From Ground Zero

It was a triumph of the human spirit as New Yorkers rose as one to help the injured. In hospitals, emergency systems were activated to treat the victims.

On the Brooklyn Bridge. Many of the victims walked over the 486-metre-long bridge to hospitals in Brooklyn.-ANDRADE PATRICK/GAMMA

THE daily routine is starting to return to normal in downtown Manhattan. Of course, normal has become quite a relative term in New York City since September 11. Downtown New York remains quieter than usual, darker and more solemn, but slowly the city is beginning to make its way back, and hospitals are attempting to resume normal operating schedules.

On September 11, New York City was whirled into emergency conditions, and the civic community braced itself for what it realised would be a few long days ahead. Hospitals cancelled their daily routines, downtown Manhattan was literally shut down to the thousands of civilians who regularly lived and worked there, and the city was forced to create makeshift morgues as New York became the ruins of a war zone.

It started as an average morning for most of the hospitals. Sanjay Chawla, a Pulmonary and Critical Care Fellow at the Cardiac Surgery Intensive Care Unit of St. Vincent's Hospital, arrived at the hospital in downtown Manhattan around 6-45 a.m. By 8 a.m., the doctors had finished their early morning rounds and Dr. Chawla was doing blood-work on the computer. "One of our techs came in and said a plane had hit the twin towers. We didn't believe her. But all of us started running. Your first thought is, 'what are they talking about'?" said Dr. Chawla.

The doctors went outside the building from where, as with so many other buildings in Manhattan, they could see the twin towers of the World Trade Centre looming above the city. "We didn't think it was a terrorist. We just thought it was an accident - a very very bizarre accident," recalled Dr. Chawla. "A single engine plane, horsing around, just somehow wandered into the space and crashed into the WTC." When they saw the flames and smoke, the doctors rushed up to the tenth floor for a clear, unobstructed view of the buildings. "From the tenth floor we could see a huge hole in the shape of a plane."

Around 8-45 a.m., Salil Gupta, a third-year resident at New York University's Hospital for Joint Diseases, was in the operating room at the Tisch Hospital performing surgery on a patient's shoulder when a nurse came in and told the doctors the news. Stunned, the doctors continued the surgery, discussing whether it was an accident and how a plane could hit the World Trade Centre. About 20 minutes later, the nurse returned to say that a second plane had hit the other tower. America seemed to be the target of a terrorist attack.

"We still didn't understand," said Dr. Chawla of St. Vincent's Hospital. "We went down one floor to the ICU to find out what we should do. Then, I went to the stairwell next to the nurses station and there I saw a huge fireball coming out of the other tower. I thought it was debris or an explosion from the first. Later we found out that it was another plane."

On the other hand, at the Tisch Hospital, too far for anyone to see anything but the smoke, the doctors, like so many Americans around the nation, relied on television to stay abreast of the situation. "We were watching TV. We heard that the Pentagon had been hit, that there was a car bomb outside State Department, and everyone got really nervous," recalled Dr. Gupta.

"Then we realised that if the building was on fire, it can fall. One corner was on fire. It seemed like a chair with three legs," said Dr. Chawla.

The hospitals announced that they would prepare for emergency conditions. St. Vincent's, on 12th Street and Seventh Avenue, is the closest 'trauma one' unit to the WTC. Bellevue Hospital, on 27th Street and First Avenue, is the largest 'trauma one' unit in downtown Manhattan. A 'trauma one' unit is a hospital adequately equipped to handle any type of trauma. Since the 1993 WTC bombing, when the two hospitals served as the main centres, the hospitals had emergency disaster drills to prepare for any such incident.

At the Tisch Hospital all the residents were called together, beds were set up, supplies were prepared, casting materials readied, and all scheduled surgical procedures were cancelled. At St. Vincent's, the doctors regrouped in the cafeteria, which also served as the main meeting station. The hospitals tried to keep the emergency rooms clear. "Any patient who could leave the ER was moved out," explained Dr. Chawla.

