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Work on the Sept. 11 Memorial and Museum at the World Trade Center site continues, as the city prepares for the 10th anniversary ceremony. More than 80 of the 104 planned stories of the new “Freedom Tower” at the World Trade Center are complete.

They both were working the day the planes crashed into the World Trade Center in New York City. They saw the twin towers crash to the ground, the soot and debris covering lower Manhattan, and the puzzled faces of loved ones searching for information in the EDs of their hospitals. And while the memories are vivid and the shock of the terror still resides in them, they have chosen distinctly different paths since the 9/11 attacks 10 years ago.

Born and raised in Queens, Adam Trosterman, MD, grew up looking at the World Trade Center from his apartment window, studied medicine at Albert Einstein Medical Center in Manhattan, and was the intern on call for trauma surgery at NYU Bellevue the day of the attack. Today, he works as a hospitalist in Colorado and plans to spend Sept. 11 biking in the peaceful altitudes of the Rocky Mountains.

“I will probably go for a bike ride with my wife and enjoy some fresh air,” Dr. Trosterman says. “I don’t plan anything special, but I think about [Sept. 11] and I don’t think about October 11.”

A mere 10 blocks south of NYU Bellevue, straight down First Avenue, Dahlia Rizk, DO, was the hospitalist program director at Beth Israel Medical Center and in the middle of grand rounds when she first heard about the attacks on the twin towers. She has since moved to Battery Park, just a few blocks from the construction site for the new World Trade Center, and plans to participate in the 9/11 anniversary ceremony.

“I think that the memorial, the new building, and that whole area is just coming alive again. It is a real testament to the resilience of New Yorkers. Honoring the victims and their families is just so important. It’s such an incredible thing,” Dr. Rizk says. “I’m looking forward to the remembrance and celebrating the human spirit.”

Two physicians, two hospitalists, two human beings: They look back at 9/11 in diverse yet illuminating ways. These are their stories.

The Intern

A self-described New Yorker, Dr. Trosterman remembers Sept. 11, 2001, as a “beautiful, gorgeous morning” in which the sun was high and the temperature was pleasant. He, however, was in poor spirits, as everyone at NYU Bellevue “hated to be on trauma surgery” rotation. He was 29, single, and, as he puts it, “having a very good time” living in Manhattan.

He arrived at work at 6 a.m. and went about the basic duties of every first-year resident on trauma surgery rotation, rounding with two of his colleagues on 15 patients. At about 8:30 a.m., he ran into another surgery intern who informed him there was a “big trauma coming, something to do with a plane, you might want to check it out.”

Big traumas in New York City are a regular occurrence, and after nearly three months on, he says, he was “pretty well versed in how to run the trauma service. You grow up fast.”

“Back in 2001, you grew up really fast,” he adds. “There were no work-hour regulations; I was working 115 hours per week.”

Dr. Trosterman ran to his trauma slots in the ED—they were “acting weird,” he notes—and began setting up the four trauma beds for the unknown mass-casualty incident (MCI). “It took maybe five minutes,” he says. “Then I got a call from one of my colleagues who was a neurosurgery intern. He starts describing to me what happened, and tells me to come up to the ICU.”

Manhattan is one of the most happening places, and downtown Manhattan, it doesn’t matter what time of day it is, there’s always somebody in the street and there’s always something open. Everything was closed, dead, silent, scary, barren. It was the most surreal thing I can ever remember in my life.

—Adam Trosterman, MD, University of Colorado Denver

Bellevue’s ICU is on the 15th floor, with an unobstructed view of lower Manhattan. When he got there, Dr. Trosterman had a perfect view of the horror at the World Trade Center. “I was like, ‘Oh, my God,’ ” he recalls. “There was a humongous hole in the tower. At that point, I almost started laughing to myself. Not really, of course, but … we had to mobilize a whole different system, which, of course, I was a part of. But it was no longer my typical role for trauma.”

The first patient Dr. Trosterman saw that morning was pronounced dead on arrival. Ironically, he says, the patient looked a lot like his best friend’s stepfather, who worked in the World Trade Center. “They were like parents to me,” he says. “I couldn’t get through. It wasn’t until the second day that I could make a call. I don’t think I spoke to them until Sept. 13.” (Fortunately, everyone Dr. Trosterman knew who worked in the towers survived.)

