One of the most wrenching moments in your work as an Ebola nurse is when you leave the red zone.

There has been plenty of coverage in the media about PPE. Many people know that the “doffing” procedure — wherein you have to slowly and deliberately get out of your contaminated PPE without infecting yourself — is, by far and away, the most dangerous moment in the ETU.

And while this is stressful, and takes an inordinate amount of concentration (especially when you are exhausted, dehydrated, and drenched in sweat), this is not the moment of which I speak.

The most wrenching moment is when you are safely out of the doffing station, your arms and hands and face are scrubbed with chlorine, then soap and water, you have a full bottle of cold water in your hand…and you look back, over your left shoulder, over the double-walled fence, back into the red zone.

And you realize that while you get to go to the nurses tent, and sit down, rehydrate, rest for a moment, chat with the other staff, there is someone dying on the other side of the fence.

There is a child in a ward, curled up on his side, his stick-thin knees pulled up to his chest, his head covered in hematomas from every time he was left alone, tried to stand, and fell. He is shivering in the grip of a fever of 41 degrees Celsius. He is acidotic and septic and tachypnic and moving into the final stages of a hideous death. Within the next eight hours, he will start to seize, and he will suffer seizure after seizure, until his body is released from the endless motion and his breathing stops. And he will die alone.

~ ~ ~

This moment is wrenching because we are, finally, as nurses, betrayed by the frailty of our own bodies. We take great pride in our 12-hour shifts, the double we pulled on New Years, that one time we didn’t pee for 6 hours because we were so busy saving lives.

But here, in the unrelenting heat of the afternoon sun, we cannot go on. We have rounded through the ETU twice already. Each round was almost two hours long, and we worked on someone every single minute of each hour. And if we didn’t have our hands on a patient, we were busy emptying buckets, begging/cajoling/demanding that our patients drink the ORS, starting IVs, capping IVs, and cleaning our hands with chlorine between every.single.task. Over, and over, and over, and over, and over.

We know he is dying; there is a “look” they have as they enter the terminal stage. But unless we leave the ETU, right now, with just enough strength and wits to get out of our gear safely, our bodies will betray us and we will collapse inside the ETU, covered in live Ebola virus.

We cannot go on. I have never in my life worked for only four hours a day, and been so completely spent.

And so, suddenly faced with the terrible realization that we are only human after all, we leave the ETU, look over our left shoulder, think of everyone left inside…..and then go back home to our dorms.

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This is the dichotomy of the Ebola nurse. Your primary patient is yourself, and you care for that patient above all others. You turn your back on the suffering in order to spare yourself the same.

You walk away from the dying because you must live.