Doctors' Journals: Horror and Frustration

Doctors share their horror and frustration from their experiences at Ground Zero, during the first and following days of the World Trade Center attack on Sept. 11. Here are excerpts:

Dr. Susan M. Briggs, Surgeon, Massachusetts General Hospital

I left on three hours notice with a group of 70 people, all of whom belong to the Boston FEMA (Federal Emergency Management Association) unit. In this type of situation there's a lot of uncertainly about the number of survivors and casualties. So we packed up a "full load," with tents, generators, and plenty of medical supplies. At 4a.m. we arrived at Stewart Air Force Base, and then made our way into New York. In the pouring rain, we set up our equipment in a playground near the site, but there were no complaints from any one of the 70 people.

As soon as crews secured the scene and the fires stopped, we set up four tents at each of the four quadrants, about ten feet from the rubble. We've seen a huge number of injuries to the rescue workers, both minor and major. Many of them have been eye injuries—however, some workers got burned the other day because of an explosion on top the rubble. If it's not a serious injury that requires hospital care, they keep digging through the rubble—we can't get them to quit!

When I look at the numbers, it's hard to believe the fatality rate versus the survivors. I've been to a lot of disasters, like earthquakes, some which were pretty bad. But at least there were still a lot of survivors. Because of the nature of these explosions, the number of people who got out alive are very few. Hospitals here haven't been overwhelmed at all, in terms of injuries, only several hundred.

The dedication of everyone is unbelievable! … It's incredibly inspiring watching people who lost loved ones digging through the rubble instead of trying to grieve.

Dr. Richard Hatchett, Attending Physician, Urgent Care Center, Sloan-Kettering

I was on duty in the emergency room at 8 a.m. on Tuesday, Sept. 11. I heard about the plane hitting the fist tower, and came out to see what was going on, and saw the second plane hit. We stood there gaping for a few minutes, in total disbelief. Nobody knew what the numbers would be. I thought we'd see a lot of victims. But as the day wore on, we realized there weren't going to be a lot of survivors.

I came back the next morning, just to see what was happening. Somebody had posted a notice that the city had called for volunteer physicians to help out at the site. Joey Nuccio and I had the privilege and honor of serving as coordinators for the volunteer effort at the Stuyvesant Triage Center. Neither of us was appointed to this position and neither of us was qualified by anything other than a desire to help. Several hundred New Yorkers working "under" us put together a functioning, exceptionally well-supplied medical and surgical triage unit comprising of 25-30 beds.

We provided services to search and rescue workers, ranging from suturing of wounds and setting of broken bones to eye washes, to acute respiratory and cardiac care to grief counseling in about 48 hours. There was no specific chain of supply, no secure communications, no staffing arrangements, and no financial support. We were given space, some rudimentary starter supplies, the right to organize ourselves, and accumulated probably hundreds of thousands, if not millions of dollars' worth of drugs and medical equipment.

The only problem we had was when there was a near collapse of one of the structures. The debris fell very close to where the triage area was. There was a stampede of firemen and other workers, and a pregnant nurse was trampled on. EMS didn't want us up there because they didn't know which buildings were safe, and they didn't know what came out of the building, such as jet fuel and toxins in the dust.

By Thursday there were a lot of people smiling and hugging each other. The human response to the tragedy made you feel like somehow good was going to come out of this. Whoever attacked the towers had failed, if their purpose was to terrorize us. What it did was galvanize us. As soon as I signed off to the federal disaster team, I felt fortunate to be given to opportunity to help out. To be task-oriented was good thing. I feel bad for Americans who live far away and can't do anything except give blood.

The site was a total sensory thing, gravel crunching under your foot, ash, the smell was just awful, the most penetrating thing you could imagine. You would walk by and look at these private financial documents, strewn across blocks and blocks like wallpaper. These confidential documents are now totally irrelevant. There just wasn't a camera shot that could give you a sense of the devastation. It really looked like a special effect out of a movie. It was utter ruin, like a nuclear bomb had gone off. It was devastating, hard to imagine.

