A friend of ours, Dr Sam Brisbane, died recently. He was a Liberian doctor, and he died from Ebola, a horrible, nightmarish disease.

Information coming out of Liberia has been scarce. Since Dr Brisbane's death, we've learnt that other doctors and nurses with whom we've worked have also contracted Ebola and have died or are being treated in the types of rudimentary facilities we see on the news. As we live in dread of each phone call, questions about how we die and what we're willing to die for have been weighing on us.

The ancients had a concept of a "good death" – dying for one's country, for example, or gloriously on the battlefield. Solon, the sage of Athens, argued that one couldn't judge a person's happiness until one knew the manner of his death. The Greeks recognised that we're all destined to die and that the best we can hope for is a death that benefits our family or humanity.

For emergency-medicine clinicians such as us, the concept of a good death can seem too abstract, intangible. Rarely are the deaths we see good or beneficial. We see young people who die in the throes of trauma; grandparents who die at the end of a long, debilitating illness; people who kill themselves; people who die from their excesses, whether of alcohol, food or cigarettes. Last year, as part of a new disaster-medicine fellowship programme, we developed a partnership with John F Kennedy Memorial Medical Centre in Monrovia, the only academic referral hospital in Liberia. We collaborated with the hospital administration to develop disaster- planning and resilience programmes and teamed up with the emergency department (ED) staff to enhance medical training and establish epidemiologic studies of trauma. It was there that we met Dr Brisbane, the ED director. He immediately struck us as a genuine ED doctor – at once caring and profane, light-hearted one minute, intense the next. A short, bald man with weathered skin and thick glasses, he spoke openly and easily; his laugh was best described as a giggle, and he swore frequently.

When we conducted an initial vulnerability analysis for the hospital, we discussed our concerns about severe supply and personnel shortages, regular power outages, and occasional electrical fires. Dr Brisbane replied that what scared him the most was the potential for an epidemic of some viral hemorrhagic fever. He was right to be scared. We encountered rationing of gloves, a limited supply of hand soap, and an institutional hesitance to practice universal precautions, probably because of the limited resources. The hospital was not prepared for the kind of epidemic it's now facing – nor was the city of about 1.5 million people.

