Having witnessed the surreal and horrific attacks on September 11 from the street in front of my Greenwich Village office, I shared the shock and grief of my fellow New Yorkers. Hundreds of traumatized people who worked downtown were covered in ash and marched uptown to get away from the disaster. Others were desperately trying to reach loved ones who worked downtown on their cell phones, but there was no reception. Parked car doors were flown open with radios blaring to hear any news of the attack. As a crowd of people massed, I heard wails rise from the street when the Towers collapsed and disappeared from view. Hysteria predominated as family members remained, unable to reach loved ones who were at Ground Zero. I thought this was the stuff of nightmares or Hollywood movies. Feeling determined to transcend my helplessness, I cancelled office hours the following day and proceeded to walk down to the disaster site. I would spend the next 16 hours helping move debris and eventually provide medical and psychological support to rescue workers who were having difficulty coping.

Because the State policeman did not initially believe I was a physician, I had some difficulty, but succeeded in passing through several checkpoints on Houston Street. The streets in Soho were eerily quiet and deserted. Lower Manhattan looked like a frozen zone, with bridges and tunnels closed to traffic and pedestrian traffic limited to residents and fellow emergency workers. The smell of choking, toxic fumes intensified and burned my eyes and lungs. Ground Zero was a moonscape of white ash, battered and scorched vehicles, scattered trade orders, memos, and family photographs. It was still raining ash and there were many mounds of smoldering wreckage. The streets were covered in many inches of white dust, which became mud wherever firefighters turned their hoses. The Twin Towers had been my beloved and familiar site of training in preparation for the 2001 New York City marathon, which encompassed running along the west to east side promenade along the Hudson River. Now the disaster site was unrecognizable and disorienting, with the remains of the South Tower facade serving as a headstone for the site where thousands had perished.

As I got further into Ground Zero, I was given a pair of work gloves and instinctively joined a human chain of first responders to remove debris, which we handed off to the next person down the line. We formed bucket brigades to remove debris, hoping to identify any hidden victims. Torches were used to cut away large fallen girders and scores of trucks were lined up to haul away the ashes to distant places. The National Guard encircled the disaster site as workers struggled to ascend the mounds of debris five stories high.

An ad hoc medical team was eventually hastily assembled on the perimeter of this tomb of rubble. We were anxiously anticipating providing medical aid to the survivors of the catastrophe. It slowly became tragically apparent that that we were going to be reduced to caring for the rescue workers. Many of the rescue workers, including firemen and construction workers who slid into holes in the rubble, created false rumors of survivors being pulled out, when in fact it was these rescue workers who were recovered. As medical personnel attended to the injured rescue workers—there were no survivors—I became part of the medical unit on the south side of what was once the Twin Towers. Rescue workers in need of medical attention were triaged and evaluated initially by an Army nurse who would then, if necessary, request my psychiatric care. I was also asked to evaluate rescue workers by an emergency room physician who worked in Connecticut and was now coordinating this medical unit. I was the sole psychiatrist in this makeshift medical unit who evaluated and aided a large number of first responders. Three rescue workers of particular interest follow.

An Anxious and Panicked Construction Worker

I was asked to support a burly, middle-aged construction worker who came from upstate New York to volunteer aid with the rescue effort. He, like myself, had a personal connection to the Towers, as he had helped build them many years ago. Being in shock and denial over the extent of the wreckage and the fact that the collapsed Towers had not yielded any of the living, he was having difficulty breathing and had some chest pain. Feeling humiliated by his display of anxiety and difficulty coping, he refused to tell the Army nurse his name, as he took pride in being stoic and non-emotional. Feeling less threatened, he felt secure enough to share with me his name and horror at searching and hoping for miracles but finding only a severed human head and a woman’s foot with her shoe partially attached. Although a few survivors were pulled from the wreckage, the intense heat, fire, and instability of nearby buildings kept him and other rescue workers at bay. We were told that if we heard five warning horn blows, we should run, as an unstable building was coming down. While shedding tears, this otherwise macho man shared his feelings of grief in not being able to do more. While talking with me about his anxiety of not finding survivors, his breathing became less labored and he felt less panic. Becoming more accepting and less panicked by the fact that there would most likely would be no survivors, he was able to return to using his crane to remove debris.

A Fireman with Post-Traumatic Stress Disorder

Normally, firemen are reluctant to talk to therapists, but the fact that this was a shared experience of horror led to an unprecedented sense of connectedness. We were all coming together as first responders in an attempt to lessen each other’s suffering. Also, most of the many firefighters I pulled over to the medical triage area to get their burning eyes washed to lessen their pain did not know I was a psychiatrist.

