I ran it by Dr. Hirsch in his office and told him about the expired medications, the lack of equipment, the untrained and underqualified staff, the overlap in patient care. Hirsch agreed without reservation: Gabriella Alonso’s death should be mannered a homicide. “But,” he advised, “before you finalize it, you ought to notify the DA and see if their investigation from ’96 concurred with the findings by the OPMC.”
The assistant district attorney who had been assigned the original case had retired and left the office years before. I spoke to the head of the NYPD’s Special Victims Unit, who forwarded me to a guy in Homicide, who was on vacation. Next I tried an ADA who specialized in cold cases. She wasn’t thrilled, but agreed to provide me with all the records and documents I would need for my independent investigation. It took her five months. The day I finally had everything in hand was January 22, 2003—the thirtieth anniversary of the Supreme Court’s decision in Roe v. Wade.
The file made for a sobering read. I started with nurse-anesthetist Dennis Morton’s deposition in the civil action Gabriella’s family had filed against him. The whole first half of the document actually concerned another case, in which he had left another woman in a coma—six months after Gabriella Alonso. When asked, “What do you think the reason was that this woman was comatose at the end of the procedure?” Morton’s answer was, “I don’t know.”
In his deposition, Dennis Morton made it clear that he believed his responsibility—or, as he put it, his “care for the patient”—ended when the procedure ended. How could a professional medical provider drop a woman who is visibly drowsy in an office chair with no monitoring and accept that five minutes later she is in a coma? It’s unconscionable. It may even be criminal—but no criminal charges were ever filed. The medical board doesn’t have the power to prosecute. The Queens County district attorney does, but he didn’t exercise that power. The state attorney general had also investigated the incident that left Alonso in a coma, and took no action. The police never arrested anybody. Could I now call what happened to Gabriella Alonso a homicide?
I went to Hirsch in his office again. “If Gabriella had come to the clinic for an abortion and had a fatal allergic reaction to Brevital, I would certify this as a therapeutic complication,” I said. “If Morton had inadvertently killed her by pushing ten times the proper dose of Brevital, the manner of death would be accident.” Hirsch said nothing; I could tell he was already one step ahead of me. “But if the circumstances allowed that an accident or therapeutic complication would have gone unrecognized to such an extent that the patient asphyxiates and ends up brain-dead from even a minor problem such as too much sedation—that’s an accident waiting to happen. It’s a smoking gun.”
My boss raised his eyebrows. “Not exactly a smoking gun. But yes, I do agree that based on the investigation you have completed, the only way to certify this properly is as a homicide.” I signed the death certificate and finalized my report on January 23. Under line 7F, “How injury occurred,” I wrote, “Extreme medical negligence.”
The detective who called me the next week was irritated. “What is the criminal charge in this case?” It had been referred to the Homicide Division, and now it was his job to present the case to the district attorney’s office.
“You’ll have to ask the ADA that,” I replied. “I am qualified to tell you that it was extreme medical negligence that caused Gabriella Alonso’s death. What defines criminal negligence is outside my field.” My response did not make the detective any happier. Just because I call something a homicide doesn’t mean the DA can find a criminal violation worth charging—but the police still have to investigate it.
I never heard from the detective again, and I never found out what the Queens County District Attorney’s Office decided to do about that homicide.
10
DM01
One of my best friends from medical school was an oncologist at Memorial Sloan-Kettering hospital on the Upper East Side of Manhattan. When she heard the news on the morning of September 11, 2001, she rushed to the trauma center nearest to her apartment, about five miles north of the World Trade Center. At the hospital she found fellow doctors of every stripe—cardiologists, dermatologists, geriatricians—assembled in the ER intake bay, prepared to help treat the injured when they arrived. They got to work gathering gurneys, setting up care-level stations, stockpiling splints and bandages. Then they waited.
