It's hard to imagine it now, when the death toll from Ebola is in the thousands. But just a few months ago, you could count the victims one at a time.
For Dr. Joshua Mugele, the counting began one morning in June when he showed up for work at the John F. Kennedy Memorial Hospital in Monrovia, Liberia. Mugele, an ER doc and associate professor of clinical emergency medicine at Indiana University School of Medicine, was on a fellowship, working with staff to develop disaster readiness programs. The project had nothing to do with Ebola.
On that particular morning, Mugele showed up at the hospital to find a colleague in the parking lot, nervously making phone calls. When the man saw Mugele he told him the news: "We have a patient with Ebola."
One of Mugele's first questions was whether the patient was in isolation. He was told the Ebola victim was in the same crowded emergency department where he'd been all night.
Mugele raced to the emergency department and paused at the door. Small and crowded with no ventilation or air conditioning, the room always had a horrible stench; today was no exception. As he stood there, a colleague pointed to the back of the room. There he was — you couldn't miss him. "He was lying on an iron bed at the far end of the emergency department, obviously sick," Mugele remembers. "He's sweating. He's moaning. He's essentially comatose."
Two doctors joined Mugele in the doorway: Dr. Samuel Brisbane, one of the hospital's senior physicians, and Abraham Borbor, head of medicine in the emergency department. This was a moment they'd all been dreading. For weeks, Ebola had been at the forefront of their thinking as the epidemic seemed to pick up steam. Mugele says they'd talked a lot about the virus and how scared they were about what might happen if a patient with the disease turned up.
Brisbane, 74, was especially worried because he knew from past experience treating other viral hemorrhagic fevers just how dangerous these types of viruses could be. He was so worried he carried around a thermometer to take his own temperature on a regular basis, just in case he'd been exposed to the disease without knowing it.
Now all that worry would have to turn into action.
It took the three of them a few minutes to figure out what to do. "We knew we needed to get him into an isolation room," Mugele says, "and we were trying to decide if the room had to have a sink or a working toilet. Or can you use plumbing with Ebola, or do you have to actually burn the feces? We just were trying to remember exactly what had to be done."
In the end, they decided the most important thing was to move the man into an isolated room with its own trash can. Not a lot to ask for, and yet there just weren't any empty rooms to spare; a small enclosed area at the back of the emergency department would have to do.
They began gowning up. Mugele says everyone was nervous, yet they were joking around. At one point, he reached for a pair of gloves and grabbed for a gown when Borbor stopped him. "He laughed at me and said there's no way you're going to be touching this patient. He said, 'I'm not going to make the international news for letting the first white man catch Ebola.' "
Mugele didn't want to pull back. But he felt that as a guest at the hospital, he had to respect Borbor's demand.
Mugele turned to help two custodians who'd been called in to move the patient — men in their late teens or early 20s. They clearly had no idea how to put on protective gear: "I doubt they'd ever put on latex gloves before."
Mugele demonstrated how to put a gown and mask on properly and how to put on not one but two pairs of gloves. "They were very nervous, obviously; they were terrified," he says.
Once gowned up, the two young men and Borbor grabbed hold of the iron bed the patient was lying on and tried to move it through the doorway and into the isolation area. The bed wedged in the doorway. They yanked the bed out and decided to carry the patient on the mattress. But there was a problem, Mugele says: "There's one person on one side of the mattress and two on the other, so they have a difficult time navigating around the iron bed and almost drop the mattress. And so Dr. Brisbane, who's sitting next to me and who hasn't gowned up, grabs a pair of gloves and puts them on and grabs the mattress and holds it up."
Between the four of them, they were able to navigate the patient and his mattress around the iron bed. They needed to take a break, so they put the patient and mattress down. They then shoved the mattress through the doorway as much as they could and climbed over it, "pulling it the rest of the way into the small isolation room," says Mugele. "It's terrifying watching it." It was equally terrifying for the custodians and for Brisbane, who came perilously close to an Ebola patient with no protective equipment except a pair of gloves.
