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Today, the New York Doctor Who Contracted Ebola Is Feeling Fine

Dr. Craig Spencer, ebola survivor
Craig Spencer in May, seven months after contracting Ebola. Photo: Christopher Anderson/Magnum Photos for New York Magazine
The
Doctor
Who
Got Ebola
New York’s one-man pandemic-scare is feeling fine.
Photograph by Christopher Anderson
Craig Spencer in May, seven months after contracting Ebola.

Five months into West Africa’s Ebola outbreak, last September, a young New York emergency-room doctor named Craig Spencer headed to Guéckédou, Guinea, to volunteer for five weeks with Médècins-sans-Frontières (known here as Doctors Without Borders), the international medical-aid organization. During the first two weeks of the trip, Spencer kept a diary, in which he wrote “tired” or its synonym no fewer than 20 times. He held limp, dying babies in his arms because their parents could not. He treated patients who were confused and violent from the effects of the disease. He told families their loved ones’ bodies had to be buried without viewings. “It was, by far, the hardest mission I’ve ever done — physically, mentally, and emotionally,” he told me one day in March, six months after his return. “I felt off the entire time I was there and when I came back. I don’t think anyone could’ve felt on.” 

Spencer returned on a Friday in October, exhausted and drained. His fiancée, Morgan Dixon, and their friends urged him to go out and try to restore some normalcy to his life. In a now meticulously documented 36 hours starting that Tuesday morning, he drank Blue Bottle coffee on the High Line, ate meatballs at the Meatball Shop, bowled at the Gutter with Dixon and two friends, and rode on the A, L, and 1 trains.

On Thursday, he woke up with a fever. That evening, doctors confirmed that Spencer, 33, was New York’s first Ebola patient. His brush with the deadly virus launched a wave of often misplaced panic among city officials and the media and ignited a debate about our pandemic preparedness. It also thrust Spencer and Dixon into a media circus. They were hounded by the press, which implied Spencer had recklessly endangered the lives of New Yorkers, an experience that still haunts the couple.

Spencer grew up outside Detroit, where his father installed garage doors. The only person in his family to go to college, he was 20 the first time he boarded an airplane. He has since provided medical care in about a dozen countries. In 2012, Spencer and I became colleagues, both working as emergency-medicine doctors at a Manhattan hospital. Over the past few months, we’ve talked often about his ordeal, what he would have done differently, and where he thinks health officials made mistakes. What bothers him most, it’s clear, is what he considers the New York City Department of Health and Mental Hygiene’s departure from scientific protocols. He also believes the health department played a role in the media’s discovering his name, a claim health officials categorically deny.

As soon as Spencer woke up that Thursday morning, he knew something was wrong — he was breathing too fast. His temperature was 100.3. He called the offices of MSF immediately. “It was a sigh of relief,” he told me. “It doesn’t make sense, but this moment I was fearing had arrived — I could stop worrying about it now.”

Soon, he was on the phone with an official from the health department who took down his travel history and then said she’d have to call him back. Spencer sat on his couch and waited. “It was clear they had no plan,” he said. Finally, around noon, two FDNY medics arrived at their apartment building. Spencer’s door buzzer was broken, but the medics wouldn’t allow him to walk down the stairs by himself and declined his suggestion to toss his keys out the window. Instead, they had the building’s two sets of doors dismantled. By the time the medics, in full hazmat gear, carted Spencer out on a stretcher, a curious crowd had formed on West 147th Street. It wasn’t until two o’clock that Spencer was finally in the ambulance en route to Bellevue Hospital.

By that time, the press already knew his name. A city health official had asked Dixon to come down to Bellevue for an assessment. On her way there, she received a text message from a friend who said she’d read about Spencer on the website Gothamist. “Well, you know more than me at this point!” she texted back. Meanwhile, a CNN reporter had called Spencer’s parents in Michigan requesting an interview. It was the first that they’d heard that their son was in the hospital.

At Bellevue, Spencer was ushered into a small room in a dedicated isolation unit, where he met the hospital’s director of critical care, Laura Evans, who was dressed in a full protective suit. Spencer was surprised to see her entire face through the clear plastic mask: serious chestnut-brown eyes; a tough, square jaw; and a spectacular smile. “It made a huge difference,” he said, to be able to look into his doctors’ and nurses’ faces. In Guinea, the protective equipment he wore covered everything but a smudge of his eyes, hidden behind fogged goggles.

