Working, Helping, and 9/11
You saved my life,” stated my patient during a psychotherapy session. I initially wanted to attribute this sentiment to an idealized transference that my patient had developed toward me. However, there were some facts that I could not dispute. I had started a session with this patient at 9:00 a.m. on Sept. 11, 2001, and we ended our session at 9:45 a.m. He had been studying to be an EMT and wanted to go down to the World Trade Center site to help in the rescue effort. By the time he left my office, it had become difficult to travel downtown and he was unable to get there before the buildings collapsed. In the end, I realized that the timing of my patient’s session could have potentially saved his life. Our shared experience of this tragic event went beyond the usual doctor-patient relationship. It was one of those historic moments that leaves an indelible impression on a person’s mind and we had gone through this time together.
Over the past year and a half, many people have asked me about my life as a psychiatrist at Saint Vincent’s, one of the hospitals closest to the World Trade Center. At times, it has been difficult for me to express in a coherent manner a description of the impact these events have had on me as a resident at the hospital. In addition, the current war in Iraq has highlighted some of the changes in Saint Vincent’s, in New York, and around the world since that day. I have felt the need to write down my thoughts and reactions for some time, but even now this proves to be a very emotionally demanding process.
During residency training, we become experienced in listening to people’s stories of hardship and trauma. However, on Sept. 11 I was exposed to the same trauma as my patients. I had to learn how to cope with these events and yet still be available to address my patients’ psychiatric needs. This was a difficult task given the striking changes that took place in my environment and my outlook after Sept. 11. In July 2001, I had started my third year of residency in psychiatry. This is the year in which we get our own offices and begin to work with outpatients. I was concerned with the placement of the desk in my office, whether the lighting was adequate, and what pictures to put on the wall. After Sept. 11, these concerns seemed trivial. For about a week, police prevented travel below 14th Street, near Saint Vincent’s. My hospital ID allowed me to make my way through a maze of barricades, police, government officials, military personnel, media, and hundreds of onlookers simply to get to work. Helicopters circled over the city to “protect” us, and I remember not wanting to look downtown to the hole in the skyline. Instead, I would frequently look uptown toward the Empire State Building to reassure myself that at least it was still there. It was a struggle for me to figure out how I could contribute to caring for others in the midst of my own reactions. Although I had received training in the evaluation and treatment of psychiatric patients, little of my training seemed relevant in the context of the new challenges I now faced.
On the first two nights, I volunteered at the family center Saint Vincent’s had set up at the nearby New School. This site was where the lists of treated patients at all the immediate New York and New Jersey hospitals were sent. I had been told that psychiatric residents would be present at the site to counsel families. However, I quickly learned that the numerous family members visiting the center were not interested in counseling. Their only goal was to find out if their loved ones were on the list of treated patients. So instead of providing counseling, I sat for hours reviewing the lists with the families that came in to look for their missing loved ones. This was where the magnitude of what had happened truly hit me. In those two nights of reviewing names with family members, I never found a match. As I walked home from the New School, I encountered countless flyers of missing persons that had been posted all over the neighborhood. These were the pictures of the people I had been searching for on the hospital lists. In the middle of such uncertainty, it was difficult to feel like I had made any impact.
In the days and weeks that followed I began to realize how the hospital had in fact made a difference. Saint Vincent’s had compiled one of the most comprehensive lists of treated patients from all the local hospitals. There was also a family center set up on the top floor of the psychiatry building. The center began counseling those impacted by the tragedy and offered free acupuncture and massages. Many of these services are still being offered for free to the Saint Vincent’s community. Along with many of my fellow residents, I became involved in the evaluation of those impacted by Sept. 11 who had sought help at the family center. We counseled people about the normal reactions to trauma and were able to dispense medications to help those who were anxious or having difficulty sleeping. Some of my colleagues also began volunteering their time at local firehouses. It was working in this environment that reminded me of the special qualities of Saint Vincent’s. It also reminded me of why I had been initially attracted to the hospital for my residency. Saint Vincent’s has remained committed to treating those people affected by the trauma. We have been a part of Project Liberty, a federally funded program providing free counseling and treatment to those affected by Sept. 11.
I was fortunate not to have lost someone personally in the collapse of the towers. Most of my patients were also fortunate in this regard. However, it was clear that no one had escaped the impact of these events. In my residency program, we have learned a great deal more about post-traumatic stress disorder and have been involved in treating those who have developed symptoms. In addition, the patients I worked with who had previously suffered from depression and anxiety became more anxious and depressed. Similarly, those who had paranoid thoughts became more paranoid when anthrax scares gave them reason to be truly worried. I began to follow the same advice I gave to my patients to limit exposure to media coverage. Watching the replay of the towers collapse on television, over and over again, only served to be re-traumatizing. I continue to warn my patients about the media, telling them to limit the amount of war coverage they watch. I must also remember to ask them if current events are affecting their sleep, their mood, and their anxiety level.
In the past year and a half, many friends have visited New York and have wanted to see ground zero. I pointed them in the right direction but did not accompany them there. I realized that even more than a year later I have had no desire to visit the site. Recently, helicopters have started flying over New York again, the sound serving as an eerie reminder of that time filled with barricades, armed guards, and uncertainty. The war heightened my sense of vulnerability, with the color-coded alert status to warn the nation as to the level of potential danger. The hospital has also instituted disaster drills with some codes of its own. “NBC” used to only signify a television network in my mind. Now I must think "Nuclear/Biological/Chemical" when I hear the NBC disaster drill over the loudspeakers at the hospital. We are still adjusting to a new reality. This year I am serving as chief resident of the department. The challenges I face in this role are frequently put into perspective by the larger events taking place around me. And still I look up to the Empire State Building for comfort on my walk home from work each evening.
Submissions for Moved to Speak can be sent to Editor, Haverford Alumni Magazine, 370 Lancaster Avenue, Haverford, PA 19041 or via e-mail to Steve Heacock at email@example.com