In pictures: Ebola virus Show all 62 1 /62 In pictures: Ebola virus In pictures: Ebola virus Ebola virus A health worker from Sierra Leone's Red Cross Society Burial Team 7 carries the corpse of a child in Freetown In pictures: Ebola virus Ebola virus A health workers from the Sierra Leone's Red Cross Society Burial Team 7 is sprayed with desinfectant after removing a corpse from a house in Freetown In pictures: Ebola virus Ebola virus Health workers from Sierra Leone's Red Cross Society Burial Team 7 prepare to remove a body from a house in Freetown AFP In pictures: Ebola virus Ebola virus Health workers from the Sierra Leone's Red Cross Society Burial Team 7 place a body in a grave at King Tom cemetary in Freetown In pictures: Ebola virus Ebola virus Mustapha Rogers of the Red Cross talks as health workers from the Sierra Leone's Red Cross Society Burial Team 7 remove a corpse from a house in Freetown In pictures: Ebola virus Ebola virus A citizen from Mali arrives at a hospital in Murcia city, south-eastern Spain. The protocol for a possible case of Ebola has been activated as the man, who arrived from Mali to Jumilla town in Murcia province five days ago, presents clinical symptoms of high fever and vomiting EPA In pictures: Ebola virus Ebola virus Kenyan medical workers show how to handle an infected Ebola patient on a portable negative pressure bed at the Kenyatta national hospital in Nairobi Getty Images In pictures: Ebola virus Ebola virus A health worker sprays disinfectant onto a college in Monrovia, Liberia AP In pictures: Ebola virus Ebola virus A burial team in protective gear bury the body of a woman suspected to have died from Ebola virus in Monrovia, Liberia In pictures: Ebola virus Ebola virus Healthcare workers in protective gear work at an Ebola treatment center in the west of Freetown, Sierra Leone AP Photo/Michael Duff In pictures: Ebola virus Ebola virus A healthcare worker in protective gear is sprayed with disinfectant after working in an Ebola treatment center in the west of Freetown, Sierra Leone In pictures: Ebola virus Ebola virus A member of the NGO U Fondation leaves a house after visiting quarantined family members suffering from the Ebola virus in Monrovia In pictures: Ebola virus Ebola virus An Ebola sign placed infront of a home in West Point slum area of Monrovia, Liberia In pictures: Ebola virus Ebola virus A Liberian man carries his sick brother suspected of having Ebola after being delayed admission to the Island Clinic Ebola Treatment Unit due to a lack of beds at the clinic on the outskirts of Monrovia, Liberia In pictures: Ebola virus Ebola virus Health workers remove the body a woman who died from the Ebola virus in the Aberdeen district of Freetown, Sierra Leone In pictures: Ebola virus Ebola virus A health worker fixes another health worker's protective suit in the Aberdeen district of Freetown, Sierra Leone In pictures: Ebola virus Ebola virus Health workers spray themselves with chlorine disinfectants after removing the body a woman who died of Ebola virus in the Aberdeen district of Freetown, Sierra Leone In pictures: Ebola virus Ebola virus A woman crawls towards the body of her sister as Ebola burial team members take her sister Mekie Nagbe (28) for cremation in Monrovia, Liberia In pictures: Ebola virus Ebola virus Sophia Doe sits with her grandchildren Beauty Mandi, 9 months (L) and Arthuneh Qunoh, 9, (R), while watching the arrival an Ebola burial team to take away the body of her daughter Mekie Nagbe, 28, for cremation in Monrovia, Liberia In pictures: Ebola virus Ebola virus Varney Jonson (46) grieves as an Ebola burial team takes away the body of his wife Nama Fambule for cremation in Monrovia, Liberia In pictures: Ebola virus Ebola virus Family members grieve as Ebola burial team members prepare to remove the body of Nama Fambule for cremation in Monrovia, Liberia In pictures: Ebola virus Ebola virus A Liberian burial squad carry the body of an Ebola victim in Marshall, Margini county, Liberia In pictures: Ebola virus Ebola virus An Ebola burial team dresses in protective clothing before collecting the body of a woman (54) from her home in the New Kru Town suburb of Monrovia, Liberia In pictures: Ebola virus Ebola virus An Ebola burial team carries the body of a woman (54) through the New Kru Town suburb of Monrovia, Liberia In pictures: Ebola virus Ebola virus An Ebola burial team dresses in protective clothing before collecting the body of a woman (54) from her home in the New Kru Town suburb of Monrovia, Liberia In pictures: Ebola virus Ebola virus Health workers in protective gear carry the body of a woman suspected to have died from Ebola virus, from a house in New Kru Town at the outskirt of Monrovia, Liberia In pictures: Ebola virus Ebola virus Volunteers in protective suit bury the body of a person who died from Ebola in Waterloo, some 30 kilometers southeast of Freetown FLORIAN PLAUCHEUR/AFP/Getty Images In pictures: Ebola virus Ebola virus Nowa Paye (9) is taken to an ambulance after showing signs of the Ebola infection in the village of Freeman Reserve, about 30 miles north of Monrovia, Liberia In pictures: Ebola virus Ebola virus Medical staff members burn clothes belonging to patients suffering from Ebola, at the French medical NGO Medecins Sans Frontieres (MSF) in Monrovia PASCAL GUYOT/AFP/Getty Images In pictures: Ebola virus Ebola virus A medical staff member wearing a protective suit walks past the crematorium where victims of Ebola are burned in Monrovia In pictures: Ebola virus Ebola virus A Liberian burial team wearing protective clothing loads the body of a 60-year-old Ebola victim after retrieving him from his home Getty Images In pictures: Ebola virus Ebola virus Sick women rest while hoping to enter the new Doctors Without Borders (MSF), Ebola treatment center near Monrovia, Liberia Getty Images In pictures: Ebola virus Ebola virus Hanah Siafa walks in the rain with her children Josephine, 10, and Elija, six, while waiting to enter the new Doctors Without Borders (MSF), Ebola treatment center in Monrovia, Liberia Getty Images In pictures: Ebola virus Ebola virus UNICEF health workers walk through the streets, going house to house to speak about Ebola prevention in New Kru Town, Liberia. The virus has killed more than 1,000 people in four African countries Getty Images In pictures: Ebola virus Ebola virus Local residents watch as public health advocates stage an Ebola awareness and prevention event in Monrovia, Liberia Getty Images In pictures: Ebola virus Ebola virus Public health advocates stage an Ebola awareness and prevention event in Monrovia, Liberia. The