Evans had been in a meeting with hospital leadership about Ebola preparedness when the hospital’s medical director told her a patient who had been working in West Africa was coming in with a fever. The case seemed so textbook, she thought at first it was a drill. As they waited for the Ebola blood tests to process in the city’s public-health laboratory across the street, the two chatted about his trip to Guinea. Spencer remained calm. “At this point, I thought there was a 50-50 chance that I had Ebola.”

While Spencer was upstairs on the seventh floor, Dixon was in the emergency room on the ground floor. As soon as she stepped into the hospital, she was placed in an isolation room. A nurse shoved a thermometer at her and told her to check her own temperature. Dixon was baffled. She didn’t feel ill or have a fever. Frightened and confused, she started crying. A different nurse came in and gave her a hug. “It was the best thing anyone could’ve done for me at that point,” Dixon told me.

Finally, at around seven o’clock that night, the lab results came back. With any critical test, it’s standard practice for the physician to repeat the results back to the technician. Evans could hardly say the words — “positive for Ebola virus” — they felt so surreal. She went into the room alone to tell Spencer. “I spent a few minutes just not having any thoughts at all,” he said. “But then I wanted to know, ‘What’s the next step? What are my treatment options here?’ 

Spencer called Dixon. “I’m young and healthy,” he told her. “I’m getting the best care possible. I’ll be okay.” Soon, Evans was executing protocols she and her department had spent months devising but never anticipated actually having to use. For physician care, Spencer would have a team of two doctors, herself and Amit Uppal, director of Bellevue’s medical-intensive-care unit, supported by around-the-clock care from the unit’s nurses.

The first night, Uppal and Evans had to place a large intravenous line into Spencer’s internal jugular vein. The process involved maneuvering several pieces of equipment, including a needle inserted into the neck — a sensitive spot that sometimes causes patients to jerk involuntarily, increasing the chances of the physician getting punctured and infected. When they were devising their protocols, the team had agreed that all Ebola patients, regardless of how sick they were, would get such a line to minimize the potential for other staff to be infected while taking blood samples or revitalizing the patient with fluids. Inserting the line ended up being one of the tensest moments of Spencer’s hospitalization. “It really helped that we had already thoroughly talked through this, knew our rationale for doing it, and had made a plan beforehand,” Evans said.

This was yet another difference between Spencer’s care in the U.S. versus the care of his patients in Africa. There, patients didn’t routinely get intravenous lines, unless they became very sick and couldn’t take in any fluids through their mouths. They also didn’t have access to any blood work, besides tests for Ebola and malaria. But the biggest disparity, Spencer said, is that “whereas in Guinea I took care of 30 patients, in the U.S., 30 doctors took care of me.”

New York Post cover, October 24, 2014. Photo: TIMOTHY A. CLARY

While Spencer was experiencing the best of American health care, Dixon was ensnared in the public panic. Ebola can be transmitted only when bodily fluids are passed through openings like broken skin or the nose or mouth and not through the air. The Centers for Disease Control and Prevention do not recommend mandatory quarantines for people without symptoms like a fever, but soon after Spencer was diagnosed, Dixon was served a 21-day-quarantine order. The two friends the couple went bowling with were also quarantined.

Dixon spent the next two nights at Bellevue, during which time the city contracted a company called Bio Recovery Corporation to clean her and Spencer’s apartment. Finally, she was cleared to go home for the remainder of her quarantine. Leaving the hospital, she was ushered into a black car, flanked by press. The city health department’s deputy commissioner for disease control, Jay Varma, was sitting in the front seat. According to Dixon, she asked him how Spencer’s name had been released. “He nonchalantly replied, ‘Oh, yeah, sorry, it must’ve been leaked during one of our interagency calls,’ ” Dixon told me. She was furious. Varma declined to comment, and the health department denies that Spencer’s name was ever mentioned in any interagency calls.

At home in Harlem, she found what seemed to be a white chemical film on the counters and tables. There was mud tracked over the floor. Many of their clothes, shoes, bedding, and kitchen supplies had been discarded. Their refrigerator had been emptied; plants were dead and broken pots were scattered throughout. “It was like a ghost town,” she said. City officials told her they were on-site the entire time, yet somehow videos of the inside of their apartment ended up on the website of the Daily News. “They could’ve had kids come into our apartment and blow bubbles,” she told me recently. “There was no scientific evidence behind what they were doing.”