"The patient is septic, so he's covered in sweat," Mugele says. "And these guys are now all in this hot little room, and they're covered in sweat. Dr. Borbor's mask actually slips down over his mouth at one point." Mugele reached over to adjust the mask, but Borbor snapped at him: "Get Brisbane to do it; he's already touched the patient."
It was a mess.
The patient was having difficulty breathing, so Borbor crouched by the man and tried to keep his tongue from closing off his throat. While this was going on, Mugele noticed that, to his horror, the custodians were leaving the isolation room. "And I'm yelling at them, 'Stop! Don't move. Don't come out of that room. Don't touch the walls.' "
At about that time, the patient, who had been holding on since midnight the night before, died. The custodians and the two doctors removed their gear and left, holding their hands up so as not to touch anything. They headed for a sink and spent the next 10 minutes washing "and really trying to decontaminate as best they can."
Unfortunately, their best was not good enough. Mugele returned to Indiana a week later; a few days had passed when he received a call from an acquaintance in Monrovia. Dr. Samuel Brisbane had contracted Ebola and was being cared for at a government treatment center.
Brisbane died a few days later. So did Borbor, the man who just might have saved Mugele's life by preventing him from getting close to the patient.
The custodians, those two nervous young men who helped move the patient, left the hospital that morning and have not been heard from since.
Joshua Mugele may well be the only one from that small group of caregivers who is alive — and still counting the ever-growing number of deaths from Ebola.
RACHEL MARTIN, HOST:
It's hard to imagine now, but the early days of the Ebola epidemic weren't all that long ago, when Ebola cases were counted not in the thousands but one at a time. Dr. Joshua Mugele was in Liberia's capital when the epidemic began. He's an associate professor of emergency medicine at Indiana University, and he was in Liberia to help develop programs to prepare for various disasters. Mugele's work had nothing to do with Ebola, and yet that is exactly what he found himself suddenly facing. Dr. Mugele spoke with NPR's Rebecca Davis about the day the first Ebola patient appeared at JFK Hospital in Monrovia.
REBECCA DAVIS, BYLINE: As Dr. Mugele tells it, he arrived for work early one morning at the hospital in Monrovia and was told by an anxious colleague that a very sick man was admitted to the emergency department the night before. At first the medical staff thought he had malaria, but as the night wore on, they realized he had all the symptoms of Ebola. Dr. Mugele was shocked to discover that seven hours after the patient arrived, the man still had not been put into isolation. He asked to see the patient.
JOSHUA MUGELE: So we go into the emergency department. The one room he's laid in is a small, crowded room without air-conditioning, and there's always a horrible stench going in there just because there's 20 sick people in a room with very poor ventilation. And so we go in there, and we see as we walk in the patient we're talking about is on an iron bed, and he's obviously sick. I mean, you can see it from across the room. He's sweating; he's moaning; he's essentially kind of comatose at this point.
DAVIS: As Dr. Mugele stood there, two other doctors, Abraham Borbor and Samuel Brisbane joined him. They all realized the moment they'd been dreading had finally arrived.
MUGELE: Everybody was terrified. We had had many conversations in the preceding week about how scared they were and what might happen if an Ebola patient came in. So everybody was realizing that this was finally here. It had happened, and now they were going to have to deal with it.
DAVIS: They tried to recall off the top of their heads what they would need for handling this patient without infecting themselves or anyone else.
MUGELE: We knew we needed to get him into an isolation room, and we're trying to decide if the room had to have a sink or if the room had to have a working toilet, or can you use plumbing with Ebola? Or do you have to actually burn the feces or - you know, we were just trying to remember. It's like we couldn't remember what exactly had to be done.
DAVIS: They decided to move him into a small empty room at the back of the ER. The doctors and nurses started putting on their gloves and masks and gowns. Dr. Mugele says everyone was really nervous, but they were sort of joking around as they gowned up.
MUGELE: So I reached for a pair of gloves and grabbed for a gown, and Dr. Borbor, who's the head of medicine in the emergency department, he laughed at me. And he said, there's no way you're going to be touching this patient. He said, I'm not going to make international news for letting the first white man catch Ebola.
DAVIS: Dr. Mugele pulled back. He didn't want to. But because he was a guest and a visitor to this hospital, he felt like he had to respect Dr. Borbor's wishes. So he turned to help two custodians put their protective gear on. They'd been called in to help move the patient.
