The Oklahoma City Bombing: A Psychiatrist's Experience
Phebe Tucker, M.D.
Associate Professor, Director, Anxiety Clinic Department of Psychiatry and Behavioral Sciences
University of Oklahoma Health Sciences Center

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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