Remembering 9/11

Entrance to Bellevue; photo by Troi Santos

by Danielle Ofri
Los Angeles Times.

“It’s gonna be a big one,” one of the nurses said in a dry, blasé voice, as she walked down the clinic hall. “Plane just hit one of the twin towers. They’ll be coming in droves.”

Her tone was the nearly bored resignation of someone who’s worked in a city hospital for years and who’s seen it all: Bellevue Hospital, after all, is the quintessential municipal hospital — huge emergency room, Level 1 trauma center, recipient of New York City’s urban fallout for 275 years. Another plane crash, or train wreck, or gunfight, typically elicits not much more than a “Here we go again.”

It took exactly 17 minutes for that attitude to crumble. As soon as the second tower was hit, even the crustiest of old-timers was shaken. From the upper floors of the hospital, the smoking towers were visible 60 blocks downtown.

And then the hospital shifted gears like I’d never seen in my 25 years working there.

The staff was reacting based on the memory of the nearly 1,000 people Bellevue treated from the World Trade Center bombing in 1993. They knew that the ER would need to be expanded, and then there would be an acute need for hospital beds, especially intensive care unit beds. Our medical clinic was quickly transformed into an additional ER, with triage stations and equipment for first aid, burns and smoke inhalation. Other clinics were converted into ICUs, with cardiac monitors and ventilators wheeled in from storage.

Upstairs on the inpatient wards — as usual, at maximum capacity — doctors rounded the halls, discharging anyone who could walk, clearing out the beds to handle the influx.

The overnight staff remained in the hospital along with the day staff. Busloads of doctors from hospitals in Brooklyn and Queens arrived at Bellevue. Off-duty doctors and nurses showed up of their own accord. “I didn’t know what else to do,” I overhead one pediatrician saying, “so I came here.” Even the retired chairman of medicine, Dr. Saul Farber, hobbled in to the hospital with his cane.

The ER was packed, six doctors deep wherever you looked. The clinic was overflowing with medical reinforcements and equipment. Everyone was geared up, eyeing the ambulance bays nervously.

And then … no one came. A spooky calm flooded the hospital. Thousands of medical workers — doctors, nurses, medical students, technicians, orderlies, therapists, clerical workers — were poised at the ready, but there were no patients. Mostly we stood around, nervously fingering stethoscopes and lab coats. Nobody could tend to their regular work — that felt unseemly.

A handful of patients, mostly first responders, trickled in over the course of the day; they were so outnumbered by doctors that the scene felt surreal. There were almost no victims from the towers. Myself, I treated precisely one patient on Sept. 11, a firefighter with mild smoke inhalation. It was the strangest relief to lay hands on an actual patient, to do something, to take my mind off external events even just for a moment.

An old ER hand turned to me by the elevators. “In every disaster, there are three zones,” he told me. “The center zone is death on impact. The middle zone is the gravely injured. The outer zone is minimal injury. Today — ” and here he sighed with emotion that I’d never seen in him before — “there was no middle zone.”

By midafternoon, it was apparent that there would not be mass casualties coming to Bellevue. The administration decided to release all staff who lived locally, figuring these people could be called back easily in the evening or night if needed. I was in that group, and was discharged out into the impossibly perfect blue of that warm Tuesday afternoon.

Just in front of Bellevue stood an enormous, temporary wooden fence enclosing a new clinic under construction. Already, people had begun taping 81/2 x 11 fliers of the missing onto the wall. The official center to register missing persons had been set up in the building between Bellevue and the chief medical examiner’s office — a logical but unsettling location. A queue of agitated families stretched well down the block, crowding the sidewalk.

As I walked along First Avenue, I saw people tacking up fliers on every available phone booth, lamp-post, mailbox, traffic sign. Even the news vans were papered over.

As evening fell, the city seemed to settle into a queasy calm. The endlessly cycling images of the collapsing towers on TV had become too painful to watch and people had taken to the streets, wandering around the neighborhood in small groups, stopping to gaze silently at the posters.

In the days that followed, the hospital slowly returned to normal, but the posters remained everywhere. To get to work each day, I had to walk along the construction wall that was now a block-long confluence of white papers leading right up to the main entrance of the hospital.

Each flier contained a photo — almost always of a person smiling. There were wedding photos, school portraits, beach pictures, family gathering photos. The happiness in the photos made it impossible to stride purposefully by. The smiling faces of the dead stood in stark contrast to the anguished faces of the living who walked by each morning, struggling to get to work each day without breaking down in fresh tears.

I found myself compelled to stare at each one. I became familiar with the people on the fliers — began to know their names, their distinctive birthmarks, what floor of the north or south tower they’d worked on. They came to feel like the patients I would have treated, if only ….

Though the hospital never received a deluge of casualties, the medical examiner’s office did. A white tent was pitched in a back parking lot as a temporary extension to handle remains, and East 30th Street was closed off to allow workers going about their grim duty to shuttle between the main office and the extension.

Long after the last lamppost flier was downed by a rainstorm and a section of the construction wall was taken to the Museum of the City of New York, the sorting and examining of remains continued.

East 30th Street remained closed for nearly three years. The white tent still stands today, visible from all the windows on the north side of Bellevue. More than 9,000 unidentified remains are there, still under active study; a positive identification was made a few weeks ago. There is something simple but somber about the white tent — a memorial that is not for show, but a practical reminder of how the medical profession responded to New York City’s worst crisis.

In the end, that duty didn’t fall to the trauma surgeons, the ER docs, or the paramedics — the usual responders to such emergencies. It fell to the pathologists, doctors we don’t normally think of as the ones to interact with patients, to respectfully, painstakingly — and continually — handle Sept. 11 and its aftermath.

The pulmonologists of Bellevue have since established a World Trade Center clinic to treat the many New Yorkers who were exposed to toxic dust and continue to have respiratory symptoms. But for most of the medical staff who were on duty that day, our only patients are the memories we have of the faces on the fliers.  (from the Los Angeles Times)

 
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Danielle Ofri’s newest book is What Doctors Feel: How Emotions Affect the Practice of Medicine. She is a physician at Bellevue Hospital and an associate professor of medicine at N.Y.U. School of Medicine. She is also editor-in-chief of the Bellevue Literary Review.

 

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