Within hours of the airplane hijackings last month, physicians jammed the phones of medical associations across the nation, volunteering to care for survivors of the worst terrorist attack in U.S. history.
Medical societies on the East Coast were inundated with calls from healthcare professionals willing to help. More than 4,000 physicians contacted the Pennsylvania Medical Society. The California Medical Association offered to seek state funding to fly patients to the state's burn units. The general call center at the AMA processed 2,000 names of doctors who wanted to help.
But what officials needed weren't doctors to care for the wounded. They needed pathologists to identify the dead.
As the nation struggles to recover its sense of security, physicians who treated the wounded and walked among the dead are beginning to describe what they saw and to share their frustration with not being able to help.
Care of 'no use'
Jennifer Svahn, M.D., spent the early morning of Sept. 11 doing what many young mothers do: reading to her 14-month-old son, Jack. Her nanny burst through the front door crying, completely frantic and yelling that a tower at the World Trade Center was on fire. Svahn, her son and their neighbors in their waterside Brooklyn Heights neighborhood ran outside. She looked toward lower Manhattan and saw the billowing smoke.
"Part of our skyline is, was, the World Trade Center," she says. Everyone surmised a plane or helicopter must have veered off course and accidentally struck the building. When the second building exploded, "we were extremely distraught . . . Everyone had their own response. It was extremely visceral. Obviously, it was terrorism."
After getting her son and nanny inside and collecting herself, Svahn changed into scrubs, grabbed her ID badge and ran to the Brooklyn Bridge. Police officers escorted her across the bridge, and she arrived at Beth Israel Medical Center, where the 35-year-old vascular surgeon has practiced for two years. Her brother and husband are also doctors and were at their hospitals implementing disaster plans.
"We got all (the disaster procedures) set up expediently and efficiently," she says. "Unfortunately it was to no use. Other than relatively minor injuries, smoke inhalation, there was certainly no life-saving work going on at our hospital. It became obvious" there weren't many survivors.
Svahn walked home that night and returned to work at 6 a.m. the following day.
"We weren't operating, something we had all hoped we would be able to do," Svahn says. "So myself and my chief resident decided to go down to the actual epicenter to see if we were able to do some hands-on work."
A police escort dropped them off at the perimeter, and FBI officials and military officers let Svahn and her colleague enter the area. She found at the triage station only firefighters getting their eyes irrigated.
"I wouldn't be able to tell you; it was completely surreal, a devastating scene to be in it and (feel) small in it," she says. "It's completely different than seeing it on television. You smell the smell and taste the grit and feel the burn in your eyes and experience the other people. You talk about the 1,000-mile stare. There were firemen sitting there crying, holding their heads. Even though we were doctors and had the ability to help, it was almost like witnessing a really private moment without being able to do anything. In a bizarre way, I started to ask, 'What am I doing here? What utility am I?'"
Svahn had her camera and took pictures at the scene. She eventually approached The New York Times, which ran some of her pictures.
She says the situation left her feeling frustrated. "I was no more useful than you were in Chicago. It was really disappointing not being able to (find people) that needed to be saved."
Svahn echoed the same sentiment hundreds of others have: The city of New York has pulled together in a way previously unimaginable. People, she says, are trying to return to some semblance of whatever normal may be.
As for her family, they wait. In addition to being the head of trauma and critical care at a New York hospital, her husband is in the Navy Reserves, and Svahn says it's very likely he'll be called up.
"Nine days out, people want a break," she says. "You want to get away from the news or not talk about it. But you're not able to get away from it a whole lot. I still smell it in my apartment in Brooklyn Heights."
Waiting for injured
Randa Zakhary, M.D., went to nearby Liberty Park in Jersey City, N.J., just as ferries full of people trying to escape the horror arrived. By training a neurosurgeon who now works as a consultant, Zakhary waited for the injured in the city park. "The majority of people had minor injuries," Zakhary says. "Tuesday evening it was definitely many more volunteers than there were people who needed help."
Initially, the New Jersey medical community expected the New York hospitals to fill with survivors and divert patients to them. "To put it simply, there were a lot of volunteers. There really wasn't much to be done, at least from the medical community's side."
Zakhary says she treated fewer than 10 people that evening. "It took some effort to find someone who needed help."
Zakhary says she never thought she would use her medical training to treat survivors of terrorism.
"All of us in my generation have grown up without, for the most part, a significant tragedy," she says. "I never contemplated, never thought, I could experience something like this. Certainly, as a physician, I never thought I would be involved in some type of war setting.
"Never at a time in your life did you feel more proud to be a physician and hopeful that you can offer hope to someone. But it was very disappointing to realize there was very little you could do."
Zakhary says she also felt a sense of personal disappointment. Her parents immigrated to the United States from Egypt about 30 years ago.
"Everything that happened was horrendous enough. To think that people from Egypt, from the country that my parents had come from, had some part in this was very tragic," she says.
The Washington scene
Yorke Allen, M.D., chairs the Department of Emergency Medicine at Virginia Hospital Center in Arlington, the medical facility closest to the Pentagon. He is also operational medical director of the Arlington County Emergency Medical Service. He was in Connecticut when the hijacked aircraft struck the Pentagon, and he had three minutes to activate the disaster plan before the phone circuits jammed and he lost contact with the hospital.
After driving all day, Allen arrived in Washington around 4 p.m. "We treated people for smoke inhalation, burns and some major orthopedic problems," Allen says. "We saw a lot of people with minor cuts, bruises and smoke inhalation."
His story was the same as those at hospitals throughout New York and Washington.
"We had more doctors than patients," he says. "One thing we learned is that when you have such large numbers of people to take care of patients, you need to look at how to appropriately assign patients."
By Tuesday afternoon, it was clear the hospital would see more dead bodies than injured patients. "The scene was more of a morgue than a significant rescue," Allen says. "By 5 p.m., we suspended disaster status at the hospital."
Washington-based freelance writer Gina Rollins contributed to this report.
CondolencesOur prayers and condolences go out to the families and loved ones of all the victims, including Paul Ambrose, M.D., of Washington; Yeneneh Betru, M.D., of Burbank, Calif.; and Frederick Rimmele, M.D., of Marblehead, Mass.
Ambrose was a fellow in the HHS Office of Disease Prevention and Health Promotion; Betru was medical affairs director of IPC-The Hospitalist Co. of North Hollywood, Calif.; and Rimmele was on the faculty of the Hunt Family Practice Center in Danvers, Mass. All three physicians were killed aboard aircraft hijacked by terrorists.