After we had gone to one of the sites, we were walking away and saw an empty baby carriage covered with ash, upside down, abandoned on the side of a street. That's when it all hit me.

Dr. Joseph Ornato, Chairman of Emergency Medicine, Virginia Commonwealth University Medical Center

On Sept. 11, I was attending a National Institutes of Health research meeting. Just by chance, it was held at the Brooklyn Marriott. We found out about the attacks after workers had us evacuate the hotel. A short while later we learned they needed physicians, nurses, and medics down by the site.

Someone in our group flagged down a passing fire unit, and we volunteered our help. They radioed to their command center, and the Lieutenant commandeered a bus that picked us up. Originally, they planned to drop us off at Battery Park, by the World Trade Center. We ended up getting there about an hour after the buildings collapsed. The fire crew stopped us and wouldn't let us go to the location because Word Trade Center building #7 was in the process of falling down. That was probably the scariest moment. It collapsed right down the street from us. We ran to get out of the way because the debris was heading right towards us.

We ended up setting up a triage area at the Brooklyn Bridge because so many people were frantically running across it. All of the doctors and nurses set up a fairly quick operation on the street. Had the need arisen, we would have been able to handle 30 or 50 people at once.

But we only treated 19 patients at our location. All the critical patients were at emergency rooms. Most were found in the first hour after the buildings came down.

Of the 19, most were minor injuries. The most potentially serious were two rescuers with chest pains. We hooked them up to I.V.s and checked their vitals, and they were transported to the hospital. It was terribly frustrating not to have any patients, though.

I had never seen anything like this. I never thought I would live to witness thousands of people die, in line of sight of where I was. My heart sank when I saw the first tower collapse. All day, the people that we were dealing with, the firefighters and EMS folks, were incredible. The stories they told us about how they managed to get out were just unbelievable.

One firefighter happened to be inside the first tower on the 46th floor when it was hit. He was unable to go up the stairs, and somehow got separated from the rest of his men. He wound up getting to the bottom, and as he was about to leave, the second aircraft hit and he got trapped. A rescuer was able to punch a hole through the door, allowing him to get out. Luckily, he escaped with a minor injury to his head. As doctors checked him out, he kept saying, "Give me my boots back, my men are inside, I have to go!"

Another day, there was an 18-year-old kid, brought into us after he was found wandering around the streets for hours. He had gone to school that morning, but they let students out after the attack. He wound up taking the subway downtown. He finally wandered into my area with a quarter in his hand, and asked me, "Do you know where a phone is? I have to call my mother." I asked him "Why?" He said: "I last saw her this morning." When I asked him where she worked, he pointed to the collapsed buildings. Luckily, we had a whole bunch of social workers and clergy. I took him over to them, and they took care of him.

I've been to a lot of fires, and it's normal to have units come out with their head between their legs, exhausted, drained. But I've never seen the look of despair and look of helplessness firefighters at Ground Zero showed. When we finally got released and headed back to Brooklyn, we came across a fire company that had obviously been at the WTC. The firefighters were walking towards the Brooklyn bridge with heavy gear on. Their truck had been destroyed by debris, and they were walking back to the fire station. So we picked them up and gave them our seats. They sat with their heads down, completely beat. We all gave them a round of applause. They looked at us and said thanks guys, but we didn't save anybody today.

And we basically felt the same way. That summarizes how everyone felt out there. We set up and were ready to go, but there just weren't any patients.

Dr. Susi Vassallo, Emergency Physician, Bellevue Hospital, New York

Written After The First Night: The magnitude of the loss of life is not yet imaginable. … The dogs can't smell because of the smoke. The first survivor brought to us slid down from the 70th floor. That is the only survivor we got. The rest are injuries from rescue operations. We had 20 chairs with people getting their eyes rinsed out. When the lights in our building went out it was incredibly dark because of the smoke and particulate concrete matter.

