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A Cardiologist’s 9/11 Story (nautil.us)
74 points by extarial 67 days ago | hide | past | web | favorite | 40 comments



Something similar to the beginning of this article, from the Las Vegas shooting: http://epmonthly.com/article/not-heroes-wear-capes-one-las-v...

It's the story of the doctors.


> In preplanning, I knew that as we started to get some of these red tags stabilized, the anesthesiologists and surgeons would start arriving and we could open up more ORs. That’s the first major choke point. I can resuscitate four or five people, but that operating room was going to be the key to stopping the bleeding and saving lives. In a high volume penetrating MCI like this, you really need flow. You need people to get stabilized and into the operating room, not sitting around perseverating about what test to order next. Getting those ORs staffed and opened was my biggest priority. With potentially hundreds of incoming patients, it was going to be a matter of eyeballing patients or feeling for carotid pulses because we didn’t have enough monitors. Everything was 100% clinical judgment. You’re looking at all these patients, and you’re just waiting for them to declare themselves—and then you start to work on them.

Wow. It's rare to see someone who can, in a crisis situation, handle both "macro" and "micro" tasks with such foresight and effectiveness. Menes was doing the equivalent of solving a scalability problem - identifying chokepoints, modeling flow, thinking about optimizations in layout of physical bodies, handling morale - all while implementing experimental treatment procedures and making snap judgements about patients' individual statuses. How someone can keep all this loaded in working memory for hours on end is mind-boggling to me. Truly inspirational.


This piece is incredible; I read it months ago and it's still stuck in my brain.


Amazing. Thank you for posting this.


Tangentially related: There's an excellent documentary from BBC about a hospital during London's Westminster's bridge terrorist attack. They were there to shoot a planned documentary when the attack happened. Not anywhere at this scale, but it gives a pretty good behind-the-scenes look at the doctors and hospital staff preparing for the victims of a mass-causality incident.

https://www.youtube.com/watch?v=0pjUNZSajuE

netsharc 67 days ago [flagged]

Did they say, somewhat tragically, that they were getting experience handling such mass casualty incidents due to the number of attacks happening in 2017?


Bah those IS dudes are total amateurs. Check out what the IRA and UVF were able to achieve: https://en.wikipedia.org/wiki/The_Troubles#Chronological_lis...


A domestic insurgency will always be more effective than an outside group.

orf 67 days ago [flagged]

I doubt it, but I'm sure their experience with such events pales in comparison to the doctors treating the injured from the 307 mass shootings that happened in the USA that same year.


FYI, that number is probably at least an order of magnitude too high: https://www.npr.org/sections/ed/2018/08/27/640323347/the-sch...


The NPR article you've linked seems to be about shootings in schools, not mass shootings, which can take place outside of schools.


FWIW, "mass shooting" isn't really defined and can be anything from Columbine to a gang scuffle of four people where nobody died.

https://www.politifact.com/california/article/2017/oct/04/ma...


As someone also says the experiences in the troubles in NI and the UK fed into this.

Also the UK does has done civil contingency planning /gaming since ww2.


Very interesting story! Reading about arrhythmia always gives me anxiety, this story even more so because now I'm thinking my elevated anxiety can cause a feedback loop that makes my heart beat differently causing even more anxiety until I ultimately go into cardiac arrest. LOL I'M FINE THOUGH!


Same I wonder if my panic attacks would make a heart attack more fatal because I'd fully panic if I got one


For anyone interested in this story, the Household Name podcast has an excellent episode covering this story. The title is "The Bodies at the Brooks Brothers."


I'm extremely interested in the story of the woman who survived the rubble.


I know it's not about cardiology, but I remember the day after the attacks. As I'm an Australian, I had gone to bed early so I didn't see what happened till the next morning, when I turned on the television.

There aren't too many events that you can say utterly changed your view of the world. I remember listening to Triple M that day, and listening as grown, gruff Australian men who listened to rock music called in to Andrew Denton, crying and in distress.

I can only imagine what it must have been like for the doctors who had to do to identify bodies, and bits of bodies. The thing that hit me most was that they were doing their job, waiting for patients that never came. They were all dead. I can barely comprehend this.

