I'm dreaming that I'm back in Liberia. In the dream, I'm walking around with my camera looking for people I know. But the streets are eerily deserted, and I can't find anyone.
I wake up in a dark room. I wonder if that's what it would feel like to be dead — alone and confused. The beep of the EKG and throb from my neck where medical personnel inserted the IV remind me I'm not dead. I'm at the Nebraska Medical Center; it's mid October and nine days ago, I was diagnosed with Ebola. It's starting to look fairly certain that I will live.
I glance at the clock on the concrete wall opposite my bed: 4am. In two hours they'll come to draw blood from the tubes in my neck so the Centers for Disease Control and Prevention (CDC) can run tests. Soon, I hope, my blood will come back negative for Ebola, but today I know it will be positive. My head starts to hurt again. I think about Liberia and how lucky I am to be an Ebola survivor. Or is it too early to say that?
* * *
It's late August, and I'm in England with my girlfriend. I'm reading an article in the New York Times about how badly things have deteriorated in Liberia since I left last May — army troops appear to have opened fire on people who violated quarantine in a Monrovia neighborhood that I used to live next to. It has become impossible for me to read about what is happening in Liberia from far away, so I open a new window on my laptop and start searching for flights.
* * *
The first two weeks of September go by quickly despite my long days. I try to get as much writing and video to as many news outlets as I can. Most Monrovians are nervously going about their lives, but outside of Ebola clinics the scenes are devastating. People die in the back seats of cars, while ambulances place half-conscious people on the ground, where they wait for beds to open. Every night, trucks pick up dozens of bodies from each clinic, take them to a secluded site near a beach, and burn them.
The stress starts to build. I'd only seen a few dead bodies over the course of my life prior to this trip. The first day I'm back in Liberia I see three. One is a girl who looks to be about 8 years old.
Every day I see acts of bravery from Liberians. Exhausted doctors, overworked ambulance drivers, underpaid nurses. I ride around with one of the "burial teams" who carry potentially infected bodies out of the houses in which they die. I meet Ebola survivors. Some flash broad smiles of relief, others swim in grief. One survivor tells me about how she forced herself to eat when she was in treatment and had no appetite. Later I will think of her every time I see food.
* * *
Late September. Last week I worked with VICE News, this week I'm shooting for NBC. I like the crew. One of the producers tells me she needs me to go across town to interview a CDC worker who's staying in a fancy hotel. I'm in a great mood as I head to the car. But then I lean back into my seat and feel a strange ache roll across my back. What the fuck was that? I ask the driver to swing by my apartment. I need to take my temperature.
Once there, time moves in slow motion. My heart pounds. Panic envelops me as I watch the dial on the thermometer: 99.1… 99.7… 100.3… 100.8… 101.3… beep beep beep. I unwrap a second thermometer, hoping the one I just used was malfunctioning. No such luck. I throw the thermometer onto the bed and put my head in my hands.
I can see fear in the eyes of the nurses at the sight of my blood, which is now one of the most dangerous substances on the planet.
Malaria is one of the world's most lethal diseases and a constant threat in West Africa. In the two years I lived in Liberia, I came down with malaria nearly a dozen times — but by the end, I didn't even skip work. Instead I'd buy pills for about $5 and get on with my day. Malaria always came on the same way for me: a fit of sneezing and a runny nose.
I know that I do not have malaria.
I can't even feel my feet touch the ground as I realize that it's possible I've contracted Ebola. I put on rubber gloves, pour bleach onto a towel, and wipe down all the doorknobs I touched on the way in. Then I start contacting people. My email to my father reads: "Call me right away. Unfortunately I might be in trouble." I pace on the balcony, chain-smoking in the dark. Of course the night I come down with Ebola, the fucking power is off.
I call NBC and tell them that I'm quarantining myself. They tell me they've "got my back." I pace some more. As I do, I notice a pain in my knee, like I twisted it playing sports. But I haven't exercised in a month. I text my girlfriend and notice that my arm feels sore and that my thumb isn't as tactile as usual. The phrase "sudden onset of symptoms" pops into my mind.
An hour or so later, an American who works for the World Health Organization (WHO) calls me and asks me to explain how I'm feeling and whether I've been around Ebola patients. I tell him I'm a journalist and that yes, I have. I describe my temperature spike and joint pain. His tone is not reassuring.