The next patient Dr. Trosterman saw was a police officer who had a dislocated shoulder and a small fracture. He was screaming and it was difficult to tell if his outbursts were pain-related, Dr. Trosterman says. “He was ranting about what had happened—appropriately ranting,” he says. “He was saying, ‘My partner was at my side and I was trying to save him, but I knew I couldn’t get him out and save myself. I just had to run or I would’ve died. I left my partner to die. I left my partner to die.’ It was horrible. He probably still feels guilty about it right now.”

Contrary to some reports, Dr. Trosterman says, Bellevue and other New York City hospitals were overwhelmed with work, if not injured patients. Much of the work following the attacks was moving inpatients to free up space for casualties. The trauma service ballooned by 40 patients. “We saw more people than we ever see,” he says, “and, literally, the same number of doctors. I was, physically, unbelievably busy. I was emotionally worried about my friend and his family, and I hadn’t had contact with anyone for 48 hours. … I was frustrated that all I kept hearing on the radio was that there were no patients. I was like, ‘You need to come visit me and see what I’m doing!’ It was nonstop and nobody was alive.”

The saddest part really was the faces. I remember a college friend of mine actually coming and looking for his girlfriend’s family member at the time, and I just remember how horrified these family members were going from hospital to hospital throughout the city looking for loved ones.

—Dahlia Rizk, DO, hospitalist program director, Beth Israel Medical Center, New York City

Dr. Trosterman cared for dozens of patients on 9/11, working into the wee hours of the night (see “The Most Interesting Patient,” below). He was told to go home at 3:30 a.m. but had to return to work at 6 a.m. He says walking out of the hospital that night was like walking through the morgue.

“Manhattan is one of the most happening places, and downtown Manhattan, it doesn’t matter what time of day it is, there’s always somebody in the street and there’s always something open,” he says. “Everything was closed, dead, silent, scary, barren. It was the most surreal thing I can ever remember in my life.”

In the midst of the chaos and confusion, loneliness and isolation replaced communication.

“Everyone was working, working, working, but no one was talking,” Dr. Trosterman says. “When I look back on that day, I feel angry, frustrated, scared, weird....While there weren’t 1,000 people [to save], those 10 or 15 lives that were saved, that were critically ill, were unbelievably important to the doctors who were taking care of them—no one knows about that.”

The Optimist

Ten years ago, Dr. Rizk was director of a three-hospitalist HM service at Beth Israel Medical Center; now the program has 26 FTE hospitalists and 15 physician assistants on staff. She was running late to grand rounds that day, coffee in hand as she passed a television and saw the first news reports of an airplane crashing into the first tower. Moments later, the hospital activated its disaster protocol, and Dr. Rizk rounded up her hospitalists.

“We very rapidly started discharging patients,” she recalls. “I actually went up to the 11th floor of our hospital and could see at that time that the second tower had been hit. It was almost like a dream, like a horrible nightmare. We could see the skyline changing when the first tower dropped. I could hear the sirens and see the smoke that was filling the air.

“We started to create triage stations outside our ED, and we had all the physicians at the hospital available. The ED was pretty chaotic in terms of the throughput. There wasn’t clear instruction; we didn’t know what was happening. ... There was a lot of debris and scratches and fractures that came through our ED.

continued below...

The MOST Interesting Patient

Dr. Trosterman, shown here tandem biking, plans to bike in the Rocky Mountains on the 10th anniversary of 9/11.

Although his 9/11 was chaotic, stressful, and exhausting, Dr. Trosterman didn’t perform many miracles on survivors. Even so, he does have an interesting story to tell about Port Authority officer John McLoughlin.

“He was buried under the rubble. They found him and dug him out” on Sept. 12, says Dr. Trosterman, who was the on-call intern for trauma surgery at NYU Bellevue. “He had massive crush injuries to his leg. … He was brought into the hospital and taken to the operating room.”

The surgical team saved McLoughlin’s limbs, but he slipped into a coma. Dr. Trosterman was in charge of the post-care unit in which the officer was assigned.

“I remember being yelled at by multiple trauma surgeons, telling me what to do,” he recalls. “I had to watch this guy and make sure he didn’t die overnight. That was the most traumatic patient, but he was also the most famous, celebrated man in New York City at the time.”

