Sadness

Boston is going to be tied up for some time in managing recent events (which sound crazier and crazier – unfortunately, I don’t know much more about them than you will if you read the NYTimes), so I don’t have much hope of having my last posts from “in country” approved any time soon. I’ll continue with non-(directly)-work-related posts until then.

I have been puzzling over how I feel being away from Sierra Leone. From time to time, I’ve tried to describe it to my friends, but – for one, it seems like it requires a somewhat longer description than is conversationally polite, and also – doing so in French would wear me out. For some reason it hadn’t occurred to me to write about it here until today.

I don’t know how many of you read Craig Spencer’s article from the New England Journal of Medicine that I posted here (it’s really worth a look: http://www.nejm.org/doi/full/10.1056/NEJMp1501355), but he said something that made a moderate impression on me when I first read it a couple of weeks ago and which now really stands out: That when he got back, he felt very sad. In particular, he said that he has never been a depressive person (which I can well believe from the two weeks I once spent with him on a course), but that, in his first few days back, he felt like he became depressed. It seems that something similar has happened to me (er – except for the fact that I AM a depressive person!). I feel anxious, doomy, and close to tearful frequently over the course of a day.

Perhaps it seems obvious what this must be about – all that death; all that inability to stop it; all that awareness that trying our best wasn’t really helping that much (and that at times it may even have done some harm). I’m sure that’s the main thing. (Although I, personally, have never had an experience where pain was so clearly and neatly deferred, like a task or a conversation – can’t feel it while I’m working; start to feel it as soon as I’m not. Is emotional pain really that fungible? Maybe it is.)

I think that at the moment, though, all of this is compounded by anxiety over the possibility of actually catching Ebola. As I’ve said before, it wasn’t something I consciously worried about that often, but seeing that a colleague really can get the disease makes you think about all the run-of-the-mill mistakes, all the things that happened that weren’t completely kosher, and you start to wonder – was that enough that I caught it, too? And the thing is, there simply is nothing to do but wait and see. I’d say I still have something like 5-10 days before I will feel completely internally confident that I am clear, and in the meantime any strange occurrence or sensation starts you worrying again. All in all, stressful/fearful, which I think compounds the sadness. (Also, right at this moment – many of my friends still over there are caught up in various possible exposures, various possible evacuations, and I’m worried about them, too.)

Then, as one of my friends pointed out, we were all probably running on an unusually high dose of adrenaline, just due to the daily stress of the work. So it may be that no longer having that hormone burst means that, on a simple, physical level, we are more prone to a kind of inner collapse.

Finally, there are the antimalarials. Here are some of the side effects that are listed for Malarone, the one I am taking (which isn’t even the scary one): “sleeplessness,” “trouble sleeping,” “unable to sleep,” “discouragement,” “fear,” “feeling sad or empty,” “irritability,” “loss of interest or pleasure,” “nervousness,” “trouble concentrating.” My guess is that they play a part, too. (I can’t stop taking them, however, until the full course is finished in four more days. If I got malaria (very, very unlikely, but still), the hospital here would have no choice but to treat it as possible Ebola, and that is a road we just don’t want to go down.)

So, many possible sources – but whatever the reasons, I’m feeling more sadness, and more anxiety and doubt (and grief?), than I would have predicted.