Fifteen years ago, New York City was changed forever when terrorists struck down the Twin Towers of the World Trade Center. Almost 3,000 people lost their lives in the attacks and more than 6,000 people were injured.

The tragedy of that day brought all of New York City together: the first responders, paramedics, firefighters, police officers, doctors, nurses, area businesses, co-workers, neighbors and strangers.

NewYork-Presbyterian staff was called into action to help victims in the immediate aftermath of the attack, with four NYP EMS professionals sacrificing their lives that day to save others.

The 9/11 Memorial at NewYork-Presbyterian/Weill Cornell Medical Center honors the four NYP EMS workers who died that day saving lives: Keith Fairben, Mario Santoro, Kevin Pfeiffer and James Pappageorge

Several NewYork-Presbyterian staff members came together to share their stories throughout the week. Follow #NYPReflects to read more from our dedicated staff.

Barbara Ritchwood, RN, NewYork-Presbyterian/Weill Cornell, standing in front of a hyperbaric oxygen chamber used for burn treatment (Photo by Connor Hadley)

Barbara Ritchwood, RN (BR), NewYork-Presbyterian/Weill Cornell: I lived in Jersey City and took the PATH train to WTC and was there at 6:16. I exited 6 WTC and walked to Fulton Street Station and took the train uptown to work.

Dr. Howard Beaton (HB), general surgeon, NewYork-Presbyterian/Lower Manhattan Hospital: I finished my overnight shift at the hospital after being on call for general surgical emergencies until 7:00 AM that day. I went home with plans to have breakfast and then vote in the primary election being held that Tuesday. I remember thinking what a glorious September day it was with absolutely clear blue skies.

Dr. Yoshifumi Naka (YN), director, Cardiac Transplant Program, NewYork-Presbyterian/Columbia University Medical Center: I had an emergent surgery scheduled that morning at around 9:00 AM. The patient was a former pro football player — he was dealing with end-stage heart failure. His condition had been declining and he had a left ventricular assist device (LVAD) implanted from a previous surgery while we waited for a donor heart. Given his size, it was difficult for us to find a heart that was right for him. But that morning, we heard that a match had been found from a donor up in Boston.

Before we could implant the new donor heart, we had to remove the LVAD, so his surgery was very complex. We only had a short window of time to remove the LVAD and implant the heart.

8:46 AM — The first WTC tower is hit.

Dr. Antonio Dajer, director of the Emergency Department, NewYork-Presbyterian/Lower Manhattan Hospital (Photo by Connor Hadley)

Dr. Antonio Dajer (AD), director of the Emergency Department, NewYork-Presbyterian/Lower Manhattan Hospital: Out the second floor conference room windows, in the midst of grand rounds, every intern and resident in the hospital saw the first tower ignite.

BR: I remember standing in a room with a patient with schizophrenia who was yelling and didn’t want to see the news. The next thing I knew, the plane was crashing into the World Trade Center…I looked at my coworker from the night shift and said, “I don’t think you are going home…”

Dr. JoAnn Difede (JD), attending psychologist at NewYork-Presbyterian/Weill Cornell and director of the Program for Anxiety and Traumatic Stress Studies (PATSS): I returned home from swimming to a blinking light on my answering machine, which had a message from a colleague who knew that my son had started preschool the day before across the street from the U.N. The message said to turn on my TV and go get my son. After a quick glance at the TV, I jumped in my car to go to my son’s nursery school which was across the street from the U.N. The U.N. was being evacuated as the attacks were occurring. As I neared the UN, I could see people streaming out and I could see the smoke clouds from Second Avenue. After I picked up my son, as we were driving north on the FDR back to the Weill Cornell campus, I heard that the bridges and tunnels were being closed. The next thing I knew, my beeper started going off and just didn’t stop.

Dr. Yoshifumi Naka, director of the Cardiac Transplant Program, NewYork-Presbyterian/Columbia

YN: While we were doing the dissection of the heart, one of the nurses came into the operating room to tell everyone that a plane had hit the World Trade Center. My initial reaction was that it must have been a smaller plane — one of those private planes. We just continued on with the surgery.

John Episcopo (JE), NewYork-Presbyterian Emergency Medical Services: After switching shifts to help out a friend, I was working on an inter-facility transport EMS unit. Upon hearing the horrific events of the day over the EMS radio, I was asked to immediately return to our base at the hospital.

