6 ms·

A Cardiologist’s 9/11 Story

74 points by extarial 8y ago

deelawn 8y ago
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."
- deleted 8y ago
  [deleted]
zuppy 8y ago
Something similar to the beginning of this article, from the Las Vegas shooting: http://epmonthly.com/article/not-heroes-wear-capes-one-las-vegas-ed-saved-hundreds-lives-worst-mass-shooting-u-s-history/ http://epmonthly.com/article/not-heroes-wear-capes-one-las-v... It's the story of the doctors.
- tptacek 8y ago
  This piece is incredible; I read it months ago and it's still stuck in my brain.
- cafard 8y ago
  Amazing. Thank you for posting this.
- btown 8y ago
  > 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.
chris_wot 8y ago
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.
- saiya-jin 8y ago
  I am sorry if I will sound cold or not caring (which is not the case at all), but as an US outsider too, I don't get these strong emotions. I look at the cold, hard facts since pure emotions are a bad way to perceive... well anything in this world. 3000 people died, very sad. What were your emotions when 250,000 died in pretty horrible ways during 2004 tsunami? Rwanda genocide? Or any ongoing genocide in the middle east? Surely some NY-based bureaucrat isn't more valuable to you than any other human being, no? I presume you must have had mental breakdown for 6 months after every such event and carry every trauma with you forever. Damage to infrastructure was substantial, but nothing that city like NY can't absorb in couple of weeks, apart from directly affected companies that were in the buildings. It sure looked like whole US population froze in disbelief for quite some time, traumatization well supported by US media running 24/7 just about the attack. Now imagine how it is living in Vietnam, Iraq, Afghanistan, Syria, Yemen or other war-torn places where smaller-scale but similar situations happen almost daily (most of them as a direct result of US actions). Suddenly 9/11 is just a small blip on your radar, yet another horrible event in a long line of horrible events. Things changed (mostly) for the worse, but only because general population allowed it to be changed. To me, 9/11 is a prime example how easily human population can be manipulated, how easy is to scare them into accepting ridiculous things, and how whole society still works on sheeps/wolves principle on all levels. As always, as everywhere.
mavidser 8y ago
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 https://www.youtube.com/watch?v=0pjUNZSajuE
- netsharc 8y ago
  Did they say, somewhat tragically, that they were getting experience handling such mass casualty incidents due to the number of attacks happening in 2017?
  - orf 8y ago
    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.
    - endtime 8y ago
      FYI, that number is probably at least an order of magnitude too high: https://www.npr.org/sections/ed/2018/08/27/640323347/the-school-shootings-that-werent https://www.npr.org/sections/ed/2018/08/27/640323347/the-sch...
      - aaron695 8y ago
        There's around one a day. https://www.theguardian.com/us-news/ng-interactive/2017/oct/02/america-mass-shootings-gun-violence https://www.theguardian.com/us-news/ng-interactive/2017/oct/...
      - deleted 8y ago
        [deleted]
      - kevinmchugh 8y ago
EADGBE 8y ago
I'm extremely interested in the story of the woman who survived the rubble.
M_Bakhtiari 8y ago
>We treated firefighters suffering from smoke inhalation American firefighters don't use SCBA?
- JshWright 8y ago
  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...
  - M_Bakhtiari 8y ago
    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.
    - JshWright 8y ago
      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.
frebord 8y ago
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!
- homero 8y ago
  Same I wonder if my panic attacks would make a heart attack more fatal because I'd fully panic if I got one

74 points by extarial 8y ago

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."

deleted 8y ago
[deleted]

zuppy 8y ago

Something similar to the beginning of this article, from the Las Vegas shooting: http://epmonthly.com/article/not-heroes-wear-capes-one-las-vegas-ed-saved-hundreds-lives-worst-mass-shooting-u-s-history/ http://epmonthly.com/article/not-heroes-wear-capes-one-las-v... It's the story of the doctors.

tptacek 8y ago
This piece is incredible; I read it months ago and it's still stuck in my brain.
cafard 8y ago
Amazing. Thank you for posting this.
btown 8y ago
> 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.

chris_wot 8y ago

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.

saiya-jin 8y ago
I am sorry if I will sound cold or not caring (which is not the case at all), but as an US outsider too, I don't get these strong emotions. I look at the cold, hard facts since pure emotions are a bad way to perceive... well anything in this world. 3000 people died, very sad. What were your emotions when 250,000 died in pretty horrible ways during 2004 tsunami? Rwanda genocide? Or any ongoing genocide in the middle east? Surely some NY-based bureaucrat isn't more valuable to you than any other human being, no? I presume you must have had mental breakdown for 6 months after every such event and carry every trauma with you forever. Damage to infrastructure was substantial, but nothing that city like NY can't absorb in couple of weeks, apart from directly affected companies that were in the buildings. It sure looked like whole US population froze in disbelief for quite some time, traumatization well supported by US media running 24/7 just about the attack. Now imagine how it is living in Vietnam, Iraq, Afghanistan, Syria, Yemen or other war-torn places where smaller-scale but similar situations happen almost daily (most of them as a direct result of US actions). Suddenly 9/11 is just a small blip on your radar, yet another horrible event in a long line of horrible events. Things changed (mostly) for the worse, but only because general population allowed it to be changed. To me, 9/11 is a prime example how easily human population can be manipulated, how easy is to scare them into accepting ridiculous things, and how whole society still works on sheeps/wolves principle on all levels. As always, as everywhere.

mavidser 8y ago

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

netsharc 8y ago
Did they say, somewhat tragically, that they were getting experience handling such mass casualty incidents due to the number of attacks happening in 2017?
- orf 8y ago
  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.
  - endtime 8y ago
    FYI, that number is probably at least an order of magnitude too high: https://www.npr.org/sections/ed/2018/08/27/640323347/the-school-shootings-that-werent https://www.npr.org/sections/ed/2018/08/27/640323347/the-sch...
    - aaron695 8y ago
      There's around one a day. https://www.theguardian.com/us-news/ng-interactive/2017/oct/02/america-mass-shootings-gun-violence https://www.theguardian.com/us-news/ng-interactive/2017/oct/...
    - deleted 8y ago
      [deleted]
    - kevinmchugh 8y ago

EADGBE 8y ago

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

M_Bakhtiari 8y ago

>We treated firefighters suffering from smoke inhalation American firefighters don't use SCBA?

JshWright 8y ago
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...
- M_Bakhtiari 8y ago
  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.
  - JshWright 8y ago
    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.

frebord 8y ago

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!

homero 8y ago
Same I wonder if my panic attacks would make a heart attack more fatal because I'd fully panic if I got one