On television the buildings burned. The buildings fell. Cameras showed panic in the streets of Lower Manhattan. My oncologist friend peeked out the intake bay doors every once in a while, watching for the parade of ambulances to come screaming uptown. As minutes turned to hours and they didn’t arrive, a terrible realization settled over the crowd of medical professionals in that emergency room. By the late afternoon it was impossible to ignore. No patients were coming to the hospitals outside Lower Manhattan. There would be no triage. The victims were dead.
The dead came to the morgue at the Office of Chief Medical Examiner. I was there. I was one of the thirty doctors who spent the next eight months identifying their remains and assembling the evidence of their mass murder. The experience of cumulating the human toll of the World Trade Center attacks changed me forever, as it changed my colleagues and the whole class of thousands of men and women who came to be known as the recovery workers.
* * *
I saw American Airlines Flight 11 a few seconds before it hit the North Tower. The too-loud whistle of jet engines turned my head as I was hustling down 30th Street on my way to work that morning. The plane appeared from behind the Midtown skyscrapers, flying low in the clear blue sky of a beautiful day. I worried about it for a moment. Must be an unorthodox approach to JFK, I told myself, as I continued down the last block to the office. It was a quarter to nine.
I dumped my purse in the fellows’ room and five minutes later bumped into Stuart in the hall. He was agitated. “Did you hear? A plane just crashed into the World Trade Center!”
“What?”
“They think it might have been a Cessna or a sightseeing plane. The news reports are coming in right now.”
“It’s an airliner!”
“Huh? How do you know?”
“Stuart, I saw the plane! It was a big jet—real big! Oh my God.”
We followed the first instinct that grabbed us and went down to the Identification office to see what was happening. Everyone was in the investigators’ room, glued to a small television. The camera remained fixed on that burning building, with the voice of the newsman telling us over and over that nobody knew exactly what was going on but that fire trucks were flooding Lower Manhattan.
One thing we did know: Whatever the number of passengers on that plane, this was a “mass-casualty event.” Doug, Stuart, and I figured we might as well make ourselves useful before the office went into action, so we walked over to Todaro’s, the little grocery store around the corner on Second Avenue, to stock up on supplies to keep everybody fueled. We were on our way back to the ID office with breadsticks, cold cuts, soda, and fruit when Barbara Sampson met us at the door. “Another plane just hit the second World Trade Center tower, and it’s now burning too,” she said. “This is an act of terrorism.”
Dr. Hirsch was arranging to take a team down to the World Trade Center to find out what was going on and to set up a field morgue. Other doctors and technicians gowned up and went to the Pit as usual; there were autopsies to do that morning, because people had still died in ordinary ways on September 10 in New York City. Since I hadn’t been scheduled for autopsies, I decided to go to the fellows’ room and try to get some paperwork done until somebody told me different. I was doing no one any good standing there in the ID office, watching those black plumes rise out of the twin skyscrapers.
At my desk I tried to finalize the case of a chronic alcoholic found decomposing in his apartment back during the late-July heat wave. It was a garden variety natural death, but I found myself staring at the same page of the investigator’s r
eport—staring, but not reading. Sometime after ten o’clock, Karen Turi knocked on my door. She looked shaken. “One of the Twin Towers has collapsed.”
It took me a long moment to apprehend what she had said. “What? What do you mean?”
“They thought it was another explosion, but then when the smoke cleared, the tower was gone. It collapsed onto the street below. The other one’s still burning, and now they’re worried it’s gonna come down too.” I didn’t say a word. I didn’t have any. “Another plane hit the Pentagon, and it’s burning now. It’s on TV.” Karen left down the hall to spread the news. I got up from my chair and sprinted downstairs.
No one else was in the investigators’ room. On the television a huge cloud of smoke and dust spread all over Lower Manhattan. Only the tower on the left still stood and burned. The tower on the right wasn’t there. I went cold and numb.
I didn’t have the first clue what to do, but I didn’t want to return to my office and just wait for orders. I went by the front door and poked my head outside. There was no trace of the smoke. As I was standing there in the doorway, a couple of NYPD cruisers pulled up with their blue lights on. Patrolmen with rolls of yellow DO NOT CROSS tape emerged and started roping off 520 First Avenue.
