Words for Mom

Good morning everyone. I cannot make it today so I hope you don’t mind that I’ve asked Uncle Bob to read some words for me to mom. It is so totally unfair to do so but thanks for doing this for me. Funerals are hard enough for everyone and to have to step in and speak for someone else is especially difficult. Here we go.

My dearest precious loving mother –

This is both the hardest and the easiest thing I’ve ever written. It’s the hardest because it is a goodbye. A final goodbye. I said goodbye to you mom many times over the past 30 years since I left home. Hard as many of those goodbyes were I knew there was a hello coming soon. When I said goodbye to you in December when I left for Africa I knew then it was quite likely I would never see you again. You knew it too. It was hard. We both knew we weren’t going to get to say hello again in this life. Yes there is that great gettin’ up morning promised someday when we will see each other again but today is goodbye. Goodbyes are just plain hard

This is also really easy to write though. When you have a great subject and some great stories the words flow. Mom, you can’t imagine the flood of memories and stories that have crossed my mind over these last few days. I hope it’s ok if I mention some of them to the folks here today. Each and every memory speaks to your kindness, your love for your family and friends, your selflessness, your faith, your optimism, your laughter, your gorgeous voice and your sense of wonder.

Let’s start with the last one, your sense of wonder. Mom, did you ever think when you were growing up in Natick that you would ever marry a hillbilly, raise three boys, make countless treks across the country by car and air, spend 18 summers in the Ozarks, live in California, Hawaii, visit Europe. The list goes on. Your life was filled with adventure and wonder. I can’t believe you spent your honeymoon without running water. Even I didn’t do that to Jess. The adventure never stopped until this past Friday. The wonder I’m sure continues as you sit at the foot of the Father.

Let me tell them about your kindness. I think the first Bible verse you taught me was Be Kind. You always, always were. There are a million times I remember you being kind but one stands out because it was so quiet, so simple but so kind. Remember when we worked at GBC – General Battery Company? I made 8 dollars an hour on Saturdays there. That was awesome money in the 70s. There was a kid there named Steve. I can’t remember his last name. He and his girlfriend had a baby girl and as you were fond of saying “didn’t have a pot to pee in”. On our way into work together one Saturday at 5 in the morning you had me get some bags and boxes into the trunk. They were filled with clothes, diapers, toys, and a baby seat. I asked who these were for and you said Steve and his family. I started to ask who gave them to you and before I could finish my jaw dropped. I realized you had bought all the stuff yourself and were just giving it out of the kindness of your heart. I saw it repeated by you throughout my life but that one memory really stands out. When we got there you called Steve to your car and had him bring his car over. He had no idea. When you had me open the trunk he just stared. He couldn’t speak. His jaw dropped. He too realized that you did something like this simply because you had a pure and perfect heart.

Let me tell them about your love of family. Nothing came before family in your life. As a child you just assume you are the center of the universe but Billy and Stevie and I really were to you. Your husband too. You had an unbreakable bond of marriage, faithfulness to family and a strength that defined your love. You constantly kept us pointed in the right direction and served as a model for others. I can’t tell you mom how many people asked me over the years what you “did right”.  I don’t know the answer and I don’t think you did either but it worked. Everyone recognized how special a mom you were. You touched so many with your love over the years -from little babies in cradle roll, to the neighborhood kids piled in the huge Imperial with you carting us all to Wingaersheek Beach, to college roommates who asked every other day when we were heading over to your house, to me. You always listened, never criticized and loved unconditionally.

Your loved your friends too and they loved you with a purity and a power that is present today. It was just second nature to you. Everyone in your orbit loved you - your brother and sisters, your in-laws, neighbors, church family, dental patients, the pizza guy, the gas station guy, the bank lady. I often wondered why you were so friendly. Were you born that way? Did you decide to be that way? I’ve come to the realization it was your name. Myrtle. People named Myrtle have to be friendly. And people named Myrtle Crabtree have to rise above the moniker and be extra friendly and be the most normal, friendly genuinely loving person possible. You always were. I think you had practice with the name thing though. Your mom was Bessie Mae. Your mother-in-law was Gertrude. Goodness. When it came time to name our daughters, Jess and I never really considered Myrtle but maybe we should have. It defined you. Folks may forget Myrtle is mentioned throughout the Bible. It’s found in Isaiah, Nehemiah, and Zachariah. It always refers to the beautiful, fragrant evergreen that to this day adorns temples in times of celebration.  It is fitting the plant was named after you.



