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January
2002
Volume 66 |
Number
1
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September
11, 2001:
When Our World Was Changed |
Roy A. Winkler
ASA Communications Assistant
Photographs by Kenneth M. Sutin, M.D.
Change begets change. Nothing propagates so fast. If a man
habituated to a narrow circle of cares and pleasures, out of which
he seldom travels, steps beyond it, though for never so brief
a space, his departure from the monotonous scene on which he has
been an actor of importance would seem to be the signal for instant
confusion — The mine which Time has slowly dug beneath familiar
objects is sprung in an instant; and what was rock before, becomes
but sand and dust.
— Charles Dickens
(1844)
Few could argue that before September 11, 2001,
each and every one of us was not habituated to our own narrow
circle of cares and pleasures. As much as mass media saturation,
instantaneous electronic communication and rapid means of travel
have made ours a “global culture,” we Americans, for
the most part, remain communal beings. In general, we tend only
to worry about what goes on in our own backyards — the times
are rare that we have a need to worry about anything more. But
on the morning of September 11, 2001, the narrow circle of our
individual cares and pleasures was forever altered. As we watched
the tragedies unfold in New York City, Washington, D.C., and southwestern
Pennsylvania, Americans collectively understood that a monumental
and unprecedented change had taken place. Certainly it was important
that these events represented the only direct attacks on American
soil since Pearl Harbor more than 60 years ago. More important,
however, and perhaps more devastating, were the symbolic consequences.
In a span of two hours, an as yet unnameable and invisible foe
had reduced to rubble and ash the mammoth twin symbols of American
commerce and prosperity in New York and had infiltrated the very
brain trust of our military might in the Pentagon.
As the ruins of the World Trade Center and the damaged
Pentagon smoldered, as dismay and horror turned to speculation
and rage, we began to realize the most insidious truth about these
unprecedented events. We realized that our highest ideals, our
most cherished institutions, and our belief and faith in human
goodness had been used against us. Soon after that fateful morning,
we were dramatically confronted with an enemy that we were to
learn hated us for our ideals and beliefs. They hated our values
and they hated our lifestyles. We were shocked into confronting
what we had collectively become: fragmented and isolated, despite
the fact that television and the Internet had supposedly made
us so connected. We were still communal, but our communities were
within ourselves. We cherished such ideals of freedom, goodness
and tolerance, but we also had reached a point where we largely
took them for granted.
On September 11, 2001, that all changed. In mere
minutes, we watched our symbols of prosperity and cultural tolerance
crumble to the ground. We realized then that everything that we
have held dear up until that point had been challenged.
The collective reaction, for a culture so supposedly
complacent and jaded, might have been as astonishing as the grisly
images on that morning of September 11. The evil of that day was
met with an equal amount of solidarity and compassion from Americans
and from people the world over. The terrifying acts of September
11 initially achieved their intended effects — Americans
were shocked, frightened and confused. But just as quickly as
those acts of terror reduced the World Trade Center to rubble,
they galvanized the collective American spirit of unity and pride.
Americans from all ethnic backgrounds donated their time, their
services, their money, their blood. The most culturally diverse
melting pot of citizens in the world had become one again.
The Damage Done
In the midst of the chaos in lower Manhattan and the vicinity
of the Pentagon, firefighters, police officers and ordinary citizens
scrambled to help those in need. Hospital and emergency medical
staff were also preparing for the worst.
J. David Roccaforte, M.D., an assistant professor of anesthesiology
at New York University and co-director of the surgical intensive
care unit at Bellevue Hospital in Manhattan, was preparing an
elective oral surgery case on the morning of September 11. Around
8:50 a.m., he and his associates received word that an explosion
had taken place at the World Trade Center. Looking out the windows
of the Bellevue intensive care unit, they saw billowing smoke
from the towers. Many in the ICU there saw the second plane hit
the south tower. It did not take long for the hospital staff to
realize how badly they would be needed.
“We proceeded to the emergency department and began setting
up for mass casualties,” Dr. Roccaforte said. “Elective
cases were completed, ICUs were triaged and cleared, and operating
rooms were placed on standby. Within an hour, we were fully prepared
to accept and treat injured patients up to our capacity.”
In the ensuing hours, Dr. Roccaforte and his co-workers treated
about a dozen critical trauma patients, and the emergency department
processed and treated around 200 minor casualties. When the trade
center towers collapsed, however, they understood that minor casualties
would probably be minimal from that point on.
While Dr. Roccaforte and countless others struggled amid the
chaos in New York City, more tragedy was occurring in the nation’s
capital. At 9:43 a.m., American Airlines Flight 77 crashed into
the Pentagon. Evacuation began immediately, but lost in the great
plumes of smoke and scattered rubble was an objective appreciation
of the damage done. Once again, like in New York, area hospitals
and trauma units were rushed into action.