I spoke to five physically exhausted and emotionally numb firefighters who had battled toxic fumes and raging fire for 34 hours. Fifteen colleagues from their unit had perished in the disaster. The massive terror and grief allowed one of the firemen to share his emotions. He was a strapping young man who related feeling massive exhaustion, anxiety, impending doom, and burning eyes and lungs. He was unable to rest for more than an hour in a nearby battered building, as he awoke startled at any loud sound. Feeling an immense sense of helplessness, he had recurring thoughts of seeing people jump from the Towers. He felt physically and emotionally spent. The physicians in the triage had access to medication, so I was able to administer to this young man a low dose of ativan, which lessened his anxiety. Then  I encouraged these five fireman to get medical attention for their burning eyes and lungs and then to go home to sleep and come back the next day if they desired.

An Agitated Family Member Threatening to Intervene in the Rescue Effort

I was asked to help manage a 32-year-old Central American man whose younger brother worked in the Towers. Through a volunteer second year Yale medical student who functioned as my translator, this man said his brother had phoned him asking for help while trapped under a massive amount of rubble. This desperate man was holding on to the slim hope that his trapped brother was alive and insisted we find him. Becoming increasingly agitated as time elapsed, he felt nothing was being done to rescue his brother. He had a deep identification with his brother, as he was all that remained of his family. He continued to insist that his brother could not be dead and he maintained he had spoke to him hours ago. His whole life was dedicated to caring and protecting his younger brother. He expressed the wish to exchange places with his brother because his “brother has a better life” than he did. His feelings of survivor guilt were a defense against processing his grief and feeling of helplessness. As he became less irritable, he was able to reminisce about his brother. Over many hours with me and others, including a Spanish priest, he became more calm and able to have more emotional space to reflect on his relationship with his brother. Eventually, he expressed his profound guilt, despair, and desolation.

I subsequently referred this man to the Grief Relief Network, which is a national initiative that was created by Dr. Kevin Hopkins in response to the massive trauma sustained by family members who lost loved ones to terrorism. Being honored to be a founding member of the Grief Relief Network, I felt this man would benefit from getting support from other family members of victims who had perished in the Oklahoma City bombing and other disasters. This network provides peer-to-peer video conferencing and creates a supportive community of surviving family members who lost a loved one in a terrorist attack. While supporting this man, we heard five horns, which meant a building was collapsing. We all ran for our lives.

Personal Reflections

I felt a vicissitude of emotions consisting of grief, rage, and patriotism. When providing medical and psychological aid to other first responders, I saw dismembered body parts, an experience emotionally different from handling corpses as a medical student. The perishing of thousands of innocent victims was incomprehensible. In addition to the overwhelming loss of human life, my sense of sorrow was further enhanced because I consider Lower Manhattan my backyard. At the time, I was training for the upcoming New York City marathon. Battery Park was smothered in an angry, thick, toxic blanket of dust.

The disaster brought me back to my own history of traumatic loss, which deepened its   significance. My beloved analyst, who had been a hidden child in Hungary during the Nazi occupation in World War II, had unexpectedly and suddenly passed away during my therapy. After her death, her childhood memoir, Castles Burning, was published. I identified with what I imagine were her feelings of ferocious rage, devastating sorrow, and powerful resilience. Her brother, who was resisting the occupation in Hungary during World War II, was killed by the Nazis. Now, I had a deeper understanding of my analyst’s devastating loss of her older brother. The life she described in her childhood memoir had, in one swift and unimaginable moment, become real.

My 9/11-Related Breast Cancer Diagnosis

In 2001, Christine Todd Whitman, who was the administrator of the Environmental Protection Agency, continually reassured first responders and those who lived near Ground Zero that the air was tested and not harmful. Despite Todd Whitman’s confident report that the air was tested and not dangerous, I directly contradicted her statements while I was on NBC News, stating that the air was and remained toxic to the skin, eyes, and lungs for months.

Ironically, 16 years later on a routine mammogram and ultrasound, I was shocked to be diagnosed with breast cancer. Having no family history of breast cancer, I was initially in denial and had to repeat over and over to my boyfriend that I had breast cancer to have the news sink in. My breast surgeon stated that the origins of my breast cancer could be consistent with being exposed to a toxin, as she “had never seen cancer with such high resolution and detail on ultrasound result.” Since 2017, I have been on the World Health Trade Center Insurance, as my breast cancer most likely resulted from my exposure to toxins at Ground Zero. Even if I had prior knowledge that going down to Ground Zero would result in my developing breast cancer, I still probably would have chosen to volunteer to help others. Despite the stress of having a nine-hour surgery consisting of a right mastectomy with reconstructive surgery, my breast cancer may have been a necessary but small price to pay to be able to aid so many others. This tragedy was a instinctive, pure calling for me to be of service to others in need, and took me out of my normal sense of time, experience, and consciousness. Aiding others in this effort felt like a sacred experience. During such massive catastrophes as 9/11, our own person pales in comparison to the greater good.

Conclusion

This a story of a great city coping with the worst disaster in its history. It marked the end of American innocence and the beginning of a way of life we had fooled ourselves we could avoid. The city in all its diversity came together as a cohesive unit to discover a sense of civic responsibility, exemplified by the noble heroism of the firefighters and rescue workers. The attack annealed our resolve and determination as a peace-loving people in what will surely go down in history as the defining moment of our generation.