News / National
Zimbabwean born Ebola doctor's return from the 'Edge of Death'
09 Dec 2014 at 10:37hrs | Views
The medical record, from an Ebola case, made for grim reading, but Dr. Ian Crozier could not put it down. Within days of the first symptom, a headache, the patient was fighting for his life. He became delirious, his heartbeat grew ragged, his blood teemed with the virus, and his lungs, liver and kidneys began to fail.
"It's a horrible-looking chart," Dr. Crozier said.
It was his own. Dr. Crozier, 44, contracted the disease in Sierra Leone while treating Ebola patients in the government hospital in Kenema. He was evacuated to Emory University Hospital in Atlanta on Sept. 9, the third American with Ebola to be airlifted there from West Africa. He had a long, agonizing illness, with 40 days in the hospital and dark stretches when his doctors and his family feared he might sustain brain damage or die. His identity was kept secret at his request, to protect his family's privacy.
Now, for the first time, he is speaking out. His reason, he said, is to thank Emory for the extraordinary care he received, and to draw attention to the continuing epidemic. He and his family granted their first interviews to The New York Times, and gave permission to interview his physicians.
His account offers glimpses of the hardships and dangers that have confronted doctors and nurses who volunteered to fight an epidemic that has claimed the lives of more than 330 health care workers - most of them African - and of the desperate need that has drawn them to the front lines. Dr. Crozier told of three brothers, just 4, 5 and 11, who fought for their lives on his ward in Kenema. Not long after, he lay near death in an isolation room at Emory, with his mother reading him poetry through an intercom.
Dr. Crozier, soft-spoken and genial, is now on the mend in Phoenix, where his parents and sister live. But the disease has taken its toll. Six-foot-5 and 220 pounds before he got Ebola, he has lost 30 pounds, much of it muscle. He tires easily, but has begun a grueling physical therapy program to rebuild wasted muscles.
"Ian was by far the sickest patient with Ebola virus that we've cared for at Emory," said Dr. Jay B. Varkey, an infectious-disease specialist.
Doctors say his recovery has taught them that aggressive treatments, even life-support measures like ventilators and dialysis, can save some Ebola patients. Dr. Bruce S. Ribner, who leads the Emory team, said that until recently the general practice was not to bother intubating Ebola patients or put them on dialysis, because if they got that sick they were going to die.
"One of the things Ian taught us was, guess what, you can get sick enough to need those interventions and you can still walk out of the hospital," Dr. Ribner said. "I think it has sent a message to our colleagues around the world."
Young Brothers in Peril
Dr. Crozier was born in Masvingo, Rhodesia (now Zimbabwe), but his family moved to the United States when he was 10, and he became an American citizen. He went to medical school at Vanderbilt University on a scholarship, specializing in infectious diseases.
He was always drawn back to Africa. He was living in Uganda, treating patients with H.I.V. and training doctors at the Infectious Diseases Institute in Kampala, when Ebola broke out in West Africa. He wanted to help.
"Anyone who was on the ground in Africa and not in West Africa, you would think, maybe we're missing the bus, missing something remarkable," he said. "And my skills meet the need."
Dr. Crozier signed on with the World Health Organization - expenses only, no pay - and by August he was in Kenema. He planned to stay three or four weeks.
It was even more wrenching than he had imagined - the sights, the sounds, the smells, the steady stream of deaths. There were often 60 to 80 patients, sometimes more, suspected and confirmed cases, from all over the country. They arrived day and night.
Blood, stool and vomit were ever-present though cleaners mopped with chlorine several times a day. Choruses of delirious patients with bloodshot, eerily vacant eyes would shout "Doctor! Doctor!" over and over. Some were too sick to clean or feed themselves, and there were never enough staff members to tend to them. A patient might lie in one bed and a corpse in the next, waiting to be disinfected, bagged and taken away.
"Those isolation wards are horrible places," Dr. Crozier said.
But there were moments of grace. Mothers whose babies had died would feed children who were orphaned or alone.
"Childless parents took care of parentless children," he said.
The protective gear required to enter the ward - hood, masks, rubber boots, goggles, double gloves, Tyvek suit - was stifling. No one could wear it for more than an hour without becoming dangerously overheated. Dr. Crozier would go into the ward two or three times a day for as long he could stand it. When he came out to cool off, he would pour the sweat out of his boots.
One night, the three young brothers were brought in. All were infected. Their mother had died, and their father was absent.
"I didn't think they'd survive," Dr. Crozier said.
The oldest, Victor, 11, was also the sickest. Dr. Crozier, the oldest of four children in his family, saw a bit of himself in Victor. The boy had taken on the role of father, and even when he was lying on a mattress on the floor, soiled by vomit and diarrhea, the younger ones, Shaku and Ibrahim, would not leave him.
"They were this little band of brothers," Dr. Crozier said. Sometimes he wished he could rip off his protective gear and hold them.
The last thing he would do at night was make sure they and the other children were fed.
