Anthony P Azar
A Report from the forgotten Hospital at Ground Zero.
We had just gotten back to NYC after a one week vacation and I had arrived early at my clinic to catch up on paper work before the arrival of patients. My wife, an ob/gyn who I share clinic space with, called to tell me that a plane had just crashed into the WTC. I dropped what I was doing and ran to NYU Downtown hospital, were I work as an emergency physician. The hospital is only a few blocks away from my clinic, a brisk seven minute walk or so, and about six or so blocks form the towers of the WTC. We live only about ½ mile from ground zero, and a twenty minutes walk to the hospital from home. I considered running to the crash but decided against it.
The tower was clearly burning, and small fragments, like pieces of tin foil, were floating in the upper sky and glistening in the bright morning sunlight. An otherwise perfect morning, dry, clear and calm with crystal blue skies that would soon turn black-gray. those fragments were paper blown out of the offices now floating in the breeze. Seeing the tower burn, nearly a ¼ mile in the sky left me thinking that this was not going to be fun. Must have been some idiot in a single engine prop who lost control and slammed into the top floors. Yet, that’s too much fire and smoke involving too many floors of the building. This was not the first mass causality incident and as emergency physicians we are trained to deal with this. My mind raced. People falling down stairwells filled with smoke. People will trample over themselves in a panic. Glass, flying debris, anxiety, death and destruction, mangled and burned people, eye injuries. Hospitals run drills involving similar scenarios and the hospital had handled the first WTC bombing. All in a days work, no big deal really. We did it before, will do it again. Or so it seemed.
By about 9 am, the worst trauma cases had arrived, and the place was awash with lights and sirens. The staff was setting up a second emergency room in the adjacent cafeteria and that would be my post. Casualties were mounting. Chaos was forming. Somehow we managed to pull it together and the entire hospital was there to help, sort of an “all hands on deck” phenomenon. This had been rehearsed during the drills. It was brought to our attention that it was a commercial airliner full of passengers and jet fuel that had hit the tower. That explained the intensity and quantity of smoke and fire. Next thing there was a low rumbling noise and a second explosion, followed by more chaos. My God, we must be under attack and, a rumor that airliners also hit the pentagon and the Sears tower in Chicago was circulated along with some news of a downed jet somewhere in Pennsylvania. The situation took on a new dimension not anticipated in any scenario or drill. An act of war? Expect even more critical injuries, and more walking wounded. Do we have enough resource, this little community hospital? It had dealt well with the first WTC explosion in 1993, but two WTC explosions, in separate towers and two airliner crashes almost simultaneously? Everyone there was shaken, and jumpy. Any low frequency noise, and everyone panics thinking of another attack. I had to learn some new tricks, fast. Volunteers came form everywhere with all sorts of different backgrounds to help. My capacity at that time was similar to that of an air traffic controller. Identify the most serious patients, stabilize and enlist someone to continue their care. This is what ER docs do best. I randomly selected an attending physician and a resident to go around and be the “candy man”. They were to hold and dispense narcotics and sedatives, and to please be liberal with them. Ironically, the attending physician who I assigned and who i had just met for the first time, runs a methadone program affiliated with the hospital. Many people from the community came forward to volunteer their services. They were used as gofers, escorts, guards and almost any thing else. Nurses, medical students, doctors, and EMT’s form various institutions presented to help and the team effort was phenomenal.
As causalities mounted, the cafeteria was overwhelmed with patients and a courtyard adjacent to the cafeteria was opened to hold otherwise stable patients. We put out chairs and oxygen tanks and most of the walking wounded and smoke inhalation patients went there while awaiting further evaluation and treatment. The cafeteria was quickly divided into sections and different triage areas, the ophthalmologist opened the clinic upstairs. All of the clinics were made available and patients were sent there prior to discharge from the hospital. Seriously injured patient were sent to the main emergency department or to the operating room. The sound of an airliner flying that fast and that low has an unnatural and unusual sound to it, but its still recognizable for what it is. But, How can the mind conceive of what a half of a mile of a concrete, steel and glass should sound like when it collapses upon itself and vaporizes? There it was again that low rumbling noise, but this time, much louder and it seemed much closer. The building shook and a cloud of smoke and dust were engulfing the hospital. In a flash, many things happened. The patients and staff in the courtyard naturally panicked, and some who had lower extremity injuries tried to run, walk or crawl. All hands on deck quickly turned into “every man for themselves”. Staff ran in all directions, people started to scream, and trample upon themselves trying to escape. Terror in the belief that that a bomb had been dropped. Smoke and dust were everywhere and the air was unbeatable with visibility reduced to 10 feet. Thoughts of nuclear weapons or missile attacks were expressed.
