En español l On a brisk October morning, Nancy Writebol is regrouping in the Fulton, Mo., home of her 82-year-old mother, Mary Sillivan. "It's a privilege to be alive," she says, no doubt realizing the understatement of her words. "I thank God for that."
The second American citizen to be diagnosed with the deadly Ebola virus that has spread across West Africa and to the U.S. since March 2014, Writebol can be credited with bringing a face, and an urgency, to one of the largest and most frightening epidemics of our time. Ebola has officially killed more than 5,000 people so far, though most experts believe the number is much larger.
Writebol's story — how she contracted and somehow beat Ebola — illustrates some of the mysteries of the disease. It also offers insight into the motivations of thousands of aid workers and religious missionaries who, like Writebol, take great risks to toil in the developing world, saving strangers' lives.
Writebol, 59, comes from a family steeped in religious evangelism. Her father, a volunteer firefighter, made humanitarian trips to Haiti when she was growing up; her parents hosted traveling missionaries in their home. "The influence and the stories — hearing what God did all around the world — was very influential," Writebol says.
Writebol's husband, David, also 59, her high school sweetheart, became a youth pastor after the couple married and soon felt the call to greater service. So when their two boys were in their late teens, the couple, then living in Charlotte, N.C., began exploring options to do mission work. David, a software specialist, and Nancy, a stay-at-home mom and later a college counselor, agreed in 1998 to abandon the security of their home for lives of service in virtual poverty.
"We felt compelled because of our faith," explains Nancy. "People didn't understand, but that life seemed normal to us."
The couple sold their four-bedroom house and all their possessions except clothes, scrapbooks and computers. Their beloved pet collie, Sophie, went to Nancy's mother before they took up volunteer posts in Ecuador, in northwest South America, and then Zambia, in southern Africa. In August 2013, they decided to join the 120-plus-year-old interdenominational Christian group known as Serving in Mission (SIM) in Monrovia, Liberia, the fourth-poorest country in the world and a nation recently wracked by civil war and sectarian violence.
Nancy and David lived in a small bungalow within SIM's Eternal Love Winning Africa (ELWA) compound, home to a 50-bed hospital, a Christian school and the first Christian radio station in Africa. David worked as the technical manager of the hospital, and Nancy served as a nurse's assistant. When not working, the pair delighted in getting to know the locals, strolling the beach nearby and spreading the gospel in the war-torn city, which lacks basic infrastructure.
When the first Ebola patient arrived at the ELWA hospital on June 11, soon followed by dozens more, Nancy was charged with overseeing health workers as they donned personal protective equipment (PPE) and spraying them with a bleach solution after they'd been in contact with patients.
"When I did the decontamination, I was five feet away," insists Nancy, who did not wear PPE but instead a disposable plastic gown, gloves and surgical mask. During 16-hour workdays, she also spent time with patients' family members and trained a young Liberian to help her with decontamination. (He would later die from Ebola.)
While Nancy says, "I never felt like I was in a situation where I was exposed," she began feeling achy and feverish in early July. Assuming she was suffering a recurrence of the malaria she'd contracted months earlier, she started a second course of treatment for the mosquito-borne disease.
She and David had planned to celebrate her birthday on July 22 at a restaurant, but that afternoon Nancy didn't feel up to it. "David fixed me a bowl of ramen, and I went to bed," she recalls. "It wasn't the birthday I was expecting." As a precaution, a chief ELWA doctor tested Nancy for Ebola.
The next day, David entered their bedroom with news that Kent Brantly, M.D., a close friend who worked with the couple at ELWA's hospital, had Ebola. Then David's voice caught. "And so do you," he added. He reached out to put his arms around her, but Nancy held up her hands to stop him.
"I didn't want him touching me," she says. "I knew how contagious Ebola was. I thought about how close we'd been, sleeping in the same bed. I knew this disease was a death sentence. We'd had 40 Ebola patients at the hospital by then, and only one survived."
There are five strains of the Ebola virus; Nancy had the Zaire strain, the deadliest. To this day, neither she nor her doctors know how she contracted it. Could she have comforted a patient's family member who was, unbeknownst to them, also infected? Could the young coworker she had trained have exposed her? Or had a patient's bodily fluids somehow hit her while she was decontaminating a health worker?
