November #76 : Masters of Disasters - by Shana Naomi Krochmal

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Table of Contents

Masters of Disasters

Out of the Chaos, Voices

The Mighty ACT UP Has Fallen: The Philadelphia Story

Hit Me, Baby, One More Time

Final Chapters

Pilgrim's Progress

St. Louis Blues


Truth and Dare

Dateline Dec. 1

Psst...Get This

Hope Screens Eternal

Hearts & Crafts

Shelf Life

Treatment Interruptus

New Drug Watch: Tenofovir

The Real Female Rubber

Twice Bitten


Curve Ball

Heart Smart?

Darkness at Noon

Stranger in a Strange Land

Editor's Letter


The Face of Terror

Most Popular Lessons

The HIV Life Cycle


Herpes Simplex Virus

Syphilis & Neurosyphilis

Treatments for Opportunistic Infections (OIs)

What is AIDS & HIV?

Hepatitis & HIV

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November 2001

Masters of Disasters

by Shana Naomi Krochmal

What does the AIDS epidemic have to do with the events of September 11? Nothing -- and everything. Shana Naomi Krochmal on a tale of two tragedies, one hospital and a community of compassion.

There was a time, long before the current terror, when we said ground zero and meant the gay community clustered around Christopher Street, say, or the Castro. Even then, St. Vincent's Hospital and Medical Center, in Greenwich Village, was the epicenter of a fresh hell. The conservative Catholic hospital, with its many images of Christ and the sad-eyed saints, held desperate gay men with AIDS, grieving lovers and embattled doctors. Many of New York City's PWAs came to St. Vincent's seventh-oor AIDS unit to die -- and then, with the advent of better drugs, to return to life. Like its West Coast counterpart, Ward 86 at San Francisco General, it was a place too many HIVers and their vigil-keeping loved ones knew too well.

Yet HIVers weren't the rst dazed or guilt-ridden survivors to be tossed up at St. Vincent's in a world that had stopped making sense. Ninety years ago, the women and children of the Titanic clambered ashore and were brought there. After the World Trade Center was bombed in 1993, the hospital treated more than 200 of the injured.

And then, on September 11, a phalanx of physicians in green scrubs gathered amid a raft of stretchers, wheelchairs and ambulances on Seventh Avenue outside St. Vincent's -- once again the designated trauma center to this new Ground Zero. The hospital administration immediately turned to its AIDS Center staff to coordinate the disaster plan and manage the emotional fallout. "I certainly didn't expect to get asked to be the disaster expert," said Kristina Jones, MD, the AIDS Center's director of psychiatry, with a long-suffering laugh. "But AIDS is a chronic disaster, so here I am."

With skills forged in the crucible of the epidemic, the center's 70-person staff applied old lessons to the new crisis. "This was our chance to do it a second time," said Matt Baney, the center's administrative director since 1993, when the 150 beds on St. Vincent's AIDS unit were packed with PWAs. "With AIDS we did a lot of things wrong the rst time, and we learned from our mistakes." Lesson No. 1: Health-care pros, from surgeons to social workers, trained to erect defenses against their own painful emotions in the face of mass injuries and death, were encouraged by Jones and company to "feel their feelings," as Baney puts it.

The hundreds of doctors waited on the sidewalk for the estimated 5,000 victims, breathing smoke and ash through surgical masks and watching the TV crews spring into action when the occasional ambulance arrived. Meanwhile, local HIVers taking in the scene's overabundance of MASH-like units and outpouring of volunteers nursed their own share of painful emotions: Where was the nation's disaster plan when HIV decimated a generation of gay men in the '80s? Imagine then-mayor Ed Koch sounding as stricken by AIDS' toll as Rudolph Giuliani by the WTC attack when asked to predict casualties: "More than any of us can bear."

"Yes, there was a bit of bitterness about what we had to go through," Baney said. "A trauma like this reopens so many wounds that you thought were covered up." And two decades of AIDS horror may have even served as a buffer of sorts, he said. "Because of the epidemic, we lived through the explosion already. September 11 seems like a quiet mufe to us."

Night fell on the besieged city, and as the Day After dawned, the platoon of waiting helpers had to face a terrible truth: Silence indeed equals death. After the rst 300 or so, Ground Zero disgorged few new bodies. There were no more bodies to heal. "We were in a crisis mode," Baney recalls. "You know, 'If we build it, they will come.' So we're waiting and waiting. We're thinking, if they pick up this wall, if they pick up that beam, they're going to nd all these people."

But they didn't. And that's when the AIDS Center's staff and scores of HIVers found their true calling, as they switched gears from managing the crisis to caring for the caretakers -- helping an army of shocked medical practitioners accept their powerlessness to save.

Day and night, stunned family members from all over metropolitan New York stood in long lines outside St. Vincent's for a chance to call out the name of their missing at an info table set up by center staffers. Inside, the scene was reassuringly busy for those in charge: Exhausted police and reghters who lost their entire squad, plus injured volunteer rescue workers, had to be restrained as they tried to jump off gurneys and return to the burning ruins; doctors and nurses awake for 36 hours with no one to treat had to be talked down from their do-or-die furor. Even clients of the AIDS Center, closed for the crisis, pushed through National Guard barricades on the Manhattan streets to make sure their favorite nurses were hanging in there. Then they stuck around to comfort grieving relatives: When no one else had the strength to cross the sidewalk and comfort the bereft, HIVers rose to the occasion. This was home.

In the ensuing days, as the realization set in that few of the countless lost in the wreckage would be recovered alive -- or at all -- the scene at St. Vincent's became that of a monumental memorial. The hospital's southern wall was plastered with hundreds of handmade pamphlets bearing photos of the once-smiling faces and identifying details of the missing. There were masses of owers and ickering candles. The likeness to symbols of AIDS mourning -- the Quilt panels, candlelight vigils -- was haunting and unmistakable. "I had a ashback to an AIDS memorial moment in Washington Square," Jones said, "but these just happened to be red, white and blue instead of all red. I thought, 'How many pictures -- how many walls -- would we need for HIV?'"

New Yorkers arrived on the scene to donate work boots, socks, gloves, ashlights and food for the mammoth, still-ongoing rescue-and-cleanup effort, and HIVers were no exception. They dug deep. "Men came in with donations of things their dead partners had given them, saying, 'If he was alive, he would have been here with me for this,'" Jones said. "Or, sometimes, 'I'm glad he didn't see this.'" As history, in a moment, changed the known world forever, AIDS survivors checked in with their missing and dead.

On the rst Friday of this new world, one such man carefully pushed through the crush of TV crews and families behind the blue barricades outside St. Vincent's. Carrying a pair of almost-new work boots by the laces, he crossed Seventh Avenue and passed the line of bleary-eyed doctors and soot-covered cops getting grub. He handed the boots to a volunteer organizing the piles of stuff for the rescue workers. Then, instead of leaving, he began to read the lives detailed by the "Missing" fliers on the wall.

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