I will never forget September 11th as long as I live. I work with young guys now, mostly 21 to 24 years old. None of them truly understand what happened that day, they were all too young. I'm glad in many ways they don't, but they also don't understand how truly profound that day was. I hope they never do, nor never need to.


[flagged]


> It sure looked like whole US population froze in disbelief for quite some time

Your memories of that time do not match mine. I recall people banding together in various ways. I recall anger, fear, frustration. I recall strong emotions. I recall people jumping up wanting to take action. I recall the "Not In Our Name" movement reacting against that. I recall an increase in government action, and many stories of first responders who jumped up and acted. I recall old friends getting back in touch because despite the odds against an old schoolmate who moved to NYC being part of the 3000 who died, you still wanted to check.

What I do not recall is people frozen in disbelief.


On the one hand your comment is callous but on the other hand it's true. 9/11 was very tough but I thought it would also cause the US (and the West) to have more sympathy with other countries who go through similar or bigger tragedies but that didn't happen.


> have more sympathy with other countries who go through similar or bigger tragedies

Inflicted by us, no less


Not only. There are tsunamis, earthquakes and other things. Not everything is the US's fault. But it would be nice if people recognized how much suffering there is in the world and be more willing to help.


There was a massive outpouring of support in the U.S. and worldwide for the victims of the 2004 Tsunami.


why do people care so much about mass shootings when they make up a tiny share of total homicides? it's not the body count, but the symbolic implications.

3000 deaths is not that many in the grand scheme of things. we expect thousands to die every year to disease, accidents, regional conflicts in unstable areas and are not shocked when it continues to happen. but it is a severe violation of what we expect for foreign actors to kill that many in the financial center of the most powerful country in the world. I would argue that anyone living in the west should be shocked by this sort of event. like it or not, the US is a key part of the west's defensive posture. it wouldn't take too many of those events to destabilize our half of the world.


> anyone living in the west should be shocked by this sort of event

I think this is similar to the good old irrationality of the fear of flying in many people (including my mom) - it doesn't matter how much cold hard facts are told over and over, some people just freak out and switch to completely different behaviour.

I am a bit different (no clue why). Not because I lack emotions or compassion, but emotions generally don't affect my judgement much (call it advantage or disadvantage if you want, but it helped me greatly in life so far).

I refuse to be shocked be these kind of things, not more or less than any other mass killings/deaths out there. People are people, we are equal and this is also what true equality means - it really doesn't matter if some indian peasants are killed in flood caused by some dam breaking, or somebody kills white collar people by plane. The true effects of those attacks were really small on global scale. The over-reactions, mainly from US government but not only were disproportionate and will be felt for many years to come.

And you know, going with the hysterical flow is exactly what the terrorists wanted to achieve - I think the after-9/11 reality surpassed even their wildest dreams and desires. Again, something I refuse to go along with, it doesn't make a tiniest bit of sense.


I think you are missing my point here a bit. 17 year later, there have been no more terror attacks at the same scale as 9/11. in hindsight, it's easy to say that we overreacted to a single very bad event. but this isn't what people were responding to at the time. people didn't believe this sort of thing could happen at all, and the next day they had to start wondering how long until the next one and how often these events would occur.

try to imagine living in a world where huge office buildings can just come down at any time on a yearly, monthly, or weekly basis. I feel like the "rationals" underestimate just how destabilizing that would be.


> try to imagine living in a world where huge office buildings can just come down at any time on a yearly, monthly, or weekly basis. I feel like the "rationals" underestimate just how destabilizing that would be.

So, like in Syria, or Palestine?


yeah, these are very unstable places. it should be shocking to imagine the west devolving into that.


I was trying to place what makes me so uncomfortable with your comments. I think I know why I have a problem with them now.

Basically you consider emotional responses to be irrational and illogical. By your argument, the death of your son should not affect you because there are thousands of people who die every day and you don’t feel anything for those people.

Basically what you are standing in judgement of is that because life is tragic everywhere, you should not feel the tragedy of any individual event if you don’t feel the tragedy of every terrible event. Which ironically seems to have made you come to the conclusion that you shouldn’t feel emotion to any event because there are so many of them.

