When they wheeled Preston Gorman into a light spring breeze outside the National Institutes of Health nearly five years ago, he was, medically speaking, among the most fortunate people on the planet.
Gorman’s doctors had just defeated advanced Ebola virus disease, one of the most fearsome infections known to medicine. There were smiles and hugs and handshakes in the NIH Clinical Center in Bethesda, Maryland, where Gorman had spent the previous month in isolation, attended every moment by a medical SWAT team in moon suits.
Doctors, nurses and other caregivers gathered for a short prayer with Gorman and his family before sending him home to Texas in the same private jet that had raced him to NIH from Sierra Leone. At his parents’ home outside Dallas, siblings, aunts and cousins turned out to celebrate the emaciated young man who had returned from the dead.
And then Gorman’s life fell apart.
At a time when another Ebola outbreak is spreading, Gorman is a reminder of how easily trauma can be overlooked after severe illness. Gorman’s family and friends, and the medical system that so skillfully battled his disease, all missed the gravity of his condition.
“No one said, ‘You’ve just been selected for a really hard journey, and by the way none of your family is gonna understand, none of your friends are going to understand and you’re not going to understand,’ ” Gorman recalled. “They’re thinking it’s all over, and I walk into this group of people, and I don’t even know what’s happening.”
A prolonged battle with severe post-traumatic stress cost Gorman his family, the woman he intended to marry, his friends and his job. One of the luckiest men alive, he considered suicide.
Gorman, 38, who chose to remain anonymous until now, was one of 11 people treated for Ebola infections in the United States during the West Africa outbreak of 2014-2016. The others have been previously identified.
Today Gorman is climbing back. He has a job, roommates and new friends in Austin. He maintains his faith, though his views on religion have changed. He still struggles at times, but he also feels joy again. And hope.
“It forced me to dig deep, find out who I really was, and rely on God’s direction in the healing process that is still ongoing to this day,” Gorman said in one of many emails and conversations over the past few months. “There were many mistakes and dark moments. But a journey that, I hope, in the end will be worth it.”
Research has revealed extensive post-traumatic stress among Ebola survivors, their caregivers and witnesses to the widespread death in West Africa. During his brief stay in Sierra Leone, Gorman was all three.
“He wasn’t just there to witness it, but rather became a victim himself,” said Lorenzo Paladino of SUNY Downstate Health Sciences University, who has studied post traumatic stress. Fear, survivor’s guilt, deferred grieving and helplessness, as well as Gorman’s history of depression, all can play a role in post-traumatic stress.
Medical experts are also learning that surviving a life-threatening illness that requires intensive care can leave cognitive and emotional scars, a condition called post-intensive care syndrome.
“We’re not very good, even in this country, at figuring that all out and giving people that support,” said Natasha Tobias-White, an intensive care nurse who worked with Gorman in Sierra Leone.
Working in Maforki
Gorman grew up in Cedar Hill, Texas, a Dallas suburb, in an evangelical family. He trained as a firefighter and paramedic, then went back to school to become a physician assistant.
When Ebola broke out in West Africa, he felt a calling to help. He quit his job and volunteered with the Boston nonprofit Partners in Health, which had opened a treatment center, its first, in the Sierra Leone community of Maforki.
“I think having been a firefighter, having been a paramedic, I was used to running into situations where everybody else is running out,” he said. “And that’s what I did.”
Care for Ebola patients in West Africa consisted mostly of providing support – intravenous fluids, pain relief and other medication – in the hope that the victim’s immune system would rally and conquer the virus. About 40% of the 28,600 people infected in West Africa died.
Hundreds of health-care workers were infected. Providing care required meticulous attention to putting on and taking off the protective suit and mask. Every inch of skin had to be covered. A single exposure could be fatal.
After a week of training, Gorman arrived in Maforki in March 2015 and spent a few days shadowing other caregivers at the Ebola treatment center in a former vocational school. But then he was sent to the government hospital in nearby Port Loko and assigned to manage a men’s ward with a mix of patients.
In chaotic, understaffed wards without electricity and running water, foreign medical providers tried to care for people with tuberculosis, broken bones and malaria. “I’ve never treated TB before,” Gorman said. “It was overwhelming. You could barely keep track of it all.”
Gorman did not have to wear the protective suit there. Anyone suspected of Ebola infection was separated at the entrance and sent to a treatment center. One day, at a morning meeting, he passed out. Dehydration was common; his colleagues quickly assisted him. He went back to the living quarters in Maforki to recuperate.
The next day he awoke with a high fever, a sign of Ebola infection. No one knows how Gorman contracted the disease.
He was quarantined. The colleagues who had touched him when he fainted were sent home for monitoring. Gorman’s clothes, his computer and all his possessions, except for a flip phone, were confiscated and, presumably, burned. He never saw them again.
