This is how people lose their minds

Six months ago I almost died. It’s taken this long to know how to write about it.

These are the parts that I remember.

It started simply and quietly as exhaustion. Each morning I struggled to get out of bed and each evening I collapsed as soon as I got home. My husband told me it was stress—I had just taken a promotion—but I knew it was something else. I blamed Ramadan and the fact that we were getting up two hours earlier every morning. I took vitamins, drank rehydration salts, and scoured WebMD without improvement.

“To say I’m exhausted can’t even begin to describe how I’m feeling.” I wrote in my journal. “It’s trying to stay upright without bones in your legs. It’s melting so completely into the bed that you no longer hear the alarm.”

The fever started two weeks after I wrote those words. It came in the evening with the familiar chill I’ve learned to associate with tropical fevers. Wrapped in three blankets with teeth chattering uncontrollably, even the memory of heat seems gone. It’s a cold like I’ve never felt in the worst winter. Then suddenly, about an hour later, the sweat comes and blankets are thrown off. My husband soothed me with cold compresses through the night and by morning it had completely passed and I was back at the office.

All my bosses were coming from America and I had been asked to plan and facilitate the three-day annual workshop. I’d had similar fevers before and wasn’t too concerned. If the tablets didn’t clear it up I’d just go to the hospital for an injection.

By the third night the fever was out of control. At 3:00am I woke my husband on the verge of tears. I was freezing and sweating at the same time and my head hurt. The thermometer read 105° F. He told me to get dressed so we could go to the hospital. “I can’t,” I whimpered. “Please help me.” He somehow got me in the car and we made the short drive to the hospital.

The government hospital is a place you imagine people go to die, but I wasn’t worried. I had been there with malaria a year earlier, just a few days before my wedding. They had given me an injection and I’d left an hour later to recover at home. I assumed today would be the same and I’d be in the office by mid-morning.

Because of my fever I had to be admitted to the ER, a new rule post-Ebola. It’s a small room with no more than ten beds crammed inside. People lay naked, bleeding, and moaning with no privacy. The first time I visited they took me to the bathroom to give a urine sample and feces covered most of the floor and half of the wall. “If I don’t have typhoid already,” I thought, “I have it now.”

No, the hospital doesn’t have running water.

This morning we met only one nurse in the ER. He eyed me suspiciously and gave me a wooden school chair to sit in while Sellah retrieved my records and paid the $10 admission fee. I slumped over and rested my head in my lap as sweat soaked through my clothes. When my husband finally returned with the receipt the nurse agreed to admit me but refused to give me a bed because we hadn’t brought any bed sheets. Sellah rushed home and I remained slumped over in my chair.

Several children were in the ER that night and a small girl was discharged while I waited. She had taken her treatment bravely but screamed uncontrollably when she was forced to walk past me to exit. I shared a weak smile with her exhausted mother before closing my eyes again. A little boy lay on the bed directly across from me, an IV in his tiny hand and his breathing ragged and painful. Behind a lapa screen a woman moaned uncontrollably while family members tried to calm her, her pain and the boy’s pain falling into an eerie rhythm.

When Sellah returned with the sheets I was given a bed in the only private part of the ER, where the few outdated instruments are kept. After giving blood and urine samples to the lab I told my husband to leave and go to work. “I’ll be fine,” I smiled weakly. “If you’re worried call Siaffa to come.” Siaffa is a student I sponsor at the university and he is widely known to be my “son.”

Shortly after Sellah left I heard wailing outside the door. “It’s time to go,” I heard the nurse saying. “The beds are for patients not bodies.” The little boy was dead.

The sun was bright when I woke up. I had an IV in my hand and my fever was gone. My husband shook my arm and I turned my head to see him standing with my son and the doctor. “You have typhoid,” the doctor announced. “You’re going to have to stay here for a few days.” I shook my head weakly, “That’s not possible. I have malaria. I will leave today.” The doctor laughed. “Maybe if you were one of us, but looking at your condition as a white person I can’t agree to that. You have to stay.” I continued to shake my head and explained about the meeting and my bosses. “I live five minutes away. I’ll come for my treatment every night. Just give me the drugs. I’ve been here five years. I’m not afraid,” I insisted, still unable to sit up.