Spencer tried to insulate himself from the media frenzy. The television in his room was broken, and he consciously avoided most websites, though friends texted him updates about what was going on outside his room. He tried to dodge calls from reporters. Once, Spencer said, he picked up the phone and the person on the other end said she was his neighbor, so he continued to talk to her, thinking she was calling about Dixon. She eventually said she was a reporter for the New York Times. He ended the call, but soon after he saw himself quoted in the paper. (The reporter, Anemona Hartocollis, does have a nearby address and says she identified herself immediately as a reporter and a neighbor.)

Mostly, though, he focused on getting better. He included himself in discussions about his progress and treatment and tried to be a model patient. “I tried my best to do the most high-risk actions, like cleaning my bed and throwing away my waste. Of course, there were things I couldn’t do when I was really weak.” Every day, he reviewed his own lab results, which he found fascinating. Reviewing how the disease was attacking his organs, he often felt he was looking at another patient’s data. It’s only in reflecting back now that he can grasp exactly how sick he was. His kidneys and liver were failing. His platelets, cells that stop us from uncontrollably bleeding, dropped to a precipitously low number. He developed a severe throat inflammation and what was most likely a transfusion-related lung injury from the blood plasma donated by a patient who’d recovered from Ebola, Nancy Writebol, a U.S. missionary who was infected while working in Liberia. When liquid began filling his lungs, a condition called pulmonary edema, he was put on oxygen.

As sick as Spencer was, his doctors were optimistic and tried to keep his spirits up. Early patient mobility is now a staple of intensive-care recovery, and Evans encouraged her charge to stay as active as he could, joking that she was playing mom to a teenager, making him get out of bed, shower, and ride on the stationary bike. Evans and Uppal decorated his room one morning so that he woke up to walls plastered with posters of teenage heartthrobs. Uppal tried to lend him a USB drive uploaded with movies, which Spencer at first refused. “I prefer to read books,” he told him. By the end, boredom took over, and he spent long stretches watching YouTube clips. “There was no day that I felt absolutely horrible,” Spencer said. “There were days I would get frustrated at how many times I had diarrhea. But by never thinking about the possibility of death, I could focus on other things.” Evans knew he was recovering when his jokes got funnier.

Each day, Dixon would record and send a song to Spencer from her quarantine. Dixon had a hard time adjusting to the isolation, especially when it seemed so pointless and arbitrary. With the help of the New York Civil Liberties Union, their friends were able to end their own quarantines early. The nurses and doctors caring for Spencer, meanwhile, were only required to self-check their temperatures twice a day.

A week into her quarantine, Dixon was allowed visitors. I stopped in several days later. Walking into their apartment, I felt Spencer’s presence. On one wall, above a red couch, is a rendering of the George Washington Bridge that he drew, over which hang bookshelves he made from raw wood and metal. The apartment is filled with books and photos and souvenirs from their travels, including a kora, a large West African harp that Spencer lugged back from Guinea. All the curtains in the apartment were drawn, since she’d caught someone filming her through the bedroom window.

Dixon, noticeably thinner, hugged me, and I was struck by how composed she appeared. Wearing a button-down shirt and jeans, with gold-and-red Chinese house slippers, she tucked her short maple-colored hair behind her ears and poured me a glass of water. We sat down at their large picnic-style table, and she pushed her laptop to the side. She was actively avoiding websites — “I don’t want to know what the media is saying” — though the press had been camping outside her apartment building and calling her phone.

It was like being in solitary confinement. I couldn’t look beyond the wall eight feet in front of me,” she told me later. “I was starting to lose my mind.” Their buzzer worked only sometimes and their oven was broken, but no one could come inside to fix them. She was too afraid to order anything anyway. One time, she unintentionally buzzed in a reporter who she thought was a deliveryman. In the first week, she relied on friends to drop off meals, clothes, and bedding, though she hadn’t seen any of them — per quarantine policy, they had to leave before she opened the door.

Spencer in West Africa during an earlier aid mission in 2009.

After 19 days, Spencer was discharged from the hospital. With representation from the NYCLU, Dixon was able to end her quarantine that same day — 72 hours early. Their neighbors welcomed Spencer home with balloons on the front of their apartment building. When Spencer eventually returned to work in the emergency room, one of his first patients was an 88-year-old Puerto Rican man. “I prayed for you,” he said to Spencer in Spanish, crying.

