Physician executives were at ground zero in New York and Washington, D.C., when terrorists attacked a year ago this month. They've been working ever since: overcoming their personal reactions, responding to subsequent bioterrorism events and preparing our healthcare systems to better respond to future attacks. Here are some of their stories in the wake of 9/11.
Nobody to save
Taking the Staten Island Ferry to work every day in Manhattan, Robert Bonvino, M.D., says he always notices the gap in the New York City skyline where the World Trade Center stood.
The void reminds him of the five days he spent waiting to tend to victims at ground zero after Sept. 11, when the dead far outnumbered the injured. It will always haunt him, he says.
"I didn't save anybody; I didn't treat anybody," he recalls. "I'm still having a difficult time coming to terms with what took place."
It took two days for Bonvino, an OB/GYN who was then president of the Medical Society of the State of New York, to trek from his home on Staten Island to Brooklyn and then walk across the Brooklyn Bridge to Manhattan, arriving on scene in the early hours of Sept. 13. Rescue workers motioned him and a few other doctors to a patch of rubble to stand and wait.
"The firemen would come over and say, 'Don't worry, Doctor, we're going to find somebody,'" he recalls.
But no one was pulled out alive after he arrived.
"It was extremely frustrating. All you were trained for as a doctor was basically put on hold."
He ended up giving minor first aid to rescue workers and helping with the bucket brigade carrying away debris, he says.
"I have never seen in my life acts of heroism as I witnessed in those days," he says. "I saw firefighters take off their helmets and squeeze through tight places to see if anybody was alive in there."
'There's going to be a disaster'
Nelson Botwinick, M.D., remembers driving into the parking lot at NYU Downtown Hospital and watching the first airplane smash into the World Trade Center just four blocks away.
"There's going to be a disaster," he recalls saying to the staff. "Let's get ready."
For the next 12 hours, Botwinick, who is chief of hand surgery at the hospital, worked nonstop in the OR sewing up "lots of mangled people."
"It doesn't affect you until afterwards," he says. Almost a year later, "I'm still dealing with it."
Botwinick says he is still caring for patients injured in the disaster. One is a woman who lost both her legs when something fell on her from the towers. He says he thinks it was the engine of one of the planes.
"It's very heart-wrenching to see people die," he continues. "You're mad, you're angry, you're depressed."
He says he dealt with his feelings by going back into the hospital the next morning and working some more. Three months after the tragedy, he lost his "World Trade Center cough," caused by clouds of dust from the explosion, but his feelings about the tragedy will last forever, he says.
"It does affect you," Botwinick says. "Doctors are human."
Test of emergency response
In Arlington, Va., many of the casualties from the attack on the Pentagon were triaged at Virginia Hospital Center, just across the Potomac River from downtown Washington, D.C.
Yorke Allen III, M.D., chairman of emergency medicine at the 334-bed, not-for-profit hospital, was able to activate the hospital disaster plan before the phone lines jammed. However, just as in many New York hospitals, there were more doctors than surviving patients.
Allen says it was the Oct. 20 appearance of the first case of inhalation anthrax in a postal worker in neighboring Fairfax County that proved an even greater test to the regional emergency response capability.
"Our biggest concern by mid-October's anthrax mailings was a uniform lack of preparedness as related to biological or chemical terrorism," Allen says.
Hundreds of people arrived in the ER each day, demanding antibiotics.
"Guidelines changed on a daily basis," Allen says, and each hospital was on its own.
Those shortcomings prompted the speedy formation of the Northern Virginia Emergency Response Coalition, which Allen co-chairs.
The coalition comprises all 11 hospitals in the region, as well as area public health agencies, emergency medical services and police and fire departments. The various entities have developed a coordinated disaster plan for any "all casualty" incident, be it natural or man-made.
"It's a level of cooperation that has never been seen before in Northern Virginia," Allen says.
Among the nearly 3,000 people who lost their lives in the terrorist attacks on Sept. 11, 2001, three were up-and-coming physician leaders aboard hijacked planes.