My husband took my hand, “RB, we’ll discuss it later. Right now you need to get dressed. You’re leaving the ER.” They helped me back into my sweat-soaked lapa suit and I stumbled down the corridor holding my son’s arm, refusing their offer of a wheelchair. As we rounded the corner a large group stood up in the waiting area: my colleagues from the College. Embarrassed, I tried to straighten my dirty hair and bowed weakly. “I’m alright,” I assured them. “I’ll be at the meeting tomorrow.” They followed me to my new private room, praying and singing gospel songs before the nurse ushered them out.

My new room cost $30US a night and I couldn’t believe it existed in such an otherwise dilapidated hospital. There were two beds, an air conditioner, and a private, clean bathroom. The nurse gave me a new IV and a second injection of antibiotics in my thigh. I was starting to feel better and Siaffa and I told jokes and stories until Sellah came back. He carried a plastic bag in his hand and looked exhausted. “I decided to go for my own test,” he said. “I have typhoid and malaria.” He collapsed on the other bed and asked a nurse to inject him with some of the medicine from the plastic bag.

The doctor came in the evening and said that he would allow me to go to work if I agreed to sleep at the hospital for several days and always come for my treatment on time. I slept well and we returned to campus the next morning. I dressed in my favorite new suit, black with a burgundy lace design, and carefully wrapped the hair tie around my hand to hide the IV. I drove to the office and immediately wondered if it was a mistake. My head started to swim and I was sweating but it was too late. Someone handed me the program and asked me to introduce the meeting. Standing in front of the group I heard words coming out of my mouth and saw my boss nodding encouragingly but I had no idea what was going on. They quickly sent someone to replace me as facilitator and I took my seat next to the University President.

I made it through the morning then excused myself at lunch to go for my treatment. I stopped at the house to get a book and feed my parrots then drove the five minutes to the hospital. I had no idea I wouldn’t be back for several days.

I reported to the nurses’ station and made the long walk to my private room past the hundreds of less fortunate patients crammed on cots and curled on floor mats, their babies crying, their loved ones begging for their better treatment. I averted my eyes and said a silent prayer of gratitude that I had the means to afford better treatment. I vowed to continue fighting for a more just world.

Inside the room I turned the air conditioner down and settled in bed with my book. The nurse gave me another IV and came to check my blood pressure and temperature every few hours. She glared at me silently and resentfully every time she entered the room. I was fully aware I needed her friendship if I was going to receive good treatment so I struck up a conversation and asked her name. Ma Etter is one of the people I credit with saving my life a few days later.

Later that afternoon my husband arrived looking weak and I read The Ladies No. 1 Detective Agency to him until he fell asleep. That night my fever returned and the next morning I couldn’t get out of bed. My husband’s family brought me food but I refused to eat. “My head hurts,” I moaned to a different nurse. She shrugged and told me I was sick.

The next few days are a blur but I remember Sellah and I stayed at the hospital through the weekend. I missed both the workshops I had helped plan and that I was supposed to facilitate. Our conditions swung back and forth. I would feel a little better so I would take care of him. When I got worse again he would feel better and take care of me. They had diagnosed him with malaria in addition to typhoid and it was raging. One afternoon he couldn’t stop vomiting. After four hours and a nearly full shower drain I wrapped a lapa around my waist and tottered out to the nurses’ station. “No one has been to our room for hours,” I said angrily. “My husband can’t stop throwing up. Please send someone!” She was reading Facebook on her phone and barely looked up. “He’s sick. What do you expect?” I slammed my fist on the desk. “I want to see the doctor!” She laughed. “There is no doctor. It’s the weekend.”

No one came until the nurses changed shift in the evening.

My condition was taking a definite turn for the worse too. Lying under the air conditioner I constantly complained I was hot. “Take my temperature!” I begged the nurse. “I have a fever!” She stared at me blankly and said the thermometer was broken and she couldn’t treat me for a fever she couldn’t prove I had. This was the same nurse who the day before yelled at me for having my belongings strewn across the floor rather than packed neatly.

I woke up in the middle of the night with my head throbbing, my mind reeling, and sweat soaked through all the sheets. “This is how people lose their minds,” I thought calmly before going back to sleep.