You definitely fail to understand that people react to events differently, and the closer to the event you are the more tragic it seems. And in fact, that’s really the way it should be. As tragic as the death of a child in Africa (and it is tragic) it can in no way ever compare to my own son or daughter dying. At least to me. And there is nothing wrong with that, so long as I can acknowledge that there is tragedy everywhere.

If I took your logic to it’s most extreme, then I would need to be either a complete basket case (everything produces an equally emotional response) or a total robot who is not allowed to feel anything because it’s unfair to be more emotionally involved in one event than another.


this might be the worst take ive ever read in my life

The fact you can't understand how people could be shocked by one of the most unexpected, deadly terrorist attacks in history is scary.

Of course people will be shocked, they saw themselves in the victims, they saw their family, they saw their neighbors. Not only that but it was completely unexpected which makes the pain even worse - something clearly mentioned in the article.

Humble bragging that your 'emotions don't affect your judgement' and that it has 'helped you greatly' in life is just incredible.

Have some empathy one time for me


If you only look at the numbers perhaps, but there is much more to the issue than body counts. People aren’t hypocrites for feeling strongly about the events of 911 and less about the 2004 tsunami. Personally I remember both days pretty well and was shocked by both.


Your comparisons of one event to other catastrophic events are not apples to apples.

3000 died, on TV, in a first world, far from war, in an act of war, in one short hour, with few survivors.

250,000 died, in "lean world" regions, in an act of God, across several hours, with many survivors.

Rwanda massacre happened, in culturally tense environment, in Civil War, over many months, with many survivors

Ongoing genocides, in culturally tense environments, in unsafe crime/war zones, when everybody very well understands how bad it is, with many survivors.


You really presume a lot, you have no idea how these affected me. Both of these affected me terribly. In fact, as an Australian, it’s rather ironic you mention the 2004 Tsunami. My entire country mobilized around that event.

And I never had a “mental breakdown” after September 11. Where you got that from, I have no idea. As someone who has PTSD, I consider that to be a pretty ignorant comment.


I wonder how a Vietnam vet felt on 9/11? Or a WW2 survivor, for that matter.

I don't think it's a matter of US / non-US, but rather generational. It's one thing to be aware of war and death, and another to see dead bodies in the street. And it's not just the 3000 people that died, but the millions who saw the destruction first-hand, and the hundreds of thousands that lost family and friends that day.

For me, the question is not "why do Americans feel 9/11 so viscerally" but rather "why don't we feel the same way when similar events occur around the world?"


Very true. The US unleashed orders of magnitude more hell than that, abroad. Why should we be so biased?


>We treated firefighters suffering from smoke inhalation

American firefighters don't use SCBA?


You had thousands of folks working 24/7. Assuming you had that many SCBA in the first place (generally you just have enough for a given shift plus some spares, not enough for all the off duty shifts working at the same time as well), how would you propose keeping that many bottles filled? When it takes an hour or more to get to the work-site, are you supposed to take a half dozen extra bottle with you just for the commute?

This was obviously an extraordinary situation, and it seems bizzare to me that you would draw the inference that SCBA is not used in the US...


I obviously don't believe they never use SCBA, but doing physically demanding labour while breathing a toxic atmosphere is not an exercise in heroism, but in futility. Supplying bottles in such a situation is challenging for sure, but I find it hard to believe that going without was at all productive.

I hear a lot of remarks in passing from firefighters that their American peers are rather careless with their personal protection equipment, it would be interesting to hear from one of them.


This event was so far beyond the scale of what is reasonable to plan for though. Consider an engine company that may have 4 firefighters on a typical shift. They probably have 6-7 SCBA to account for equipment failures, etc. So, what happens when you recall all 4 shifts and suddenly have 16-20 firefighters trying to use less than half that number of SCBA? It's a situation with no "right" answer.

I was not at ground zero, but have friends and colleagues that were, and my understanding is that SCBA use was prioritized for the "most" IDLH areas, but that still left a huge number of folks working in areas where, under normal circumstances, you'd absolutely be wearing a pack.

I can only speak for myself and my agency (a suburban combination career/volunteer dept in upstate New York), but we are were careful about PPE usage, air management, etc.


If a firefighter can save ten lives in one day and develop emphysema many years later, it was a worthwhile trade-off. It would be only futile if they dropped dead after every person saved.




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