Psychiatry Residents in N.Y. Heed Post-Disaster Call

Working long into the night and providing psychiatric assistance wherever they can in the wake of the terrorist attacks is another group of “New York City’s finest”—its psychiatry residents. Residents from St. Vincent’s Hospital, Cornell University, Beth Israel Medical Center, Columbia University, and Bronx-Lebanon Hospital Center are among those providing a comforting mental health presence in a world turned upside down by death and destruction.

The residents are working under the aegis of Disaster Psychiatry Outreach (DPO), an organization established in 1998 by three former residents at Columbia University’s department of psychiatry—Craig Katz, M.D., Anand Pandya, M.D., and Edward Kenny, M.D. The psychiatrists first moved into action after the crash of Swissair Flight 11 off the coast of Nova Scotia in 1998.

Katz, who is now president of DPO, said the organization has agreements with many major medical centers in New York City that facilitate residents to volunteer their time and services to help victims of the World Trade Center attacks.

In the Line of Duty

When Heather Lewerenz, M.D., decided to go into psychiatry, she probably didn’t think her work would take her up and down 32 flights of stairs to rescue apartment dwellers from a building that had no water or electricity and was in danger of collapse.

But that’s just what the chief resident from Beth Israel Medical Center did as part of a rescue team called to the scene of the World Trade Center attacks. “I was asked to join a group of doctors, nurses, and emergency medical technicians (EMTs) who were going to evacuate an apartment building in the vicinity that housed many handicapped people and senior citizens,” Lewerenz told Psychiatric News.

When rescue crews found out that Lewerenz was a psychiatrist, she was sent to the 32nd floor of the building with three EMTs in search of a woman who had not taken her Haldol and had become agitated.

With no electricity in the building, and thus no elevator service, they had to climb the stairs to get there. They wore masks and gloves, because the air was filled with dust.

“We didn’t see the psychiatric patient, but we found an 80-year-old woman in a wheelchair, a family with a baby, and a man with 10 pet rats,” recalled Lewerenz. The team managed to get everyone—wheelchair, rats, and all—down the 32 flights of stairs and to a local shelter.

Lewerenz then worked until midnight debriefing firefighters and policemen who had been working in the rubble at ground zero.

Arnold Winston, M.D., chair of the department of psychiatry at Beth Israel Medical Center, said that in addition to helping out at the site of the attacks, residents staffed a hotline and walk-in center that had been established at Beth Israel’s clinic. Many others have been spending nights and weekends at the New York City Family Assistance Center. This center, located on Pier 94 at West 55th Street and 12th Avenue, is the central coordination point for disaster-related assistance of all kinds—legal, housing, and mental health services, for instance. It was here that, beginning on September 26, death certificates have been issued to families of the missing.

Lewerenz said that both her medical training and her psychiatric training enabled her to help victims of the attack. “But nothing could have prepared us for the event itself and the effect it has had on our lives,” she added.

No End in Sight

On the day after the World Trade Center attacks, Lisa Mellman, M.D., who is the associate residency training director of psychiatry at Columbia University, accompanied chief resident Serena Volpp, M.D., to the site of the new medical examiner’s office, where officials had established a temporary morgue.

Here, bodies and body parts from the collapsed buildings were being shipped in large refrigerated trucks to the medical examiner’s office to be identified.

“Hundreds of police officers were working shifts of 12 hours with no real end in sight,” Mellman told Psychiatric News. “This was incredibly gruesome work and unlike anything they had ever done before.”

During the officers’ 90-minute breaks, Mellman and Volpp spoke with those who were receptive and offered them written information about acute stress reactions and normal variants of stress and grief. “Most of them were either numb or overwhelmed and trying to be calm,” she said.

Mellman noted that the culture surrounding the police force promotes an emotional stoicism and machismo, and that some were more receptive to written information if Mellman suggested that their colleagues might benefit from it.

A few residents went to the site of the collapsed buildings to offer their services to rescue workers, but most residents from the Columbia program went to the Family Assistance Center at Pier 94.

While the residents had courses on trauma before the attacks took place—Mellman taught one of the courses—there was a great demand for training in this area after the attacks. Ronald Rieder, M.D., the director of residency training in psychiatry at Columbia University, said that one such session for staff and residents focused on the treatment of patients with acute stress reactions.

In the session, faculty member Milton Wainberg, M.D., talked about how to foster the healing process, not intrude on it. Rieder also said that participants were told that multiple supportive sessions for victims of trauma are more beneficial than one brief, tense session.

