Abass’s Smile

 by Emily Scott

I arrived for my evening shift at Maforki on Monday anxious to hear how my patients had fared since I’d last seen them 24 hours before. I expected (and part of me hoped) to hear that Foday had passed away and was no longer suffering. No one I worked with could remember seeing a patient recover after progressing to the bleeding stage, so it had begun to feel like we were simply torturing him. I dreaded the thought that Abass might have died.
I immediately scoured the whiteboard with patients’ names and breathed a deep sigh of relief to see that Abass was still on it. When day shift reported that he had seemed a little better to them, I told myself it was because he was on the upswing; that the worst hadn’t killed him, so he would survive.
Monday night taught me that you can’t make predictions about Ebola. Another patient in Abass’s room, a 36-year-old woman named Mariatu, had been looking comparatively well when I met her on Saturday. She was sitting up in bed, eating and drinking and completely lucid, unlike her roommates Foday and Abass. Although she had diarrhea and vomiting the last time I’d seen her on Sunday, she still seemed to be in better shape than the others. When we reached her bedside during our first round in the Red Zone, she was moaning with pain and laboring heavily to breathe. Since we hadn’t anticipated Mariatu being in so much discomfort, we hadn’t brought any pain medicine into the Red Zone for her. We had used our last dose on a patient in the previous ward. She would have to wait until our next round in a couple of hours before we could get her some. Promising her that we would be back to take care of her, we left Mariatu in bed moaning in pain.
When we returned for our second round at 9:45 pm, it felt eerie in the dim fluorescent light of the Red Zone. We found Mariatu lying on the ground just outside the door of her ward. I suddenly remembered another nurse checking under the beds while he was giving us a tour of the Red Zone, and telling me about this “weird Ebola thing” – that patients often crawl out of bed near the end and die on the floor.
But Mariatu was still alive, breathing hard and looking at us with wide, terrified eyes. I helped my coworkers sit her up against the wall, then stepped into the ward to check on Foday and Abass. When I turned back to the door a minute or two later to ask if they needed help getting Mariatu back into bed, they told me she was already dead.
I couldn’t believe I’d heard right. I started to take a moment to process it, then looked around at the rest of my team who were moving forward with the job at hand. With only 90 minutes in the Red Zone, we don’t have any time to waste. Mariatu’s body was left where we found her and covered with a lapa. Ebola is extremely contagious in the bodies of the deceased, and it wasn’t our job to care for her any longer. The corpse team would be called after we left the Red Zone, and they would come the next day to move her to the morgue so the specially-trained burial teams could come to pick up her body. Nowadays every death in Sierra Leone (whether Ebola-related or not) is handled by the burial teams in full PPE, just to be safe.
With nothing left that I could do for Mariatu, I walked back to check on 10-year-old Abass. He and his 25-year-old neighbor Foday were now both lying on mattresses on the floor; they’d been moved out of bed when they were agitated and the clinicians worried they might fall. Abass had pulled his IV out since we’d last seen him, and another team member felt he would die overnight if we didn’t get another one in him. In the poor light, no one felt excited about attempting it: An accidental needle stick injury to one of us is statistically a death sentence. One of the national nurses stepped up without missing a beat, and had a beautiful IV in Abass’s arm before the rest of us could even tell her to be careful. We hooked him up to a bag of IV fluid and were feeling pretty good.
Then the lights went out.
I won’t pretend it isn’t scary to be the the Red Zone of an ETU at night with no lights. You become extremely aware of all the infectious material around you that you suddenly can’t see. I hate to be dramatic, but it does feel a little like a horror movie. Unfortunately power outages aren’t an unusual occurence, so our more experienced coworkers had warned us beforehand that if we found ourselves in total darkness in the Red Zone, we would have to stop whatever we were doing and leave. I knew we had to go for our own safety, but I wanted to scream out of frustration, since we’d just arrived and had barely started caring for our patients. I was fortunately still holding the battery-powered LED light I’d shined on Abass to help the national nurse get more direct light to start his IV. We all agreed we could take a moment to unhook his IV fluids, otherwise he would tear his IV out again as soon as we walked away.
As soon as we had unhooked Abass’s line and resolved ourselves to leave, the ceiling lights sputtered and flickered back to life. The Red Zone is not a comfortable place to be, but I silently cheered that we wouldn’t have to leave. We restarted Abass’s fluids and decided to try to feed him since he was awake and calm. Fortunately some formula had been left in the Red Zone, so I drew up a few mililiters in a small syringe, squatted on the floor next to his mattress, and held it to his lips. I knew he had painful mouth sores and I worried that he’d refuse it, but he silently swallowed the tiny amount that I squirted into his mouth. I flicked away an ant that skittered across his mattress. Another nurse sat above him, stroking his head. We both encouraged him to eat and cheered him on every time he swallowed a few drops. His eyes met mine while I told him how well he was doing, and I felt sure he was lucid. I tried a silly little dance and suddenly he was smiling. His grin was weak but wide, and his eyes were bright, and all of a sudden I could clearly see the little boy he was before he was sick. I laughed and smiled back at him as hard as I’ve ever smiled, certain that he would see it in my eyes if I could just smile hard enough, even though my mask and hood covered every other part of my face. He babbled at me in a language I couldn’t understand, then called out “Auntie, auntie!”
I don’t know how long my friend and I sat there, entreating him to swallow drops of formula, rubbing his head and his bare chest, dancing and singing in our suits, hoping to elicit another smile. We were rewarded with a few more beautiful grins before Abass shut his mouth and refused to eat any more.
Our time was up anyway. I knelt beside him and told him he was strong. I promised we would be back for him soon. Maybe he didn’t understand, but I think some things don’t need to be translated. I reluctantly stood up and walked away, leaving him alone with his neighbor Foday struggling to breath, and the body of Mariatu just outside the door. As we were leaving the ETU later that night, one of the other nurses told me she thought he had a shot.
Abass died the next day.
I don’t know if he was afraid, or in pain, or even if anyone was there with him. I hope someone was. I hope I made his last night a little less frightening. I think I brought him joy and I have to believe that matters.
I wish I could find the right thing to say to make his death meaningful, but I don’t think there’s any meaning in a 10-year-old dying alone on the floor. I could rant about how he might have been saved if he’d had access to the best medical care in the world, but I’d rather just let him be a sweet little boy than an example of all the injustice in the world. Even though it was only for a fraction of the time I spent with him, I’ll always think of him as Abass with the big contagious grin and the bright eyes, not as one of thousands of children who have died of Ebola. I didn’t know him very well, but now you all know a little piece of him too, and I think that counts for something.