News came in that the second tower had collapsed. I found Stuart and Doug outside the fellows’ room. The three of us were huddling there trying to decide what we should do next when Mark Flomenbaum came along—looking spooked. “Dr. Hirsch is back,” Flome said. “He’s been injured—but he’s okay. They were consulting with a fire captain in the middle of the World Trade Center when the first tower collapsed. Everybody got thrown around by the shock wave and debris.” I realized I had been holding my breath and had to remind myself to exhale. “Diane’s ankle is broken. Amy Zelson has broken ribs and an elbow fracture. Dan Spiegelman got hit in the head with a flying brick and was unconscious for a little while, but appears to be okay now.”
“Head injury?” Stuart demanded pointedly.
“Dan’s getting a CT scan. Dr. Hirsch has some contusions and lacerations, and needs stitches. He’s pretty shaken up but not badly injured.” Dr. Flomenbaum stopped talking, but we three were still staring at him, speechless. He looked away for a moment, then seemed to come to a decision.
“I want to prepare you for what’s going on. When I saw him, Dr. Hirsch was covered in white ash and dust, with blood on his head. He reported to me that when he arrived down there it was like nothing he had ever seen, not in all his years. People were jumping or falling from the buildings. They seemed to take forever to fall, tumbling through the air. They would hit the pavement with a loud thud—very loud—and bounce, and land again. Dr. Hirsch told me the sounds of the bodies hitting the ground echoed off the buildings, one after another, over and over.” My hand went to my mouth and I forced it back down. “When the tower came down, it happened suddenly. In the concussion debris he saw dismembered limbs, body parts flying everywhere. We don’t know how many human remains there will be, or what the state of them is. I’m told the fires are still burning.”
He looked each of us right in the eye, assessing our reactions. “I want you all to understand the task at hand. This is blunt trauma and thermal injury, nothing you haven’t seen before, but on a much larger scale.”
“When will bodies start coming?” Doug asked.
“We don’t know. We are holding a briefing at one o’clock in the lobby. You three please be there. Until then, don’t go far.” With that, Flome left us.
Stuart and Doug looked like they had been mugged. I felt the same. The three of us returned in silence to our office, but again I found I couldn’t sit still and wait. I went back to the ID office, hoping to get news. There was none coming in except through the TV—and the TV was repeating rumors and fears, rerunning footage of the planes hitting, of each building falling. By the elevator I ran into Jonathan Hayes, looking grave. He told me he had seen Dr. Hirsch.
“Is he okay?” I asked.
Hayes said nothing for a moment. “You know, I have never seen that man look more than thirty-five years old before today,” he finally replied—and it was enough.
Forty people gathered in the lobby for our one o’clock meeting. Some of the medical examiners from the outer boroughs had arrived, so there were more doctors on hand than I had ever seen before at the OCME. Through the tall lobby windows I saw that the police cordon had become a roadblock. They had shut down First Avenue entirely and surrounded our building with wooden barricades and armed officers.
David Schomburg, the OCME’s chief administrator, ran the meeting with an air of institutional control and personal calm. “Understanding the scope of the problem is going to be your toughest job right now,” he told the crowded room. Forty thousand people worked in the Twin Towers, and there was no way to know how many had been there and how many of them had made it out before the buildings collapsed. Fatalities could well be in the tens of thousands. We didn’t know for sure who had launched this attack, whether they had employed other weapons such as biological or chemical agents, or whether there were other attacks on New York planned for the coming days. Reserves from DMORT, the federal Disaster Mortuary Operational Response Teams who provide professional manpower during mass-casualty events, were on their way. Our office had established a command post close to the World Trade Center—or the World Trade Center site, as it was being called since the buildings fell. “But the main work of identifying the bodies is going to be done right here.”