Rieder also spoke of a grand rounds session unlike any he had attended before. In “Terrorism and Its Aftermath,” faculty member Stuart Kleinman, M.D., presented information on the psychology of terrorists. Staff and residents learned about what motivates terrorists to commit acts of terror and why many radical terrorist groups dissolve quickly, for instance.

Mutual Support Offered

Psychiatry residents at St. Vincent’s Hospital, which was only 20 blocks from ground zero, responded immediately to those in need. Perhaps it was because chief residents Pearl Louie, M.D., Matthew Kleban, M.D., and Tamara Kanfer, D.O., worked so close to the scene that they began telling Psychiatric News about their efforts immediately after the attack by describing their personal reactions to the tragedy.

Said Kanfer, “We are dealing with [the tragedy] just like other people have—registering shock at first and then realizing the enormity of what happened. . . .As with the citizens of New York City, the residents here have really pulled together and shown a lot of unity.”

Kleban added, “On the inside, we are all changed.”

The residents had a chance to express their feelings and offer support to one another at regularly scheduled support groups for residents, according to Louie. In some of the meetings, attending physicians joined the group to remind residents to follow the same advice they give to their patients: eat well and get enough sleep. The residents needed to learn the message that to be able to care for others, they needed to care for themselves.

“The whole hospital was working in crisis mode for the first couple of days after the attacks,” said Louie, who mentioned that her fellow psychiatry residents were enthusiastic about staying extra hours and nights to volunteer at several sites throughout the city. Some residents went to the site of the World Trade Center, while others helped families of the missing. Still others worked around the clock at a recently established family care center at St. Vincent’s, where residents address the needs of families of the victims and those who witnessed the attack.

In addition, residents at St. Vincent’s are screening the emergency room for people who may be vulnerable to psychiatric problems such as posttraumatic stress disorder.

Someone to Talk With

Gary Brendel, M.D., is one of the chief residents in the Weill Medical College of Cornell University’s department of psychiatry, and he has talked to many people whose lives have been changed forever by the September attacks.

Hundreds of families flocked to the Lexington Armory at Lexington Avenue and 26th Street in the days after September 11 to try to obtain information about missing family members, and Brendel was there to help them go over lists of the missing and unidentified persons. He also met with a few individuals to counsel and evaluate them.

“I spoke to one woman who was a security guard in tower two,” recalled Brendel. “She told this horrific story of her escape from the building and had just come from her apartment. She had been experiencing symptoms of severe anxiety and hadn’t been able to leave [her apartment] for a week after the incident.” Brendel’s psychiatric evaluation led him to refer her for ongoing psychiatric treatment.

Brendel and his fellow residents also traveled to the satellite offices of companies once housed in the World Trade Center to counsel surviving employees. In some cases, the companies gathered in hotels the surviving employees and family members of those who had perished.

“I went to one hotel to meet with people from an investment banking firm, and met with the husband of a woman who was missing,” Brendel recalled. “I wasn’t performing a psychiatric evaluation so much as I was just listening to his story.”

Feeling Helpless

At New York University’s psychiatry residency program, residents found themselves in the position of helping wherever they could, according to Carol Bernstein, M.D., who is the training director of that program.

Bernstein traveled to APA’s Institute on Psychiatric Services in Orlando last month to speak about her experiences and those of the residents in the aftermath of the attacks. She said that initially, the families of the missing had gathered at the Family and Children’s Services Building, which sits on First Avenue between Bellevue and NYU hospitals.

Residents soon discovered that the families did not want mental health counseling; they wanted to find their loved ones. So residents stayed up through the night with family members going over lists of names of people brought to area hospitals.

“By 4 in the morning, they realized that the most useful thing they could do was to pass out milk and cookies, and they were exhausted, sad, and felt very helpless,” said Bernstein.

She stressed to her residents that everything they were doing was extremely important. “I told them they needed to take care of themselves, be with their loved ones, eat, sleep, and try to get back to their normal routines. It’s hard to remember to do these things when you feel as if there is a whole city that needs you,” Bernstein said.

Nalini Juthani, M.D., who is the psychiatry residency training director at Bronx-Lebanon Hospital Center, said that residents from that program have been counseling families of the missing and those receiving death certificates at the Family Assistance Center at Pier 94.

“We educated our residents before they volunteered with information on trauma from APA’s Web page,” Juthani told Psychiatric News. She added that the information helped residents with their outreach efforts.

APA resources related to the terrorist attacks are posted on www.psych.org under “Coping With a National Tragedy—Resources, Tools, and Other Links.” ▪