Several years before a close friend had gone crazy after experiencing malaria symptoms. He disappeared into the sick bush, diagnosed with an African Sign and a “demon.” Witchcraft.

Sellah begged the nurses to treat me for malaria but they refused, insisting my test was negative.

After three or four days my stomach started running. I was extremely lucky to have a private bathroom but I couldn’t maneuver the IV to get inside. I asked Sellah to find a nurse to remove it, but as soon as he left I realized I couldn’t wait. I got up and tried to pull it behind me the way people do so easily in TV shows. The stand was old and heavy, however, and rather than move with me the needle pulled out of my hand. The last thing I remember is blood running down my arm as I stumbled the few steps to the bathroom.

“RB, WAKE UP!” I heard Sellah shout. “THE DOCTOR WANTS TO SEE YOU!” Cold water hit my face and I gasped and opened my eyes. I was flat on my back in the middle of the room, soaking wet and naked from the waist down, covered with the black and burgundy lapa I’d so proudly worn to my meeting. Six people in full Ebola gear looked down at me, their eyes scared behind the hard plastic masks. My husband was slapping my face and the doctor sat nervously on a plastic chair in the corner.

They would later tell me that I had passed out, stopped breathing, and had a series of seizures, “tremming” as they call it in Liberian English. I am grateful not to remember any of this.

“I’m ok,” I said trying to sit up, “I was just going to the bathroom.”

“You’re not ok,” the doctor said from across the room. “We have to move you for observation.”

The Ebola suits lifted me onto a stretcher and whisked me down the crowded hallways. The other patients strained to see, probably as terrified by the white suits as I was.

They put me in a room across from the nurses’ station and gave me several injections. My husband sat by my side and held my hand. “I think you should go home,” he said. I stared at him for a second, “To Cuttington? You’re right. I’m not getting better and this place is terrible.” “No,” he whispered, “to America.”

That was the moment I became scared. “No,” I shook my head. “It’s not that bad. Let’s go to Monrovia first.”

My condition stabilized after an hour and he left to find food. Siaffa was left in charge and I asked him to tell me stories. I never told him this, but I held on to his voice for those few hours as a lifeline to reality. I’m not sure I would have kept my sanity without him. They brought a sort of warm corn mash and energy drinks. I hadn’t eaten for several days and I had no appetite but I begged Siaffa to feed me. “I’m sorry, please just put it in my mouth.”

As the sun rose in the sky my new room got excruciatingly hot. The nurses said they didn’t have any fans but they refused to let me return to my air-conditioned room, insisting it wasn’t safe for me to be so far away. “You aren’t doing anything for me anyway!” I remember shouting. “I’ve been here five days and I just keep getting worse! I already paid for my room and I want to go there!”

But those were big words for a woman too weak to walk.

They finally agreed to let me return to the private room in the evening. An uncommonly kind nurse had treated us over the weekend and my husband convinced her to stay over night as my private caregiver. She gave me seven or eight injections of “food” in my thigh and I credit her with saving my life that night.

The next morning, terrified I would die, my boss had arranged for the project car to transport me to Monrovia. The hospital refused to transfer me, claiming they were able to treat my condition, and said that if I left it would be against doctor’s orders. There was no hesitation: “We’re leaving.”

My husband’s sister came to help us transfer our things the next morning and he left the room to meet her at the gate. A few minutes later I heard shouting in the corridor and they burst into the room, followed by a security guard. It was raining heavily and Sellah had ushered his sister through an employee entrance to avoid walking all the way around the building in the rain. The security guard was furious and had chased them through the hospital to our room, attempting to arrest them and insisting it wasn’t visiting hours. “I’m a patient!” Sellah kept shouting. “What is wrong with you?” A crowd gathered at the door as more nurses and security guards came to see what was happening. “Please stop,” I pleaded from bed. “I’m sick. We’re both sick. We’re trying to leave.”

