Four months ago. America.
“So the guy in room one is a John Doe. Young-ish guy, probably in his thirties. SPD scraped him off the sidewalk near the square. He’s covered in track marks, burns, scabs. Looks like he’s got some big abscesses on his legs. He’s septic; he’s tachy in the 130s and I haven’t seen his temp drop below 39 degrees.”
“Did we give him any Tylenol?
The nurse reporting off to me delicately raised an eyebrow. “He’s got a GCS of 9. He’s not going to be able to swallow Tylenol.”
“Rectal?” I asked in response, raising an eyebrow of my own.
The nurse offered up a half-smile. “Girlfriend, if you want to plunder those depths, you go right ahead.”
“All right, let’s get him up on his side,” I said to my nursing assistant.
We were dressed identically – isolation gowns covering our scrubs, double gloved, masks with eye shields. I pushed and she pulled and his dead weight rolled away from me onto his left side. We re-organized our tubes and lines — foley catheter with a temperature probe, two large-bore IVs inserted into the deep veins of his upper arms using an ultrasound, two liters of saline running fast under their pressure bags, all the wires leading to the monitor. He moaned a little with the movement, but otherwise remained oblivious to the world around him.
As I got the Tylenol suppository ready, I noticed absently that his back was the only part of his body left unscarred and unburned. He had likely been quite handsome at some point in his life, but now, after a decade or more of IV drug use and polysubstance abuse, his young body was a battered, hollowed shell of its former self.
His arms and hands were a mass of hardened, scarred veins from one needlestick after another. His neck was scarred from where he tried to shoot into the huge veins there after he could no longer find a vein in his arms. And now his legs were swollen, scabbed and abscessed, as he could no longer use his arms or neck and had started digging for veins in his legs and feet.
He was covered with bruises and abrasions, and his face was puffy — someone had clearly beaten the shit out of him in the square before walking away and leaving him there unconscious. And the scattered, waffle-like patterns of old burns across his chest and arms told me that at some point in his past he’d smoked crack, or tried to make meth, and it had blown up in front of him.
I sighed, and dabbed the suppository in some lube. “Once more unto the breach, dear friends, once more! Or close the wall up with our English dead!”
My nursing assistant gave me a funny look. “What?”
I shook my head. “Never mind,” I said, and administered the Tylenol.
Acetaminophen is a lovely drug, and two hours later the temperature probe reading on the monitor showed John Doe to be be normothermic. His pulse had come down slightly, and his blood pressure was holding steady. I walked up to his bed and laid my hand on his shoulder.
“How we doing, my friend?” I said, automatically checking the lines and tubes and fluids. I was startled when he suddenly turned his head towards my voice, and opened his eyes. For a brief moment, he looked at me and saw me, knew I was there next to him. And as quickly as it had come, I saw the awareness start to fade away again.
I shook his shoulder. “Hey, man, what’s your name? Tell me your name, friend.” If we could figure out who he was, we could access his medical chart, and knowing his history would improve our ability to care for him immeasurably.
His lips were dry and cracked, but he tried to speak. “….Stephen…..,” and then his eyes began to drift shut.
I shook him again, less gently this time. “Stephen, honey, what’s your birthday? What day were you born?”
He frowned and tried to pull away from me, but I refused to let go. I spoke much more loudly. “Stephen, do not fall asleep on me, tell me your birthday first!”
“……May -” then he slurred a sound I didn’t catch – “…eighty-three….” And he lapsed once again into unconsciousness.
There were several people named Stephen born in May of 1983 in our medical records. This is not surprising in a city of nearly 700,000 people. However, a quick glance at their “Reason for Visit” lists quickly ruled them all out – sports physicals, annual checkups, and other routine visits that the homeless, addicted populations of the world do not make.
Stumped, I stared at the monitor for a few more moments, tapping my fingers idly on the desk next to me. Then I leaned forward again, and typed “Stephens” into the “Last Name” field in the search box.
The third name to come up was young man born in May of 1983. Seen six months ago for medical clearance after being arrested. Seen one year ago for an abscess I&D and IV antibiotic therapy. Seen two years ago for a heroin overdose. Seen five years ago for burns.