"We all have tiny breaks in our skin that we don't know are there," says Frank Glover, M.D., an international public health specialist. "With this virus, that's all it takes. When you are spraying a vigorous aerosol, it's possible a virus droplet can get on your skin."
For the next two weeks, Nancy was treated in her bungalow, now converted into an isolation unit. David visited outside their bedroom window as his wife's symptoms steadily worsened. "I grew weaker and weaker," she says. "I had terrible diarrhea, couldn't stand and didn't want to eat or drink. There were many very dark days when I thought I was not going to make it, and others when I woke thinking, 'I'm alive!' Thank heavens I had my faith."
To combat dehydration, doctors started IV fluids, but Nancy still developed neurologic problems, including memory lapses, due to a loss of electrolytes. Like many Ebola patients, she also began suffering from internal bleeding, indicated by the broken blood vessels in her reddened eyes.
"Before long, Nancy could no longer move," David recalls, a hitch in his voice. "Her skin became exceedingly sensitive. I once gently laid my gloved hand on her leg to comfort her, and she said it felt like needles. She was in such pain that even the bedsheets hurt."
They both knew she was dying.
SIM had obtained small quantities of an experimental antiviral serum called ZMapp; Brantly was the first human ever to receive it. Whether it should be given to Nancy, too, was a Solomonic decision that fell, in the end, to her husband. "We considered the spiritual dimension," he says. "Even if Nancy were not to survive, she would have eternal life. We believe that."
Days later, Nancy was still declining. Then, on Aug. 5, a specially designed aircraft with an isolation pod that was used during the SARS outbreak arrived in Monrovia. Through the auspices of SIM, she would be transported to the Infectious Disease Unit at Emory University Hospital in Atlanta. (David, astonishingly, avoided contracting Ebola and returned to the U.S. on a separate charter plane.) "I don't remember much about that 15-hour flight except being very thirsty and craving water," says Nancy. "I knew I was very sick. I wasn't sure I was going to live to see Atlanta, or even see dear David again."
At Emory, Nancy received aggressive supportive care, blood and electrolyte infusions, and a third dose of ZMapp. The Writebols' two sons flew to Atlanta to visit but were allowed only close enough to talk by phone through the window of her room. "It was like visiting someone in prison," says Nancy. She still couldn't get out of bed, her vision was blurred, and she suffered from neuropathy (nerve pain) in her feet.
But gradually over the next few days, she began to sense that she would beat the virus. The turning point seemed to come when she walked with the help of a nurse into the shower and stood under the spray. "I can't tell you how wonderful that shower felt," she says with a laugh.
Finally, on Aug. 19, tests indicated that Nancy was free of the virus. (Brantly, also transferred to Emory, survived as well, and both he and Nancy have donated their blood, thought to contain Ebola antibodies, to other Americans with the disease.)
Experts don't know exactly what saved Nancy Writebol — whether it was the ZMapp, the blood transfusions or simply the supportive care she received in the U.S., something that doctors have pointed out is sadly lacking in West Africa. But the Writebols attribute their good fortune to the prayers of their many loved ones, and most of all "the grace of God."
Nancy, who's shrunk from size 12 to 8, will remain stateside for at least nine months to recover fully. Still battling residual effects, including fatigue and hair loss, she is taking time to visit with family — first her mother, then David's mother, then their boys and four (soon to be five) grandchildren.
She and David had planned to take a Mediterranean cruise in August to celebrate their 40th wedding anniversary, but that's been put off until next year. In the meantime, says David, "We have spent time alone, talking, reflecting, holding each other close. It was hellish when we both were in isolation."
"Yes, it's a very lonely place to be when you can't be with people you love," Nancy agrees. She pauses, then adds, "I think God uses things like this to bring awareness." Which is why the Writebols say that, despite all they've been through, they're not finished with mission work yet. They remain open to the possibility of continuing in Liberia, though they know Nancy could be reinfected with one of the other strains of Ebola.
To those who would question why she and her husband would once again take such extraordinary risks to help others, she says, "It's simple. This is not my story. It's God's story. We are humbled that he chose us to tell it."
Jan Goodwin is an award-winning journalist and a senior fellow at the Schuster Institute for Investigative Journalism at Brandeis University in Waltham, Mass.