AD: I was, ridiculously, in the bathroom. An overhead page blared, “Respiratory stat to the emergency room!” My thoughts were scrambled…there is no other attending physician out there. All we have are 12 admitted, stable holdovers from the night before. And I’m not about to intubate anyone, so who the hell is calling respiratory?

Once I was back on the floor, I caught the charge nurse rounding a corner. “An American Airlines plane hit the World Trade Center!”

JE: A task force was assembled with more than 10 NewYork-Presbyterian EMS staff members in ambulances and other medical vehicles to respond to the location, in addition to NewYork-Presbyterian EMS staff that was working in the New York City 911 system and already on their way.

Dr. Howard Beaton, general surgeon, NewYork-Presbyterian/Lower Manhattan Hospital (Photo by Connor Hadley)

HB: As soon as I got home, my wife received a phone call from her friend Suzi Mascitelli at NewYork-Presbyterian/Weill Cornell, informing her that a plane had struck the World Trade Center. I immediately got in my car and tried to drive back downtown. I got as far as 34th Street and could see the traffic stopped ahead. I left my car in a garage and took one of the last subways to make it downtown that morning. I didn’t return home for the next five days.

9:03 AM — The second WTC tower is hit.

BR: The phones were ringing like crazy. Someone was yelling, “Turn on all the TVs! We have a disaster situation and we need to see what’s going on.” People everywhere were coming out of the woodwork. All we could think was, “How quick would the patients get to us? How many…if any…?”

“After the second plane hit, then I realized something bad must be going on. But we couldn’t stop the surgery, we had to keep going or risk major complications for the patient. I was focused on the surgery — I didn’t have time to worry.” — Dr. Naka

YN: The donor heart was on its way. It was leaving from Boston that morning. I didn’t know this until later, but they closed the George Washington Bridge after the planes hit. If they had been just five minutes later, then they wouldn’t have been able to bring the heart for my patient.

9:10 AM — first patient arrives at NewYork-Presbyterian/Lower Manhattan (then NYU Downtown Hospital)

HB: I cannot recall whether I first went to the OR or to the ER. All ORs were running with emergency cases staffed by the nurses and surgeons who were already there. The old emergency room on the ground floor was packed with injured patients being attended to by doctors and nurses. The old cafeteria on the ground floor of the B building was being used to treat patients with minor injuries. The hallways were filled with other patients with minor injuries.

As I walked in, one man caught my arm and asked me to help with his dislocated finger. I pulled it back into place, he said thank you and left. I helped one of the surgical residents perform a tracheotomy on a patient with a severe head injury and difficulty breathing.

BR: I remember the strong smell of gasoline. I remember the faces and bodies looked like they had been dipped in wax…everyone looked like they were the same ethnicity. I remember the humming of the IV pumps, all infusing as fast as they could go….I remember the vents alarming…the pharmacy handing out IV bags…

HB: It is hard to describe the eerie sense of isolation that most of us felt after that first hectic hour. With the collapse of the towers, new patients suddenly ceased coming to the hospital. I saw the collapse of the North Tower from my office.

Many of us milled about in front of the ER waiting for ambulances that never came. The hospital was running on emergency power and the telephones were out. Even cell phone service was not working. Inches of a white, foul, fine dust covered everything. It looked like the aftermath of World War III.

JD: The burn center was jam-packed, not just with patients, but with family members as well. It received almost all the people who survived. By contrast, the ER was quiet. There were all these people waiting for something to do, but no one was coming. Bed after bed, bay after bay was empty. Everyone was shocked. We had all of this expertise and training, and other than those working at the Burn Center or in psych, there was little to do.

Dr. JoAnn Difede, attending psychologist at NewYork-Presbyterian/Weill Cornell & director of the Program for Anxiety and Traumatic Stress Studies with virtual reality display (Photo by Connor Hadley)
“The hospital vanished inside a filthy, acrid cloud. Inside, we thought we needed to seal the doors. But out of the murk, ghostly hands were pounding on the lobby glass.” — Dr. Dajer
John Episcopo, NewYork-Presbyterian Emergency Medical Services

JE: My first view of the smoke coming from the World Trade Center buildings came as we were driving down the FDR. We staged the vehicles on West St. near the WTC complex and deployed our equipment. As we approached the location, a building began to collapse. Through the chaos, we made sure to stay together while looking for ways of helping those who were already injured.

