Part One is here.

Part Two is here.


We climbed, one by one, out of the back of the tuk-tuk and into the red zone of triage at the holding center.  Esther and I resumed our positions on either side of the old woman, each of us holding onto one of her arms.  Over the fence in the green zone, I saw Mother standing there with her triage papers, watching us.

“Mother,” I called from behind my mask, “we’re going to take her in and put her in a bed.  She’s too weak to go through triage.”  I could feel the woman’s legs shaking, her body completely exhausted from her ordeal.  Above and beyond her exhaustion, however, was an awareness of my own rapidly waning strength.  I was drenched in sweat and conscious of the faintest hints of lightheadedness pushing at me from behind my eyes.

Mother nodded, and Esther and I walked the woman into the ward.  We made it to one of the small, green, military-style folding cots just in time.  The woman collapsed onto the edge of the bed.  Esther and I each grabbed a leg and swung her up so that she could lay comfortably flat.  She moved not at all, and never said a word.

Esther looked at me, concern shining from her eyes.  “She needs a cannula,” and her gaze flicked over to the table in the room where we kept the IV supplies.

I shook my head.  “We’ve done enough.  Night shift can give her the cannula.  We’ve been in too long; we need to get out.”  I glanced over at David, who had followed us into the ward.  “Leave the spray tank.  We’re all going now.”

He nodded, and left the tank outside the ward.  We walked together down the ramp, past the third wing of the center, around the back, and started the long walk towards doffing.  I had never been so hot or so tired.  The forty feet to the doffing lane seemed to stretch on for miles.  I focused every fiber of my being on making that walk, staying upright, getting decontaminated, and getting out.

For the first time since arriving in Sierra Leone, I entered the doffing lane before my staff.  I’d always made sure my staff got out safely first; I always sent them ahead through the decontamination process.  But it had been weeks since I’d been in PPE, and I wasn’t as acclimated as I’d been in December and January.  The suits were less permeable, the weather was hotter, and I was suffering from a massive adrenaline crash.  If I didn’t get out soon, I was terrified I would collapse.

I bribed myself mentally with the promise of two orange Fantas at dinner.  Extra barbecue chips.  Anything.  Just. Get. Out.


Fifteen minutes later, I stepped backwards over the red line painted on the ground into the green zone, and headed straight for the water spigot.  I usually went and soaked my head after doffing; this time I squatted down and stuck my whole torso under the pipe, and opened it full blast.  Water rushed over me, tepid from the enormous black rubber tanks high up on their stands, absorbing the relentless daily sunlight.

I sat there for many long minutes.

I had no way of knowing it then, no way of seeing the seeing the future, the sudden and brutal collapse of our program in Sierra Leone just two weeks away, and the final decisive moment of unmitigated fury when I abruptly cancelled my contract and escaped to Europe.  But then, there in the Northern District, late in the evening, I had just exited a red zone for the very last time.


I ducked inside the main building, dripping water, grabbed my phone from my backpack, and went back out to stand in the middle of the yard.  I dialed the number for the head of the command center, a quiet, powerful British Army Major.  He was smart, respectful, intelligent, and I admired him entirely — working with the Brits was one of my favorite things about being in Sierra Leone.

I usually tried not to bother him too much, or escalate issues to him directly, but that evening I was furious, angry enough to chew rebar and spit nails.

“Hello, Martha,” came his lovely accent over the phone.  I could have listened to him read dictionary entries all day and been perfectly content.

But not today.  I attacked.  “Where are you?  Are you at the command center?”

He paused, clearly startled by the venom in my voice.  “No, I’m not.  The Captain and the RSLAF commanders and I are on our way back from Pamalap.  We met with the Guinean officials all day today on the border.  You knew about this meeting.”

Shit.  SHIT.  I had known about the meeting, but in the disorder of the day it had slipped my mind entirely.  No wonder communications from the command center had failed; the competent players had been absent from the district since sunrise.

Embarrassed but no less angry, I pressed on.  “I don’t suppose you heard about the three ambulances that we got slammed with this afternoon, all unannounced?  Or the incredible shitshow that just went down at the market??”

Now he was simply surprised.  “No, not a thing.  What on earth happened at the market?”

I was yelling now.  “Two of my staff and I just walked into the market – on MARKET DAY – in FULL PPE and extracted a woman who just MAYBE has EBOLA from amongst TWO HUNDRED screaming people and then drove her back to the holding center in a FUCKING WATER TRUCK because we have NO FUCKING AMBULANCES in this STUPID FUCKING DISTRICT!”


And then I took a breath, and added, “Oh, and the back door fell off the water truck, too.”

And then I started to laugh.  Part hysteria, part awareness of the ridiculousness of the day, part exhaustion, and part simple, unmitigated joy.  I was alive.  I was working in West Africa during the worst Ebola outbreak in history.  Everything I had ever tried to achieve as a nurse and as a human being had finally come together, and I was exactly where I was meant to be in the world at that moment.

I was unimaginably lucky, and I knew it.

The Major had no idea whether to laugh or apologize.  So he did both.  “My God, Martha, I am so sorry.  What a mess.  I had no idea.  Are you guys ok?”

I was still laughing, nearly doubled up, tears streaming down my face.  “We’re fine.  The woman is fine; she probably doesn’t even have it.” I took another deep breath, and fought for some composure.  “I gotta be honest, Henry, after six weeks of administrative and clerical work, and those endless evening briefs, getting back into PPE and getting some real work done felt fan-fucking-tastic.”  I burst out laughing again; I couldn’t seem to stop.

I could just see him grinning into the phone.  “Glad the district could help you out with that.  Look, let’s meet tomorrow morning and debrief this and try to make sure it never happens again.”

“That’s the best idea I’ve heard all day.”


As I walked back across the yard to get my backpack and go home, another of the sprayers jogged over to me.

“Martha, you are a nurse?”

I blinked at him.  “Yes, of course.”

He flashed a huge grin at me.  “I did not know that!  You are always the boss, in charge, not working in PPE.”

I smiled back at him.  “I was in PPE in Port Loko for the whole month of December.”

He nodded approvingly.  “I did not know you were one of us.”  He raised his elbow for an elbow bump, the equivalent of a high-five in the days of Ebola.  “You did good work today.”


The night shift started an IV in the old woman, drew her blood to check for the virus, and rehydrated her with several litres of LR.  They fed her dinner, changed her clothes again, got her a warm blanket for evening.

Then, deep in the dark of the night, she rose from her bed, left the ward, climbed through the back fence, and escaped into the jungle.

We never saw her nor heard any news of her again.

Her PCR for Ebola came back negative — just as I suspected it would — but the fact of her elopement started a cascade of administrative and political headaches that would plague me for the remainder of my time in the district.

Furthermore, there were very few people to whom I could tell the story of what happened that day.  I’d broken almost every rule established for our safety by our NGO, and I still had two months left in my contract.  They already knew about my temper and it had nearly cost me my job once before; I certainly didn’t want to give them any other excuses to ship me back to the States.

So late that evening, after an amazing bucket shower, a set of dry clothes, and a surprisingly delicious dinner, I stretched out on a couple of the strangely repurposed “Philadelphia Civic Center” stadium seats that served as our dining room chairs.  Then I told the story of my day to the doctor that worked with me in the district, and a few of my closest housemates.

The doctor shook his head at me.  “Only you,” he commented.

I scowled at him.  “I’m never giving you the day off ever again.”

He grinned at me.

I gave up, and laughed.