Nine eleven

“The tumors of the heart are myxomas, sarcomas, rhabdomyomas. Myxomas are associated with emboli and a ball-valve effect….”

The lecturer is taking the microphone off his collar while the hotel officer is providing him information. The conversation is being prolonged excessively. What is going on?

“I must inform you that there has been an explosion at the World Trade Center.”

Em?

“We don’t have much details but it could be serious. We will take a vote: Do we proceed with the lecture?”

“Yeah, Yeah.”

“The mechanical post myocardial infarction dysfunctions include rupture of the cordae tendinae or papillary muscles with valvular regurgitation and severe congestive heart failure, rupture of the myocardium with cardiac tamponade….”

From the back of the lecture hall: “I suggest that we discontinue this lecture. Some of us want to volunteer our services. The World Trade Center bombing has casualties and….”

“Yes, and I don’t see how we can justify continuing this lecture. There are one hundred and twenty surgeons in this room. We can do something to help….”

“Ok, this is what we have. The Fire Department will provide us with transportation to the World Trade Center. Those of you who would like to volunteer….”

But where can we leave our bags and other personal effects?

“Dr Longley is making his room available. You can leave your books and bags in Room 1411.”

“The first of two buses is at the doorway ready to transport volunteers to the World Trade Center.”

We pick up our books and pack or bags. “I think we should go to the hospital. Casualties will be taken there for surgery.”

“But the opportunity to go to the World Trade Center is a unique one. Lets go to the World Trade Center.”

“What will happen to the lectures? Will they be cancelled? Should we come in tomorrow?”

“Oh hell, I am losing a day I could be reading.”

I am out in the Hotel Lobby now. There is a television on a side table that I notice for the first time.

“We are getting the TV plugged in.”

I look at the blank screen. People milling around the lobby not knowing what to do, maybe I should go home. But we need to know if the lectures will continue. Oh, forget it. We can’t know that now.

“Here is the Hotel’s business card…. Anyone wants our business card? You can call the Hotel in the morning. We will inform you about the lecture program then.”

I put the business card in my pocket.

The TV is plugged in. I see the image of a burning North Tower. Hey, another jetliner ploughs into the South Tower. There is that huge ball of yellow flames and smoke engulfing the South Tower. “There are bomb threats in other parts of the city.”

Me: “Hey, man, I’ve got to go to the World Trade Center. Where do we leave our bags?”

“Lets leave them by the receptionist’s desk. We will be able to find our bags here at any time. Room 1411 will no doubt be more of a problem with the doctors gone.”

“Can we leave our bags here?”

“Yes, just paste this tag on your bag with your name on it.”

I secure my beeper to my side. I am sure Marie (my wife) will beep me a telephone number for me to call.

“Lets take the bus.”

We fall into the queue and walk into the second bus. The Fireman comes in and says “we will transport you to the scene.” To the bus driver he says: “Drive across to the West Side Highway and down the Highway. You will be met by firemen at the scene. Should you see a policeman ask him to escort you through the traffic.”

“See you soon.”

Driving across the avenue the bus driver stops to speak to policemen. They can’t escort us. “This is a busload of surgeons.” They move their cars blockading the roads and allow us through.

We can now see the thick black smoke billowing and flowing across the skyscrapers. People on the sidewalks are stationary, talking and viewing the smoke, many talking into their cell phones. The firemen, the policemen, the emergency workers in small groups talking while others direct traffic.

“I am Lieutenant Smalls. You are the doctors from the South Gate Towers Hotel. This is the score. The two towers of the World Trade Center have been hit. They are both now gone. We have no plan. This has never happened before. We will play it by ear. I want you to get yourself a buddy. Under no condition must you leave your buddy. Stay together. On the scene you are to touch nothing on the ground. The scene is dangerous. There are explosions going off. Lets select a leader for the group.”

“Colonel, you are the leader of the group.” Dr Hugh is a colonel in the Army. He served in Vietnam. We appoint him leader of the group.

“How many doctors do we have?”

“There are twenty-one surgeons and two EMTs.”

“How did you guys get onto this bus?”

“We reported at the fire station. The authority there directed us to this bus.”

We have now been driven into the thick gray smoke. This is ground zero. My eyes burn somewhat. Ok, we get off the bus. “Stay as a group whatever happens.”

“Here is a surgical facemask.” It won’t help. Nevertheless, I put on the surgical mask. Hopefully we will soon have the large brown cotton handkerchiefs the rescue workers have on.

