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The
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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