I quickly clicked on the visit for burns, and found exactly what I was looking for. The burn team had photographed each burn to document initial injury and stages of healing. And there, in the third photograph, was a picture of the burn on his left bicep, which intersected a very distinct tattoo. I’d seen that burn scar crossing that same tattoo a dozen times so far this shift as I checked on my John Doe.
I walked over to the doctor’s area, and sat down next to the resident. “I have a present for you,” I said, and handed him a slip of paper with John Doe’s name, birthday, and medical record number on it.
He stared at it for a second, and then looked at me, and grinned.
Thirty minutes later we walked back into John Doe’s room together, and I shook him awake again. He opened his eyes, and slowly focused on the resident’s face.
“Hello, Matthew,” said the resident.
The young man in the bed tried to clear his throat. “Hello.”
~ ~ ~
Nine months ago. Liberia.
The ten people of my training class walked single file away from the Ebola Treatment Unit, away from the blue tarp walls stretched tightly over wooden frames, away from the chain link fence and gravel underfoot, away from the incredible noise and clamor of the green zone and the frightening hush of the red zone. We walked along a thin dirt path and stepped into the jungle, and entered another world.
The chaos of the ETU was lost almost immediately amongst the thick vines, wide green leaves and heavy red dirt of the Liberian countryside. We heard the chatter of birds, the sawtooth calls of insects, and our own quiet footsteps. Nobody spoke. We walked for more than five minutes, much longer and further than I had expected.
And then abruptly the jungle parted, and we were in a small, dimly lit clearing. Stretching out to my right, my left, and deep into the foliage in front of me, as far as I could see, were graves.
This was the fifth day of seven I would spend at this particular Ebola Treatment Unit, enrolled in a training class sponsored by an huge international NGO. We’d had three days of classroom lecture and theory, one day of mock ETU work, and then yesterday we’d entered the red zone for the very first time. When the opportunity arose to visit the graveyard, several of us had given up our mid-day break to take the trek into the jungle.
I didn’t know then that I would separated from my Liberian colleagues less than a week later, shuttled quickly aboard a UN plane, and flown to Sierra Leone to try to fight the burgeoning epidemic there. At that moment, standing amongst hundreds of hand-painted markers and the open, hungry, gaping mouths of dozens of freshly dug graves, all I knew was a vast and fathomless sense of loss, and shame.
Dishonour not your mothers: now attest,
That those whom you call’d fathers did beget you.
Be copy now to men of grosser blood,
And teach them how to war…
I was standing in a field of the casualties of this battle. I had arrived too late for this war.
I wandered between the piles of earth, reading names quietly to myself. No one was exempt. The young, the old, the middle-aged. Men and women. Stillborn infants, their sunrise and sunset – birth and death – the very same day.
A group of my classmates, psychosocial workers-in-training from Liberia, and themselves Ebola survivors, walked past me, checking the dates on the markers.
“Have you located the graves from August?” one of them asked.
I shook my head. “No, but I’ll help you look.”
We wandered further back into the graveyard, spread out among the long rows. One of the women spoke quietly to me as we walked.
“Our friend was a taxi driver in Monrovia,” she said, stepping carefully through the dirt. “He picked up a pregnant woman who said she was in labor, and before he was halfway to the hospital she began to vomit blood. Her skirt was soaked in it.”
She stopped to check a marker. “She was nearly dead by the time they arrived at the hospital, and he had to carry her to the doors. He left her there, then went to the river and washed out the back seat of his car.
“Some days later he began to feel feverish and weak, and knew that he had Ebola. But he was afraid of the hospitals in the city, knew that they piled people on mats on the floor and left them to die. So he drove himself here.”
I raised my eyebrows at that; we were four solid hours from Monrovia over some terrible roads. I could only imagine the horror of that final drive; sick, frightened, knowing what would happen to your body in the coming days, not knowing what would happen to your family if you died, not knowing if you infected them before you left.
One of the others called out to us, and the conversation stopped abruptly as we headed to meet them. They stood on either side of yet another mound of dirt, in the middle of a row, nondescript, entirely unique.
She knelt then, and gently brushed some dirt from the white- and black-painted wooden marker, her fingers as soft as if she were touching his face one last time.
“Hello, Matthew,” she said.