The medical director of the clinic, Dr. Bechara Choucair, defended his staff. ''Some providers believed that prior vaccination with the smallpox vaccine is necessary before providing any direct patient care,'' he wrote in a letter sent to me in March. A spokeswoman later pointed out that, strictly speaking, Anderson's partners were not obligated to participate in Rebecca's treatment because she was not a patient of Crusader Clinic, with which they were affiliated. SwedishAmerican would have had its own rotation schedule of doctors. The spokeswoman added that ''the fact that the partners hadn't been vaccinated would have hindered their
participation.'' The pediatrics partners themselves declined to comment.
''They were angry,'' Anderson said. He said he believed they were scared. In the end, Anderson and the clinic's director agreed that he'd take a leave to serve full time at SwedishAmerican, staying for as long as the girl remained.
''It was exciting,'' he said. ''It was a chance to provide care. I naively thought that everyone would want to be part of something like that. But I guess not.''
For years, the concerns faced by the doctors of Rockford have echoed through the halls of African hospitals, whose personnel are disproportionately beset by Ebola, Lassa fever and other killers. Invariably, only some doctors and nurses will volunteer to care for infected patients. A few of them may die, like Dr. Matthew Lukwiya, who was profiled in this magazine in February 2001. Others will flee. ''If you have an outbreak of, say, Ebola,'' said Dr. Daniel Bausch, an associate professor at Tulane University's School of Public Health and Tropical Medicine and a veteran of many epidemics, ''most of the medical staff heads for the hills. They've noticed that the last two or three people to catch the disease were health care workers, and they decide, quite logically, that it's not worth the risk.'' During an outbreak in 1995, an international team of doctors arrived in Kikwit in Congo to find that Kikwit General Hospital was deserted and silent, except for a half dozen or so patients, including medical staff, lying unattended in a back room, dying of Ebola.
Monkeypox is not as lethal as Ebola, but the issues, emotions and responses it elicited in Rockford did resemble those of the health care community in Kikwit. ''There's always fear of things you don't understand,'' said Wildey, who forbade her pregnant secretary from having any contact with her after she entered Rebecca's isolation room. Later, on that first Friday night, arriving home after 10 p.m., she was not surprised when her husband suggested they might sleep in separate rooms. By then, she had had her vaccination. The vaccine uses a live poxlike virus called vaccinia to help the body develop immunity against smallpox. It was not very likely that she could transmit the virus to her husband or anyone else, but she understood his concern. ''He didn't want to touch my body,'' she said matter-of-factly, and during the next several days, moving between the hospital and her home, she swapped one isolation unit for another.
North American doctors are still getting used to the idea that their jobs can be so dangerous. ''Over the years, I've had colleagues die from occupationally acquired hepatitis B,'' said Dr. Lawrence Dean Frenkel, a 60-year-old professor of pediatrics and microbiology at the University of Illinois College of Medicine in Rockford and an academic consultant on the monkeypox case. Each of those colleagues was stuck with a needle or otherwise came into contact with tainted blood. Another physician died of meningitis, caught while she was resuscitating a young child. She breathed into the infected child. The child breathed back.
Those incidents are rare, though. Only the rise of H.I.V. in the 1980's dented, for a while, most doctors' and nurses' complacency about the safety of their jobs. ''I was an intern at San Francisco General Hospital just before AIDS was identified,'' said Dr. Julie Louise Gerberding, now the director of the Centers for Disease Control and Prevention. ''We'd be staying up all night with these patients who clearly were deathly ill, but we had no idea what was happening. We were sometimes lax about personal safety.'' At the time, she was delighted to have her scrubs splashed with blood: ''It made me look like a real doctor.'' It also gave her hepatitis B, but she recovered.
Such insouciance disappeared as people came to understand that H.I.V. could be transmitted through body fluids. Doctors started turning away AIDS patients. The situation became acute enough that in 1987 the American Medical Association released a rather magisterial statement:''A physician may not ethically refuse to treat a patient whose condition is within the physician's current realm of competence, solely because the patient is seropositive for H.I.V.'' In other words, buck up, follow the standard precautions and get back to work.
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Shortly after Michael Anderson arrived at SwedishAmerican, Rebecca was moved from the emergency room to the reverse-airflow unit in pediatrics. The room was behind glass doors within a larger room that was once part of the pediatric I.C.U. Now that area was filled with a ghostly lineup of unused metal cribs, the whole place underlighted by a funereal yellow glow.
Anyone going in to see Rebecca was required to wear a leakproof N-95 respirator mask, a splash guard, a surgical hat, a gown, gloves and booties. In this get-up, faces are obscured. You can't touch skin. Doctors who wear glasses, like Anderson, complain that the masks are so tight that lenses fog up. For Rebecca, it must have felt as if she were being treated by indistinguishable wraiths.
What motivates one doctor or nurse to volunteer in an outbreak and another to beg off? No one really knows, since epidemics in the West have become so rare. ''Even before a polio vaccine was available, large numbers of health care workers, oblivious to their own safety, would volunteer to care for the polio patients in iron lungs,'' said Dr. Donald A. Henderson, professor of medicine and public health at the Center for Biosecurity at the University of Pittsburgh Medical Center and the man in charge of the global smallpox-eradication campaign. ''I am confident that this same selfless concern for others would prevail today should an epidemic occur.''
But when SARS hit in Toronto last year, that's not what happened. ''It was hard at first to find doctors to cover the SARS wards,'' said Dr. Leslie Nickell, a family doctor who assisted the SARS control team. Early in the epidemic, Nickell, who is also an assistant professor of family and community medicine at the University of Toronto, organized a study of the psychological impact the disease was having on the personnel at her hospital, Sunnybrook and Women's College Health Sciences Center, which ultimately admitted 71 SARS patients. Twenty-three of these were health care workers, some from Sunnybrook. The results of her survey, published in the March 2, 2004, issue of The Canadian Medical Association Journal, are disturbing. Of the 2,001 respondents, 65 percent reported significant concerns about their health and that of their families. Almost 30 percent, including 45 percent of the nurses who responded, displayed significant levels of ''emotional distress.''
Health care workers disliked wearing the uncomfortable masks and having their temperature taken every morning as they reported to work, though they knew these measures were necessary. Nickell also heard more mundane concerns. ''They said that they couldn't have Easter dinner at home with their families,'' Nickell said, because they were in quarantine or on extra shifts. ''That may sound petty, but it matters. Others said their neighbors didn't want them to visit. They felt stigmatized.''
Doctors and nurses with children were particularly affected, according to Nickell, prompting some to question whether they would continue to report to work. ''No one wants to spread disease to their family,'' Nickell said. But microbes don't fight fair. They do follow people home. Some of those who developed SARS in Toronto, as in Hanoi and elsewhere, were the children, parents, siblings or close friends of hospital workers. Not all of them survived.
Ultimately, though, enough doctors and nurses volunteered in Toronto that the SARS wards could be manned. ''It wasn't a hard choice for me,'' said Nickell, one of those volunteers. ''I don't have children, which helps. I suppose my husband was a little concerned.'' She laughed. ''But I don't think it was about my bringing something home to him as much as it was about my own health and well-being. Still, I was very careful for both our sakes.'' There were bad moments, though. ''I remember one day,'' she said, ''we heard that a third hospital had gone down.'' About that time, across Toronto, many medical facilities were closing their doors because SARS had spread to the staff. ''I was with another worker, and we're there in the hospital's SARS control room,'' Nickell said. ''We look at each other, and we both say, 'O.K., now I'm scared.' ''