It seemed to us at the time that this was a well thought out, bankrolled, rehearsed and executed plan to hijack large fully fueled commercial airliners, crash them kamikaze style into military, political and Financial targets, and then follow it up with secondary targets on hospitals in close proximity to the attack site knowing that large numbers people and most medical resource will concentrate there. As a middle-aged man with young children I no longer perceive myself as the immortal young man expendable to a cause. PLEASE GOD LET ME OUT OF HERE AND LET ME HOLD MY FAMILY ONE LAST TIME BEFORE I DIE.
As the smoke cleared, new victims now presented encased in a layers of soot and dust, looking like what must have been the last day of Pompeii. Many of the new casualties were emotionally distraught, yet manifesting behaviors raging form catatonic to hysterical. Some of the more stoic ones quickly decompensated. It was explained that the WTC was now gone, those magnificent towers had collapsed. No bomb was dropped. The hospital was now on emergency generator, the water system may be compromised, and the phones were overwhelmed and not working, Concerns of bio terrorism and chemical warfare were voiced. Comparisons were made to pearl harbor. A quick calculation of the number of dead could conceivably meet those of the entire Vietnam War.
Four hours later the flow of injured ebbed to a trickle, an ominous sign that very few survived. No one had a clue that the office of emergency management, the nerve center of rescue operations, was wiped out. Rescue personnel were streaming in form around the area and no one to direct or coordinate the operation. The top brass and leadership of the fire, police, emergency medical crews and rescue personnel was obliterated. The mayor had escaped by a hair.
How many casualties did we treat in those first few hours? 100-200-300, it’s a blur, and little was captured on paper. Patients had to be moved in and out as quickly and safely as possible. When faced with such an avalanche of causalities no serious attempts to register patients and generate charts can be made. Information was collected as patients were discharged. A point was reached where it was unsafe to discharge people. We are too close to ground zero and there was no way in or out of the area. Where were they going to go, and how would they get there? More building could collapse. So many people just hung out until some arrangements could be made to insure their safety. Order was eventually restored and things again ran smoothly. We now had more medical and support staff than patents. The trauma cases were out of the OR and doing well. A curious thing started to happen. Like a Pavlov’s dog, I experienced a wave of terror and panic when hearing a low frequency noise. It is now over 72 hours later, and I still have a visceral reaction to this noise. On the way home my wife joined me and my brother in law, a pediatrician who had been with me in the cafeteria tending the wounded, and we stopped off in a bar to belt down a drink and watch the news before going home for dinner and a shower. No mention of our hospital. All the news was from other institutions. What is wrong here? NYU Downtown (a.k.a Beekman Downtown) hospital had handled most of the causalities form the first WTC bombing. We had numerous casualties, had been involved in not just caring for the victims but also in helping with rescue efforts, and were from the start performed admirably while under fire. No one had died and our general and orthopedic surgeons performed heroically as did the entire medical and ancillary staff while facing terror and panic.
Absolutely no mention of our situation. Hey, we are just six blocks form the site and amidst danger and adversity, still performed and attended to the stricken. That evening the hospital was quiet. An Eire calm, and surreal feeling fell upon the area. The police gave me a ride back to the hospital as far as they could before I had to walk the rest of the way because various military and rescue apparatus blocked the roads. The air was thick with smog and dust and smoke, and walking kicked up a cloud of gray dust. Emergency workers and national guardsmen were scattered everywhere. The site of military vehicles made the impression that this was a war Zone. This vibrant area, the money capital of the world had been transformed into what a friend of mine referred to as “a somber bizarre eerie surrealistic nightmare”. Dust, paper and shoes were scattered everywhere. Never have I seen so much paper. All of corporate America spewed out on the street. City Hall, just around the corner form the hospital, had been evacuated.
