mybetterdoctor

Hi everyone,

As the 10th anniversary of 9/11 nears this Sunday, it seems everyone’s been looking back on what went on so long ago and reflecting on where we are today.  I was a medical student at NYU when the towers fell, and am attaching my account of the events surrounding those days, if you’re interested. The descriptions are pretty graphic, so please be advised.   Reading over it now, the thing that sticks with me most is how impossible to believe it was that “this too shall pass.”  And although things have definitely moved forward, there’re plenty of things left as a legacy of that day (not the least of which is the airport security theater).  I suppose that’s what life is. Things move forward.

I leave you with this final thought, that I find so apropos to 9/11 and what we encounter in medicine (and life) in general.

“That some good can be derived from every event is a better proposition than that everything happens for the best, which it assuredly does not.”

— James Kern Feibleman, philosopher and psychiatrist (1904-1987)

Best,

Denitza

 [As will become clear below, Vera is my sister.]

 Tuesday 9/18, 2001 – One week after

      I laughed when I received an email from a fellow medical student a few days ago about his “NEED” as he put it, to email everyone he knows an hour by hour account of the days post the attack.  Although I started Agora, the NYU School of Medicine Literature and Arts Magazine, and the Creative Writing Club with the idea that in medicine we see so much, and writing is a good way of expressing it, I tried to keep my accounts of the past week as brief and strictly factual as I could.  I didn’t suspect that I would rush to the CVS pharmacy urgently searching for a notebook so that I could put my account on paper, here, sitting in a coffee shop on Irving Street, dressed in scrubs from surgery, but wearing a black long-sleeved shirt for normalcy.

  Two weeks ago, in this very same shop, I had ordered a “Dr. Feelgood” cookie and laughed as the salesperson smiled and offered that he wasn’t the one who named it. Today I smiled and bit my lip so as not to be so obvious in my search for a “feelgood” anything.

        As a warning before reading the remainder – some parts of it may be too graphic to be easily digestible.

Tuesday 9/11/2001

         My day started early since it was my first day to scrub in to a cardiovascular surgery.  It was an aortic valve fibroelastoma removal.  We had already been looking at the heart beating through the hole in this woman’s chest for half an hour, when a person wearing scrubs came in to the OR, said “A plane crashed in the World Trade Center,” and left.  We looked at each other wondering whether he was joking and commented how it wasn’t funny.  People periodically trickled in all morning with declarative statements and little by little, we found out that two planes had crashed in the 2 WTC towers, that the towers had collapsed under the weight, and that a plane had crashed in the Pentagon and one close to Pittsburgh as well.  We were told to get all patients out of the OR asap, and to wait for trauma patients from the WTC attack.

          The attending surgeon came and proceeded with the surgery.  The patient was put on the heart-lung bypass machine.  I kept thinking of Vera and her proximity to the WTC.  I was mad at her for never wanting to go downtown and show me where she worked.  I was numb and in disbelief, weighing my options, realizing that even if I scrubbed out I’d have nothing to do but worry.  I decided I’d better finish the surgery and give her a chance to get out and call me to say she’s OK.  At the end of the surgery, the attending handed me the defibrillator paddles to start the patient’s heart, so that it would beat again, and she would live.  “Yeah, yeah, it’s a great day,” he said and pushed me aside to close the incision, while I looked in amazement of the flat line on the monitor that had turned into a regular rhythm.

          Back from the windows of my room, I could see smoke rising where the twin towers usually stood, while listening to my father’s voice on the machine telling me Vera was OK and on her way to see me. Once I found her, I refused to let go of her, and she stayed with me for the next several days. Fortunately, when Vera came to my place, she was exhausted from a sleepless weekend working, and she slept in my room for most of the time I was away.

            I spent most of the next 48 hours in my scrubs.  I waited with all the attendings, residents, nurses, and medical students at the entrance to the Bellevue Emergency Room, expecting trauma patients who had survived.  I went over to the Medical Examiner’s Office with a couple of friends and we found ourselves staring into the empty space where the brain normally lies, watching the eye balls dangle as the body was wheeled to the back.  Watching from outside we wondered why everyone wore masks, but once we went in, we could hardly remain there for more than 20 minutes without coming out for a breath of fresh air.