Liberian government and international groups are trying to convince residents of the danger and are urging people to wash their hands to help prevent the spread of the epidemic Getty Images In pictures: Ebola virus Ebola virus Hanah Siafa lies with her children Josephine, 10, and Elija, six, while hoping to enter the new Doctors Without Borders (MSF), Ebola treatment center Getty Images In pictures: Ebola virus Ebola virus A health worker examines patients for Ebola inside a screening tent, at the Kenema Government Hospital AP In pictures: Ebola virus Ebola virus A health worker cleans his hands with chlorinated water before entering an Ebola screening tent at the Kenema Government Hospital, about 86 miles from Sierra Leone’s capital Freetown AP In pictures: Ebola virus Ebola virus Aid workers and doctors transfer Miguel Pajares, a Spanish priest who was infected with the Ebola virus while working in Liberia, from a plane to an ambulance as he leaves the Torrejon de Ardoz military airbase, near Madrid, Spain AP Photo/Spanish Defense Ministry In pictures: Ebola virus Ebola virus A Liberian money exchanger washes hands between customers as a precaution to prevent infection with the deadly Ebola virus while conducting business in downtown Monrovia, Liberia EPA In pictures: Ebola virus Ebola virus A Liberian health worker sprays disinfectant on a drivers boots to stop the spread of the deadly Ebola virus at the Christian charity Samaritan Purse head offices in Monrovia, Liberia. Over 660 people have died of Ebola in West Africa in 2014 making it the world's deadliest outbreak to date according to statistics from the World Health Organisation EPA In pictures: Ebola virus Ebola virus A Liberian taxi driver wears protective gloves as a precaution to prevent infection with the deadly Ebola virus whilst driving in downtown Monrovia, Liberia. Many Liberians have taken to wearing gloves and washing hands after every interaction in an attempt to curb the spread of the deadly virus EPA In pictures: Ebola virus Ebola virus A Liberian money exchanger wears protective gloves as a precaution to prevent infection with the deadly Ebola virus while transacting business with customers in downtown Monrovia, Liberia EPA In pictures: Ebola virus Ebola virus A woman from Liberia takes food to a sick relative in the Ebola isolation unit at the ELWA Hospital where US doctor Kent Bradley is being quarantined having contracted the Ebola virus. Over 660 people have died of Ebola in West Africa in 2014 making it the world's deadliest outbreak to date according to statistics from the World Health Organisation EPA In pictures: Ebola virus Ebola virus The disease has now spread to Liberia and, for the first time, Sierra Leone and Nigeria, killing at least 672 people in 1,201 cases, according to the World Health Organisation’s latest figures AP In pictures: Ebola virus Ebola virus Health specialists prepare for work in an isolation ward for patients at the Medecins Sans Frontieres facility in southern Guinea AFP/Getty Images In pictures: Ebola virus Ebola virus A Liberian street vendor wears protective gloves as a precaution to prevent infection with the deadly Ebola virus while transacting business with customers in downtown Monrovia, Liberia EPA In pictures: Ebola virus Ebola virus A nurse from Liberia sprays preventives to disinfect the waiting area for visitors at the ELWA Hospital where a US doctor Kent Bradley is being quarantined in the hospitals isolation unit having contracted the Ebola virus, Monrovia, Liberia EPA In pictures: Ebola virus Ebola virus Staff of the 'Doctors without Borders' ('Medecin sans frontieres') medical aid organisation carry the body of a person killed by the virus In pictures: Ebola virus Ebola virus A Liberia man (right) talks to a nurse (left) about the health of his relative who is in the isolation unit of the ELWA Hospital where a US doctor Kent Bradley is being quarantined having contracted the Ebola virus, Monrovia, Liberia EPA In pictures: Ebola virus Ebola virus A nurse from Liberia walks to spray preventives to disinfect the waiting area for visitors at the ELWA Hospital where a US doctor Kent Bradley is being quarantined in the hospitals isolation unit having contracted the Ebola virus EPA In pictures: Ebola virus Ebola virus Staff of the Christian charity Samaritan's Purse put on protective gear in the ELWA hospital in the Liberian capital Monrovia AFP In pictures: Ebola virus Ebola virus Lagos State Health Commissioner Jide Idris, speaks, during a news conference in Lagos, Nigeria. No one knows for sure just how many people Patrick Sawyer came into contact with the day he boarded a flight in Liberia, had a stopover in Ghana, changed planes in Togo, and then arrived in Nigeria, where authorities say he died days later from Ebola AP Photo/Sunday Alamba In pictures: Ebola virus Ebola virus Staff of the Christian charity Samaritan's Purse put on protective gear in the ELWA hospital in the Liberian capital Monrovia. An American doctor battling West Africa's Ebola epidemic has himself fallen sick with the disease in Liberia, Samaritan's Purse said AP In pictures: Ebola virus Ebola virus Protective gear including boots, gloves, masks and suits, drying after being used in a treatment room in the ELWA hospital in the Liberian capital Monrovia AFP In pictures: Ebola virus Ebola virus A Liberian man holding a Civet being sold on a roadside as bush meat in Lofa County. Bush meat is one of the major carriers of the Ebola virus. The Liberian government and International partners have warned people to not eat it. The World Health Organisation (WHO) reported that a total of 888 Ebola cases including 539 deaths have been recorded in West Africa since February AFP In pictures: Ebola virus Ebola virus People unload protection and healthcare material at Conakry's airport, to help fight the spread of the Ebola virus and treat people who have been already infected AFP/Getty Images In pictures: Ebola virus Ebola virus Body of evidence: health workers transport a casket of a nun whose death resulted from an Ebola infection in Zaire in 1995 Getty In pictures: Ebola virus Ebola virus Peter Piot in Yambuku, northern Congo (then Zaire), in 1976, where he was part of the original team to discover the Ebola virus J Breman In pictures: Ebola virus Ebola virus A member of Doctors Without Borders helps to unload protection and healthcare materials in Guinea Getty In pictures: Ebola virus Ebola virus Doctors in protective gear work inside the Medecins Sans Frontieres isolation ward as Guinea faced the worst ever outbreak of the Ebola virus Getty Images