Meanwhile, the staff waited. They did not know what to expect or when. At the Tisch Hospital, the staff remained glued to the television in the children's playroom. "At some point, we learned that the Pentagon had been hit, then some place in Pittsburgh," said Dr. Chawla. "We knew then that it was bigger than we originally thought. That we were under attack."

Dowtown Manhattan was immediately evacuated, and public transportation was shut down, displacing the thousands of people who regularly spent their day there. Ramez Habib, an ear, nose and throat resident in downtown Brooklyn, said many of the victims who arrived at his hospital had walked over the 486-metre-long Brooklyn Bridge.

Throughout Manha-ttan, emergency medical facilities were created and the hospitals were prepared for the worst. The Hospital for Joint Diseases converted its lobby into an emergency room, bringing out equipment. The Chelsea Piers, a sporting complex on 23rd Street, and the area outside the Stuyvesant High School downtown served as on-site medical clinics. The ice skating rink at the Piers was converted into a makeshift morgue, as were the refrigerated food trucks along the way, said Dr. Gupta.

Meanwhile, at St. Vincent's a few people, including rescue workers and policemen, had already begun to trickle in with burns and the effects of smoke inhalation. "Some victims were brought in with burns from head to toe; their clothing had melted onto their body," said Dr. Chawla.

The Tisch Hospital remained fairly quiet, so Dr. Gupta went to his place of residency, the Hospital for Joint Diseases, on 17th Street and Second Avenue, where most of the downtown hospitals were sending their patients with orthopaedic problems. Most of the patients were rescue workers injured simply by the tremendous heat in the area, explained Dr. Gupta. "Most of the firefighters couldn't even get into the buildings for hours because they were so hot."

Continuing to brace themselves for the worst, the doctors tried to keep the facilities clear for emergency patients and those with severe injuries. Patients with minor injuries were sent home after their wounds were bandaged. "Behind them we expected a lot more people," said Dr. Chawla. "We went out onto the street; the south tower was already down, but the north tower was blocking our view. However, we got the sense that something was missing."

At St. Vincent's, when the doctors returned they received a call that a person who had suffered cardiac arrest was being brought in. When he arrived, he had no pulse. "We worked on him for 20 minutes, and just when we were about to give up hope his pulse came back, and so did his blood pressure. While we were working on him, we noticed a badge around his neck, which said he was a firefighter from Jersey City." But the doctors were still not sure what he was doing before he came in, with no reports from the Emergency Medical Services (EMS). Still critical, the firefighter was sent up to the ICU.

The doctors had worked on a few more patients - predominantly burns, smoke inhalation and heart attack victims - and it was still before noon. "Then all of a sudden, nothing was happening," said Dr. Chawla. "We went outside to see what was happening. Everything was gone. There was smoke billowing up, and that was it."

The doctors went in to check on the firefighter. He had, according to Dr. Chawla, become increasingly distended. "He had lacerations to the liver, kidney, spleen, and heart. Something had hit him in the abdomen and cut everything inside." He died in the operating room. But, said Dr. Chawla, given the length of time he had remained without his heartbeat, had he survived he probably would have been a vegetable.

At a time of such suffering, the doctors were moved by the display of human compassion and the spirit that bound New Yorkers together. One doctor said: "Within hours people swarmed in with donations, food and clothing, whatever little deli, Starbucks, continuously. People who lived in the neighbourhood would go home, make sandwiches and bring them back in plastic bags for you. There were so many people here that at one point when an announcement seeking blood donations was made, swarms of people just shifted. The hospital couldn't handle it."

Dr. Gupta wrote in an e-mail message to his friends and family: "Amidst this nightmare I can honestly say that I have seen a remarkable side of the human spirit. The random acts of love that have been occurring on random street corners, people lining up four to five blocks long and waiting up to six hours to donate blood, people bringing home-cooked food into the emergency room, hospital residents coming in to work when they are on vacation and the obvious heroism of those who gave their lives has been touching to the very core."

Some of the downtown hospitals were closed because they had become unstable, but whichever hospitals were able to, remained open and ready overnight "since no one was sure what would happen," said Dr. Gupta. The St. Vincent's staff divided themselves, and some of the doctors went home to rest with their beepers nearby. "I tried to sleep. But at 4-30 a.m., I went back to the hospital. Not much had changed." A reporter from Russia, working for "something TASS (probably ITAR-TASS news agency)", said Dr. Chawla, had been brought in with a ruptured aorta and rushed to the ER.

