as my mental home away from home while I worked in the ETU, on the campus of Ebola University at Cuttington, or at JFK in Monrovia. Thanks therefore to David Clive, Sara Jacques, Chris Bielick, Keith Boundy, Katey Walsh, Tara Bouton, Sunkaru Touray, Suzanne Sprague, Adam Hodes, Justin Lui, Tony Ogunsa, Shu Yang, Vitaly Belyshev, Anne Barnard, Kim Cullen, Emily Bouley, and Jennifer Perez. Also thanks to my internal medicine clerks who insisted that we continue didactics from Monrovia via Skype: Valerie Valant, Caroline Bancroft, Sarah Fulco, Mary Cavanaugh, Jasmine Khubchandani, Justin Vaida, and Sarah McGowan.

  I would also like to thank some non-UMass members of the ACCEL group, a consortium of academic institutions devoted to ongoing work in Liberia. There is Lise Rehwaldt, an ob-gyn long based in Liberia working at Phebe; my Liberian karaoke partner Tina Thomas; Alexandra Vinograd; Kathleen Rowe; A. K. Raja Rao; and Gregory Engel, who has been getting the residency program back on its feet after losing so many critical players. Also thanks to Ian Yeung of the National Institutes of Health in Bethesda for his kindness, scholarship, and clinical acumen.

  Bravo to all the members of the staff at JFK Hospital, whose bravery knows no bounds. I would especially like to thank Joyce Bartekwa, Zoeban Kparteh, Yassa Barclay, and Ian Wachekwa for their enthusiasm and thoughtfulness, as well as Joseph Njoh, JFK’s sole internist at the time of my return in 2015. A great thanks is due to Phil Ireland, who not only endured what even an atheist would regard as hell but came through the experience seemingly spiritually unscathed, still ready and willing to answer the call to help heal his fellow Liberians and patients in general. Hippocrates is smiling somewhere, I’m sure of it.

  I am grateful to Pastor O’Malley Moore Segbee and the congregation of Grace Baptist Church in Gbarnga for their gracious hospitality in taking me into their fold for one day. Pastor Segbee passed away during the writing of this book; I hope that my words about him and that day have proven worthy of his leadership during the outbreak. Similarly, Dennis Khakie exhibited heroism in going before his congregation as an upbeat survivor, setting an example for courage in the face of terror. Dennis, too, has since passed away; may his name be a blessing.

  Thanks to the pros: Andy Ross for maintaining faith in his slush-pile writer; George Witte for his editorial work and for seeing value in the project; Sara Thwaite, my fellow Buckeye, for timely and helpful replies; Carrie Watterson for continuing our collaboration; Meg Drislane, Tracey Guest, Rebecca Lang, and the rest of the St. Martin’s crew.

  Thanks to the people who read portions of the manuscript and gave h
elpful feedback, a pat on the shoulder, or both. Jana Broadhurst was the first person to listen to the proto-thoughts that would eventually develop into this book one night in Anniston, Alabama; I very much appreciate her feedback, which allowed some ideas to take root. Isaac Peace Hazard, Barrie Wheeler, and Amit Segal propped me up at various points during the writing of the manuscript. Bruce Borowsky and Bess Welden (along with her wonderful husband, David Hilton) all provided special help with their typical brilliance, especially as I made my final push in finishing the manuscript during some cold days in Maine in March 2016. Mark Meyers, as he has done since a tender age, served as my sounding board from beginning to end and in doing so kept my deeply neurotic but intermittently productive core on track, patiently indulging all my trepidations and making the world seem not quite as severe a place as I frequently assume it to be.

  With characteristic fortitude, Miriam Tuchman unflappably protected her family while the world watched Liberia and the rest of West Africa with bated breath. No set of words can fully convey my appreciation for her sacrifices.

  A final thanks to my children, Erez and Ariella, for being my Polaris, even when the rest of the night sky went to black.

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