            We followed a man, wearing a suit, who nodded “yes” to the question of “ready?”  He covered his nose and mouth with his jacket and walked to see the body of a fireman with a crushed skull, the intubation tube still sticking out of his mouth.  “Can you give us a positive ID?” a voice asked him, while another voice explained that the fireman had been hit on the head by one of the people jumping off the roof, while he was walking toward the burning towers.

            Two of the other bodies were charred, and looked unlikely to belong to police people or firefighters.  One man’s wedding band was removed  into a bag, while another set of remains was being worked on.  “It’s a man,” a voice declared of the remains, and by the time we looked at him again, a charred but perfectly preserved face had been uncovered.  The face, with eyebrows, eyelashes, a small sculpted nose, and lips intact, could’ve been a picture of someone young and beautiful sleeping, except for the pale tongue protruding halfway through the clenched teeth.  The face was laying amid the remains. I stared at it for a while hoping to memorize it so that I could draw it.  The skin was perfectly black and even-colored, although the man was Caucasian. I kept looking at the face in the pile wondering how, exactly, it had been concluded that the face had belonged to a man.  A woman followed the line of the “neck” to a “shoulder” and identified a stump of some sort as his arm.  She moved it – it was rigid in rigor mortis – and the face moved.  Despite the raw edge of the exposed joint, all I saw was a face amid a pile.

            We left the ME office a bit shaken that it was the only busy place, while the Emergency Room was quiet.  Despite our constant assignment and reassignment to trauma teams and trauma slots, and shifts, most of the people coming in to the ER off the ambulances were rescue workers with smoke inhalation.

            One policeman in the ER had been seriously injured.  His pregnant wife, and his policeman friends were with him all night.  The policemen were eerily saying things like: “Did you hear they found John & Kevin in the rubble?”

[One week later, he is still very sick, and he probably won’t make it.]

Wednesday 9/12/2001

           By 6:00 AM it had become clear that the calm before the storm, was the calm after the storm.  I volunteered to register people who had come to report their loved ones missing.  One brown-haired, 5’7” girl came in talking on her cell phone, stressed, “together”, and not crying.  She was in a hurry and wanted me to finish explaining the protocol asap so that she could continue her search for her brother who had worked at the WTC.  It was too easy to see myself in her.

           Groups of people came in reporting tens of their friends and coworkers. “They all worked at Cantor-Fitzgerald,” they said, or “They’re brothers,” or “it’s my husband,” and on and on.  I asked for names of missing persons and my heart stopped when I heard “Rosenthal,” the last name of an acquaintance in college, a common last name thankfully, as the first name didn’t match the person I knew.

            The questionnaires these people had to fill out about their loved ones asked things like: “height” – and I could see the metal bar that the examiners at the ME office had used to estimate height; “Dentist’s address” – and I thought of the protocol of taking dental x-rays, but then remembered the shattered face with missing teeth I had seen the previous evening.  The questionnaire asked for pictures, tattoos, scars, previous surgeries, jewelry, clothes, DNA donors – genetic relatives willing to donate DNA to match remains to a brother or a mother.  What these people hoped for was a list of missing people who were all huddled in some secret hospital, unhurt but for a bump on the head, simply not having had the opportunity to call earlier.  What we offered them instead was rather imaginative, state-of-the-art ways in which we could identify their Jane or Yung or Tom from the charred remains brought back from the rubble.

         One 20 yo’s voice rang clear: “So, are we going to go in and there are bodies there?” as he was told to go to the auditorium to wait.  There were no bodies to be shown to relatives, and he had no idea how little walking through charred remains would help in identifying people.  One man came in asking where to go to donate his DNA.  His brother’s wife had asked him (as a genetic relative) to give his DNA.

Noon Wednesday 9/12/2001

           I took a van with a delegation of NYU surgeons, nurses and a few medical students to Ground Zero, as the WTC area had come to be known.  We drove downtown under the bright early fall sun and blue sky.  We were the only car down the normally busy FDR.

         Once we got close to the area, we could smell the same smoky odor the ambulances would emit when they opened their doors to relieve themselves of the smoke inhalation rescue workers.  We put on our respirators (unaware at the time of the asbestos in the air) and gloves, expecting to walk out and work on rapidly bleeding but blissfully rescued victims.  As we walked out, it dawned on us that even if people had survived the collapse, the air was hard to breathe and people wouldn’t have lived in that fire and smoke long enough to be saved.

The scene at ground zero was unimaginable.