We are in the Brooks Brothers building directly across the street from the blast. All of the windows are blown out. The cell phone doesn't work; I can't even get my messages off of it. I was down there at the WTC all day until midnight. I will go again today and work 4 p.m. to 2 a.m. Our building that the first aid station was in caught on fire.

I climbed high up on the rubble with the firemen and other rescue people because they found two people trapped. Today when I go back, I will go with morphine and other drugs so that if drugs are needed they will be there. Getting these controlled substances to the possible survivors is a problem — nobody has it and it's hard to reach the people. Balancing on one foot and loaded with crap the questions were: "Do you have your stamper?" "What is your DEA number?" It was a little surreal! I dug crap out of my pocket and pulled out my stamper (required by law to release narcotics) and stamped a 4-by-4 envelope so the paramedic would document where his 20 milligrams of morphine, Versed and Valium went. I had things that you'd usually use in a hospital, like a white coat or lubricant, that were completely useless in that situation.

It was quite a sight. It seemed organized only because everybody was experienced. Many were there as I was as volunteers. I would pass stuff up the line: People would radio down from the top of the rubble: Batteries!!!! Blades!! Portolights! Lots of weird names for various types of yellow and black heavy electric cutting tools, about two or three feet in length each. The people at the top of the pile used these heavy hand-held machines to cut some of the big beams. One night we did get one person's foot out, and the work was rather frantic, because we were afraid that we'd have to amputate, if we didn't get the person's foot out. They eventually were able to remove the parts of building from this man. Blades were sent up repeatedly, as they wore out or broke from all the cutting through thick beams.

Charge the line! Two long hoses were hand-over-hand handed up the rubble. "Charge the line" means turn on the water. I got soaked, which explains why the EKG leads wouldn't stick to one young firefighter with chest pains. I basically passed all my stuff up and was glad to be rid of it, especially the oxygen tank I was carrying, because it was very heavy and you need two hands to get up the rubble. I wear a hard hat. I was the only woman on the rubble pile, which seemed strange. There don't seem to be any female firefighter or police emergency unit people.

14 Days Later: We felt so ineffectual down there, so useless. I gained five pounds. Everyone's plying you with cookies and snacks, thanking you, and I hadn't done anything. There was nobody to save. There was this one police dog, and he got insulation in his nose and would have died. I put an I.V. in and put him on oxygen. Policemen, firemen, doctors huddled around, showing how little there was for anyone to do. I treated eyes, inhalation injuries, ischemic heart problems caused by constricted breathing or stress. I think the thing that strikes us all from the first night, is how enormous the effort was and how little we accomplished from a medical point of view. From a doctor's standpoint, there was so much effort and nowhere to place that energy. Even now we feel kind of irritated by that, that there was no outlet for that energy.

Dr. Michael Karch, Orthopaedic Surgeon, Georgetown University Medical Center

Tuesday morning in Washington , D.C. we went on level 1 Terrorist alert at approximately 9:00AM after the Twin Towers were hit. Most of us were shocked and frankly watching the TV not thinking that this would actually happen to us about forty minutes later. When the news came that the Pentagon was hit, we scrambled to set up with expected ER admissions in the hundreds.

Only one patient actually came with severe third degree burns and smelling of jet fuel. Nothing, of course, came afterwards because most of the victims died. Feeling extremely frustrated I jumped on a train and headed for NYC. I packed a backpack filled with food, water, water filter, stove, headlamps, clothes, and medical supplies. No thought was given by me to bring a helmet, gas mask, goggles, rain wear, or multiple socks, all of which I needed in order to work and all of which I eventually obtained but could have used right way.

Outside NYC Penn Station the air was smoky with ash. I took a cab initially to St. Vincent's Hospital but they said more help was needed at Pier 61 (Chelsea Piers) about 20 blocks from Ground Zero. I took a cab there and began working. Chelsea Piers at that time was a combined clinic for the walking wounded and morgue. As the clinic was becoming less and less busy by the time I got there and the morgue was more and more busy, I was assigned to carry body bags from a truck and lying them out on the ice (Chelsea Piers has an ice skating rink). After about two hours of this, word came that the fire at Ground Zero had been controlled long enough so that forward medical personnel could go in. They called for volunteers and I, and two other physicians (ER and General Surgery), went.