During our time at JFK, we became friends with Dr Brisbane. We learnt that he'd trained in Germany in the 1970s, had returned to Liberia to work, and had chosen to stay through the civil war and during Charles Taylor's despotic rule, continuing to see patients despite the bloodshed around him. He had welcomed the country's new democratic leadership and a new female administrator at the hospital – a first. He ran a successful coffee plantation and gave us bags of coffee every time we visited him. He was the father of eight biological children and six adopted children, and he had numerous grandchildren around the world.

Within a few days after our return to Monrovia in June 2014, the city's first patients with Ebola presented at Redemption, the county hospital, and we soon got word that a doctor and some nurses there had died. Rumours were rampant, and staff quickly abandoned that hospital. At JFK, our colleagues grew nervous. There were tensions between the hospital administration and the public Health Ministry. There was no clear plan for what to do if a patient suspected of having Ebola showed up at the hospital. How would staff members protect themselves? How would they isolate the patient? How could they move the patient to one of the ministry's isolation centres? Dr Brisbane was a wreck. He chattered nervously, his smile disappeared when he thought we weren't watching, and he openly wondered how he could protect himself. He told us bluntly: "Leave Monrovia."

Then one morning, we arrived at the hospital at 7 o'clock and ran into Dr Philip Zokonis Ireland, one of our young doctor friends. He was agitated, his fear evident in his face: there was a patient in the ED with suspected Ebola. The patient had lain in a bed in one of the small, crowded treatment areas for six hours, surrounded by nurses and other patients, until someone recognised his symptoms. We rushed to the room and met Dr Brisbane and Dr Abraham Borbor, the head of internal medicine. Others were sensing that something was wrong. Patients and their family members quickly disappeared, and nurses hung far back in the hallway.