Returning to the ward each morning, he kept expecting to find that one or more of the brothers had died. But they kept surprising him.
"They just sort of pushed each other through it," he said.
They recovered enough to race around the ward with other children - including two boys named Success and Courage - playing, laughing and making a nuisance of themselves, Dr. Crozier said.
"In such a dark place, they were little cracks of joy," he said. The brothers survived, but others like them did not.
Many local nurses had contracted Ebola and died in Kenema. Aid workers from other countries also became infected, and Dr. Crozier arranged medical evacuation flights for several of them. He never dreamed he would become a passenger on that plane.
On the morning of Saturday, Sept. 6, during rounds on the ward, he developed a fever and a headache. He isolated himself in his hotel, hoping he had malaria. A colleague brought equipment so that Dr. Crozier could draw his own blood for an Ebola test.
She called him the next morning, crying: His Ebola test was positive.
He had no idea how he had become infected.
The plane picked him up on Monday. The World Health Organization paid for the flight, and his medical care. Neither W.H.O. nor Emory would provide an estimate of the cost, but a spokesman for Emory acknowledged that treating Ebola patients was very expensive.
Dr. Crozier took pictures of himself during the flight as his face swelled and he broke out in a rash. It may have been a way to disconnect from fear, he said.
"I had seen seven, eight, nine, 10 people a day die from what I had," he said, adding, "If I had stayed in Kenema, I would have been dead in a week."
Deteriorating Condition
He has no memory of the three weeks after he arrived at Emory. The isolation unit there was built 12 years ago at the request of the Centers for Disease Control and Prevention, which is less than a mile away.
Dr. Varkey, the infectious-disease specialist, said there were warning signs early on that Dr. Crozier might become severely ill. The viral load in his blood was extremely high, more than 100 times that of the other patients Emory had treated. And he was becoming delirious, a sign of encephalitis. Doctors do not know why some patients become so much sicker than others. Dr. Crozier's age may have worked against him: People over 40 tend to have worse outcomes than younger ones.
His family and girlfriend filled with dread as they watched him decline. They could not enter his room, but could see him through a window and talk to him over an intercom. His temperature was 104 degrees. His hands shook violently. He spent more and more time sleeping, and sank into delirium, his mind still in Kenema.
The family had been warned that Ebola often causes such intense diarrhea that patients can lose eight or 10 quarts of fluid a day, and Dr. Crozier was heading toward that stage. He would be pumped full of fluids and salts to prevent dehydration, which kills many Ebola patients. The family thought that once he got through that phase, he would start to improve.
Instead he got worse. By Friday he was struggling to breathe, his chest heaving. The sight tore at his relatives. On Sunday morning, he was placed on a ventilator.
"It seemed to signify final stages," said his sister, Anne.
"It's a horrible-looking chart," Dr. Crozier said.
It was his own. Dr. Crozier, 44, contracted the disease in Sierra Leone while treating Ebola patients in the government hospital in Kenema. He was evacuated to Emory University Hospital in Atlanta on Sept. 9, the third American with Ebola to be airlifted there from West Africa. He had a long, agonizing illness, with 40 days in the hospital and dark stretches when his doctors and his family feared he might sustain brain damage or die. His identity was kept secret at his request, to protect his family's privacy.
Now, for the first time, he is speaking out. His reason, he said, is to thank Emory for the extraordinary care he received, and to draw attention to the continuing epidemic. He and his family granted their first interviews to The New York Times, and gave permission to interview his physicians.
His account offers glimpses of the hardships and dangers that have confronted doctors and nurses who volunteered to fight an epidemic that has claimed the lives of more than 330 health care workers - most of them African - and of the desperate need that has drawn them to the front lines. Dr. Crozier told of three brothers, just 4, 5 and 11, who fought for their lives on his ward in Kenema. Not long after, he lay near death in an isolation room at Emory, with his mother reading him poetry through an intercom.
Dr. Crozier, soft-spoken and genial, is now on the mend in Phoenix, where his parents and sister live. But the disease has taken its toll. Six-foot-5 and 220 pounds before he got Ebola, he has lost 30 pounds, much of it muscle. He tires easily, but has begun a grueling physical therapy program to rebuild wasted muscles.
"Ian was by far the sickest patient with Ebola virus that we've cared for at Emory," said Dr. Jay B. Varkey, an infectious-disease specialist.
Doctors say his recovery has taught them that aggressive treatments, even life-support measures like ventilators and dialysis, can save some Ebola patients. Dr. Bruce S. Ribner, who leads the Emory team, said that until recently the general practice was not to bother intubating Ebola patients or put them on dialysis, because if they got that sick they were going to die.
"One of the things Ian taught us was, guess what, you can get sick enough to need those interventions and you can still walk out of the hospital," Dr. Ribner said. "I think it has sent a message to our colleagues around the world."
Young Brothers in Peril
Dr. Crozier was born in Masvingo, Rhodesia (now Zimbabwe), but his family moved to the United States when he was 10, and he became an American citizen. He went to medical school at Vanderbilt University on a scholarship, specializing in infectious diseases.