HB: Despite the dust and the chaos on the streets, a decision was made to leave the William Street doors of the hospital open as a refuge for anyone who wanted to enter. The lobby and hallways were filled with dust-covered, stunned people. Someone was carrying a young child left by its babysitter to wait for her mother who eventually arrived. The hospital provided surgical masks to anyone who wanted one.

BR: The doctors from each service and a burn nurse were in each of the empty rooms to receive them as they arrived.

JD: I realized that the families of the burn survivors did not want to leave the waiting area, as their loved ones were critically ill, and for many survival was uncertain. So I tried to implement stress management interventions for the families in the waiting room.

I asked a yoga expert, Beryl Binder Birch, who had been the yogi-in-residence at the Road Runners club, to lead patients and families in guided meditation and breathing techniques with me right there in the Burn Center waiting room. At that time, yoga wasn’t widely accepted as it is now. It was remarkable to see the tension drain from the faces of people who were so understandably worried and fearful for their loved ones’ survival. I was impressed by the power of the intervention. So I submitted a grant to the Greater New York Hospital Association to start a yoga program for the healthcare workers taking care of WTC survivors. The grant was funded, so we were able to offer about four to five classes a week. Everyone from surgeons to office workers attended. A smaller version of the program continues to this day.

(Photo by Connor Hadley)

AD: The air was gray outside. Inside, patients had been moved upstairs or to the operating rooms. We were transferring out the burns, the head traumas, and the bad fractures to clear the decks for another hundred patients. But instead there was only a trickle. The street suddenly fell quiet.

A half hour later, I walked to City Hall Park, three blocks away. The smoke funneling up Broadway was black and endless. Discarded shoes were everywhere. A crust of papers and thick gray dust blanketed the park, the streets…the world, it seemed. We found an EMS commander in a deserted lobby. “Downtown Hospital is open,” I told him.

3:00 PM

YN: Meanwhile, my surgery took about six hours, and went well. I later asked the donor procurement team what they would have done if the George Washington Bridge had been closed before they could cross it. They said they would have run with it across the bridge.

We used to be able to see the Towers from the bridge at NewYork-Presbyterian/Columbia — all we could see was smoke. I kept calling my friends to make sure they were all right. All hospital surgeries were ceased to prepare for others who could be coming. But no one came.

We didn’t have anything else to do on that day. I left the hospital earlier than usual and was stuck in traffic trying to get out of the city. When I realized the gravity of the situation, I thought, “This is crazy, this is a war against the United States.”

Taken from NewYork-Presbyterian/Columbia (Photo by Marie Wallace)
(Photo by Connor Hadley)
“It occurred to me that my wife had no idea what happened to me. Unable to call, I realized that the internet seemed to be working, so I emailed my son in Boston and asked him to call my wife at home to let her know that I was OK.” — Dr. Howard Beaton

BR: I remember calling my mother and telling her to come and get my dog…I thought, “I can’t leave, it’s just too busy here and I would be nothing but a crying mess if I could not work through this.”

(Photo by Connor Hadley)

HB: Around 6:30 PM, 7 World Trade Center collapsed, shaking the ground again and covering us all with more dust. Rumors abounded. We were told that surrounding buildings were unstable and going to fall. We worried that the hospital was going to collapse. Someone said that they were going to need amputation equipment to help rescue survivors trapped in the debris. Equipment was sent from the OR, never to be seen again.

“I remember working until midnight, and then I went next door to the Helmsley Tower with a bunch of other nurses. We cried ourselves to sleep, only to wake up and come back at 7:30 AM to do it all over again.” — Barbara Ritchwood, RN

HB: I slept fitfully on the couch in my office that night waiting for more injured patients that never came.

(Photo by Connor Hadley)

AD: A young man died, his lungs slowly and inexorably gave out. An ICU attending, in practice for 20 years, said it was his toughest case ever.

After his family arrived, a resident, trembling, had to tell the patient’s wife her husband is dead. She dropped to the ground. When the resident tried to help her up, she punched him with brutal force.

