Sunday, April 18, 2010

Podiatrists who responded on Sept. 11th

Baptism by Fire

Podiatrists who dealt with the September 11th attacks.

By Steven G. Shalot, D.P.M. Dr. Shalot is a Senior Editor of Podiatry Management magazine.



There's a terrace in a high-rise apartment building in Forest Hills, NY. The building is about 4 miles from the heart of midtown Manhattan in the outer borough of Queens. It's a beautiful late-summer morning with blue skies and perfect visibility. Down below, the street traffic appears almost normal, the breaking news from the city barely noticeable amidst the hustle of the morning commute. It isn't until you gaze from the terrace, across the expanse of Queens into Manhattan, that you realize something is terribly, horribly, out of place. Later that evening, and into the wee hours of the next morning, these thoughts come from the terrace:


"It is just after 3 a.m. here in New York City, and I simply can't sleep. Looking out the window of my bedroom on the 17th floor, there is an unobstructed view of the Manhattan skyline. I search again for the once familiar sight of the two tall white buildings that marked the lower end of the skyscraper-filled island. All I see are some eerie searchlights of the rescue crews. "Like everyone else, I have been in shock all day, particularly since I witnessed in real-time the morbid views of the second plane hitting the World Trade Center and the sequential collapse of both towers.


"The gamut of emotions runs from shock, fear, sadness, to anger. Barely one-half century after the Holocaust, despite all our technological advances, man remains uncivilized. "The realization sets in that the terrorists who committed this crime could have and still could set off a nuclear bomb, killing millions. The safety and security we have taken for granted in America is and never will be the same."

The writer of these words and the occupant of that terrace apartment in Forest Hills, NY is Editor-In-Chief Barry Block of Podiatry Management magazine. For him, like so many of us, the events of Sept. 11th changed the way we live our lives, and ponder our futures.

There were many heroes who rose to the challenge of that day, and some who gave their lives in trying to save others. Among them were New York City firefighters,police officers, emergency services workers, and ordinary citizens. As podiatrists, we too can be proud of our own on that and the days that followed.

Three podiatrists have their practices in and around Ground Zero, and were able to give Podiatry Management some unique and candid pictures of the events as they unfolded. We can read and understand the words, but not even begin to grasp the emotions.

John Zboinski is an attending at NYU Downtown Hospital, formerly known as Beekman Downtown. He was seeing patients in his office, which is a few blocks from Ground Zero. "The first report that day was from a patient who stated a plane had hit the World Trade Center, but to what extent we had no idea," according to Zboinski. Just a few minutes later he felt the building begin to shake and heard what sounded like a rumble. More patients kept running in and saying that an airliner, and then a second airliner, had hit the WTC.

People everywhere were getting upset. Soon they were visited by the chief of medicine who asked all physicians to report to the hospital, and told them that there was a disaster and that their services would be required. Dr. Zboinski is with a group of orthopedic surgeons, Seaport Orthopedic Associates, and soon all of them found themselves in the emergency room "to do what we had to do."


A Hollywood Movie Scene



There was, outside the hospital on Beekman street, a major flow of pedestrians coming from the WTC area. "It was like crossing a river of people," Dr. Zboinski said. Some were injured, helping others, covered in soot, others not injured, but all walking or running to get away from the immediate area. Frantically, police and firemen were trying to keep people moving, imploring them to stay calm, and scanning the throngs of pedestrians for the more seriously injured among them.


Outside the hospital, Dr. Zboinski turned, looked around and up and saw "multiple floors of the twin towers just burning away." At that point, said Zboinski, "I knew we were in for a long haul. It was like a scene from a movie, where one would expect to see a Bruce Willis or Steven Segal come running in to save everybody. I saw people running for their lives and these famous buildings just burning away. It was the last thing I wanted to see on a beautiful Tuesday morning, especially in the United States."