Actually getting to Ground Zero was no small feat, as there is a checkpoint about ten blocks out where no reporters, civilians, etc. can go past. … I was shuttled up to about four blocks from Ground Zero and dropped off, as there was no road left. We walked up about two more blocks and dropped off gear at a local high school, which had been deemed a medical and general supply staging area. And then we left for the front. To get to Ground Zero, one has to walk through a maze of 6-12 inches of ash, paper, twisted iron, mud, junk. It looked like a tornado had hit the city.

Next, you have to walk through a bombed out portion of 2 World Financial Building. It is essentially a pitch black 150-200 meter tunnel with water up to your boot line. This is where the "Atrium" dining area used to be with high vaulted multifaceted glass ceilings and palm trees looking up at the twin towers. It was decimated as the steel structure supporting the huge glass windows had caved in. There was cable, iron, electrical lines, glass, mud, ash, and running water everywhere.

Through this and in the backdrop of smoke one could see outside the front wall of the North Tower, which was now only about five stories high atop a huge pile of burning rubble and leaning 45 degrees. Hollywood could not have created a scene as bad as this. The tunnel then continued on for another 100 meters or so past underground mall shops and stores with the front windows smashed in on blast impact until one finally reached the outside and Ground Zero itself.

Up to this point, my understanding of the event had been limited by what the TV cameras had shown me. I was immediately struck by the immensity of destruction and the fact that it wasn't just the Twin Towers. It was a two-block radius of decimation. The smell of rotting flesh and another body flattened on the ground who had apparently jumped.

Body bags were being brought in empty and being returned only half full. This was the most horrific thing I have ever seen. All the buildings still standing around the perimeter were severely damaged and some were leaning and ready to fall into the "pit." Firemen, the hard-asses of NYC, were dazed, crying. It was an unexplainable sight. The three of us set up a MASH unit at the base of a building in what became known as MASH Unit Ground Zero West. I dumped my backpack supplies and went back through the "tunnel" to the staging area two blocks back to pick up more supplies while the others set up the mini hospital. I ran this shuttle four or five times with my pack full of dressings, betadine, and saline eye wash, which was desperately needed. Each time, I was convinced that the "tunnel" was going to collapse on me. Thank god for speed workouts on the track, as my heart was racing about 250 beats per minute. Once Ground Zero West was fully stocked, we began treating the firemen. The guys are complete animals and it was like a football game mentality — patch them up and get them back to the pit to work (mostly lacerations, eye washes, inhalation, burns, etc).

The firemen began bringing out bodies in bags and placing them down at the edge of the pit, which was in front of the MASH unit. The smell became incredibly bad and I soon found myself on a crew carrying these bodies back through the tunnel to the outside perimeter. We piled them in a bread truck to be taken back to the ice rink morgue. Out of the 17 that we carried out, only one was a complete body. In fact, one bag was so light that when we picked it up, we thought it was empty and cast it aside, only to find out that it had only half of an ankle and foot inside. There was no more.

At about 1 p.m. Friday morning, a report came out that there were people with a cell phone trapped below us. The WTC has a 5 story underground mall beneath it. The 3rd, 4th, and 5th floors were crushed, but apparently the bottom 2 were intact. The crews began digging and trying to find these people. Unfortunately, the crews couldn't get there and the fear is that by now the mall itself has filled with water from the fire hoses.

Firemen have a bond that is stronger than brotherhood. New York firemen live and die by this creed and the New York iron workers and cops are of the same breed. These men are the American heroes. They truly felt that the only reason that they themselves were alive is because they were late for work that day, or their truck got caught in traffic, or they were on vacation, or it was their day off. So when their shift was over in the "pit," they would not leave, but just stood there at the edge of the pit unrested. These men were starting to get tired, even dazed and this can be very dangerous around heavy equipment, fire, twisted iron, etc. It was just a matter of time before someone got hurt. My respect for the American firemen, cop, iron worker, medical personnel, red cross, guardian angel, volunteer in any form is at an all time high! These are unbelievable people who live in an incredible place and will overcome this. I never had a chance to see the infamous WWII generation at its peak, but I did get to see America at its finest hour on September 11, 12, 13, and 14th, 2001.

