Correspondence
From a Physician in Lower Manhattan
N Engl J Med 2001; 345:1504November 15, 2001
- Article
To the Editor:
I have a private practice, with two other family physicians, in an office in the financial district of lower Manhattan, five blocks (300 m) from the site of the World Trade Center. Most of our patients work or live in lower Manhattan, including many who worked in the World Trade Center or its vicinity. We have learned of the deaths of at least four of our patients who were trapped in the collapse of the World Trade Center towers on September 11.
At the time of the attacks, our office had just opened for the day. (I was on the New York City subway, which had been stopped shortly after the crash of the first airplane.) Within minutes after the crash of the second airplane, when the nature of the attacks became clear, much of lower Manhattan, including our office, was evacuated. There was considerable fear and anxiety, particularly about the prospect of further attacks, but everyone was evacuated safely.
Federal and city authorities kept lower Manhattan evacuated, except for emergency personnel, for six days after the attacks. Electricity and telephone service remained disrupted, and sanitation crews cleaned tons of debris and thick dust from the streets and building facades. We kept in touch with many of our patients by means of an e-mail list we maintain. Patients contacted me by e-mail, as well as by telephone, at our satellite office in midtown Manhattan. A state of shock and grief pervaded New York in the first weeks after the tragedy. The most common requests from patients were for refills of existing prescriptions. Many patients had been evacuated from their homes and had left their medications behind. Others depended on pharmacies that were closed. One popular pharmacy was destroyed in the collapse of the buildings.
During the second week after we had reopened our office, the psychic consequences of the tragedy became clear in the problems our patients reported. Many reported insomnia, difficulty concentrating, nightmares, fear of reentering the vicinity of the attacks, and tearfulness. Most accepted prescriptions for antidepressants, anxiolytic agents, and hypnotic agents. Many accepted referrals to mental health professionals, who were overwhelmed with calls but remained available during the crisis. Somatic manifestations of post-traumatic stress were common.
Patients told of narrow escapes from the buildings, attempts to outrun the thick plume of debris that rapidly filled the canyon-like streets of New York. They told of witnessing people jump from the tops of the towers, and they told of seeing bodies and body parts. Others told of the loss of friends and family members who had worked in the World Trade Center. One patient lost seven coworkers. Another counted among the dead 17 colleagues at the Fuji Bank in the World Trade Center.
Over a month after the tragedy, New Yorkers are still preoccupied with thoughts of the disaster, despite pleas by the mayor for a return to normalcy. Most of our patients continue to express their fears, and many continue to experience depression and anxiety.
The attacks of September 11 were unprecedented. Unfortunately, there is now a lot to learn in lower Manhattan about the medical and psychiatric consequences of terrorism.
Mark E. Horowitz, M.D.
Downtown Family Medicine, 42 Broadway, New York, NY 10004- Citing Articles (1)
Citing Articles
1
Edgar Jones, Robin Woolven, Bill Durodié, Simon Wessely. (2006) Public Panic and Morale: Second World War Civilian Responses Re‐examined in the Light of the Current Anti‐terrorist Campaign. Journal of Risk Research 9:1, 57-73
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