"So I reported to the emergency room from my clinic, and things were already in place, people were coming in, it was just a high volume of

patients coming. I just rolled up my sleeves and went to work," Zboinski said. Initially, they set up the cafeteria as a triage/treatment area for the ambulatory patients. Dr. Zboinksi and his colleagues handled numerous ankle sprains/fractures, and foot fractures. At one point they began to do a lot of suturing of lower extremity wounds, as well as on other parts of the body. "We basically functioned under the Chief of Orthopedics, Ronald Krinick, and the chief of surgery, Howard Beaton. We assisted whatever way we could," said Zboinski.


Bad Air


There is a little courtyard outside the hospital cafeteria, which is surrounded by the four walls of the hospital. Dr. Zboinksi and colleagues were preparing to put patients out in that area for more space. However, as the Towers collapsed, this cloud of dust began coming over the hospital itself, and the sky kept getting darker and darker, "until you couldn't even see across the courtyard. We ended up having to put duct tape around the doors and windows to prevent the dust from coming in. It was just like night," Dr. Zboinski said.


Dr. Zboinski's car was in the hospital lot outside, and it was completely covered with dust and debris. "Our problem," according to Zboinski, "was that we really didn't know what was happening outside of the hospital - we lost phones, lost electric, lost cable TV. We were completely under emergency power." He has no recollection of when that happened, only that he and his team worked non-stop throughout the day, and that he would probably spend the night in the hospital, which he did.


Then, about 7:00 p.m., some excitement. A report came in that a field amputation was required down at Ground Zero. A firefighter or rescue worker was supposed to have had his legs pinned, and they were going to do an amputation of both legs. So, a surgical team was hastily put together which included Dr.Zboinski. They were taken by police vehicles down to Ground Zero, with supplies which included battery operated saws from the operating room, to perform the expected procedure.


"We waited and waited for a patient who never showed up. Apparently, they were able to get him out, or they managed to so something, but our services were not required," according to Dr. Zboinski. That night, they didn't get back to the hospital until midnight. That first evening at Ground Zero was the first chance to see the devastation and what happened at the trade center. "The dust was so horrible and intense, that we constantly wore surgical masks. I'm still coughing from all the dust. We wore caps and surgical goggles for eye protection. I still can't put everything I saw into words," Dr. Zboinski said.

Then, there were the memorable patients and experiences to capture for a moment and show our profession at it's best: The girl's name was Debbie, and she had bilateral open tib-fib fractures. She had a left heel avulsion, where most of her calcaneus was ripped out. In addition, she had both major portions of her gluteal muscles torn away - all from falling debris. She was in the operating room for about eight hours that first day.


Another woman was brought into the emergency room, having an asthma attack and in a state of panic. Dr. Zboinski recognized her as a patient from the hospital clinic and went over to her. As soon as she started talking to him, a familiar person, her panic and asthma subsided somewhat and she was able to undergo treatment.

"It was just like being in a M.A.S.H. unit. We did, I am very proud to say, adapt to that role very well. My residents performed in a fantastic manner - they pitched right in," said Dr. Zboinski. In addition, three other podiatry attendings affiliated with Downtown hospital managed to get to the emergency room from offices uptown. They were Drs. Joe Fox, Richard Frankel, and Stuart Mogul. All three identified themselves as physicians from the hospital, and were brought by police escort right to the emergency room.


"24/7"


Stuart Kitton, D.P.M., has his private practice just a few blocks from Ground Zero. The twin towers of the WTC were an imposing and magnificent sight, and were really the heart and soul of the area. Many of Dr. Kitton's patients worked in the financial district and at the WTC - he lost some of them in the disaster. During the first few minutes of the bombing, Dr. Kitton had presence of mind to step outside his office, and photograph events as they happened.


One particular photograph, shown here, seems to capture the essence of what Sept. 11th was all about. On the right side of the photo you see green foliage against a perfect, blue, late summer morning sky. On the left hand side, you see the dramatic image of one of the Towers on fire, moments before the collapse. There is a contrast here, a conflict. It is, as if, the picture demands to be split down the middle - the two halves simply don't belong together on the same page. Yet, the two images present in the same photo remind us of the theme of that day: senseless violence tearing into the fabric of our peace, security, and everything we hold beautiful and admirable about our culture. So, perhaps the photo should stand as it is.


