A Good Death — Ebola and Sacrifice

The first priority was to get the patient out of the common room and into an isolation room, but the bed he was lying on was too wide for the doorway. So Dr. Brisbane, Dr. Borbor, and two custodians hastily donned gowns, gloves, and masks, then lifted the patient — mattress and all — and carried him into the isolation room, nearly dropping him in the process. The man had begun gasping for breath, and despite their efforts, within 5 minutes he was dead. Later that day, laboratory tests confirmed that he was indeed infected with Ebola virus. His body stayed in the now-otherwise-empty ED until it was retrieved hours later by the health ministry.

We remained in Monrovia for the next week and helped however we could. Dr. Brisbane brought his own thermometer and checked his temperature religiously, fearing the telltale sudden fever. He wore a fedora in the hospital as a protective talisman. And yet he still joked with us, displaying a sort of gallows humor.

A few days after we'd returned to the States, we got a call from a friend in Monrovia saying that Dr. Brisbane was in isolation and had tested positive for Ebola. The next call informed us of his death and hasty burial on his plantation. By late August, Dr. Ireland and one of the nurses we knew had contracted Ebola and were fighting for survival, and Dr. Borbor and a physician assistant who'd worked in the ED had died from the virus.

Dr. Brisbane didn't have to stay at JFK and continue to care for patients. He could easily have retired to his coffee plantation with his wife and children and grandchildren. He was terrified of Ebola, and yet we knew that every morning when we entered the ED, we'd find him there, seeing his patients.

Doctors and nurses have a duty of care toward their patients.1 We're expected, on the basis of our training and an unwritten social contract, to fulfill that duty even in less-than-ideal circumstances — in the face of depleted resources, for example, or undesirable patients. But we also have a duty to ourselves and our families, and when our work becomes life-threatening, we have to decide what benefit we will be to our patients and what cost it will exact from us. In such circumstances, we cannot be expected to uphold the same duty of care. But during the world's worst Ebola outbreak to date, clinicians like Dr. Brisbane are on the front lines — and are dying as a result. They care for patients despite the risks to themselves, despite the inadequate supplies and infrastructure, despite their insufficient training in infection control.

Dr. Sam Brisbane's death diminishes us as a people. But with apologies to his wife and family, who saw him die horribly and unjustly, and despite the deep loss we feel, we believe our friend died a good death — as did all the nurses and doctors who have sacrificed themselves caring for patients with this awful disease.

Note: This article was reprinted with permission of the New England Journal of Medicine (10.1056/NEJMp1410301).

References

1. Sokol, D.K. Virulent epidemics and scope of healthcare workers' duty of care. Emerg Infect Dis 2006;12:1238-1241