It is dismaying to learn that the two most egregious violations of voluntary self-quarantine for Ebola in the U.S. were committed by health care professionals. The first was the Dallas nurse, Amber Vinson, who took care of “patient zero,” the late Thomas Eric Duncan, and broke her quarantine to board a flight shortly before developing Ebola. And on Thursday night we learned about Craig Spencer, a 33-year-old physician who had just returned home to New York City after heroically treating Ebola patients in Guinea. Astoundingly, the night before, he boarded a subway bound for Brooklyn, bowled ten frames with his friends, and returned to his apartment in Harlem that evening by taxi. The following morning, he developed a fever of 100.3 degrees and, shortly thereafter, found himself in the isolation unit at Manhattan's Bellevue Hospital Center.
Voluntary quarantine, staying at home, avoiding contact with others, self-monitoring one’s temperature and any new symptoms are not difficult concepts to understand. It may be lonely, boring or even frightening to follow such edicts. Yet one would assume that if anyone would follow these public health rules to the letter, it would be a physician. Sadly, that old adage, “doctors make the worst patients,” seems to ring especially true when considering Dr. Spencer’s decision to break his self-quarantine and go out for the evening.
I do not know Dr. Spencer and I am in no position to condemn or reprimand him. But I am not all that surprised that he went bowling despite being advised to stay home. I’ve been a physician for well over a quarter of a century and have taught in a medical school for more than 20 years. Consequently, I do know many doctors and the strange thoughts that swirl around in our heads. The question that is keeping me awake Thursday night is not the fear that Ebola will overtake New York City (it won’t) but, instead, what is it about Dr. Spencer's psyche that would facilitate taking such a risk to oneself and to others?
Social critics have observed that in our current era, adolescence often extends to one’s twenties and even one’s early thirties. Psychologically, adolescence is a time when one feels that nothing can hurt you and illness or poor health is for other people. I used to call it the Rambo phase of development. Now, combine that magical thinking with the power and psychological impact of becoming a doctor, being responsible for other people’s lives, and having specialized knowledge and skills that most people only read about or watch on television. Add to this psychological mix of prolonged adolescence the socialization process of medical school and residency training. It is an intense time that thrills many a young doctor and makes him or her feel healthier and stronger than mere mortals.
I well recall the power and strength I felt as an intern, whenever I donned my white coat and strode onto the hospital ward. “How could I possibly get sick,” I thought to myself on many occasions, “when I have so many sick people to heal.” One’s colleagues or teachers rarely check this form of magical thinking. Indeed, the boldest members of my medical school class were instantly attracted to staying up all night saving lives in an emergency room, slashing open the body of a trauma victim, or going overseas to tackle a raging epidemic. Such activities only reinforced this sense of invulnerability, the inability to be stricken with illness even in the face of an epidemic, and, most cogently, a disdain for following the very rules and medical advice we give to our patients everyday.
With the passage of years, the ravages of aging when my body has begun to conspire against me, and having young children and a wife who depend upon my presence, I now realize that I am all too mortal and life is very fragile. I have become far too risk-adverse to travel to Africa to conquer an epidemic like Ebola even though I have spent much of my working life studying the social dynamics of epidemics. When it comes to my own medical complaints, I remain a poor patient and often think I know more than the fine physicians who treat my various maladies and complaints. I try to be compliant with their advice and prescriptions but I frequently am not. Fortunately, my medical complaints are restricted to a couple of herniated discs, an elevated cholesterol level, and a stomach ulcer instead of the contagious and unforgiving exposure to the Ebola virus.
I hope Dr. Spencer’s battle with the Ebola virus is victorious. He is obviously a committed and heroic physician who did what few of our medical colleagues have done by going to Guinea and treating Ebola patients. I also hope that he was not far enough along in his course of Ebola to be contagious to any of the people he may have had contact with. Indeed, I remain confident that the chances of him infecting anyone that night is extremely low.
I cannot presume to know what Dr. Spencer was thinking when he went out bowling the other night. He might have just been bored. He might have just not been thinking at all about the potential risks to himself or others. But if he is like me when I was a bold, young physician out to conquer illness as if I were a soldier in a good war, I bet he just thought Ebola could not happen to him.
The piece has been updated. On Thursday, health officials said Spencer reported to authorities a 103-degree fever. On Friday, according to the Times, officials said he reported a 100.3-degree fever, and that the mistake was due to a transcription error.