Your selflessness. It seems to be a special hallmark of the women of your generation.  And it certainly was with you. You always sat down last.  Whether it was scrambled eggs at O dark thirty on Sunday mornings so Dad could get to church to set up the speakers, or beans and franks on Saturday afternoons, or Thanksgiving dinners for my college classmates you always served yourself last. You also, quietly gave us more than we deserved and more than you could really afford. You let us talk you into the Victoriaville hockey sticks with the Bobby Orr signature when the Gary Doak Sherwood would have been fine. You made sure we had Levis when Toughskins were the smarter and more economical choice. You always sacrificed. You never thought of yourself first.

Your faith and your optimism. Your faith was unshakable. I may have questioned parts of your beliefs but I never questioned your faith. The thriving church community that exists today in New England was built in large part on the bedrock your faith provided. All things were possible. Everything would work out fine. Your church burned down on your wedding day for goodness sake. How does one march on in that setting? You did. In the end, you knew your days on Earth were numbered but you never gave up. You accepted the fact that our bodies are not perfect that they wear out and that yours was quickly doing so but you met each day with promise and possibility. Just a few days before you left us mom you honestly told me when I called that you felt pretty good that morning. That today was a good day. Your optimism was your greatest gift to me. I like to think I share it in whole but I know only in part. Your optimism was boundless.

Your laughter was infectious and continuous. Sometimes you laughed so hard you peed your pants. Many of us, especially your sister Irene, learned long ago not to get on the Tilt A Whirl with you. You found joy in all things. That was another lesson your sons learned, your friends respected and God will reward you for.

Your gorgeous voice. Mom, you filled our house and our hearts with music. Dad had the big speakers but mom you had the voice. Yeah, I know dad has a distinctive voice but you had the signing voice - angelic, alto and oh so pretty. I close my eyes and hear you in the old Wellesley Park on a Sunday night when it was ok to rock a bit. I hear you in the St Joe Baptist church competing with Sarah Beth for the high notes, I hear you in our living room harmonizing with Dougie Mitcham on Unclouded Day and I hear you singing lullabies to your grandchildren. When I hear these songs I think of so many things. I think of Bert Mitchell’s perfectly scribed lyrics on the ancient overhead projector, I think of Tommy Mitcham and Wilma Shedd raising the rafters with their piano and organ and I see your hand tapping out the beat on the top of the pew. How I wish I could hold that hand again. Those songs often sang of a sweet forever… of a land beyond the river…of a place we only reached by faith’s decree…of a time when the King commands the spirit to be free. You’re free mom.

Mom, promise me you’re singing to folks in Heaven. They deserve it.

Mom, let me say a few words to the folks here. To all of you I am so sorry I could not be there in person. As many of you know I am in Liberia running a piece of our US government’s effort to help defeat Ebola. We are close. Your support made the difference. The war is not won but victory is in sight. Unfortunately one can only fly out of here once or twice a week. I just couldn’t make it. More importantly, Massachusetts would not let me participate in “public gatherings”. I guess funerals fall in that category. And can you imagine being there and NOT being able to hug each other? But worse, it is the cold and flu season and someone will have a fever and sniffles sometime in the next few days and I just couldn’t make them think they might have Ebola however unlikely. Mom and I talked about this possibility and I remember her words clearly. You take care of those folks. I’ll be with Jesus, everyone else is fine and I expect you to finish your job. It doesn’t make it any easier but I hope you all understand.

Finally mom, I need to say a few words to dad. Dad, I cannot imagine the sorrow and heartache you feel right now. Mom was a wonderful mate. But I know your faith is strong too. I know you know you will see her again. And if I know my mom she’ll have a table set for you when you next meet. Only this time, what a special table it will be. Mom will have a place for you at the Master’s Table. Can I hear a good old-fashioned Grampie Sellars Hallelujah!  And when you sit next to her dad please hold her hand under the table and give her a kiss for me. To all of you, please remember that first Bible verse mom taught me. Be kind. Take care of one another.

If God truly did make us in his image then God is not the blue-eyed bearded guy shown in the painting that hung in the staircase of the old Wellesley Park. No, God looks like you mom.

