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one of their frequent phone conversations. “Both of us, we were really terrified,” said Dr. Tulu. “You can imagine all the exposures that we had with her.” While it was Dr. Seidenfeld’s job to worry about the havoc that the woman could wreak upon Medical City, Dr.Tulu had the luxury of being more skeptical. Being from Africa originally, he also had a keen sense of just how rare it is for anybody to come down with Ebola at allparticularly in a large city. “Most of the viral hemorrhagic fevers are usually confined to rural areas,” he observed. And to the best of his knowledge, there had been no reports of Ebola in Harare or Cairo. That weekend,Tulu spoke with Stuart Nichol, of the CDC’s special pathogens branch. “There is really not much in the history that would lead me to believe that this person could be suffering from any of the viral hemorrhagic fevers,” Dr. Tulu told Dr. Nichol during one of their talks. Nichol agreed that the woman probably had an unusual presentation of a common illness, quoting a saying popular among epidemiologists: “When you hear hoofbeats, you should be thinking horses, not zebras.” Still, the two epidemiologists wanted to rule out all of the viral hemorrhagic fevers, because the woman had just been to Africa, and her symptoms were so like those of Ebola. Since there was no facility in Texas where he could test for those diseases, Dr.Tulu agreed to have the Medical City staff send blood samples to the CDC as soon as possible. Over the weekend, the Medical City staff had located the woman’s brother and her boyfriend, and had put the two men in isolation as well. On Monday, the woman’s brother told doctors that his sister had been to the funeral of a small child while in Africa. Neither the patient nor her brother could say what the child had died of. Suddenly the prospect of some fatal contagion seemed more real. At about that time, the I.C.U. staff learned that the hospital’s lab had not sent any blood samples to the CDC, as ordered. The day before, the hospital’s infectious disease control team had assured the lab staff that Ebola would not permanently contaminate their equipment. After that, the lab technicians had proceeded with the rest of their experiments, but then they had mutinied again: Lab staffers were supposed to have taken blood samples to the airport, where they were going to be sent to Atlanta via FedEx, but nobody would agree to carry the blood there.After Dr. Seidenfeld knocked some heads around, the blood was finally sent off. Late Monday evening, the hospital lab informed Dr. Seidenfeld that the African woman’s immune system was severely compromised. She had HIV after allthough that didn’t mean that she did not have Ebola. On Tuesday, however, Stuart Nichol called from Atlanta to say that the woman had tested negative for Ebola. She had tested negative for Marburg disease and Crimean Congo fever as well. She didn’t have yellow fever, or dengue fever. What exactly she did have, other than AIDS, the doctors at Medical City never discovered. HIV has long baffled the medical community due to the bewildering variety of guises that it can assume, and the clinical literature does record a few cases where HIV alone has brought on Ebola-like symptoms. Today Dr. Tulu believes that the woman simply had a bizarre case of HIV Still, for the staff at Medical City, the brief transit of the bleeding African woman through their institution was a jolting wake-up call. Despite the resolution of her case to the contrary, it told them that in today’s world, Ebola can arrive in Dallas. “It will happen,” said the E.R.’s Dr. Johnson. “It’s not a matter of if, it’s a matter of when. That was the take-home message for meyou have to keep your guard up.The world’s just getting so small.” From the vantage point of his fifth-floor office, where Dr. Tulu keeps meticulous records of all that Dallas does and does not contend with, the case held a different significance. To Dr. Tulu’s mind, the case proved that undue alarm over rare illnesses may be the one thing that is even more contagious than the worst of Africa’s fevers. “The thing that probably prompted the suspicion of Ebola was, first, the travel history, and second, the coincidence of the Ebola outbreak in Uganda,” said Dr. Tulu. “It was all in the medical media as well as the mainstream media. That may have affected the perception with regards to her.” Dr. Tulu believes that the staff at Medical City should be commended for their actions; he thinks the hospital did everything right. But he views the story of the African woman as a morality tale with paradoxical instructions. “There are two lessons,” he said. “One is that you may have to think of the common thing first, before you think of the rare things. The second lesson is that we need to be prepared, even for such a rare occurrence.” For Dr. Tulu, the case defines the permeable era in which we live, where both germs and information travel faster than they ever have before. He has to be equally ready to believe, and to doubt, in anything. Skepticism was, in this instance, a particular virtue, because it encouraged the medical experts involved to keep their suspicions quiet. Had the hospital staff broadcast their fears, they would have almost certainly caused a needless uproaras indeed a hospital in Canada did this past February, when faced 7/20/01 THE TEXAS OBSERVER 11