More Dead Than Wounded
Grant Lynde, M.D., an Army captain and CA-3 resident at Walter
Reed Army Medical Center in Washington, D.C., was in the operating
room when he and his co-workers were informed of the attacks on
the World Trade Center. While he watched television news coverage
of the New York attacks, Dr. Lynde learned that the Pentagon had
been attacked as well. The hospital was put on alert, and they
prepared for the worst.
“All of the staff in the emergency room were separated into
trauma teams consisting of a surgeon, an anesthesiologist, two
R.N.s and two L.P.N.s,” Dr. Lynde said. “We distributed
equipment and waited. My team was third up for a patient.”
Like so many who were involved in the chaotic atmospheres soon
after the attacks, Dr. Lynde understandably felt a mixture of
confusion, sadness, horror and rage while he watched and listened
to the chaos so close to him. Adding to his own personal distress
was the knowledge that his fiancée frequently visited the
Pentagon through her job as an economist. Not knowing her whereabouts,
he tried frantically to call her. As was so frequently reported
at the time, however, cellular phone infrastructure failed, and
he spent a hellish three hours until he was finally able to contact
her and learn that she was safe.
During those tension-filled hours of waiting, the first of three
patients arrived.
“He had substantial burns and required intubation due to
his injuries,” Dr. Lynde said. “Because of the edema
from the burns and overall poor airway morphology, intubation
was extremely difficult and ultimately required an emergent tracheostomy.”
A second patient came to the surgical intensive care unit and
was intubated after developing respiratory distress.
A third acute trauma patient died before reaching the ICU.
Dr. Lynde was on call that night and so was asked to provide
anesthesia for the second patient who had developed compartment
syndrome. Because the Walter Reed Army Medical Center is not a
trauma center, the patient’s severe burns presented added
challenges for Dr. Lynde and his co-workers. When the patient
was successfully intubated and sedated, however, Dr. Lynde found
a brief amount of time to contemplate.
“Three things struck me pretty deeply during the case,”
he said. “First, the patient was about my age, and I started
to think about all the people I knew in the Pentagon — prior
patients and a childhood friend. It was difficult for me to not
be incredibly sad and angry at the atrocity brought upon us by
a yet unknown enemy. Second, I was overwhelmed by the odor of
burnt flesh and the ‘non-textbook-like’ hyperdynamic
nature of the patient, as if all the fentanyl in the world couldn’t
ease his pain. And third, I was impressed by the amazing crystalloid
requirements such a patient had.”
He was not to witness much more of the same, however. The rush
of casualties that Dr. Lynde and his fellow staff members prepared
for never came. The reason was obvious: There would be more dead
than wounded.
“Waiting to Do Anything Useful”
An attending anesthesiologist at nearby Alexandria Hospital in
Alexandria, Virginia, R. David Zurowski, M.D., experienced the
same letdown as Dr. Lynde while he waited for incoming wounded
from the Pentagon. “We all sat around in the operating room
waiting, but no one came,” he said. He later learned that
the military took strict control over matters concerning the treatment
of any who were injured in the attack. As an Arlington County
Medical Examiner, however, Dr. Zurowski found himself amid the
damaged Pentagon site. “It was just like something you’d
see in a movie,” he said. “There were three or four
perimeters of fences, and it seemed everybody had loaded automatic
weapons.” Dr. Zurowski expressed amazement at the relatively
small number of people actually partaking in the rescue process.
He estimated that there were perhaps six or seven people from
all manner of governmental agencies on the scene for every one
rescue worker, but he did not know who they were or why they were
there.
Dr. Zurowski was close enough to witness the attempts at reclamation
of bodies and any salvageable items of evidence. “They would
pull out huge chunks or rubble, dump it into trucks and take it
to a different side of the Pentagon. Then they would dump it,
hose it down and pick through everything.” Because the military’s
control over all aspects of the attack’s aftermath, not even
the funeral directors with whom Dr. Zurowski worked so closely
were called upon despite the anticipated high death toll. All
in all, for civilian medical staff in the Washington, D.C., area,
the hours and days following the Pentagon attack were frustratingly
uneventful.
There seemed to be one concurrent feeling experienced by Dr.
Lynde, Dr. Roccoforte, Dr. Zurowski and the thousands of others
who were called upon to assist in helping those in need following
the attacks: a yawning helplessness. As the police, military and
the media began to piece together the events of September 11,
the situation became more clear — and more disturbing. These
terrorist attacks were soon to be recognized as the worst the
world had ever seen. They had been calculated by a faceless enemy
to take as many lives as quickly as possible. As the medical community
was learning, they succeeded in dramatic fashion.
“Several of our physicians returned from a New York downtown
hospital to report that their casualties were lower than expected,”
Dr. Roccaforte reported. “We were asked to equip and staff
a field hospital triage site at Chelsea Piers. Our reports from
physicians there were also of few if any seriously injured survivors.
The afternoon was spent in frustration, waiting to do anything
useful.”
A Brave New World
At St. Vincent’s Manhattan Hospital, where the majority of
casualties from the trade center attacks would have gone, the
same frustration permeated the medical ranks there. George G.