He was always drawn back to Africa. He was living in Uganda, treating patients with H.I.V. and training doctors at the Infectious Diseases Institute in Kampala, when Ebola broke out in West Africa. He wanted to help.
"Anyone who was on the ground in Africa and not in West Africa, you would think, maybe we're missing the bus, missing something remarkable," he said. "And my skills meet the need."
Dr. Crozier signed on with the World Health Organization - expenses only, no pay - and by August he was in Kenema. He planned to stay three or four weeks.
It was even more wrenching than he had imagined - the sights, the sounds, the smells, the steady stream of deaths. There were often 60 to 80 patients, sometimes more, suspected and confirmed cases, from all over the country. They arrived day and night.
Blood, stool and vomit were ever-present though cleaners mopped with chlorine several times a day. Choruses of delirious patients with bloodshot, eerily vacant eyes would shout "Doctor! Doctor!" over and over. Some were too sick to clean or feed themselves, and there were never enough staff members to tend to them. A patient might lie in one bed and a corpse in the next, waiting to be disinfected, bagged and taken away.
"Those isolation wards are horrible places," Dr. Crozier said.
But there were moments of grace. Mothers whose babies had died would feed children who were orphaned or alone.
"Childless parents took care of parentless children," he said.
The protective gear required to enter the ward - hood, masks, rubber boots, goggles, double gloves, Tyvek suit - was stifling. No one could wear it for more than an hour without becoming dangerously overheated. Dr. Crozier would go into the ward two or three times a day for as long he could stand it. When he came out to cool off, he would pour the sweat out of his boots.
One night, the three young brothers were brought in. All were infected. Their mother had died, and their father was absent.
The oldest, Victor, 11, was also the sickest. Dr. Crozier, the oldest of four children in his family, saw a bit of himself in Victor. The boy had taken on the role of father, and even when he was lying on a mattress on the floor, soiled by vomit and diarrhea, the younger ones, Shaku and Ibrahim, would not leave him.
"They were this little band of brothers," Dr. Crozier said. Sometimes he wished he could rip off his protective gear and hold them.
The last thing he would do at night was make sure they and the other children were fed.
Returning to the ward each morning, he kept expecting to find that one or more of the brothers had died. But they kept surprising him.
"They just sort of pushed each other through it," he said.
They recovered enough to race around the ward with other children - including two boys named Success and Courage - playing, laughing and making a nuisance of themselves, Dr. Crozier said.
"In such a dark place, they were little cracks of joy," he said. The brothers survived, but others like them did not.
Many local nurses had contracted Ebola and died in Kenema. Aid workers from other countries also became infected, and Dr. Crozier arranged medical evacuation flights for several of them. He never dreamed he would become a passenger on that plane.
On the morning of Saturday, Sept. 6, during rounds on the ward, he developed a fever and a headache. He isolated himself in his hotel, hoping he had malaria. A colleague brought equipment so that Dr. Crozier could draw his own blood for an Ebola test.
She called him the next morning, crying: His Ebola test was positive.
He had no idea how he had become infected.
The plane picked him up on Monday. The World Health Organization paid for the flight, and his medical care. Neither W.H.O. nor Emory would provide an estimate of the cost, but a spokesman for Emory acknowledged that treating Ebola patients was very expensive.
Dr. Crozier took pictures of himself during the flight as his face swelled and he broke out in a rash. It may have been a way to disconnect from fear, he said.
"I had seen seven, eight, nine, 10 people a day die from what I had," he said, adding, "If I had stayed in Kenema, I would have been dead in a week."
Deteriorating Condition
He has no memory of the three weeks after he arrived at Emory. The isolation unit there was built 12 years ago at the request of the Centers for Disease Control and Prevention, which is less than a mile away.
Dr. Varkey, the infectious-disease specialist, said there were warning signs early on that Dr. Crozier might become severely ill. The viral load in his blood was extremely high, more than 100 times that of the other patients Emory had treated. And he was becoming delirious, a sign of encephalitis. Doctors do not know why some patients become so much sicker than others. Dr. Crozier's age may have worked against him: People over 40 tend to have worse outcomes than younger ones.
His family and girlfriend filled with dread as they watched him decline. They could not enter his room, but could see him through a window and talk to him over an intercom. His temperature was 104 degrees. His hands shook violently. He spent more and more time sleeping, and sank into delirium, his mind still in Kenema.
The family had been warned that Ebola often causes such intense diarrhea that patients can lose eight or 10 quarts of fluid a day, and Dr. Crozier was heading toward that stage. He would be pumped full of fluids and salts to prevent dehydration, which kills many Ebola patients. The family thought that once he got through that phase, he would start to improve.
Instead he got worse. By Friday he was struggling to breathe, his chest heaving. The sight tore at his relatives. On Sunday morning, he was placed on a ventilator.
"It seemed to signify final stages," said his sister, Anne.
Source - nytimes