McLoughlin would stay in the coma for six weeks and endure 27 additional surgeries. After about six weeks of recovery and rehab, he was discharged. Then-Mayor Rudy Giuliani visited, taking pictures as he walked out of the hospital. McLoughlin’s story was portrayed in the Oliver Stone movie World Trade Center.

“His entire first night, when he was on death’s door, it was probably the only thing I actually did to save anyone during 9/11,” Dr. Trosterman says. “The only thing I really did was stay with him all night long. I did everything I could to make sure he stayed alive.

“And he did. I just paid super-close attention to him.” —JC

I remember very clearly standing outside of the ED as well, mostly greeting families who were looking for loved ones throughout the course of the day and collecting photographs that we posted on the wall for missing loved ones. And I remember these chilling feelings; there were so few people that were coming in that were in critical condition. I knew that this was not where they would find these patients.”

Beth Israel was not the Level 1 trauma center for lower Manhattan at the time; the now-shuttered St. Vincent’s Hospital was the go-to ED for mass casualty incidents. “They probably got the brunt of those patients, if there were any,” Dr. Rizk says. “I don’t know how many, but I can tell you from the hospitalist standpoint on the inpatient side, there was very little that was done.”

Most of the patients at Beth Israel were wheezing, needing eyewashes, or tending to scrapes and cuts. Dr. Rizk says many of the beds cleared for traumas sat empty. “We were ready, but so little happened in terms of activity on the inpatient side,” she says. “The saddest part really was the faces. I remember a college friend of mine actually coming and looking for his girlfriend’s family member at the time, and I just remember how horrified these family members were going from hospital to hospital throughout the city looking for loved ones.”

In the days and weeks that followed 9/11, Dr. Rizk says, a heavy feeling permeated the city. “Simple things like groceries and shops and restaurants—not that anyone felt like doing that—they just weren’t available,” she says. “Everybody was on foot trying to sort out what happened.”

Her brother-in-law, who worked in the building next to the towers, survived. Others she knew did not. An elementary school friend—a firefighter who rushed into the towers after the attacks—did not make it out. A close friend had an uncle, the head of the Brooklyn fire battalion, who lost his life, too. She attended his funeral.

The months that followed the attacks were “chilling” and “empty,” she says, as the soot covered the community and sorrow pierced those who lived and worked near ground zero.

Since then, Dr. Rizk has watched an “amazing” transformation in lower Manhattan. And it’s not just construction on the new 104-story Freedom Tower or the names of victims etched into the marble fountain walls, but the trees and momentum building for the 10-year anniversary.

“Just to see that renewed hope—it’s exciting,” she says. “I live down there now and am constantly reminded, every day, as I pass ground zero. I am amazed by how resilient the city is. The whole area is coming alive again.”

Dr. Rizk hopes to attend the 9/11 memorial service this month to honor the heroes and applaud New York’s future.

“[It’s] just a symbol of strength and hope for the future of people living together,” she says, “and to recognize that we all have the fundamental human commonality, and we really need to focus on how to move forward as a society—working together as a common goal.”

Jason Carris is editor of The Hospitalist.

Memorial Plaza Opening Highlights 9/11 Anniversary

President Obama (left) and former President Bush will give pre-selected readings at the 9/11 ceremony

President Obama (left) and former President Bush will give pre-selected readings at the 9/11 ceremony

President Obama and former President George W. Bush will participate in the 10th anniversary ceremony of the Sept. 11 attacks, which will mark the first time the names of all the people killed at the World Trade Center, the Pentagon, and the field in Shanksville, Pa., will be read aloud during the ceremony. Obama, Bush, former mayor Rudy Giuliani, and others will give pre-selected readings; no dignitaries will make speeches, according to New York City Mayor Michael Bloomberg.

The memorial plaza, which features two large squares where the World Trade Center stood, is set to open on the anniversary for families and dignitaries only, and to the public the following day. The names of all of the approximately 3,000 victims are etched into the walls of the memorial.

An underground museum at the site will open in late 2012.

Eighty of the 104 stories in the office tower that will be known as One World Trade Center are expected to be complete for the anniversary. It will be the tallest building in Manhattan. An underground transit center is under construction, as are privately developed office towers in the area. —JC

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