The Aftermath

HB: To those of us who were downtown on that day, September 11th will always be much more than just a date. The feeling of helplessness in the days that followed was overwhelming. The smell of the smoke from the site was a constant reminder that did not go away until Thanksgiving. The site of the National Guard troops that arrived the following weekend and the “frozen zone” that we had to enter to get to the hospital each day will never be forgotten. The notes posted to the windows and walls outside the hospital looking for loved ones who were never found were heart-wrenching.

JE: Throughout the following weeks, NewYork-Presbyterian EMS workers collaborated with city agencies to continue to provide standby ambulance crews at the Ground Zero location in support of rescue and recovery work, and facilitate transfers of trauma and burn patients from surrounding hospitals. We continued to work day and night in the days following, all the while mourning the loss of our colleagues. Four NewYork-Presbyterian staff members died in the line of duty — Keith Fairben and Mario Santoro were working for NYP in the 911 system, and James Pappageorge and Kevin Pfeifer were on duty that day in their capacity as FDNY firefighters.

BR: I worked straight through 13 days in a row. I was tired, but it felt good that I could help someone, anyone. I remember the thousands of cards from school children and suggesting to hang them in the hallway. I remember the burn teams we developed to efficiently do the burn care to prevent the patients’ from getting too cold…the friends that were made through FEMA which I keep in touch with…the people who donated food and refreshments for the families and staff…patients going to the OR every day at all times…very busy days and nights.

Handwritten cards, sent from school children all over the nation, still hang in NewYork-Presbyterian’s Burn Center today.

HB: Someday the construction at the World Trade Center site will be completed. I find the memorial fountains at the footprint of the towers to be solemn, beautiful in their simplicity and very moving. I have not had the fortitude to go into the museum yet. I don’t know if I ever will.

(Photo by Connor Hadley)

JD: In the aftermath, many civilian survivors, first responders and rescue workers experienced post-traumatic stress disorder. For most people, PTSD includes intrusive imagery that pops in your mind, even when you least expect it. PTSD can also manifest as difficulty sleeping, irritability, anxiety, hyper-vigilance and avoiding your thoughts, feelings, people and places that remind you of your experience. Hence, people typically avoid treatment since it reminds them of their trauma. People with PTSD relive the terror of the traumatizing experience and often feel tremendous guilt for surviving.

At the time of the attack, there was only one FDA-approved medication for PTSD and emerging evidence for one psychotherapy — exposure therapy. It’s important to remember that what we call “evidence-based” treatments for PTSD were still such a new concept. The first evidence-based treatment guidelines were only published a year before the attacks. Not everyone got better with these treatments, so I knew that we would need other options for those who did not respond to these two treatments.

Prior studies showed that only about half of those with PTSD responded to the medication and about 65% responded to the psychotherapy. No studies had been conducted with first responders, rescue workers or terrorism survivors. I knew that we should have other treatment options. I decided to develop a virtual reality simulation of the WTC to use in treatment.

A virtual reality (VR) software simulation and headset helps recreate the trauma in an immersive environment. During this treatment, the therapist has control over what the patient sees, and the patient talks about what he or she experienced that day while immersed in the WTC simulation. The end goal, over time, is remission of the PTSD symptoms.

When the virtual World Trade Center simulation was created, the work was experimental. We did not know if using VR simulations would be effective in the treatment of PTSD. Our work with WTC survivors demonstrated that it was effective, and helped to lay the foundation for the use of VR in treating combat-related PTSD. Now, there is substantial evidence showing that VR-based treatment is effective for PTSD related to terrorism, combat and other traumas.

One of our biggest challenges is just getting people in for treatment. PTSD can impact people’s lives in so many ways, and it often takes a long time, if ever, for them to recognize their symptoms as PTSD. I’ve had people come to me more than 10 years after 9/11 saying that they only now realize that they have PTSD, even when it’s already taken a devastating toll on themselves and their families.

It’s important for those with PTSD and other trauma-related problems to realize that it’s possible to get better even 15 years after the WTC attacks. There are people walking around right now with PTSD and they don’t understand that many of their problems are related to the trauma of that day. We encourage those who are suffering to seek help.

If you have a moment or a memory you would like to share with us from that day, we would be honored to read it. Please feel free to share in the comments below, and follow along on Facebook, Twitter and Instagram with #NYPReflects.

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