The first priority was to get the patient out of the common room and into an isolation room, but the bed he was lying on was too wide for the doorway. So Dr Brisbane, Dr Borbor and two custodians hastily donned gowns, gloves and masks, then lifted the patient – mattress and all – and carried him into the isolation room, nearly dropping him in the process. The man had begun gasping for breath, and despite their efforts, within five minutes he was dead. Later that day, tests confirmed that he was indeed infected with Ebola virus. His body stayed in the now-otherwise-empty ED until it was retrieved hours later by the Health Ministry.

We remained in Monrovia for the next week and helped however we could. Dr Brisbane brought his own thermometer and checked his temperature religiously, fearing the telltale sudden fever. He wore a fedora in the hospital as a protective talisman. And yet he still joked with us, displaying a sort of gallows humour.

A few days after we'd returned to the States, we got a call from Monrovia saying that Dr Brisbane was in isolation and had tested positive for Ebola. The next call informed us of his death and hasty burial. By late August, Dr Ireland and one of the nurses we knew had contracted Ebola and Dr Borbor and a medical assistant who'd worked in the ED had died from the virus.

Dr Brisbane didn't have to stay at JFK and continue to care for patients. He could easily have retired to his coffee plantation with his wife and children and grandchildren. He was terrified of Ebola, and yet we knew that every morning when we entered the ED, we'd find him there, seeing his patients.

Doctors and nurses have a duty of care toward their patients. We're expected, on the basis of our training and an unwritten social contract, to fulfil that duty even in less-than-ideal circumstances – in the face of depleted resources, for example, or undesirable patients. But we also have a duty to ourselves and our families, and when our work becomes life-threatening, we have to decide what benefit we will be to our patients and what cost it will exact from us. In such circumstances, we cannot be expected to uphold the same duty of care. But during the world's worst Ebola outbreak to date, clinicians such as Dr Brisbane are on the front lines – and are dying as a result. They care for patients despite the risks to themselves, despite the inadequate supplies and infrastructure, despite their insufficient training in infection control.

Dr Sam Brisbane's death diminishes us as a people. But with apologies to his wife and family, who saw him die horribly and unjustly, and despite the deep loss we feel, we believe our friend died a good death – as did all the nurses and doctors who have sacrificed themselves caring for patients with this awful disease.

This article was originally published in 'The New England Journal of Medicine'

'This is the most terrifying epidemic I can remember - and front-line medical staff are most at risk'

By Jeremy Laurance

Sam Brisbane was the first doctor to die of Ebola in West Africa. Since then, the outbreak that he strove bravely to contain has exploded into an epidemic. It is the most terrifying I remember in more than 30 years as a health reporter.

Medical staff on the front line are at highest risk. Some 152 have been infected in Liberia and 79 have died, according to the World Health Organisation (WHO).

Early symptoms of Ebola – fever, vomiting, diarrhoea – mimic those of other infections, so patients may initially be treated on general wards, where they pass the virus to others and infect medical staff who lack protective clothing. Hospitals have become incubators of the epidemic.

In Liberia's capital, Monrovia, taxis filled with families carrying suspected Ebola victims criss-cross the city looking for a bed – and find none. There are no free beds for Ebola cases anywhere in the country, says WHO. As soon as a facility opens, it is overwhelmed.

A key avenue of transmission is now thought to be the taxis and motorbike taxis that carry thousands of people every day, because they are not disinfected between passengers.

As patients are turned away from hospitals and clinics, they return home to infect others, spreading panic along with the virus. Patients with other urgent medical needs – mothers in labour, children with malaria – are unable to get treatment.

The disease has completely overwhelmed all attempts to control it. The official toll is more than 2,000 cases and 1,000 deaths in Liberia, and more than twice that number across West Africa, but almost half of these have occurred in the past three weeks. The disease is spreading exponentially.