The road is indistinguishable from the sidewalk. Everything is colored gray. There is a foot of powdered cement mixed in with as much loose sheets of gray paper on all horizontal surfaces. Strewn empty oxygen tanks across the street. There is a haze that allows a view across an empty block. “Where were the Twin Towers?” My buddy, Dr Ingram, points into the empty block: “That’s where they were.” A hole is in the skyline and below it strewn objects everywhere. Bits of gray paper and cement dust everywhere. Thick dark smoke limits my vision. My eyeglasses are cloudy with dust. My eyes burn. The air smells acrid. My hair feels stiff with dust. Only two of about 10 dusty firemen have facemasks appropriate for toxic gases. These two are walking in opposite directions, searching the dust. The other firemen are in a tight central discussion group. There is almost no activity. No motor vehicles moving. Our footsteps are soft and muffled by the dusty road surface. Motor vehicles standing along both sides of the avenue are covered with a thick layer of gray fluff. An eerie silence is in the spooky fog. Dr Hugh at the head of the double column of doctors raises his arm to signal stop.

An anxious volunteer approaches Dr Hugh and addresses him as lieutenant requesting information. I then notice that Dr Hugh has held against his hip the labeled Lieutenant Fireman’s hat.

Dr Hugh then obtains information from the Chinese Fireman, Lieutenant Wong, in the patrol group at ground zero. “We must be taken into a covered area. We will meet a local doctor, walk a few blocks over to the doctor’s office and prepare ourselves for service.”

At the corner of the block there is an abandoned vending cart all covered in gray soot. The gray milk bottle is half full and open. The row of sample drinks covered with dust.

An ambulance stands next to us. I am handed a small package: the brown cotton handkerchief for masking my face in the smoke. A cooler with drinks is opened on the sidewalk. A colleague gives me a cold iced-tea Snapple. I sip the tea and stand the bottle on a ledge against a low wall.

A fire official walks across with the local lady doctor, Dr Brevier. We are escorted through the thick gray smoke to her office along ground zero. I can’t tell exactly where we are, as I see no street signs at the corners of the block. We enter her office through a side door; clear the reception area for casualties; prepare a waiting area with chairs for walk-in wounded; collect sutures and bandages. Firemen with metal-cutting equipment are now at the front door to the makeshift medical emergency center opening the locked grill over the door. The doors are pried open. Across the street another doctor’s office is opened. We are divided into smaller groups and begin preparing the second emergency area.

My beeper goes off. Oh, hell, it’s Marie. The phone in the receptionist’s area is being used to make calls. I speak to Marie. She asks in a nervous voice: “Are you at Columbia?”

“No, I am at Ground Zero.” She continues in a shaky voice: “That means you won’t be coming home early tonight?”

Senior fire official outside on the gray carpeted roadway: “Its too unsafe. We are within the area with potential explosions and falling buildings. The powers that be are now organizing an emergency medical area for casualties in a safe area at Chelsea Piers. We must evacuate this area now. You must find your way to Chelsea Piers.”

Where is Dr Hugh? He is over there discussing with the fire officials. We walk out into the dust with boxes of medical supplies. Sirens are now screeching as the emergency vehicles pass by. Security officers with cars and ambulances make offers for transportation to Chelsea Piers. Three of our members leave for Chelsea Piers in an ambulance. No, the group can’t be broken up. We must stay together. Dr Hugh: “They must provide us with transportation to take us as a group.”

A caravan of an unmarked police car, an ambulance and a third vehicle drive us out of ground zero. Sirens blaring everywhere, there is no other vehicular traffic, only security and volunteered vehicles.

En route we hear the stories from the EMTs. “I actually saw the second low flying plane plough into the World Trade Center. The Fire Company I reported to this morning has lost so many members in the collapse of the building. A couple of our EMT partners died in the collapse. There are bomb threats for various parts of the city.”

At Chelsea Piers we walk into fresh, clear air. We take off our masks and see clean firemen and policemen. We enter a room as big as a hanger with many clean volunteer medical personnel. My trousers and shoes are dusty white. My buddy’s gray hair and gray stubby beard have aged him 50 years. The bullhorn at the side of the big room blares: “All surgical personnel, whether surgeons, surgical techs, surgical nurses, anesthetists, etc. please move over to the far side of the room. Here are the general instructions: casualties will be brought in with tags. A red tag is seriously injured with a potentially lethal injury and must be stabilized, given emergent care and transported to a hospital as soon as possible. A yellow tag is seriously injured but his life is not immediately threatened. These will be reassessed regularly and up- or downgraded while they await transport to hospital. Green tags are the walking-wounded. Black tags are dead.”

“On arrival of a red tag with respiratory difficulty or in extremis, check the airway, clear the airway if necessary. If you obtain a clear airway, maintain it and do the necessary. If you do not obtain an airway, label with a black tag.

We have secured the space next door. This will be the red area. The lighting there is better. Could all surgical personnel file over to the red area.”

The red area is cleared by workers. Tables are brought in. Poles and adjustable lights are available. Each table gets two sheets. We spread a sheet over the table and shred the other sheet for bandages. There are about 75 tables. We are assigned four to a table: one surgeon, one assistant, one nurse, one EMT. One anesthetist to four tables. Joy is our nurse. Chang is our EMT.

