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Aftermath: 9/11 and Boston

2013; Elsevier BV; Volume: 62; Issue: 6 Linguagem: Inglês

10.1016/j.annemergmed.2013.06.001

1097-6760

Antonio Dajer,

Disaster Response and Management

[Ann Emerg Med. 2013;62:631-632.] The Boston Marathon bombings brought me back. September 11, 2001, was my shift. The emergency department (ED) of New York Downtown Hospital is located 5 blocks from the World Trade Center. That morning, as I took advantage of a lull to lecture the residents, a man from Boston was walking by the twin towers. In town for just the day, D. was an IRS expert and the guy who every year helped his neighbors with their taxes. “An American Airlines plane hit the towers!” a nurse yelled. We dashed to pile up trauma equipment, to hang IVs, to think of everything in 5 minutes. A tidal wave of panicked, bleeding people, some carrying others more badly injured, surged into the ED. As chief, I was supposed to pluck out the badly wounded, stabilize them, and steer the flow. It was too many, too fast. I threw away a stack of triage tags, gathered up interns and residents, and attached them rapid-fire to patients: take them in, examine as you go, deliver to correct area, repeat. The injuries were staggering: one young woman's legs had been sheared off; another's arms stretched out woodenly with severe burns. Open skull fractures, crushed chests, shattered limbs—the result of concrete and flaming jet fuel falling onto human beings 1,000 feet below—were our business that day. Two hundred came the first hour. The South Tower collapsed. I heard the roar, thought a missile had hit another building, and then gaped as the 10-story-high cloud of dust and debris barreled up Gold Street. With nowhere to run, we braced until we dared open our eyes again. The hospital vanished inside a filthy, acrid cloud. To protect the patients inside we needed to seal the doors. But out of the murk, ghostly hands pounded on the lobby glass. Hundreds were trying to escape the smoke and dust. We opened again. The second tower came down. Another cloud. Each floor of the hospital filled. Upstairs, interns were caring for severe traumas, the operating rooms were going full tilt, everybody raced. But no badly injured patient was missed. D. must have passed through my hands but I did not remember him. His intern had detected a collapsed lung and steered him to a surgeon who immediately placed a chest tube. Worse, his spine was crushed midback, his chest burned. His wife and 3 adult children back home went from soothing logic (“What are the odds?”) to growing terror as the day wore on. They finally made phone contact with the hospital and then sped south through the night. Braving police barricades and a blacked-out, smoldering lower Manhattan, they found him in our ICU. We all spent the night at the hospital—there was no transportation out. Next day, the surprise was everyone's reaction: “I didn't do anything.” The death toll was too staggering to even whisper; our failure to undo the devastation felt unforgivable. It had all been much too fast—barely time for names, no time for real contact. We held onto each other afterward, but it wasn't enough. Upstairs, D's physicians identified yet more injuries: head trauma and a partially crushed chest. He was critical; a few days later we transferred him uptown to the ICU at NYU. Lower Manhattan stayed blacked out for 6 days. At night only the hospital, on generator power, cast light into the abandoned streets. Most disorienting was the sense of isolation. The world's attention was riveted on Manhattan, but barricades kept everyone out below Canal Street. Nurses tired of explaining to friends and strangers that no, they did not work at St. Vincent's. The photos of faces plastered everywhere—young, smiling, vibrant—were of the dead. A month later, we found D. Bill Cole, MD, a colleague at NYU who had raced downtown to help, located him in their ICU. “He's having a tough time,” Bill said when I met him outside the unit. D.'s wife had spent 5 weeks by his side, tag-teaming with the kids. We expected to meet an exhausted, wrung-out wreck. Instead, she stunned us. Petite, energetic, a fast talker with a broad Boston accent, she bestowed on us such a smile of beatific grace that, hardened Bellevue grads and all, we sat speechless. “You saved him!” she gushed. “You kept him for me. It must have been hell for you that day.” Bill and I did double takes. The love of her life lay broken, likely dying, and she was worried about us? We met D. and tried to mask our concern. Even weakened and depleted, his bravery filled the room. The other thing filling that hospital room was his wife's pure, all-in love. I traveled uptown at every chance. D. never managed to turn the corner, but that smile, his wife's incandescent embrace of all that she could love, never flagged. A month later they managed to transfer him back north, but overwhelming infection got him 3 months to the day after 9/11. I went to see her in Massachusetts and met their kids. She braved New York once but wasn't sure she could do it again. Over the years, I worried that checking in would bring back the most excruciating day of her life, but she never let on. After the horror at the Boston Marathon—one of her sons had run it in memory of his father—her voice, smiling with broad A's and absent R's, returned in my head. How are you? I typed out by e-mail. The grandkids are spectacular, she replied. There is a special person in her life now. A miracle. In the aftermath of the Boston tragedy, the media will pack up and public attention will drain away, but the urgency of holding onto each other will cycle back like the tides. E. M. Forster once wrote, “Only connect.” He had no idea.