Neuman, M.D., chief anesthesiologist at St. Vincent’s, reported
a pressing helplessness at being within walking distance of ground
zero, but not being able to get to the victims. Anesthesiologist
Steven Stern, M.D., also of St. Vincent’s, echoed that statement
and said that after treating dozens of burn victims during the
initial wave, the expected deluge never came.
Around 2 a.m. the next morning, after hours of agonized waiting,
Dr. Roccaforte’s team realized that no more casualties would
be coming into his Chelsea Piers triage site. They dismantled,
and he made his way home through the now surreal, ash-clogged
streets that just half a day before hummed with vitality and optimism.
About the casualty situation, Dr. Roccaforte commented that “this
was nothing we wouldn’t be able to handle even under ordinary
circumstances. I don’t think the disaster response was in
any way lacking. By the time the dust settled and the fires were
controlled, the golden hour was long gone. By then, all that was
left was the walking wounded and the dead. All in all, a frustrating
endeavor.”
The next morning, Dr. Roccaforte played witness to frantic scenes
on the city’s streets. “Everyone here was trying to
track down anyone they know who might have been in the buildings
or the area and sorting out if they are safe or missing.”
Eerily, he observed a wondrous contrast to the nightmare on the
city streets. “The wind shifted and the sun broke through,
it was an otherwise innocent late summer day. Welcome to this
brave new world,” he lamented.
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Regaining an Air of Normalcy
Change has a considerable psychological impact on the
human mind. To the fearful, it is threatening because it
means that things may get worse. To the hopeful, it is encouraging
because things may get better. To the confident, it is inspiring
because the challenge exists to make things better.
— King Whitney, Jr.,
President of Personnel Laboratory, Inc.
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Memorials in the dust. This column in front of
World Financial Center building number 2, just east
of the World Trade Center, was transformed into
one of many impromptu tributes that sprang up around
the city
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Eight weeks after the attack on the Pentagon, Dr. Zurowski is
amazed at how sterile it now looks. The rubble has been removed,
the damaged sections cleaned up and the workers on scaffolds give
the impression that only simple, routine maintenance is being
performed. Although the devastation was greater in New York City,
ground zero too is slowly regaining an air of normalcy. What remains
of the World Trade Center will eventually be whisked away, damaged
buildings nearby will be repaired, city planners and construction
workers will no doubt retransform the area, and it will take on
a new life of its own. Buildings can be replaced. Landmarks come
and go. The effects of September 11, however, were more powerful
than the World Trade Center was tall.
“You look at things more closely now,” Dr. Zurowski
said. “Little things creep into your life. Things that people
used to take for granted, they don’t take for granted anymore.”
For Dr. Lynde, many of the memories of September 11 will never
go away.
“Since that day, a lot has changed in my life,” he
said. “Some of my friends, attendings and colleagues are
no longer here. I still here the sounds, see the people and smell
the burnt flesh as if it was yesterday.” His fiancée
was personally unscathed from the Pentagon attacks, but she lost
four coworkers there.
All Americans lost something that day, indeed anyone in the world
who cherishes liberty and goodness lost something that day. A
relatively small few gave the ultimate sacrifice, and the lives
of their loved ones will never completely whole again, but all
of us will remember the images and feel the shock of that day.
An enemy attacked us and awakened emotions and feelings that most
of us do our best to avoid or ignore. But along with the collective
awakening of our fear, horror and vengeance came an awakening
of a collective sense of pride and unity, a pride and unity that
comes from being an American. An enemy destroyed the World Trade
Center, damaged the Pentagon and took thousands of innocent lives
above the ground and on the ground, but that same enemy did more
damage to itself than it could ever do to our country. They awakened
our slumbering sense of unity. They united the melting pot of
individuals who are here to find a life of freedom and tolerance.
Americans, as should be clear by now, work best under pressure.
Americans do not just welcome change, Americans are change. We
were full of fear and reticence that day and for the days that
followed, but we pulled together. We proved our system works.
“I’ve been in contact with some family members who
lost loved ones in the Pentagon, and I can’t begin to describe
the cathartic feelings they as family members and I as a caregiver
have felt as we have shared our stories,” Dr. Lynde said
upon recounting his efforts to save lives on September 11. “I’d
like to think that the families feel a bit better knowing that
someone cared enough to help ease some victim’s pain —
someone just like their loved one — and I know I feel better
knowing that people appreciated all of our efforts.”
On September 11 and during the days that followed, it was not
important that we were surgeons or lawyers or construction workers
or anesthesiologists. It was important that we were Americans.
Like so many times before, we pooled our talents, and we became
one again. We were forever changed on that day, but “change,”
to Americans, is just another name for growth. We grew, and as
the efforts of Drs. Zurowski, Roccafortte, Lynde and countless
others can attest to, no enemy will ever halt that growth.
Taken on September 13, Manhatten Skyline Looking South
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