Jewish World Review Dec. 14, 2001 / 29 Kislev, 5762

Drs. Michael A.Glueck & Robert J. Cihak

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More heroes: Docs deserve a little credit after 9/11 -- A COUPLE dozen centuries ago, Plato defined courage as "endurance of the soul." More recently, Hemingway called it "grace under pressure." 9/11 certainly provided countless examples of both: the citizen heroes, the firemen, the police. But only a few commentators have mentioned the nurses, physicians, and psychologists who worked without rest to provide medical care and spiritual comfort. This is wrong.

Now, don't get us wrong. We claim no personal credit. We weren't there; we treated no one. Nor do we call attention to our colleagues in some mean-spirited "Hey, what about us?" way. We simply want to present a few tales that have come to us, a few out of thousands similar, then make a more general observation.

Most doctors go through long periods of training in their respective specialties, then must pass stiff board certification examinations. Residents in radiology at St. Vincent's Hospital in New York took a double hit on 9/11. Because of nationwide disruption and the crush of the injured, the scheduled 9/13 examinations were canceled. The 4000 candidates nationwide who had prepared for a dozen years or more -- including those at St. Vincent's -- accepted the decision with the grace typical of all Americans during those days.

Others did what good soldiers do. They went toward the sound of the guns. Michael Karch, MD, an orthopedic surgery resident was at work in Georgetown University Hospital in Washington DC, when the terrorists stuck the World Trade Towers and the Pentagon. [full text posted at] After seeing one patient from the Pentagon attack, "with severe 3rd degree burns and smelling of jet fuel" no additional patients came in "because most of the victims died," Karch wrote. He felt "extremely frustrated." So he packed a backpack with emergency supplies, "jumped on a train and headed for NYC."

On arrival, he found the city "smoky with ash in the air." At St. Vincent's Hospital, he was told more help was needed at Chelsea Pier, an ice skating rink, about 20 blocks from Ground Zero. By the time Karch arrived, Chelsea Pier was "a combined clinic for the walking wounded and morgue... The clinic was becoming less and less busy... and the morgue more and more busy." He "was assigned to carrying body bags from a truck and lying them out on the ice."

After several hours, "word came out that the fire at Ground Zero had been controlled enough so that forward medical personnel could go in. They called for volunteers and I and two other physicians (ER and general surgery) went," Karch wrote. "About 4 blocks from Ground Zero" we were dropped off "as there was no road left. We walked up about 2 more blocks and dropped off gear at a local high school which had been deemed a medical and general supply staging area...The smell of rotting flesh and ash hit me like a wave."

Karch and coworkers proceeded to set up a triage and treatment area, similar to a mobile army surgical hospital (MASH) unit. Karch continues his account with disaster preparedness recommendations. These parallel earlier recommendations by Doctors for Disaster Preparedness (DDP) [].

Karch adds several additional thoughts based on his personal experience.

He concludes, "Finally, not only the fireman needed rest... 48 hours on call in a clean hospital is grueling but it is entirely different than 48 on call... in a mass casualty unit."

Common sense, certainly. But when the work rule is "Go On and Stay On," common sense sometimes fades. All the more reason to set up emergency procedures ahead of time.

Which brings us to our more general comment. Your doctors, America, are the world's best trained. But they're only as good as your medical system lets them be. For decades now, your medical system has been under attack: by government, by cost-cutting insurance companies and for-profit managed care companies, by the despicable greed of the trial lawyers, and often by the media.

At the same time, your expectations and demands have been rising. Now your medical system must gear up to provide the world's finest guidance on disaster preparedness for individuals and families. The system must also gear up be ready to provide emergency and hospital care in mass casualty situations whose location and extent no one can predict. All we know is, it's going to happen again.

So what are we asking? Only that you consider the implications of these facts . . . and that you accept our tribute to our colleagues who were there on 9/11, and thereafter.

Michael Arnold Glueck, M.D., of Newport Beach, Calif., writes on medical, legal, disability and mental health reform. Robert J. Cihak, M.D., of Aberdeen, Wash., is president of the Association of American Physicians and Surgeons. Both JWR contributors are Harvard trained diagnostic radiologists who write numerous commentaries and articles for newspapers, newsletters, magazines and journals nationally and internationally. Comment by clicking here.


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© 2001, Michael A. Glueck & Robert J. Cihak