“Does this ever get better, Doc? Does this ever go away?"
The questions were being put to me by one of my patients in the World Trade Center Monitoring Program, a comprehensive health program set up for first responders – the law enforcement officers, emergency response teams and volunteer citizens who were first on the scene on 9/11 and who were exposed to the horror of the day (and the weeks and months following), without the broadcast filters which shielded the rest of us.
It’s not a question to which I could give a ready answer. When the Twin Towers fell, it was 4pm in Riyadh, and I was at the end of a busy day as an intensive care physician at a hospital there, catching up with the US TV news. Eleven years on, these first responders, figures I had seen on my satellite TV screen in Saudi Arabia, are now my patients in New York.
We see around 2500 of the nation’s 50,000 first responders each year. Many exhibit multiple complications from their trauma: the nightmares of post traumatic stress disorder (PTSD), obesity from depression and compulsive emotional eating, obstructive sleep apnea syndrome, workaholism, alcoholism, withdrawal, isolation, rage, panic, anxiety and unremitting hyper-vigilance - uncertainty about the safety of their environments, compulsively protecting their families. Others experienced damage to their upper airways from having inhaled noxious gases, leaving them with intractable coughs, rhino- sinusitis and severe gastroesophageal reflux disease.
In my years attending these patients, I extract one painful history at a time. One of my patients is a 53-year-old former NYPD police detective. He has been unwilling to link Ground Zero to his health problems even though he has been diagnosed with PTSD. Shortly after the attacks he developed insomnia, from which he suffered for eight years before he came to consult with me. Reluctant to volunteer his involvement - like many first responders he remains stubbornly stoic - I had to probe him about his exposure to the events at Ground Zero. I was struck by his joviality, his jarring laughter, his mask of bravado.
While on duty on September 11, he witnessed the attacks from downtown Manhattan. He immediately went to respond; in the days and weeks that followed, he joined thousands of other Americans on what was known as the ‘bucket brigade’. Men and women moved every fragment of the ruined Towers with their hands, at first to search for survivors and then to find human remains. Later, he worked at the Arthur Kill Land Facility on Staten Island where all of the rubble from the fallen towers was gradually relocated. There he searched for evidence of both victims and the methods of the attack. He was also assigned to a makeshift morgue for months in the Ground Zero area.
Most difficult - in his own opinion - he assisted family members of lost ones at a Manhattan pier, each of whom came to bring DNA material of missing relatives – "Like the hair from a loved one’s comb,” he explained. Later, he was part of a unit working with U.S. Marshals and FBI operatives capturing the 100 fugitive felons on US soil implicated in the September 11 attacks.
Other patients can’t distance themselves from the scene of the aftermath. One man described entering the crumbled recesses of the Port Authority to look for survivors when he came across the cadaver of a golden-haired woman, arms outstretched to the sky, buried up to her chest in concrete.
Another first responder, a volunteer who has become a public activist, testifying many times to Congress to secure Federal funding for the Program, expressed the depression and sorrow he felt at having 'lost' the person he had been before 9/11. He says he keeps his family at a distance and no longer knows how to let them in closer. Both of us remark how enmeshed his identity has become with rescuing those who rescued others; yet he remains powerless to rescue himself.
Twenty six years into my medical career I am never unmoved when I hear these stories. Muslims everywhere, myself included, have a long journey to resolve our feelings of helplessness and culpability in these events, events which few Muslims have the opportunity to grasp in the way my patients have been able to reveal to me.
I ask myself, did Bin Laden and his henchmen imagine the police detective, the welder, the fireman, the volunteer school cook, who appear now in my office? Did he seek specifically to eliminate the ordinary American? Did he consider the burden he was bequeathing to the countless Muslim humanists whose hearts and consciences were repelled by his acts committed in the name of our great faith?
Israel knows the reality of loss, suffering and living with trauma. Some of the world's leading scientific experts in PTSD, as well as in disaster response medicine, have emerged from the Israeli medical profession and have treated patients from around the world. Sadly, in 9-11, America joined Israel in sharing part of this awful knowledge.
When I am faced with the hard questions of recovery from my patients, seeking to console them, I find two simple sentences by way of answer: “Thank you for the service you rendered our nation. You did what I could not." Remembering their public and humanitarian service often brings them some respite, a sense of relief.
Acknowledging the suffering of first responder Americans humbles me as a Muslim; their pain hurts me as a humanist; witnessing their courage privileges me as a physician. To my World Trade Center Monitoring Program patients, I salute and pay tribute on this anniversary of 9/11.
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Qanta Ahmed MD is the author of In the Land of Invisible Women (2008), a Templeton-Cambridge Journalism Fellow in Science and Religion and Associate Professor of Medicine, State University of New York, USA. Follow her on Twitter @MissDiagnosis.