Paul Ambrose, M.D.
Paul Ambrose, M.D., 32, "was big into physician leadership," according to his mother, Sharon Ambrose, COO at St. Mary's Hospital in Huntington, W. Va. He was on his way from Washington, D.C., to a conference in California on childhood obesity. He was aboard American Airlines Flight 77 when terrorists crashed the Boeing 757 into the Pentagon.
As a Luther Terry Fellow in the HHS Office of Disease Prevention and Health Promotion in Washington, Ambrose was lead author of the first draft of the surgeon general's report on obesity that came out earlier this year.
"After Paul's death, I was motivated to finish the report because of him," says former Surgeon General David Satcher, M.D. "I felt a close, personal loss. He was a fine person in addition to being an outstanding physician. He was a rising star."
Another former surgeon general, C. Everett Koop, M.D., also was affected by Ambrose's death. Dartmouth College, where Ambrose did his residency and Koop is on faculty, recently renamed its annual Resident Physician Leadership Symposium after Ambrose. Ambrose led the effort to develop the symposium in 1998.
"His loss meant the loss of a very affable person who was a natural leader," says Koop. "I have also taken the measure to have a bronze medal of him cast that will be awarded to a resident at the symposium who exhibits exceptional leadership qualities."
Ambrose was to have been married this September, his mother says.
Yeneneh Betru, M.D.
Yeneneh Betru, M.D., 35, medical affairs director for IPC-The Hospitalist Co., North Hollywood, Calif., also was killed on Flight 77. Betru was returning to the Los Angeles area after visiting his fiancee--who lived in Ethiopia--at her sister's home in Washington, D.C.
Despite his untimely death, his legacy will carry on in a state-of-the-art dialysis center, the first of its kind to be built in his native Ethiopia, according to Adam Singer, M.D., IPC chairman and CEO.
"He had a secret desire to build a dialysis center in his grandmother's name in his home country," says Singer.
Following his grandmother's death in 1998, Betru acquired six retrofitted dialysis machines that he planned on shipping to Addis Ababa, Ethiopia.
"There was no kidney dialysis there at all," says his brother, Sirak Betru. "He wanted to install them in the public hospital there."
Following the Sept. 11 tragedy, officials at IPC and at Consultants for Lung Disease, the Burbank, Calif., physician practice where Betru and Singer first met, raised $40,000 toward making Betru's dream a reality. Another brother, Aaron Betru, quit his job as an investment banker in Washington, D.C., to devote his time to the cause.
Additional funding from the Betru family and various charities, plus the gift of four new dialysis machines from Swedish medical device manufacturer Gambro, will allow the Yeneneh Betru Dialysis Center to open later this year at Tikur Anbessa ("Black Lion") Hospital in Addis Ababa.
Frederick Rimmele III, M.D.
Frederick Rimmele III, M.D., 32, was medical director of the family practice faculty at Beverly (Mass.) Hospital, where he oversaw a Boston University-supported residency program at the ambulatory Hunt Family Practice Center in Danvers, Mass.
But with the university having decided to discontinue its affiliation with the hospital, Rimmele was making plans to turn his clinic into a private practice after the residency program was scheduled to end Sept. 7, 2002. "He was the catalyst for the change," says Subroto Bhattacharya, M.D., a colleague at the Hunt Center.
Rimmele never got to see his Danvers Family Practice take root, however, because he boarded United Airlines Flight 175 in Boston last Sept. 11 to fly to a medical conference and a short vacation in Monterrey, Calif. At 9:02 a.m. EDT, the plane crashed into the World Trade Center's south tower.
Rimmele, of Marblehead, Mass., was to be one of three partners in a planned five-physician practice, along with Bhattacharya and Aliza Acker, M.D. "We are going to do the practice to fulfill the desire and the dream that Fred wanted," Bhattacharya says.
Reporter Neil Versel also is an author of this story.