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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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