Dr. Kitton volunteers his services from time to time at St. Paul's church, also pictured, where a 24 hr/7 day emergency foot clinic was set up for the rescue workers and firemen by Dr. Nancy Clark, of NYCPM's surgical faculty. He does the best he can, and hopes that some day, things will return to normal in his part of town, and his practice will return. Alfred Garofalo, D.P.M. graduated NYCPM in 1992, and is the chief of the podiatry service of Gouverneur Hospital in Manhattan, also very close to the WTC. He gave this account of that morning's events:


"We were in the office, talking with the attendings, and we heard a loud explosion. We ran to one of our windows and we saw one of the WTC towers on fire. We are on the fifth floor and we have a view of about 40 floors of the WTC. We saw it on fire, no one knew exactly what had happened at the time, and we went back into the office, trying to get some information. We found out that a plane had crashed into the WTC, and then we heard another loud explosion. Looking out the window, we saw the second tower on fire.


"One of my residents saw the second plane hit. He was coming out of the train station which was about two blocks away, and he felt this tremendous amount of heat, and he looked up, saw one tower on fire, and was staring at the scene when he saw the second plane approach and crash into the building. After the two buildings were on fire, we were still trying to figure out what we were going to do with the institution, because they called an emergency staff meeting.


"One of my attendings had taken out a pair of binoculars, and right in front of our eyes the tower collapsed. We could actually see an individual leaping from one of the windows of the building as debris was falling down on him. He just disappeared in a puff of smoke. It made me sorry I had the binoculars - I didn't need to see that."


"We waited around the hospital, because being part of the Health and Hospitals Corporation, all of the institutions were put on alert, because there may be survivors or wounded coming out. So, we waited and every hour we had an updated meeting. We had a couple of firemen come in, police officers, but no survivors. At around 5:00 p.m., they called another meeting and told us we could leave because everybody was being taken to Bellevue at that time.

"I then decided to go down to the site and volunteer with a couple of my residents to see what we could do. We got down there about 6:00 p.m., and it was still very chaotic. It was not in control like it is now with the State Troopers and the Army National Guard. We were told to go to Stuyvesant High School, which was being set up as a triage center. By the time we entered Stuyvesant high school, they were closing it down because they decided there was no need for it. They decided to move it closer to Ground Zero. Instead they told us to go the American Express building which was across the street from the WTC. By the time we got

there, they started bringing in the body bags because they had set up a temporary morgue there.


"... I remember seeing a lot of images I don't want to remember, like the wounded, the dead. There was a large section of the WTC that was over on its side, almost like a ship where they were climbing on top of it and peeking into the windows that weren't there, to see if there were any survivors there. Of course, there weren't any. We stayed in the back, by a firehouse where they set up a triage center for the firemen. We stayed there for about two or three hours, and then we all decided to leave at about 2 or 3 in the morning.


"The next day we decided to go back again after work around 5:00 p.m. It was a little more difficult getting in, but once we showed our ID they let us right through to Ground Zero again, and they let us through again to the fire station which was being used for triage. After about two hours of waiting around, one of my residents just said 'let's go up front and help,' so that's what we did. We helped dig for about five or six hours, assisted the firemen, etc.."


"The next day we went back and did the same thing till about 3:30 in the morning. We took off Thursday, I went back alone on Friday, and on Saturday I came down with about two of my friends. By that time, they moved a lot of debris out of the area, so the only thing left were remains that were just too heavy to pick up and move. At that time they weren't really letting a lot of the non-professionals up there because it was getting dangerous. We stayed back, with the firemen, and a couple of more days passed."


The rescue efforts and the subsequent care given to the volunteers and city workers during this immense tragedy was truly a team effort in which podiatry played, and still is playing an integral part. The selfless devotion shown by Drs. Garofalo and Zyboinski, as well as attendings and residents, are typical of the best of our profession. Perhaps the mood is best summed up by Dr. Zyboinski: "I realized from this experience how quickly your life can change in a matter of moments - and that all the training and all the time you put into medicine, it all comes back to you, and no matter what the situation, there is always something to do, and always some help you can give."