Third in a series.
Old instincts die hard, and preparing for his first night shift on the Ebola isolation ward in Monrovia, Liberia, Dr. Darin Portnoy couldn’t help but note the full moon.
“From the time I’ve worked in the ER, the full moon is often when the crazier stuff happens,” the Bronx clinician said. He was “juicing up”—caffeinating—with an after-dinner coffee, then meeting up with an epidemiologist who’d be joining him. He’d be on from 11 p.m. to 7 a.m. “I actually suspect tonight will be relatively peaceful,” he predicted, but added that his rounds on the Ebola ward had taught him to expect the unexpected.
“You can’t go in and out,” he explained of going to see patients with Ebola. “You can’t safely backtrack once you’ve left a patient, because there isn’t time, so you have to think of everything in advance—or try to—so you move in one direction.”
Understanding the progress of the disease is tricky, too. Patients who seemed stable only hours before can abruptly decline. The reverse is also true: Someone who was at death’s door can suddenly rebound. “This virus really challenges your judgment as a clinician,” Portnoy said. Without a way to treat the virus, he and the other doctors do their best to keep the patients hydrated, manage their pain, and reduce vomiting and diarrhea.
His twice-daily Ebola rounds, he said, have sensitized him to his patients’ mental as well as physical extremes.
“It’s an awful lonely place,” he said of the isolation ward. “There are nurses and others who enter, too, but it’s not like a normal hospital where you can call for help and expect someone to come. It’s not possible. It’s not practical.” Because of the heat, amplified in the tents, “we can only be in there in our suits for an hour or so, and it takes us that long to get in and out of them, too.” The patients have to wait. “And when we do come,” Portnoy said, “they can’t see us at all. We’re just a stranger in this ridiculous, plastic suit. We’re barely recognizable as a person. They’re struggling with the hardest thing they’ve ever faced, and they’re alone.”
The center where he works, ELWA3, has the same number of patients as it did last week—60—8 or 10 of which are new. It’s had 8 to 10 recover and leave, or who didn’t make it. It’s demonstrated that careful, supportive care does improve a patient’s chances, reducing the mortality rate from 70 percent to closer to 45 percent, according to the World Health Organization. The center is operated by Médecins Sans Frontières/Doctors Without Borders, and Portnoy says he and the other doctors are daily reviewing their protocols and thinking of ways to improve them. Recently, they’ve been preparing for what might happen if someone passes out in their suit while in the contamination zone.
The rainy season is supposed to have been ending, but it’s still been wet—“just epic, soaking rains,” Portnoy reports—and it’s been humid and sweltering by day, making it essential they complete their morning rounds early. Except for the morning after his night shift, Portnoy rises at 6, has breakfast at 6:30 (fresh fruit, yogurt, “some really strange-looking sausages”), and joins the full staff meeting at 7. At 7:30, he’s in a second medical team meeting, and by 8:30 starts pulling on scrubs and the multiple layers of personal protective equipment (PPE).
Dressing to go into the high-risk zone has offered a few moments of comedy. Because the scrubs have been donated from all over, you just never know what your colleagues are going to be wearing. “It might be the standard green, but it might be bright pink,” Portnoy said. “Sometimes you’ll be standing there and look up and there’s this hulking guy of 6-3 in a too-small shirt with teddy bears all over it.” Another guy’s scrubs were labeled “ALCATRAZ OUTPATIENT CLINIC.”
Portnoy said he’d been learning how best to care for his patients from the Liberian staff. “They’re amazing. They were here during the worst of it, when there weren’t enough beds and the mortality rate was very high, and they’ve stuck with it and are still deeply committed,” Portnoy said. “And they help us understand the cultural differences—how the patients are processing what they’re going through.”
Some of his fellow expats at ELWA3, meanwhile, are on their second or third tour. This includes Portnoy’s immediate supervisor, an Italian, who, Portnoy said, packed about two T-shirts, some underwear, shorts, one pair of pants, and saved all the rest of the room in his luggage for mortadella, cheese, and Italian wine. How long this seemingly endless stash will last—and what he’ll produce from it next—has enlivened a few dinners, which they all take together.
Portnoy’s biggest smile last week, though, was when a patient who was doing better came to a window in the hospital tent, a window where they can look out and talk to people at a safe remove, 6 to 10 feet away. Portnoy called to the patient by name and introduced himself, “It’s me, Doctor Darin.”
The man looked back at him, a bit startled.
“That’s what you look like?!” he said, before confessing that, without his bright yellow suit, Portnoy didn’t look at all like what he’d imagined.