Jessie and I miss you so much mom. Piper and Haley miss their Nanny. Jess is here with you today. I am in Africa and Haley and Pipes are back home in Hawaii. But all of us want to say aloha and a hui hou. Until we meet again.

Goodbye my dearest precious loving mother. Enjoy your eternal reward. No one deserves it more.

Your loving son, Tommy

Burn Your TV in the Yard

Burn your TV in your yard

And gather 'round it with your friends

And warm your hands upon the fire

And start again

Take the story you've been sold

The lies that justify the pain

The guilt that weighs upon your soul

And throw 'em all away

People keep asking why I am still here. Ebola is gone. Come home. The TV news said there haven’t been any Ebola cases for weeks. The disease is defeated. The enemy vanquished. Happy Christmas, War is Over was I think how John Lennon put it. Victory. None of this is true. Burn your TV.

There was a positive case just yesterday here in Monrovia. He died. During the last few days of his life he was not recognized as an Ebola patient and came in contact with hundreds of people in the community to include many healthcare workers. The good news is no one has since popped up as positive from this event – yet – and the system the government and partners have put in place to find people that may have been exposed is working well. The process is called contact tracing and it is perhaps the single most essential part of defeating this disease. What it means is you have to find every single person that may have been exposed to the infected person and at a minimum follow them on a daily basis for the proverbial 21 days. In some cases, depending on the potential severity of the exposure you may physically quarantine them. The teams here are now quite skilled at contact tracing. And it works. When you so closely monitor potential patients and isolate them the minute they start to appear ill it markedly decreases the chance they will continue to pass along the infection. All the virus wants to do is propagate, build a chain link by link. Contact tracing stops the next link from even being built. Think of how many people you come into contact with every day in your routine. Hundreds? Thousands?

Let’s explore the word quarantine for a minute. We all know what it means. We hear it used on the TV news, read about it in the papers but where does it come from? The word "quarantine" originates from the Venetian dialect form of the Italian quaranta giorni, meaning 'forty days'. This is due to the 40-day isolation of ships and people before entering the city of Dubrovnik in Croatia. This was a measure of disease prevention related to Black Death. Between 1348 and 1359, the Black Death wiped out an estimated 30% of Europe's population, and a significant percentage of Asia's population. Just to refresh your memory, the Black Plague was caused by bacteria that used fleas and rats as part of its transmission cycle. Not nearly as exotic as Ebola which is a filovirus and probably carried by bats but just as deadly back then. I have to remind you of another part of the Black Plague’s history that you may not know. We are all familiar with the children’s rhyme ring around the rosie, pocket full of posies, ashes ashes we all fall down but we may not be aware that is all about the Plague. The ring referred to a classic skin sign of infection, the pocket full of posies was carried to mitigate the stench of death and the ashes and falling down referred to the deaths. I am not sure if Ebola will birth its own nursery rhymes. We’ll see.

The original quarantine document from 1377 is kept in the Archives of Dubrovnik and states that before entering the city newcomers had to spend 30 days -a trentine - in a restricted place waiting to see whether the symptoms of Black Death would develop. Later, isolation was prolonged to 40 days and called quarantine. Venice took the lead in measures to check the spread of plague and appointed three guardians of public health in the first years of the Black Death (1348). They enforced quarantine on ships at harbor and even built quarantine facilities on small islands. Venice – such a great city.

So what happens when somebody gets Ebola? I’ll save the clinical talk for a different time but let me walk you through how a patient is cared for. There are of course many schools of thought - doctors are even worse than lawyers when it comes to arguing - but there are established protocols that most agree on. A patient showing symptoms gets to care sites in many different ways. If a person is laying on the floor of their house or hut showing symptoms people know now to contact the authorities. A specially trained and outfitted team and ambulance goes and gets the patient. They know to bring them to an Ebola Treatment Unit – an ETU. Patients may also show up on foot, via motorcycle or even via wheelbarrow.