Spencer still gets heated when he thinks about how public-health authorities responded to Ebola with “a citywide fear-management campaign,” even writing an essay about it in the New England Journal of Medicine. “I do understand and respect that the public was scared,” he said, admitting that when he first returned from Guinea, he obsessively wiped his apartment with bleach. (“I just felt it was one of the few things I could control. It was completely irrational.”) But he is adamant that the city’s public-health authorities and the media made big mistakes. “Instead of saying the risk of infection is nearly impossible because I didn’t have a temperature [yet], they discussed the risks of getting Ebola from a bowling ball. It was a prime opportunity for education, and they squandered it with misinformation and unscientific quarantines.”

In February, Spencer and Dixon met with Varma and other city health officials to discuss their concerns, particularly the release of their personal information. According to Dixon, the health-department officials told them they had investigated how the media had gotten their information and found no evidence that it had come from their agency. They had no plans for a further response. Spencer says Varma admitted that much of what the agency did, specifically cleaning their apartment and quarantining, was for the sake of public appearances. (A health-department spokesperson declined to comment on the content of the meeting.) Dixon is still rattled by the experience. “I’m trying to move on, but I still get flashbacks to being locked up,” she told me in May. “Every day, I think about what happened. Every single day.”

In March, Spencer returned to Guinea with MSF. He told me he wanted a different conclusion to his story. “I needed to go back for this bookend closure — for both Morgan and me.” Now that he was Ebola-immune, he could also return without fear of infection, though on this trip he played a more managerial role, using his experience to advise the Ebola-treatment units. Treatment had advanced since his last trip. Doctors were now experimenting with plasma transfusions from recovered Ebola patients, which hadn’t been available the first time he was in Guinea. Local doctors were hesitant to use the treatment, and Spencer was able to guide them, providing the perspective of both a skilled doctor and a patient.

Very few people in Guinea recognized Spencer. Many of his colleagues were European or African. “I thought it was great!” he said. “I didn’t want to be known.” One day, Spencer returned to Guéckédou, where there hadn’t been an Ebola case in months, to attend the closing ceremony of the treatment unit where he had first worked. “When I was there before, at the height of the outbreak, people weren’t touching at all,” he said. “When I came back, teenage boys and girls were holding hands on the street. Love had come back. Life had resumed. It felt like a very different place.”

One recent afternoon, I met up with Spencer in his neighborhood. He seemed relaxed, wearing jeans and a T-shirt and greeting me with a big, dimpled smile. He told me he thinks his and Dixon’s experience with Ebola would have been different had this happened anywhere else. “New Yorkers have heightened insecurity. We expect bad things to happen here,” he said. I asked him if he’d hesitated before visiting those public places. “If I knew I had Ebola before that morning, the last thing I would’ve done was ride the subway or eat meatballs,” he said. “I would’ve gotten help immediately and made sure I didn’t infect others. To be honest, I was actually more concerned with other people getting me sick. What if I touched a subway pole and caught the flu? Then I would have symptoms and go through the whole mental process of thinking I had Ebola.”

He still doesn’t know precisely how he was infected. An MSF investigation was inconclusive, so he’s left guessing whether the virus got trapped in a sweaty respiratory mask, or whether it happened the day he was accidentally poked in the eye by a hygienist’s gloved finger, or if it was that last day, when he was feeding and cleaning a severely ill patient with massive diarrhea and vomiting. “All day every day, you were putting something on or taking something off, always touching something,” he said. “But while we were working, we never talked about the possibility of risk. There was a perceived weakness if we did.

I know Morgan thinks about what happened much more than I do,” he said. “But once in a while, the unbelievable likelihood of it all hits me, and I realize how much of an outlier it makes me. I think to myself, Holy shit! This is weird.” Mostly, though, his life has returned to normal. He’s still working in medicine, both here and abroad through international aid organizations, and he and Dixon are getting married this summer. As we walked, several toddlers scampered past us followed by their parents, and a faint smile skimmed across Spencer’s face. “Before all of this, I never really thought about having kids. But now, I have these visions of telling our children about this crazy time in our lives.”

*This article appears in the June 8, 2015 issue of New York Magazine.

The Doctor Who Contracted Ebola Is Feeling Fine