We decide on a plan. I will try (unsuccessfully) to sleep. The next morning I'll go for a test at the Médecins Sans Frontières/Doctors Without Borders (MSF) facility that I've stood outside a dozen times with a camera in my hand. I talk to my father, who says that the WHO thinks it's "highly likely" that I have Ebola and that he's already talking to the State Department about an evacuation flight. I have a 50/50 shot of living if I stay in Liberia for treatment. Could be worse.
* * *
The next morning, I walk up to the MSF gate. A few people are milling around, anxious expressions on their faces. They look like family members who came to get word about their relatives inside; Ebola's secondary victims are those who love or rely on the sick. The MSF staff is expecting me and let me inside. The nurse who opens the door of the gate doesn't make eye contact.
I sit down in the "dirty area." A doctor and two Liberian nurses sit on the other side of a chest-high barrier. I am feeling woozy and tired. The doctor is American; he looks at me with concern and asks me to explain my symptoms. Headache, fever, weakness, joint pain, no appetite. The look in his eyes speaks words I wish I couldn't hear. A memory flashes into my mind: me on the other side of the barrier, pitying the Ebola patients during a tour of the facility a week ago.
* * *
I've been lying on a cot for six hours, waiting for my results to come back. Some Liberians are on cots next to mine, also waiting for the answer to their terrible question. Some are very young, most look sick, a few can't even stand. An old man wearing Muslim garb groans in pain with his eyes clenched shut.
Two MSF workers wearing masks and goggles enter the large tent and walk toward me. Colors seem very vivid: The white of the tent, the blue of the sky behind them, and the yellow of their rubber bibs. They walk with purpose, their eyes severe. They stop a few feet in front of me and pause. Eventually one of them says, "The results of your PCR have come back. You've tested positive for the Ebola virus disease."
The universe is now frozen and full of terrible electricity. A cloud of fear and desperation enters my mind. In the time it took to get the results back, my condition has worsened. I have a headache and my eyes feel thick. The diagnosis was not unexpected, but its finality robs me of the small hope I had of a false alarm. I recognize that I'm in mortal danger. I call my girlfriend and tell her the news. She cries and begins packing to head to my parents' house.
Later I find out that she packed a black outfit, just in case.
* * *
The US embassy calls. They are working on arranging an evacuation plane for me that is likely to come on Monday. Today is Thursday. That means four days here.
MSF staff lead me to an empty white tent in the "confirmed" unit and drag a mat onto the floor. One points to three buckets lined up next to each other, all filled partially with chlorinated water. "Vomit, Feces, and Urine," he tells me. A friend has brought me a pillow and blanket, along with some juice and toys to give to children in the facility. I decide that I do not feel like playing with children right now. The toys will stay in the bag.
Ebola. The word echoes through my head along with snippets of the Ebola awareness songs that play endlessly on Liberian radio. How did I pick it up? I was so careful. I never touched any sick people. I kept my distance and sprayed chorine constantly. I decide that it's pointless to obsess over the how and that I should save my energy for the more pressing battles to come.
Night falls. An MSF doctor enters the tent. His name is Dr. Rick or Dr. Joe or some other common first name that I won't be able to remember later. All I can see are his eyes. He gives me antibiotics and malaria medication and explains the progression of the disease. First, fevers and pain, then gastrointestinal symptoms like vomiting and diarrhea — but that won't kick in for several days. Chlorine drips from his suit onto the floor. The smell of it is overwhelming.
I get up to retrieve my phone from the communal charging outlet. On the way, I look into a tent filled with Liberian patients. They lie on their mats, weak and in pain, alone together. "My stomach is running-oh," says a man sitting in a chair next to me. He looks up at me with wet eyes. "My stomach won't stop running." He's scared. I tell him to keep drinking his bottles of rehydration salts. "I keep drinking it but still, my stomach just keeps on running." I don't know what else to say, so I walk away.
The boy stumbles into the tent, an unseeing look in his eyes. I learn later that delirium is one of the final stages before death.
The fever intensifies and I start to feel chills ripple through my body. I get cold in the tropical night and pull the covers tighter. Time drifts as I slip in and out of a listless sleep. I wake up in the middle of the night with a terrible, sharp pain in my abdomen that lasts for 10 minutes and then subsides. I try not to think about what it could mean.
I wake up on day two feeling great — no headache or pain. I decide I've miraculously beaten Ebola in 36 hours. When a nurse comes in I tell her how well I'm doing. She looks at me with sad eyes and motions with her hand. "This thing goes up and down," she says.
My phone blows up. The news has broken and everyone I know in Liberia is calling me, but I don't want to talk. What would I say? "I hope I live too." I pick up unknown numbers, hoping they're calls about my evacuation. One is a Liberian colleague that I haven't talked to in months. "Thank you for being here, Ashoka. I am praying for you," he says. It brings me close to tears.
