and faithful, intrepid friends—must pass through a smaller door into a change room, where piles of scrub suits sit folded and ready on shelves, and then through a pressurized steel door into an airlock shower. On the other side of the shower stall is another steel door. The two pressurized steel doors are never both open at once. So long as the patient shows no signs of infection, approved visitors are admitted to the Slammer wearing scrubs, gowns, masks, and gloves. If the patient proves to be infected, the suite becomes an active BSL-4 zone, in which doctors and nursing staff (no visitors now) must wear full blue suits. In that situation, the medical people shower thoroughly on the way out, leaving their scrub clothing behind in a bag to be autoclaved.
Warfield led me. We could pass through the shower stall in street clothes because the containment suite was unoccupied. When she slammed the first steel door behind us, triggering pressurization, I heard a voosh and felt the change in my ears. She said: “There’s why it’s called the Slammer.”
She had entered the suite around noon on February 12, 2004, the day following her accident, after having drawn up a will and an advance directive (stipulating end-of-life medical decisions) with help from an Army lawyer. Her husband was in Texas for advanced military training and she had apprised him of the situation by phone. In fact, she had stayed on the phone with him much of the previous night, helped through the hours of terror and dread by his long-distance support. At some point she told him: “If I get sick, please please give me a lot of morphine. I’ve seen this disease”—she had watched it kill monkeys in the lab, though never a human—“and I know it hurts.” On the first weekend, he managed to fly up from Texas and they spent Valentine’s Day in the suite holding hands through his latex gloves. There was no kissing through his mask.
The incubation period for Ebola virus disease, as I’ve mentioned, is reckoned to be at least two days; it can be longer than three weeks. Individual case histories differ, of course, but at that time twenty-one days seemed to be the outer limit. Expert opinion held that, if an exposed person hasn’t shown the disease within that length of time, she wouldn’t. Kelly Warfield was therefore sentenced to twenty-one days in the Slammer. “It was like prison,” she told me. Then she amended her statement: “It’s like prison and you’re gonna die.”
Another difference from prison is that there were more blood tests. Each morning her friend Diane Negley, who happened to be a certified phlebotomist and who knew enough about Ebola to be cognizant of the risk to herself, tapped a vein and took away some of Warfield’s blood. In exchange, she brought a donut and a latte. Negley’s morning visit was the highlight of Warfield’s day. During the first week or so, Negley took fifty milliliters of blood daily, a sizable volume (more than three tablespoons) that allowed for multiple tests plus a bit extra to put in frozen storage. One test, using the PCR (polymerase chain reaction) technique that’s familiar to all molecular biologists, looked for sections of Ebola RNA (the virus’s genetic molecule, equivalent to human DNA) in her blood. That test, which can ring a loud alarm but is sometimes unreliable, delivering a false positive, was routinely performed twice on each sample. Another test screened for interferon, the presence of which might signal a viral infection of any sort. Still another test targeted changes in blood coagulation, for an early alert in case of disseminated intravascular coagulation, the catastrophic clotting phenomenon that makes blood ooze out where it shouldn’t. Warfield encouraged the medical people to take all the blood they desired. She recalled telling them: “If I die, I want you to learn everything you can about me”—everything they could about Ebola virus disease, she meant. “Store every sample. Analyze everything you can. Please please take something away from this if I die. I want you to learn.” She told her family the same: If the worst happens, let them autopsy me. Let them salvage all possible information.
If she did die, Warfield knew, her body wouldn’t come out of the Slammer through door 537. After autopsy, it would come through the autoclave chute, a sterilizing cooker, which would leave nothing her loved ones would want to see in an open coffin.
All her test results during the