Once at the ETU the patient begins to follow a very prescribed path that seeks to isolate and protect the patient and protect the staff. The first part is triage. There, across at least a meter or two of barrier separation, a quick history is taken. The patients are guided on taking their own temperature with an accurate digital thermometer. A judgment call is made right there whether or not the patient fits the criteria. If so, a team in PPE (the spacesuits) comes and escorts the patient into an area where they are cleaned and their belongings gathered. They are now brought to a ward called the suspect ward. Here they have a blood test drawn and samples are sent. The patient receives what is called presumptive care at this point. Presumptive just means you assume that everyone may also have malaria and infectious diarrhea – both very common – and while you are waiting for the test to come back you may as well treat these. Supportive care like nutrition and fluids are also given and of course symptomatic care is given for fevers, pain and nausea for example.

It may take a day or two for a test to come back. If it is positive the person is moved to a completely new ward called the confirmed ward. Additional testing takes place. More aggressive treatment continues. The same categories of care – presumptive, supportive and symptomatic remain. Remember – there is no cure or vaccine for Ebola – yet. There are very strict guidelines on how patients and staff move and travel through the facility. One rule is there is no backtracking. A patient will never go back to the suspect area once confirmed. Remember some there in the suspect area may not have the disease. Likewise, a staff member always travels from suspect to less infectious to most infectious and does not backtrack either in order to minimize the chance of infecting other patients. The whole patient and staff flow is exquisitely choreographed. Those who went before us taught us.

Once in the confirmed ward there are two possible patient outcomes. The patient either survives and recovers or succumbs to the disease. If they recover there is a protocol for confirming a disease free state and the patient is released. They exit through a special area called Freedom’s Gate by some. They are given the appropriate support to include the basics like bedding, clothing and food since most everything was destroyed on arrival. No one is just sent out the door. The communities have a well-established network of support facilities and services. Still, a stigma surrounds Ebola survivors and many find it rough going. It is not unlike that experienced by HIV patients back in the day. Goodness, I just thought about my early days taking care of HIV/AIDS patients back at San Francisco General in the early 80’s. It wasn’t even called AIDS. We called it Gay Lymph Node Disease or Gay Related Immune Deficiency (GRID). We were all so naïve but terrified. Again, the similarities are striking.

Many patients die. Fatality rates range from 20-95% for Ebola. With good care in an ETU setting the more favorable numbers play out. When a patient does die they are treated with the utmost respect but again with very established protocols for the handling of remains. A recently deceased body is highly highly infectious. The ETUs all have proper morgues and a way to handle the remains. A very special NGO called Global Communities has taken the lead throughout this crisis for handling and burying remains. The ETUs transfer the deceased – again protocols – to the Global Communities personnel who transport the patient for burial. Every effort is made to include families in the process with appropriate attention to infection control.

I neglected to mention what happens to those in the suspect ward who prove negative. Those who recover are similarly discharged with the appropriate support. Those who remain ill are usually transferred to a more traditional health care facility or clinic. For caregivers as mentioned there is a similarly stringent workflow that starts with putting on the PPE – donning – through to how to safely perform even the most routine tasks like an IV and then when your shift is complete how to safely remove your PPE – doffing. I’ll save the mechanics of all that for a different time as well.

A couple of good video links give you an even better picture of what goes on inside an ETU. The first link is of the MSF unit at ELWA3 in Monrovia. The second is from another Liberian ETU.

https://www.youtube.com/watch?v=6Ib6WbIKyRE

http://abcnews.go.com/International/video/life-inside-liberian-ebola-treatment-unit-25873937

I’ve included some stock pictures of ETUs. You’ll note an abundance of concertina wire and snow fence. No locals call it snow fence but those of us lucky enough to have seen snow or even ski (how I miss it this season) do. The snow fence and concertina wire are to help indeed demand one follows the traffic patterns. No getting in (or out) unless appropriate. No backtracking. No left when you should go right. Some ETUs are refurbished buildings or clinics that already existed in the middle of a town. Some are just tents, although really good tents, and plywood buildings in the middle of the jungle. They all operate in a very similar fashion. They have all been critical to the success to date. Even those that have not seen a patient act as fire stations ready to jump on any ember. There’s still both smoke and fire. The house isn’t burning down anymore but there is still work to do. Lots of it. Don’t believe everything you see or read on the news. In fact, burn your TV in the yard. I haven’t seen TV in months. I don’t really miss it. Ah, that’s a lie. I miss the John Oliver show like crazy. How am I ever going to catch up?

Note: The lyrics to Throw it all Away are by Toad the Wet Sprocket

Snow Fence

Island Clinic ETU