          To start with, the streets were covered with ash/soot – a whitish dust, several inches thick, that at times had mixed with the financial papers lying about and the water leaking from the fire hoses to form a cement-colored mud we had to walk through.  Huge rivets/bars/things?! Of metal/iron/steel? Were being lifted by caterpillars up above our heads as we crossed streets we no longer recognized.  We moved quickly, not looking up

too much for fear of recognizing the possibility of the huge piece of metal toppling on top of our unprotected heads.

        It was a surreal place – a “war zone” one may have seen in a movie.  The alternate universe we were living in had changed everything and now it was possible that the loud booms and shaking of the old fire station we used as a hospital were a prelude to its collapse, that the dust covered cars lining the streets were filled with people who just over 24hrs earlier had been alive, that someone on a top floor had been reading a page of a book called “A Life in the Balance,” whose pages now lay with their burned edges at my

feet, that the Brooks Brothers store was a Morgue, that the Burger King on the corner was the temporary Police Headquarters, that the fireman who woke up that morning with all his digits in tact would have a swarm of surgeons around him wrapping his amputated fourth digit to his middle finger.  That we should be standing there, among the police people, and firefighters, and marines, and surgeons, where anything was possible and safety was no longer in numbers was not something one is able to comprehend.

            The windows of an abandoned bus served as a blackboard where someone had written: “PWPD/FD meet here,” the ad on the side of the bus said “ZOO.” People had used their fingers to write messages in the soot on the windows of the buildings in the area: “God Bless America!! Unity!!,” “God bless the dead,” a picture of the American flag, “help is here, hold on” that a few hours later had turned into “help is here, hold on !!”.  A huge sign above said “A hit from way off Broadway,” a message, that no longer promoted a Broadway show, but was now a caption to the surrounding scene.

         Walking around I found the street signs at the intersection of Broadway and Liberty street cleaned off.  I had to do a double-take, because in an instant I recognized where I was, that this was not “Mars” or some equally surreal place.

           On Wednesday night, Vera and I walked to her apartment to check messages and pick up clothes.  As we neared the Lincoln Center area, I recognized the pungent odor of ground zero and I was glad Vera was staying with me at the Hospital, where, despite all the ID checks, the refrigerator trucks lining 30th Street, the police people surrounding the ME office, the posters with pictures and identifying information of loved ones lining the Tisch ER entrance, the Bellevue entrance, walls of buildings, telephones, and any open space, there was no odor.

            By the time we came down to Bellevue again, it was clear that the odor had spread all over Manhattan.  It made me realize how vulnerable we are to bad air, and how helpless we are against it.  We were not even harboring the illusion that the face masks people were walking around with might help protect us.  I suggested that we go to a restaurant near me that Vera likes for dinner.  “An Afghani restaurant may not be the best place to be right now,” was her response.

          The posters on the streets offered words of support, pleas for the return of loved ones, and a “This too shall pass” that seemed tragic, if true.  That somehow life would go on normally after this catastrophe seemed as tragic as if it wouldn’t.

 Thursday, 9/13/2001

             Finally on Thursday about 2am I went to sleep.  Thursday evening Vera and I took a walk North up to Payard, and exquisite French patisserie and restaurant.  As we sat in the lovely dining room enjoying café au lait with various patisseries, the calm demeanor of everyone around us, the well-dressed clients and the uniformed waiters, the fine china and the long wine lists reminded us of the WWII movies where the wealthy are at a banquet and the conversation is: “I hear the Germans invaded Poland today.”  I can understand that now. 

Friday 9/14/2001

          I woke up early for cardiovascular surgery.  This time I was holding the heart so that the surgeon could sew the coronary artery bypass graft on. Someone came in and announced that the medical center (in which we were) had been evacuated due to a bomb threat in the student cafeteria.  The student cafeteria (and the ME office where it turned out the “suspicious package” had been delivered) were right next to Rubin where I live and where Vera was sleeping.  We joked in the OR of why we hadn’t been evacuated.  The surgeon told us of a medical school professor of his who had lectured on wartime medicine with the warning that if they were so fortunate as not to need the lecture, then they would be the first generation in history for whom this was the case.  But, he had added, he doubted they (we?) would be so lucky.

          I came home to Vera’s shaken voice on my machine saying that she’s “had enough of this shit” and she’s going uptown to stay with Melanie and for me to get my stuff asap and get the hell out of there.

