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Future historians will be grateful for Richard Jones' thoughtful report of the attack on the World Trade Center (December 2001 JRSM1). I too witnessed some of those horrors, on my first visit back to New York since my training concluded there in 1998. Shortly after the towers' collapse, visiting physicians offered to help in the confusion that followed. Of course, the heavy casualties did not come, and sadly there was never a need to press volunteer doctors into service. When my conference was over and I was at last allowed to leave on 13 September (New York airports were closed until that date), the return to my infertility practice in Atlanta revealed how far the ripples from those explosions would reach.
At our office, bookings for new patient appointments for the remainder of September dropped to < 30% of the expected volume. Indeed, in the 10 days immediately after the attacks we registered no new patient appointments at all. Perhaps couples used this time to think about their own present circumstance, rather than to plan for a future baby. Alternatively, for safety reasons they may have decided against flying into the world's busiest airport for the required consult in Atlanta. Within 3-4 weeks of 11 September, this low volume had rebounded, and the year-end numbers actually seem to be higher than last year. But why did this happen?
When we attempted to study this patient scheduling behaviour by questionnaire, results were at variance with what we observed directly in clinic. Our centre's internet site, [IVF.com ], continued to register heavy traffic throughout the period corresponding to the terrorist attacks. A poll conducted on that site showed 68% of people ‘intended to undergo fertility treatment as if 11 September never happened’. It must be admitted, however, that intent and action are not always parallel; clicking a computer button is far easier than spending US $ 15 000 for an in vitro fertilization cycle. In any case, the putative impact of recent terrorist activity on consumer attitudes to both urgent and elective medical procedures represents a worthy subject for future study.
As one who found myself in Manhattan that historic morning, my helplessness was probably similar to that of witnesses to the Titanic's iceberg collision or the bombing of Pearl Harbor. For Mr Jones and his example of those who were able to help the victims or their loved-ones in New York, Dante's words seem appropriate: E ciò non fa d'onor poco argomento (Honour not small shall be thy recompense).