appealing forms of African wildlife. It was Christmas evening, 2007.
They arrived home on New Year’s Day. Michelle left again quickly for a postholiday visit with her parents in Iowa. So she was already in Sioux City, on January 4, when she woke up feeling like someone had driven a needle into her skull.
She was achy all over, feverish, and had this fierce, drilling headache. Suspecting that she might have been bitten by an insect, she asked her parents to check her scalp. “Of course, there was nothing. And then, as the day went on, I started developing a rash across my stomach.” The rash spread. Besides the aches and pains, the exhaustion, the rash, she began to feel discombobulated. “Over the next forty-eight hours, I just went down really fast.” She was still on malaria prophylaxis, from the trip, and to that she now added some Cipro and ibuprofen. No relief. But she toughed out the visit, flew back to Colorado, and stopped into an Urgent Care near her home in Golden, where they don’t see a lot of Marburg virus disease. The doctor there took blood for testing, gave her painkillers, and sent her home. The blood sample got lost.
After that inconclusive consultation, plus two more with her regular doctor in the following two days, Michelle Barnes turned up at a hospital in suburban Denver. She was dehydrated; her white blood count was imperceptible; her kidneys and liver had begun shutting down. Once admitted, she faced a parade of doctors and a litany of questions. Among the first questions was: What have you been doing for the past four days? Most people seek help before multiple organ failure sets in. I’ve been sucking it up, Barnes answered. Her far-flung sisters, one of whom was a doctor in Alaska, converged on the hospital—which was gratifying to Michelle, but also alarming. Clearly, they had been given to understand that she might be going down. The doctor-sister, Melissa, played a key role in pressing Michelle’s physicians for information and action. That’s when an infectious disease specialist, Dr. Norman K. Fujita, joined the team. Fujita arranged for Michelle to be tested for leptospirosis, malaria, schistosomiasis, and other infections that might be contracted in Africa, such as Ebola and Marburg. All came back negative, including the test for Marburg.
Nobody knew what she had. But they could see her declining. The hospital doctors tried to stabilize her with hydration and antibiotics and oxygen, tried to ease her suffering with pain meds, while hoping her body would pass through the onslaught, whatever it was, and heal. The crisis must have arrived on the night of January 10 or 11, by Michelle’s blurry recollection, when another of her sisters sat with her all night and showed signs of dire concern that Michelle was about to check out. One curious thing about that night, Barnes recalled, was that she’d been placed in a pediatrics ward. There was no room anymore in the ICU. “So, for whatever reason, they transferred me to pediatrics. I know because someone came around and gave me a teddy bear.” Unlike Astrid Joosten in Leiden, unlike Kelly Warfield at USAMRIID, Michelle Barnes was never put into an isolation unit. Sometimes her caregivers wore masks, as a precaution, and often they didn’t. Gradually her body regained strength and her organs (all except her gall bladder, which had been surgically removed) began to recover. The teddy bear may have helped more than the antibiotics.
After twelve days, she left the hospital, still weak and anemic, still undiagnosed. In March she saw Norman Fujita on a follow-up visit and he had her serum tested again for Marburg. Again, negative. Three more months passed and Michelle, now gray-haired, lacking her old energy, suffering abdominal pain, unable to focus, got an email from a knowing friend—a journalist she and Rick had met during the Uganda trip—who had just seen a news article about which he thought Michelle should know. In the Netherlands, a woman had died of Marburg after a Uganda vacation during which she had visited a cave full of bats.
Barnes spent the next twenty-four hours googling up every article on the case she could find. By a small-world coincidence, she had lived in the Netherlands for three years herself, during the 1990s, so she could read the coverage in Dutch as well as in English. Early the following Monday morning, she was at Dr. Fujita’s door. “I’m an emergency, I need to speak with you,” she said. Fujita