"THE next day we went to Bellevue," said Dr. Gupta. The residents were divided between the downtown hospitals to make sure all the hospitals were adequately covered. The day began slowly. "We wanted to see if there would be a few rescues that we could help in," said Dr. Chawla. "Maybe they would need help at the site." Dr. Chawla explained that down 7th Avenue police vans and city buses, which were taken over by rescue services, were escorting firemen, emergency medical teams, police and other emergency workers downtown. "So they brought us down to the area by the Stuyvesant High School." Again, the patients were mostly rescue workers, with debris in their eyes and smoke in their lungs. While waiting there, a Red Cross worker shuttled the doctors to and from Ground Zero.

"It looked pretty much like something out of a movie. Areas I used to visit and walk around were levelled. There were holes in the buildings... Through the holes you could see the wreckage.... It was like watching a movie. It was surreal." Dr. Chawla said. "They were still putting out fires and there was so much smoke, but no victims to help." He recounted how just the previous week, after a legal meeting, the staff had celebrated at Windows on the World, the restaurant at the top of 1 World Trade Centre, renowned to have a view that stretched the length of the tri-state area.

Everything was so chaotic, he continued. "Someone told us that 50 elderly people had been evacuated from an apartment building. But we couldn't find them. Then, someone told us 10 people had just moved out in a van. We took 10 steps in the direction and then a fireman asked us if we were from St. Vincent's." Any person who was not a Federal Emergency Management Agency, or FEMA, worker was forced to evacuate as the buildings in the area were feared to be unstable. "They told us to go directly to the river and not to come back."

A boat took the doctors up to the Chelsea Piers. From the boat, they could see the new skyline of Manhattan, with all the smoke consuming it. "The boat passed Battery Park," said Dr. Chawla, "the parks one goes to on weekends, from where one can see the twin towers. The view is just completely different. It is just crazy how different the city looks without the twin towers." Dr. Gupta went to the top of Bellevue just to look across lower Manhattan. "It is amazing how different it looks without them there."

The doctors heard that five firefighters were being brought back to hospital and sought to make their way back. They asked a city bus to shuttle them back to the city. Along the way, the bus picked up people who were attempting to return to their daily lives. "It felt so weird to see people hailing cabs, when we just came from a sight so horrific," Dr. Chawla recounted. "They were not trying to ignore it, but in some sense they were trying to regain normalcy."

By early Wednesday evening, the doctors had to resign themselves to the realisation that the rescue mission was now mostly about cleaning debris, and "there was nothing more we could do, unfortunately from a medical standpoint," said Dr. Chawla. When Dr. Gupta got off work on Wednesday evening, he and three other orthopaedics and a plastic surgeon asked a police car to take them down to the site. "We were allowed in because we had medical identification," Dr. Gupta said.

There was nothing for the doctors to do around the site, "because they were not finding any bodies; they were just finding parts, pulling out limbs, and torsos, and heads," he explained. "That's what they told us. I saw them pull out arms and stuff."

Dr. Gupta walked around the remnants of the buildings he frequented since the time he was young - family trips during summer to walk along the water, during Christmas to see the lights hanging in the lobby of the World Financial Centre, the building adjoining the twin towers. "The World Financial Centre was really dark. You could see the wreckage across all the glass. In the gym across the street all the machines were covered in soot. The firefighters were walking as if on a mountain trail, climbing over stuff to get to what they had to get to." As Dr. Chawla got further down, the debris was more telling. "First you go down and see dust and debris. Then as you get further, paperwork - law suits, applications, paperwork in other languages. This is someone's office lying all over the city." Dr. Gupta described photographs of families from people's desks. "You have to see it to understand. Once you see it, you can understand why people are cancelling appointments. You can't imagine how anyone could have survived that."

"You walk around the corner," said Dr. Chawla, "and see them. You don't even realise it. They are just always there. It's like a wall in your house, and now there's no wall."