Dave yielded the floor to Mark Flomenbaum. “Four diesel-powered, refrigerated tractor-trailers are on their way right now, to be used as mobile storage for the remains,” Flome told us. More trucks would be brought in as needed.
“Are the trucks DMORT?” someone asked Flome.
“No,” he said quietly. “UPS and FedEx, mostly. We need refrigerated trailers, and they have a lot of them.” Someone started to ask something else about the trailers, but Flome cut him off. “This is not the time for questions and answers. Please let me tell you what you need to know.” The room went silent.
“We are starting a new classification system for this event. These remains will receive the prefix ‘D’—so the case numbers will begin DM zero one, for ‘Disaster Manhattan 2001.’ We will be applying a rule of thumb.” Flome held up his own to illustrate. “When you receive a specimen larger than your thumb, it gets a DM number. If you get something smaller but still useful for identification—a fingertip with an intact print, for instance, or a tooth with a filling—you will also assign it a DM number. Doctors”—he scanned the room for us, peppered among the other staff—“the decision of whether or not to assign a DM number will be yours.”
Dr. Flomenbaum paused to let that piece of information sink in. The bodies, or at least many of the bodies, had been smashed to bits. “You will treat each specimen that fits the rule of thumb as though it were a body. We would rather assign multiple numbers to the multiple remains of one individual than fail to identify someone because we failed to investigate a unique specimen. It is possible, given the magnitude of the forces at work here, that a single finger will be the only piece of a missing person we recover, and if we can use it to positively identify the person, we have done our job. That”—and here Dr. Flomenbaum’s scientifically neutral tone of voice flared up—“that is our single most important goal, the one I want all of you to keep foremost in your minds: identifying these people so their families will know what happened to them.”
I was filing the information away, trying to keep my head. I had been told the New York City OCME was as well prepared for a mass-casualty disaster as any office in the country. The senior staff had trained extensively, run drills, and maintained a disaster plan. That plan was now being implemented. The problem was, I had been in New York only nine weeks—and had not been part of any disaster drills.
“Communication is our biggest challenge right now,” Flome continued. “We don’t know when the bodies will start to arrive, or how. W
e have been told the first shipment of human remains is on its way to us by barge up the East River, but we have no way of knowing when it’ll get here.” We were going to work in “processing teams.” Each team would consist of one medicolegal investigator, one photographer, and one forensic pathologist. Professionals from all fields of forensics, including dentists and anthropologists, would be arriving from every region of the country as part of the DMORT program, Flome said. Our office was going to be converted into a compound, with tents in the loading dock and parking lots. “DNA collection will be done up front, as part of the initial processing of the remains. Whole bodies will take precedence, with body parts and fragments to be processed later. As soon as the phones come back up, our office will be accepting calls about routine city deaths, but we will not be picking up bodies for the foreseeable future. If somebody dies at home, he stays there, at least for today.”
“What if there’s a homicide on the street?” someone asked.
“The police will have to secure the scene and wait until we can get somebody there—but, again, it won’t be today.” He told us we were not to use the phones, in order to save them for crucial communication. What about our own families? “They’ll wait.” Mark Flomenbaum closed the meeting with a categorically final instruction: “We are staying here, dealing with the consequences of this event, until further notice.”
I ran into Dr. Hirsch in the hallway. He was cleaned up, but had several raw abrasions on his forehead. He looked worn and tired, and was limping. His right elbow was covered with a gauze bandage. I had never seen Hirsch rattled by anything, and now he seemed so suddenly fragile, this brilliant man, this great leader. I wanted to hug him but was afraid to hurt him, so I held out my hands. He placed his fingers in mine, and I rubbed them, then turned his hands over. The knuckles were bruised, scratched, and dirty. “See these contusions?” Dr. Hirsch asked, in the same tone of professional remove he employed at morning morgue rounds. “They are from a man hunched and covering his head.” He demonstrated, and when he did, looked very old and scared. Then, without another word, he walked away. I couldn’t tell whether Charles Hirsch was making a teaching point or confiding in me. Or both.
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