MUGELE: These are just two, basically, you know - I don't know - young 20 or teenage boys who worked in the hospital. I doubt they'd ever even put on latex gloves before. So I was trying to demonstrate to them, without touching them, the process of putting this on and how they wanted to put on two pairs of gloves and, you know, how to tie their masks. And they were very nervous. Obviously they were terrified.
DAVIS: Still they got to work helping Dr. Borbor move the patient into the isolation room just a few feet away.
MUGELE: But as they do that, they realize when they get to the door, the bed is too wide to actually fit through the door.
DAVIS: And so they ditch the idea of moving the bed and instead picked up the mattress with the patient on it and tried to carry him through the door that way.
MUGELE: There's one person on one side of the bed and two people on the other side of the bed, and so they have a difficult time actually navigating around the iron bed, almost drop the mattress. And so Dr. Brisbane, who's sitting next to me and who hasn't gowned up, he grabs a pair of gloves and puts them on. And he grabs the mattress and kind of holds it up, and they're able to kind of finally navigate the patient on his mattress around the iron bed. And I'm sure he's too heavy at this point, so they kind of set him on the ground, still outside the room and end up just manually shoving the mattress in through the doorway and then kind of climbing over it and pulling it the rest of the way into the small isolation room.
It's terrifying watching it, but it's also - I can only imagine how terrifying it was being those - not only the two custodians, but Dr. Brisbane, who's now helped transport this patient with no protective equipment on except a pair of gloves. The patient is septic, so he's covered in sweat, and these guys are all now in this hot little room. They're covered in sweat. Dr. Borbor's mask actually slips down over his mouth at one point.
DAVIS: Dr. Mugele reaches over to adjust Dr. Borbor's mask, but he snaps at him and says, have Brisbane do it since he's already touched the patient.
MUGELE: And Dr. Brisbane is trying to, without touching Dr. Borbor, is trying to readjust the mask on his face so that it goes back up over his nose and mouth, and, you know, it's a real - it's a mess.
DAVIS: By now, the patient was having a hard time breathing. Dr. Borbor crouched by his head and worked to keep his tongue from closing off his throat.
MUGELE: And at the same time, the two custodians, now essentially that their job of moving the patient is done, start walking out of the isolation room. And I'm yelling at them, stop, you know, don't move. Stay in that room. Don't come out of that room. Don't touch the walls.
DAVIS: He knew the young men could accidently contaminate themselves or someone else. He ushered them back into the isolation room. But before they remove their gowns, the patient dies. It had been just 40 minutes since Dr. Mugele first learned about the Ebola patient. The custodians and the two doctors removed their gear inside the isolation room.
MUGELE: And they all come out of the room, and they're all, you know, kind of holding their hands so they're not touching anything. And we march them all over to a sink and, you know, essentially spend the next - I don't know - five or 10 minutes just really, really scrubbing as best they can, you know, washing their hands and re-washing their hands and washing their arms and, you know, splashing water on their face and really trying to decontaminate as best they can.
DAVIS: Their best, as it turned out, was not good enough. A little over a week later, Dr. Mugele is back in Indiana, and he gets a call from an acquaintance in Monrovia.
MUGELE: And he told us that Dr. Brisbane had contracted Ebola, and then I got a call a few days after that saying that he had died. And they were going to bury him on his plantation.
DAVIS: And then another phone call. Dr. Borbor had also gotten Ebola and had also died.
MUGELE: Of the people who were there, almost every single one of them contracted Ebola, and most of them died.
DAVIS: Three deaths, one survivor - Dr. Mugele, whose life was arguably spared when Dr. Borbor kept him from directly helping with the patient. As for the custodians, those two, nervous, young men called in to help move the patient, Dr. Mugele says they left the hospital that morning as soon as they could, and no one has seen them since. Dr. Mugele says that as an emergency physician, he's seen a lot of people die, but he feels a particular sadness that comes from losing colleagues who died, he says, just from doing their jobs. Rebecca Davis, NPR News. Transcript provided by NPR, Copyright NPR.