A doctor appeared at the door and, apparently insulted that we were discharging ourselves, threw us out. “Get them out of here!” she shouted. “You are no longer welcome in this hospital!” Siaffa and Sellah’s family grabbed our things. “Can you walk?” Sellah asked, grabbing my arm. I nodded and he led me down the hallway, the security attempting to arrest us and shouting as we shoved our way through the crowded hospital. One of my guardian angel nurses rushed forward with a bag of medicine for my trip, but the security refused to let me have it. At the gate the female doctor flung herself in the doorway and blocked the exit. “Where are you going now?” she sneered, a stupid question since she had just told us to leave. But the car had parked outside the ER rather than in the parking lot and we turned the other way, exiting before she realized what was happening.

They took me to my house and asked me to pack a few things before going to Monrovia. “I just want to lay down,” I mumbled and crawled into bed. I don’t remember how long I stayed there but it was probably a few hours. “RB, we have to go now,” Sellah said firmly, shoving a handful of my clothes in a bag and pulling me to my feet. We drove to Monrovia in the pouring rain; me curled up in the backseat with my head in his lap. Sellah’s brother followed behind with our car.

The staff from my office in Monrovia met us at the hospital. I could barely stand to get out of the car so several people supported me to walk inside. They lifted me onto a hard bed in a crowded room and Sellah disappeared to pay the bills (hospitals in developing countries usually require advanced payment). I was alone for the first time and I lay still, watching the other patients.

“This is how people lose their minds,” I thought again, focusing all my attention on staying present.

After what felt like an hour my husband returned with a nurse. “You have four plus malaria” they announced. “We’re taking you to a private room for immediate treatment.” For those of you who have never lived in a malaria region, a number usually accompanies a malaria diagnosis. One is mild and four is severe, the level at which it goes to your brain and you can easily die.

I spent four days at that hospital but I remember very little of it, mostly the metallic taste of the quinine drip. The room was small and my husband slept on the floor next to the bed. On the second night he caught and killed a rat. Many visitors came and went but I remember very few of them. An old friend from the Peace Corps office brought a crate of drinking water at 4:00am one morning. I remember him smiling over me with his gold tooth and promising to pray for me.

My French boss came dutifully every day, begging me to eat. “What can I bring you?” he demanded. I shook my head. “Come on! I have delicious cheeses! I cooked some lentils and chicken!” He brought two bags of food the next day and it was the first time I ate in a week.

Gradually the haze lifted and they told me I was going to be ok. My doctor was a tall, lanky Sierra Leonean with a big Afro and Air Jordan hi-tops. Meeting him and being told I could leave is one of my first clear memories. All the nurses hugged me when I left and I thanked them for saving my life.

We drove the short distance to my office and stayed in the guesthouse for several more days while I tried to regain enough strength to travel home. Once home, I spent another week and a half on bed rest before returning to the office.

Everyone here says I am just strong, but I consider myself lucky. My husband, my son, and a handful of caring strangers saved my life. I am grateful they were by my side and that I had the financial resources to afford real drugs and good care.

Passing to our private room in the government hospital my husband had seen a friend lying on a mat on the floor. She had the same diagnosis as we did but with no money and no one to fight for her the nurses had been giving her B-complex each day and watching idly as she got worse. On Christmas day one of my students and good friends died from typhoid she had been battling for three months. Good antibiotics could have saved her.

Honestly, I don’t blame the nurses. I can’t imagine being a nurse in Liberia. When I got angry with one of them for neglecting us she apologized and told us she was assigned to 35 patients. I am sure they see people die every day and they are literally armed with nothing. Sellah and I got real drugs and more regular treatment because we could afford to give people “cold water” and, working for WHO, my husband knew what to do when the hospital claimed to be out of my medicine. (Actually the person with the key to the supply room had gone home.) We are both educated and know how to push back against broken systems. When I think about going through the same situation poor and uneducated I understand why so many people die.

I am humbled by the way my various privileges saved my life. Many Liberians die every day from the same complications I survived. Like I used to tell my gender students, though, you can’t necessarily get rid of your privilege. All you can do is be aware of it so you can use it to help others.

Liberians often say you should give a person his flower while he is still living. Those flowers, that kindness and care, saved my life. I am committed to cultivating them and sharing as many as I can during my lifetime. This is my sixth year in Liberia. I continue to stay because I continue to want a better world, a world where everyone has access to adequate healthcare and quality education. I am grateful for the opportunity and strength to keep going.

“All the flowers in all the tomorrows are in the seeds of today.”