The EMT is to decide when work is to be halted on a casualty and the casualty transferred to hospital. His decision is final.

The neighboring tech comes over to request some of our improvised bandages. Reluctantly I allow him to pilfer our supplies.

I hear the Pentagon has been hit. The whereabouts of a fourth jetliner is unknown. The President is on Air Force 1. All other air traffic is at a standstill.

Slowly we accumulate supplies as the Ambulances come in with supplies. These appear to come in singly and at hourly intervals. Oxygen tanks but no regulators. Long hours later regulators are available. We have ET tubes but no stylet; no laryngoscope; no i.v. cannulas; i.v. cannulas but no i.v. bags; i.v. bags but no sutures, no needle holders, no artery forceps.

The anesthetist assigned to the table checks our equipment. “Hi, Dr DePaz.”

“Dr Indy from Great Britain. I don’t work in the US. I was at a conference nearby. My terminology is different.”

“Don’t worry. Use your terminology. We will understand. Here you have a battery operated suction pump. Here is the suction catheter. It works. I don’t have a laryngoscope.”

“Your table is well organized. So is that table (she points diagonally across). The other two tables are not well equipped. You have four ET tubes which we can share with the other two tables.”

Chang, the EMT, is responsible for obtaining special supplies for the table. “Chang, get i.v. cannulas, i.v. delivery sets, i.v. bags and a laryngoscope.” He later comes back with the requests less the laryngoscope. The scope is a scarce commodity.

“Could I have your wish list: sutures, needle holders, clamps, laryngoscope.”

“What’s your name, your specialty, your hospital affiliation and the last four digits of your social security number? We need to have assignments per table.”

“My table is table 28.”

“You must not leave your assigned table. Restrooms are available just to the right of the entrance. No one is to leave the building. If you leave without being processed you cannot return. There is a security risk.”

A new team of anesthetists arrives. Dr Indy has to leave. She will be replaced by a local anesthetist. “Hi, I am Dr Andante from Wintrop.”

“Hi, Dr DePaz.”

“I asked the Mineola Police to drive me here. I will be taking over these four tables.”

“I have a laryngoscope here.”

“That’s great. Do you have a stylet.” He draws the stylet from the back of his waist line. We all feel ready for the emergencies.

A room next door is being shuttered in black for the dead.

Snacks, water, coffee and mineral water for the weary.

Intermittently I ask Chang for the surviving patients. No patients.

Dusty, dyspneic emergency workers are wheeled through the single official entrance across the front of the red area into the yellow and green areas.

“All those assigned to the yellow area please report to the yellow area.” Dr Andante picks up his pack and walks hurriedly towards the yellow area.

The red area is restless. Ingram and Joy occasionally leave and return with word of the TV news. Nothing new. I join my neighboring colleagues in this attentive ring listening to the President’s speech over a tiny radio. “But what action is he taking?”

“I hear Afganistan’s capital is burning.”

Colonel Hugh is in charge of the entire red area. He is on top of a table announcing through a bullhorn: “All leaders of tables please list members of your team. I know how anxious and willing you are to help. However you all have now been here for 12 hours. We don’t want to think the worst but the worst may have happened. We have fresh volunteer teams for each table. Please orient your replacements. Rest areas for you are available next door. After resting you will rejoin your team at your table tomorrow.”

I orient the volunteer well-dressed Court Officers who attend at our table. They were transported in by police from Long Island.

My buddy and I sign out at the entrance. “Hey, they are wheeling in Lieutenant Wong who met us at ground zero.” His eyes are blood shot. He has a subconjunctival hematoma in his right eye and he is dyspneic covered in gray soot. He is wheeled over to the yellow area.

“All those assigned to the yellow area please report to the yellow area immediately.”

At the entrance to Chelsea Piers the barricade is lined by a column of Policemen. At the upper left end of the barricade are all the idle cameras on tripods with many reporters around them. All heads turn towards us as we exit the entrance.

There is no transportation available to take us out of Chelsea Piers. The police will not transport us out. “Oh, come on, we are New Yorkers. Its safe.” We take the short walk from 23rd Street up to and through 34th Street then down over to the South Gate Towers Hotel on 31st Street. The receptionist is the same lady who 13 hours earlier had taken in our bags. With a knowing smile she returned our bags.

Thirteen hours instead of the one golden hour.

There will be lectures tomorrow. The coming days will be long. We will have to start some days at 6 am and go on until 9 pm.

These men standing on the sidewalk in front of the hotel are the surgeons who stayed back. They must be from out of town.

The Long Island and subway trains are running out of Penn Station. Ingram takes the subway up the East Side. I walk into the Long Island Train and slump into the chair.

This was a “scorch-earth” policy. They took no prisoners.

“You are home?”

“There were no patients, zero patients with surgical injuries.”

Its 12 midnight. I watch TV news until 2 am learning about 911.