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morning of Wednesday, April 19,1995 began routinely
in the Department of Psychiatry in Oklahoma City.
I had scheduled supervision with a resident for
8:00 to 9:00 a.m. We went a few minutes over our
allotted time, and as we finished our session
at 9:02 a.m., the office floor and windows began
to shake for a brief time, less than five seconds
in total. Similar tremors during my childhood
in the San Francisco Bay Area came to mind, and
I recall reassuring myself that these tremors
were too short for an earthquake, and that although
Oklahoma City lies on a major earthquake fault,
it is rarely active. Many in the Department went
into the hallway and toward larger windows, hearing
that there was a large plume of smoke to the Southwest,
near the downtown area. As we examined a large
dark smoke cloud about one mile away, favored
theories were that this was a natural gas explosion
or a construction accident. At this point the
air outside and our building were both still.
Our audiovisual tech turned on a television to
a local station as we gathered around. A traffic
helicopter was flying toward the smoke, and as
the prairie wind blew the smoke aside, we were
all shocked to see our Federal Building half demolished,
a picture of destruction which would shortly be
broadcast around the world. It was clear that
in such devastation there would be much loss of
human life.
Some physicians,
residents, medical students, faculty and staff
went immediately to the nearby downtown area to
offer immediate assistance, stitching wounds,
triaging the wounded, and caring for and transporting
the seriously injured. Most of us stayed at the
Health Sciences Center, since the university hospitals
were placed on Code Black status. The hospitals
began to receive injured community members and
their panicked families. As the unofficial death
toll mounted, many families frantically called
all local hospitals, hoping that their parents
or children were among the injured. I decided
to try to drive toward the downtown area, but
the four-lane road was congested with traffic
driving very quickly in only one direction, away
from the city center. I returned to my office.
My next resident in supervision thought we might
be of help at the V.A. Hospital. Although there
were by this time bomb threats for the V.A. Hospital,
the State Capital and many other public buildings,
we decided that another explosion was unlikely.
Many injured workers from the downtown area were
in the V.A. emergency room, and we talked to a
man who had sustained soft tissue injuries in
a day care center. He was in a daze. He later
sought my help in our outpatient clinic, not remembering
our encounter, but using a business card I had
given him that day to find me. He developed acute
stress disorder, and later posttraumatic stress
disorder. He is now responding to combined treatment
with a serotonergic antidepressant and weekly
counseling and support groups.
Returning to my
office, I received a call from a woman who had
been in the Federal Building during the time of
the explosion. She described with quiet horror
witnessing one half of her office disappear as
the floor caved in and vanished beyond her desk.
She was not injured, but she did not know where
her coworkers were. She recalled having difficulty
getting out of the building; fortunately, a man
who was a Vietnam veteran, appearing more calm
and collected than others, led a group of workers
down a staircase partly blocked by debris. Her
car was gone, and her husband drove her home.
She really did not want to talk about it or think
about it anymore, and I never heard from her again.
By this time,
we were ordered to evacuate our building in the
Health Sciences Center due to a bomb threat. A
few of us stayed behind, just in case there were
any psychiatric emergencies. However, these first
hours were busiest for emergency room physicians
and surgeons. The time of greatest need for mental
health professionals would come later, in the
ensuing weeks and months, as the physical scars
were healing.
Our residents
and psychiatric consultation-liaison team tended
to the emotional needs of the many victims who
were moderately and seriously wounded at the V.A.
Hospital, University Hospital, and Children’s
Hospital. Many trainees volunteered to staff crisis
lines to receive calls from the many community
members who were distressed by this horrific terrorist
act. Psychiatrists, psychologists, and social
workers volunteered to provide grief counseling
to bereaved families. I joined mental health professionals
in the First Christian Church, in which families
waited during the daytime for several weeks to
be notified officially of the deaths of their
relatives. Fortunately the American Red Cross
provided the structure and leadership, and the
atmosphere was both warm and professional. In
teams consisting of a member of the Medical Examiner’s
Office, a member of the clergy, and a psychiatrist
or psychologist, we met with each family to tell
them that the remains of their loved ones had
been identified, and to provide an opportunity
for the bereaved to express their grief. Although
days and even weeks had passed without their relatives
being identified among the injured in local hospitals,
many families still clung to the hope that their
son, daughter, sibling or parent might have been
spared miraculously. Some were calm without outward
expression of grief, and some were very passionate.
A few, angry because of the senselessness and
unfairness of their losses, aimed this anger at
us. Again the Red Cross leaders helped us understand
this part of our unpleasant task, debriefing us
after every family contact, and providing a supportive
milieu.
In fact, the ambiance
of the community was such that despite the horror
of so many unnatural deaths of adults and children,
a spirit of voluntarism prevailed. This optimistic
mood in the face of disaster was much publicized
by the media, who did not exaggerate its infectious
nature. Approximately 12,000 individuals from
the community and many other states became unpaid
rescue workers. Within the health sciences center,
first and second year medical students volunteered
to retrieve victims and human remains from the
building. Dental students joined experienced forensics
investigators to identify bodies through dental
records. Residents and medical trainees helped
care for the injured, both outpatient and inpatient.
Pathology residents volunteered in rotating shifts
to identify bodies, first painstakingly removing
any potential pieces of evidence for the anticipated
criminal trial. This was an enormous task, as
refrigerated truckloads of debris had to be sorted
through. I was asked to meet with the pathology
residents near the beginning of this task. The
residents were guarded because they were potential
forensic witnesses, and much information was to
be saved for court. However, at this early time
they appeared positive in spirit, not yet fatigued.
Soon, experienced professionals from the Federal
Emergency Management Agency (F.E.M.A.) would provide
on-site debriefing for the weeks to come.
Our local branch
of the American Psychiatric Association helped
provide psychiatrists with opportunities to serve
in needed areas. They also provided inservice
education and workshops to prepare us for grief
counseling, crisis intervention and disaster mental
health care, all very different from the more
traditional forms of psychotherapy with which
we were familiar. Local professional organizations
for psychologists, clinical social workers, licensed
professional counselors, and the clergy had similar
activities.
In the weeks and
months that followed, many individuals have presented
for bombing related problems to Project Heartland
(established through our Department of Mental
Health with funding from F.E.M.A.) A number of
these victims have been referred for formal mental
health treatment. They have had diagnoses ranging
from grief reactions to depression, posttraumatic
stress disorder, and other anxiety disorders.
Their stories are often dramatic, and many showed
extraordinary courage in helping others escape
from the Federal Building and other surrounding
structures that were heavily damaged. We do not
yet have a centralized mechanism for determining
how many have been treated for psychiatric disorders
resulting from the disaster, but we are attempting
to survey mental health professionals in a way
that preserves patient confidentiality. An early
survey determined that there was an approximate
13% increase in caseload for bombing related mental
health problems. Many individuals are still in
treatment, and we suspect that some may be troubled
for years to come.
©1997
by The American Academy of Experts in Traumatic
Stress, Inc.
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