Not much had happened since leaving the hospital earlier that day. Still no mentioned of what we had experienced as the hospital at ground zero. The press and the media didn’t even know we existed. Maybe the area is sealed off and they can’t see us. Rescue crews were still going strong, pumped up by adrenaline, although they were now starting to comprise the largest proportion of the injured. I went home before midnight, stayed up a few hours glued to the TV screen and was back early that morning. Very few survivor so far, and now EMS crews were exhausted and injuries due to fatigue were expected. Ancillary staff along with doctors, nurses and PA’s were dispatched to the site and helped ferry supplies and medications. An orthopedic surgeon was sent in case amputations on those trapped in the rubble was needed.
That afternoon I briefly left the hospital with some colleagues to survey the attack site. As we walked west along empty streets, dust, paper, shells of buses and cars, trashed rescue vehicles and those ubiquitous shoes littered the scene. In front of what had been one of the towers was the triage medical team. A lot of doctors and nurses and other health care workers standing around with nothing to do. Many rescue workers standing there waiting. Many new shinny heavy rescue apparatus from surrounding communities who had arrived to help but also had nothing to do. Dogs were used to listen and sniff for survivors. Some of the rescue workers who were first on the scene did survive, but most of them had perished. A temporary morgue was established at one liberty plaza located just across the street form ground zero. This building, just a few hours ago a sleek new modern steel and black glass skyscraper, now just a shell, covered in dust and with broken glass everywhere. One of the doctors informed us that few bodies were recovered, only parts of bodies. Some body fragments were recovered with wallets intact making identification easier. A team of buliding engineers were inspecting compromised buildings in the area, no doubt some of the buildings will need to be demolished once the area is secured. The hospital was still on emergency generators, and was without communications. Everyday operations such as paging had to be done by overhead PA or by messenger. The only phones that worked were cell phones carried by staff. The entire downtown area was without electricity or water. People had to evacuate their homes. No one went anywhere without ID, and if you had no business being downtown you were asked, nicely, to leave. Still, no mention of what had happened to our hospital and the situation we were in. No mention to those of us who held fast and did not abandon ship while under attack.
Later that day I treated a firefighter who was brought in after he collapsed. The nurses had quickly gathered around to perform their usual duties of placing him on monitors and starting intravenous lines. As I approached him, he appeared to be a middle aged man in excellent physical condition with an apparent blank stare and a sense of indifference. I ordered the staff to cease resuscitation efforts after noting that the man had very normal vital signs and was in otherwise in no distress. Further questioning reveled that he was the only one of his company of firefighters to be left alive. He had been working feverishly for 36 or so hours without a break trying to recover his fallen comrades.
Now convoys of trucks are hauling debris form the site. Flatbed trucks with twisted mangled steel girders strapped on to them. More fires and building collapses. More injured rescue personnel, candlelight vigils and the news media holding out hopes of survivors. Photos with the names of those still missing. Lets us grieve and mourn. A poster near my home reads “An eye for an eye, and soon the world is blind.
Anthony P Azar MD FACEP
NYU Downtown Hospital
Thanks to Dr Howard Beaton, chief or surgery and emergency medicine; Dr Bruce Logan director of medicine and vice president of the hospital. Dr David Goldschmidt and Dr Antonio Dajer, director and associate director of emergency service. All the staff and surgeons at Seaport orthopedics who dropped all they were doing to attend to those stricken and who help extricate people form the ruins. Ms. Mary Lyke, nurse manager of emergency services who coordinated the flow in the main department. Dr Deborah Sonneblick who compromised her own safety to help those trapped in the ruins. Ms Stacy Hughes, PA who did everything and never left the scene. Mr. Steve Vince RN who transformed the cafeteria into a top-notch trauma and emergency center. Mr. Leonard Aubery, CEO of our little forgotten hospital who provided all the resource. TO the entire medical, paramedical, nursing and ancillary staff, the FDNY, NYPD, corrections officers, housing police sanitation workers and those of other communities who stood and delivered, my respect and admiration.