Recollections of 9/11

by Philip Jeffery, MD

"The Horn of Manhattan" is how I refer to my favorite bike ride – the route that hugs the waterfront along the west side, swoops around the Battery and courses north under the East River bridges. I believe it was and is among the best urban bike paths in the country, circumnavigating so many landmarks. As the September 11 primary voting was unexpectedly quick, I was able to take this scenic route to work. It was the last time I saw those towers.

There were two residents and four medical students at readout that morning. It usually takes about two hours to get through the overnight cases and there were some tricky cervical spine exams that morning. The AES attending had came by to discuss one of them, and neurosurgery was requesting a fluoroscopically-guided cervical flexion-extension study on an unconscious patient, when the trauma chief resident called with an unusual question: "How fast can you read films?"

Upon hearing of a plane crash, I, like many, naively assumed it was an accident, like the plane that crashed into the Empire State Building in the 1940s — something that would be repaired. The trauma chief was sure we would be inundated with casualties. I was only three weeks into my new position, but I relished the challenge and the opportunity to serve. "Every day is interesting in the Bellevue ER" I chirped to more than a few people that morning. Nevertheless, trauma thought I would need help. So we brought a second PACS station down to the ground floor. I am glad we did.

The nature of emergency medicine is that things change from moment to moment. The radiologist may add views or suggest further studies as the patient’s status unfolds. This interaction with the technologists, clinicians and patients is what makes emergency radiology rewarding for me. So, although PACS allows the radiologist to be anywhere when reading the images, I suspect we will always maintain a physical presence in the Emergency Department. Michael Ambrosino arranged the second PACS system quickly, and I am grateful to Jonathan Klug who staffed it the entire day.

Casualties started arriving by mid-morning. In any disaster, it’s likely that the first to arrive will be in better shape than those still at the scene; they may drive themselves to Bellevue before we realize the scope of the disaster. Or can set up showers to decontaminate them. (Everyone in the Emergency Department risks exposure to bioterrorism, but the unimaginable had not yet occurred to most of us). Someone came by with plastic gowns and masks, but these seemed ineffectual to me, and were quite uncomfortable to wear. Frankly, I was still in denial about the scope of the tragedy. I sent the medical students away but Kyung Rhee, one of our first-year residents, offered to stay. I am grateful that she did; her grace and resolve were extraordinary and her presence reassured me.

Lauren Horowitz, one of the mammography fellows, called me from her cell phone while she was evacuating Gouveneur Clinic and gave me her eyewitness account of the second explosion. By then both towers were down and denial was becoming less available as a coping mechanism. Anger would do, but directed at whom? America did not yet know its enemy. I, however, had my enemy staring me in the face – a two-headed demon called PACS. This was the first real test for Bellevue PACS. Our disaster plan was written back in the age of film, so Willie Orozco had to deliver new PACS solutions on the fly. We changed tactics several times. I am thankful for his patience and creativity that day.

We had about thirty trauma slots on September 11. Moving these patients to the third floor for CT scans created some confusion and treatment delays, although we had a designated dispatcher to keep track of patients going to the main department. Much of the cross-sectional imaging was also done with portable ultrasound units in the Emergency Department. It was our radiologists and ultrasound techs that staffed these machines.

By late afternoon it had grown ominously quiet. No one knew what to expect: whether there were pockets of people alive, whether more buildings would come down or catch fire, or whether the retaining wall would break and flood the city. We hated to think that there would be no more patients to help. I did not want to leave. For the first time, I felt safer in the hospital.

But at 5:30 I biked home to pack some supplies for what I thought would be a long night at the hospital. The "Horn of Manhattan" was closed to me now. Instead, I rode through the streets and saw a city changed forever. Armed soldiers were directing what little traffic there was. People were dazed; businesses closed. Hand-written signs for the missing were already appearing on phone booths. And the foulest cloud blocked the sun.

My neighborhood, Union Square, hosted a vigil that lasted nearly a month. Walls of Prayers grew there, as well as at Bellevue’s entrance. The next few days were painfully slow, although we were proud to treat the rescue workers with minor injuries who wanted to get back to Ground Zero. Haskel Fleishaker covered me one afternoon when I needed some time to grieve.

By late October, stab and gunshot wounds rebounded as criminals made up for the September we never had. Several who were injured in their flight from the falling towers presented to the ER more than a month later, now with avascular necrosis and complications of their untreated fractures. Fractures many of them probably dismissed in as nothing in the face of so much loss.

Soon, my bicycle and I will set out to reclaim the Horn of Manhattan, and I look forward to that. But real acceptance will require that we learn from this tragedy and come back stronger. As I write this, our department is working on new procedures to follow in the event of another disaster (I hope not one of this scale). Each one of us will have an important role to play; and these procedures should be well known and practiced by everyone. If history calls on us again, we shall be ready.