The WHO representatives are at the nurse's station and want to talk to me. I drag myself to my feet and shuffle toward them. They smile, ask me how I'm doing, and tell me the flight will now come a day early, on Sunday. I can barely stand and suddenly my entire field of vision washes out into a bright white blur. I interrupt them. "I need to go lie down."
Oral Rehydration Salts (ORS) should be called TLS (Tastes Like Shit). They are bottles of salty, electrolyte-rich saline. If you're not getting intravenous rehydration, the combination of ORS and anti-diarrhea medication is your best bet to keep from dehydrating and dying of organ failure. This is essentially the extent of the treatment most Liberian Ebola patients receive at the overtaxed MSF facility. There are not enough nurses or doctors to put IVs into everyone. I drink ORS like it's the elixir of life.
I catch a glimpse of my eyes in the reflection of my phone. They are fire red. Silently I wonder, Am I going to die? The question's gravity pulls the sides of the tent inwards. "No. I'm going to live." I say it out loud.
* * *
That night a giant walks into the tent. I weakly stare up at him and the cascades of yellow rubber and white Tyvek that cover his body. "My name is Toe," he booms in a thick Liberian accent. "My name is Toe, and you and me are going to be friends. I like to see strong young guys like you get well. I run the burial team here." I like him. But I imagine his giant arms loading bodies (my body) into a truck and hope he leaves as soon as possible.
I wake up the next morning in a pool of sweat with numb hands. My eyelids are heavy and I can barely see. There is a Liberian nurse standing over me. She cleans the tent and gives me pills to swallow; she is crying. "I love you. I just love you so much. I'm so sorry," she says. I'm not sure whether I should comfort her. I thank her and tell her I'm going to fight and win.
Nurses bring a cot into the tent. A young boy who looks to be about 15 years old lies on it. He cries softly and then groans in his sleep. I think of all the people I filmed lying in the dirt or stuck in hot ambulances, and for the first time I understand their fear and pain. The boy is carried elsewhere, but later he stumbles back into the tent, an unseeing look in his eyes as though he's trying to escape reality. I learn later that delirium is one of the final stages before death.
Twenty-eight hours left until evacuation. Chlorine has become the only smell on Earth for me. Empty bottles of ORS pile up and are taken away. I clutch the covers close, shivering from the cold. But when I open my eyes, I see that it is the middle of the day and there are no clouds; it must be over 85 degrees. I notice that I am sweating so much that the blanket is nearly soaked through.
My new doctor is named Dr. Dan. They use first names so that Liberian patients can remember them. Dr. Dan, who is friendly and has a good bedside manner, tells me that if I can make it to day 12 I'll survive. It's currently day 4. He decides to put an IV into my arm and brings nurses to help. When the needle enters my skin I bleed ferociously. I can see fear in the eyes of the nurses at the sight of my blood, which is now one of the most dangerous substances on the planet.
Every night, the sound of sick Liberians singing church hymns drifts into my tent. Their voices fill the ward as the fires that have been set to burn the day's PPE suits cast flickering shadows on the tents. Those who are recovering sing the loudest. Some of the weaker voices will be silenced forever by morning. It is beautiful, and for a few moments when I hear it, I have no fear.
* * *
Two hours left until I'm scheduled to leave. MSF workers enter the tent and tell me my plane is on the tarmac. I don the Tyvek booties and jumpsuit they give me, and put on rubber gloves. I'm brought to a Land Cruiser that has blue plastic sheeting in the back to separate me from the driver. I get in and lay down.
The plane sits on the runway, steel grey and sleek. I contemplate the surreal circumstances that have led to a jet arriving in Liberia solely for me, and I know I am fortunate beyond words. I walk up the stairs and pass through a plastic zippered door into the back of the plane, and I am hit by a wall of air-conditioning. It feels amazing. There is a bed with a mattress, and there are small Oreo cookie packets that I decide to eat despite my lack of appetite. I've never felt more comfortable in my life. The nurse clocks my fever at 104 degrees.
The jet shudders and whines and roars. Soon many of the Liberian patients at MSF will die and be taken to a funeral pyre by Toe and his team, where their corpses will be burned. I am heading to the United States, where 40 people will work around the clock for a week to save my life. I close my eyes and fall into a deep sleep as Liberia recedes into the distance.
Follow Ashoka Mukpo on Twitter: @unkyoka