          I realized that she now lived in a world where evacuations made the difference between life and death.  That Vera had found out about the evacuation by a phone call from a friend of mine, and that nobody had bothered to evacuate the building “because they didn’t know how” because “ nobody pays attention to the fire alarm anyways” was more than she could handle.  I packed a bag with tennis rackets and met her at a café.  We took a cab to the Upper West side.  As soon as we walked into her apartment, Melz said that we smelled… kind of like BBQ?!

Friday 9/14/2001 – Sunday 9/16/2001

         Weeks ago, Melz and I had signed up for a tennis tournament in Central Park.  When Melanie had told me that the tournament was still on, I asked the very pertinent question of whether anyone had checked whether all the people in the draw were still alive.

            On the Upper West side the world was completely different.  There were no posters, no sirens, no police people lining the streets, no traffic jams, no refrigeration trucks, no bomb threats, and my biggest responsibility was to warm up for my tournament matches.

           We spent the weekend playing tennis to exhaustion, eating at restaurants because “life’s too short,” laughing at the weird people in Central Park, checking out cute tennis players, and savoring the sunny fall weather.

Monday 9/17/2001

          I left Monday morning at 5am to go to my first day of Pediatric Surgery. The radio station during the surgery played songs of a different era, but in between the DJ said: “I hope this helps… I hope the music helps.  Because that’s why we play it.”

          Back at school I signed up for 2 six-hour volunteer shifts at the ME office – taking samples of DNA remains.  The smell from the charred remains wafts up to my room at times, so I leave the AC on.

          Life is different now.  It’s hard to walk down the street, to see the posters – pictures of fathers with their babies, women in their wedding dresses, groups of young friends together, sisters, parents, children, flowers put in front of the “wall of prayers” outside Bellevue, candles lighted, gone out and relit again by random strangers, posters asking if you “know any pets whose person is missing?” and not cry.

         I no longer smile at people I see on the street, or I smile biting my lip wondering whether they knew someone who is missing.  Even asking people “how are you?” and responding with “good” flatly, because I am alive and so is my sister and that’s good, but I don’t want to gloat.  Asking friends if they knew anyone close who was affected, feeling guilty as we’re relieved that we did not.  I look at police people on the street and realize that they know someone, they know a lot of people dead, that it might have been them, it might have been someone I love.  I still haven’t taken the subway, I stay away from the Empire State building, the UN, the movie theater?!

          Thinking back of our visit to Hiroshima, the skeleton of its industrial dome standing as a monument all too similar to the remains of the WTC skeleton rising above the rubble.  Thinking how we didn’t understand Hiroshima at all, not its museum, not its peace monuments, not its people.  How completely and irrevocably different tragedy is when it happens to you – or close to you – how unable we were to understand it when it happened elsewhere, to others, in places whose names we barely knew.

           And here I am, on page 28 of my handwritten “memoir” skipping the ME psych session on dealing with volunteering at the ME office because “I don’t need it.”  I feel like I need to rent a really sappy movie where I can just cry, because the initial numbness turned into relief but not completely.  Relief as in my sister is OK, but not relief as in – she’s guaranteed to be OK forever.  And because it’s too overwhelming to even think about it or dwell on the fact that little V thought she might die and as she walked down the stairs from the 37th floor of her building a block away from the WTC she thought: “If this is it, Mom, Dad, Deni, I love you.”

 I’d rather see a bad movie.

          The anchorwoman on the news Friday night, after a long monologue by some psychiatrist said “Can I take advantage of you while you’re here?”  And I made fun of the phrase, so I didn’t hear what she said, but I stopped talking as she stopped, she was choking back tears.  The psychiatrist told her that they have been busy working, covering the tragedy and they haven’t had time to absorb what’s happened – to let it sink in.

          Life is slowly picking up.  Vera’s back to work at an alternate location, I’m still in surgery (*and* in the Quarterfinals of the Central Park Tennis Tournament to be continued this weekend!) and the ME work will go on for many months to come.  In a surge of normalcy, the one station (CBS) that I am receiving (the others’ communication towers having been on top of the WTC) stopped the incessant flow of NEWS, and at 8pm, Monday, 9/17/2001, there was a sitcom, “The King of Queens” on TV.

 I suppose this is the mother of all catch-up/what’s-going-on-in-my-life letters.  I hope you are all well and taking care of yourselves and the people who are important to you in life.

 d