The "hospital" was masterminded by a Sloan Kettering ER physician by the name of Rich Hatchett. By this point we had a staff of about 100 (doctors, nurses, techs, and about 100 more Red Cross and Guardian Angels volunteers). We had no power, nor communication system, so we set up a system of runners just like we had created with the forward mash units a day earlier at Ground Zero.

Fatigue began to set in as virtually everyone at Ground Zero, if not everyone in the country, had been up since Tuesday morning and about 60 hours had past since the attack … people kept working. Three bomb threats to the area and a rumor that more terrorists were picked up at LaGuardia Airport en route to plane-bomb the city, plagued the system but people kept working. At about 1AM on Friday we had a general staff meeting where it was announced that as of 7am Friday morning the Government DMAT (Disaster Medical Assistance Team) would be taking over our field hospital position.

At about 3am it began pouring and it was cold. Work in the pit became exceedingly dangerous and it developed into a quagmire of ash and mud. The firemen continued and now, in addition to the other injuries, hypothermia had to be considered. The rain was depressive and although temporarily spirits sank, we were "feeling the pain" so to speak, the resolve became much stronger … somebody has got to pay for this. Another bomb threat, another "false alarm," rain, cold, fatigue, mud, the smell of decomposing flesh on the firemen's boots and everywhere in the air.

At 7am DMAT went into operational and we were shut down. I walked through the rain to the new hospital across the street. Really, it was not much different from ours, except the medical staff was awake and had clean clothes. I went back and loaded up my backpack one last time, picked up my helmet, gas mask, goggles, and raingear and walked out. From this point on, things are kind of hazy. I know I walked up to Ground Zero and stood there in the rain for more than an hour, just looking. I then walked out of the secure area down Western Highway, past the reporters, all of whom wanted something and got nothing. I was drenched. I stopped at Pier 40, a supply staging area, and changed into dry clothes handed out by the volunteers and kept walking.

I was drenched again within minutes. A cop picked me up and drove to Penn Station, where I got lost. Someone took me inside and sat me down, and I fell asleep. People who were looking at me could literally smell what I had just been through. The next thing I knew someone had put me on a train headed for D.C. That's when I think it finally hit me — this could happen anywhere, anytime. It could even happen to the train I was riding on. I wanted to vomit. I slept and woke up in Union Station, Washington, D.C. As I walked through the station, with its high arched ceilings, I immediately saw it not as a spectacular architecture that it was but rather as a bombed out building like the "Atrium." I got in a cab and it dropped me off at a Georgetown hospital. I must have looked very out of place there with my backpack, filthy fireman's rain gear, and helmet/gas mask. But that really didn't even cross my mind until now as I am typing this. I bumped into a physical therapist who had just come from a hospital-wide memorial service (one of our physical therapists was on the plane that hit the Pentagon). My cell phone had died about 20 hours earlier, so I thought it would be best to go to the office and call my wife, Kim. Another resident drove me home and I fell asleep on the lawn in my sleeping bag for about three hours (too dirty to fall asleep in bed, I guess).

Now, after some sleep, I feel like I should pass some lessons on. First and foremost, we are incredible people and an incredible nation. I do believe the hearts of the firemen, iron workers, and cops are in all of us. It is for this reason and others that many people in the world simply don't like us. They are jealous of what we have. These people are highly intelligent and highly motivated and if we foolishly think that the Twin Towers/Pentagon situation is the last of this we are sadly mistaken.

Hopefully we will never have to do this again. But based on what I saw over the past two days, I sadly doubt that fact. Our way of life is too good to lose and is worth fighting for.