Here are three words you don't often see in close proximity: Good. Death. Ebola.
Yet there they stand, united in the headline for an essay in the New England Journal of Medicine this month: "A Good Death: Ebola and Sacrifice."
The essay was written by Dr. Josh Mugele, assistant professor of clinical emergency medicine at Indiana University's School of Medicine, and Chad Priest, an assistant dean at the Indiana University School of Nursing. They pay tribute to a Liberian colleague, Dr. Samuel Brisbane, director of the emergency department at Monrovia's John F. Kennedy Memorial Medical Center.
They'd worked closely with Sam Brisbane on a disaster-medicine program. He was a memorable character, they write: "at once caring and profane ... his laugh was best described as a giggle, and he swore frequently."
And he was terrified by Ebola. "Dr. Brisbane was a wreck," they recall. When they asked how they could protect themselves, he told the authors: "Leave Monrovia."
This summer, Dr. Brisbane treated a patient with "suspected Ebola." A few days later, the 74-year-old doctor came down with symptoms of the virus. He died on July 26.
"With apologies to his wife and family, who saw him die horribly and unjustly," Mugele and Priest conclude, "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."
We spoke with Mugele and Priest about the idea of a "good death."
You believe Dr. Brisbane died a good death because of his self-sacrifice?
Mugele: Dr. Brisbane was an older gentleman, he had a coffee plantation, he had a wife and children. He didn't have to treat these patients. He didn't have to be a doctor at that stage of his life. And he kept doing it even though he knew [Ebola] was very contagious and he had a high likelihood of getting it. Dying was a selfless act on his part.
You'd discussed Ebola with him even before this outbreak.
Priest: We were out in Liberia in 2013, conducting a hazard vulnerability analysis for the hospital. The hospital there is a really dangerous place. Things catch on fire, you don't have good water. And he tells us: What I'm scared of is if there's ever a viral hemorrhagic fever like Ebola that gets here; then we're all dead.
How do you think he'd feel about dying of Ebola?
Mugele: He would be really pissed off.
Do you think he'd like the article?
Mugele: He would appreciate the irony, I think. And he would at least have wanted to be made co-author.
Not all of us can die doing noble work. Are there other kinds of "good deaths"?
Mugele: We're talking about two separate issues here, a good death in terms of doing something in service to humanity, and a good natural death. Especially in emergency medicine, we have this concept of doing everything for a patient — even if everything is kind of futile.
Wouldn't you and other health workers want extraordinary efforts if you were dying?
Mugele: Most clinicians, if they get a terminal disease, would rather go home and be with family than go to the hospital. Maybe we're doing too much at the end of a life, spending too much money and too many resources for very little return.
What happens to a dying person in a poor country like Liberia?
Mugele: We saw a woman, about 70, she probably had cancer, probably had a blood clot in her lungs. We couldn't tell, we didn't have diagnostic equipment. We knew she was dying. In the U.S., we would have been putting tubes in her, putting her on ventilator, giving her a lot of aggressive medications. We knew she wasn't able to get that kind of care [in Liberia]. The best thing we did for her was to turn the monitor off and let her family come to the bedside.
So in some ways, Liberia is ahead of us.
Mugele: We have so much in the U.S. We have defibrillators and ventilators and all sorts of blood pressure medicine. And we can keep people alive for a long, long time. Whether they're comfortable or responsive to their loved ones or enjoy that extra time is the question.
Meanwhile, in the U.S., we have a hard time even talking about death, let alone figuring out how to have a good death.
Priest: I think a good death is not about how you die. It's about the quality of the life you left behind. And that's not an end-of-life discussion. It's a beginning-of-life discussion.
Note: This interview was edited and condensed for clarity.
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