Steadily weakening, Gorman was sent to a treatment facility for caregivers run by the British Army. It was two hours away, over the rough roads of West Africa.
“Somebody came in and dropped a [protective] suit on the floor and said, ‘Put this on,’ because I was going to isolate myself.”
It was a painful ride on a metal bench in the stifling rear of the ambulance. He called his father. They prayed together. Then Gorman began to vomit, another Ebola symptom. “I’m hurling all over the back of that thing. I mean, it’s just . . . a sheet of vomit back there.”
After a couple of hours, the driver banged on the wall of the cab. “We’re here,” he said.
No one came to help. Gorman let himself out the back of the ambulance and barely made it to the entry of the treatment unit. He slid off a chair and curled up on the ground. No one could touch him.
In the treatment unit, uncontrollable diarrhea began. Gorman was too weak to leave his bed. Caregivers did the best they could.
Arrangements were made to evacuate him to NIH. A four-hour ride to the airstrip in the back of another ambulance would be followed by a 16-hour flight.
“I’ve got two IV’s and I’ve got two catheters sticking out of me that I’m going to have to take with me on this damn ambulance and be all by myself the whole time. Nobody was gonna get in the back,” he recalled. “It’s terrible. I’ve never felt that lonely.”
On the plane, one of the nurses gave Gorman drugs to ease his pain and knock him out. Upon arrival, he was placed in a plastic bubble and taken off the plane on a conveyor belt. He had been in Africa for 19 days.
Daniel Chertow, one of the doctors who would provide Gorman’s care, met him at Dulles International Airport in Virginia and rode with him in the back of an ambulance to NIH.
Chertow said: “We’re going to take care of you,” Gorman recalled. “I’ll never forget that.”
Treatment at NIH
With the infection progressing rapidly, Gorman’s chances of survival in Sierra Leone were zero. In the NIH’s Special Clinical Studies Unit, one of the most advanced medical facilities in the world, his odds were only slightly better.
In the isolation unit, 50 or 60 specially trained medical personnel who had volunteered for the assignment monitored Gorman’s health in teams around the clock.
Gorman was one of the sickest patients ever housed in the NIH unit, said Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, and one of Gorman’s many doctors.
One by one, Gorman’s organs began to fail. His kidneys, his liver, his heart and his lungs were overwhelmed, his immune system unable to stop the virus, said Richard Davey, chief of NIAID’s clinical research section and Gorman’s lead physician. Gorman also developed brain inflammation.
With Ebola spreading across West Africa, an experimental drug called ZMapp had been rushed into clinical testing. Seventy-two people, most of them in Africa, would be enrolled in two groups: those given the drug; and those kept on the standard care of fluids, medication and support. The doctors asked Gorman whether he wanted to be part of the trial. He agreed.
But a computer randomized him to the control group. There would be no ZMapp for him.
(In the current Ebola outbreak in Congo, more than 800 people have received one of four experimental therapies, including ZMapp, with two others showing the most promise in reducing deaths. And this month, the Food and Drug Administration granted the first U.S. approval for an Ebola vaccine.)
Gorman’s mother sat vigil outside his room. She wasn’t allowed in, but she could see him on a video screen and talk to him through a cellphone propped next to his ear. “She would pray and read the Bible to me,” he said, though he has no recollection of it. “And just, like, talk to me and sing to me.” His father flew back and forth from Dallas. His girlfriend was there for days.
Soon Gorman began breathing so rapidly that doctors had to sedate him and put him on a ventilator. “I know what intubation means. It means things are bad. Things are really, really bad,” Gorman recalled. He asked Davey if he would ever wake up.
“I believe you will,” Davey told him.
Gorman doesn’t remember any of the 10 days he was sedated. At one point he started thrashing, the doctors said, disconnecting his breathing tube, pulling out an intravenous line and splashing blood on two moon-suited nurses who were trying to hold him down. Helpers had to first don protective suits, which under the best of circumstances takes about five minutes. No one was infected, but the incident led to a separate protocol for emergency responses, Fauci said.
As doctors prepared to put Gorman on dialysis, his kidney function began to stabilize. They held off. Slowly, his other organs improved. “Sooner or later, if you can maintain someone the way we maintained Preston, chances are the immune system will clear the virus,” Fauci said.
Eventually, the breathing tube was removed. The next day, two nurses, still in moon suits, helped Gorman out of bed. He was able to stand for 20 seconds, he said, supported under each arm. He went back to bed, exhausted.
On April 7, 25 days after he arrived at NIH, Gorman was moved out of isolation. “And for the first time in a month, I get to have human contact. And the first person in the room is my mom. . . . And she gave me a great big hug. . . . And then the second person is my girlfriend. She gives me great big hug.”
Two days later, Gorman was released from the hospital and flown to his parents’ home outside Dallas. He had lost 30 pounds. He couldn’t walk properly. He looked terrible. Gorman chose to leave without fanfare, through a rear exit.
Gorman describes the next two or three years as a “fugue state,” a time of overwhelming sadness, loneliness, alienation and, above all, bewilderment.
He went home to live with his family outside Dallas, and while he slowly recovered physically, he could not connect with his family, his girlfriend or his friends. He felt utterly alone, battling emotions he didn’t understand. Often, he found himself weeping uncontrollably.
“I was happy to be alive. But I was now instantly confused. It was like my sense of security, stability, everything had just been stripped like overnight,” he said. “Is anyone going to get this?”
His parents said that during the year Gorman lived with them, they tried to help without pressuring him.
“When he was here we didn’t talk a lot about his experience,” said his father, Gene Gorman. “We just allowed him his space. When he wanted to talk, he talked. . . . We knew this was a huge healing process, both physically and emotionally.”
Gorman, in contrast, felt enormous pressure to move on with his life, get married, start working, raise a family.
One friend told him: “Hey, dude. Ebola was last year. You need to get over it,” he said. Others implied that he was not praying enough or sufficiently trusting God.
Overwhelmed with guilt, he broke up with his girlfriend. When he tried to reconcile, she rebuffed him. Eventually, he moved out of his parents’ home and cut himself off from his family.
“What I felt was deep, significant, shame,” he said. “Like a catastrophic level of shame.”
Too focused on their son’s narrow escape from death, “we didn’t know what to do. Everybody in this thing – Preston, me, [his mother] Esther, his brothers – we were in uncharted waters. We didn’t realize the depth and the seriousness that Preston was facing post-Ebola,” Gene Gorman said.
Given Preston Gorman’s history of depression, NIH had recommended that he follow up with a psychiatrist, who prescribed medication. But Gorman didn’t find it much help.
Of the 11 Ebola victims treated in the United States, two – a permanent U.S. resident volunteering in Sierra Leone and a Liberian visitor – arrived with the virus and died. The Liberian man, Thomas Eric Duncan, infected two Dallas nurses, who were quickly treated and survived.
Six, including Gorman, were medical volunteers who contracted the disease in West Africa, and one was an American freelance journalist there. All were treated in specialized hospital units and lived.
Some of the survivors have faced challenges like Gorman’s.
“For the first 18 months, I struggled a lot. It was hard,” said Ashoka Mukpo, the freelance journalist who became infected in Liberia in 2014. He said he fought anxiety and depression, “just generally feeling shellshocked. What the hell just happened to me, and where do I go from here?”
Gorman said the only people who seemed to understand were co-workers who had been in Sierra Leone with him.
“Our phone calls would frequently be two or three hours,” added Larry Geller, a retired pediatric nurse from San Francisco who also worked with Gorman in Port Loko. “He was kind of in a feedback loop where his frustration and inability to move on was feeding his frustration and inability to move on. He was really in a dark place.”
Gorman believes that Partners in Health failed its “moral and ethical duty” to aid his recovery. He said the organization did not offer any help until he and former colleagues contacted officials there to express concern about his condition.
The organization disputes that, saying it stayed in contact with him over the years, occasionally offering to help him find therapy. The nonprofit’s human resources director also worked to help him secure workers’ compensation insurance for his health-care bills after Gorman was initially turned down, officials there said.
In late 2016 Gorman went to an Alcoholics Anonymous meeting, though he wasn’t drinking heavily, on the hunch that it was a place where he could air his problems. Someone there referred him to a therapist who specialized in trauma. Gorman began seeing him in late 2016 and still does.
In January 2017, he quit his job and checked himself into a mental-health treatment center in Tucson, Arizona, for several weeks. It was there, he said, that he began to understand the difference in the ways trauma affected him and his family.
“The family bonds while it happens, and they all feel close and tight,” he said. “The individual comes back and goes, ‘Well, why am I not a part of this?’ And they feel worse and more alone.”
Gorman said he has forgiven his family but is not ready to reconcile. “I would hope that one day we could speak,” he said. “I just don’t know when that’s gonna be.”
Last year, Gorman was befriended by Peter Hubbard, 68, who runs groups where men explore the emotions and expectations that affect their lives. Hubbard has spent many hours talking with Gorman. Other than therapists, he has made the biggest difference in Gorman’s recovery.
Gorman also has started attending a faith-based program that helps people change. He found a job he likes at the University of Texas urgent care clinic, with a supportive boss and time off in the summer. Bit by bit, he is reassembling his life.
Early in 2017, Gorman went back to NIH and handed out copies of “The Body Keeps the Score,” a highly regarded book on recovering from trauma.
“I said, ‘You need to know for your patients, when they come in here, if they have something as serious as I did, this is what can happen. And you’ve got to prepare your patients, and you’ve got to prepare your families for this.'”