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A student elective in forensic pathology had taken me to the City of New York Office of the Chief Medical Examiner, where I was working on 11 September, 2 km from the World Trade Center. First news of the disaster suggested that the hijacked planes had been small and few casualties were to be expected. This idea was soon dispelled when the 110 floors of the south tower collapsed before our eyes, and the north tower soon afterwards. Later we learned that the Chief Medical Examiner, Dr Charles Hirsch, and several members of the department had been caught in the collapse of the towers and were in hospital.
For several hours supplies came into the office in a steady stream, and we were told to get some rest before the expected delivery of bodies from ‘ground zero’. We watched the television, but there was little up-to-date information because the area south of 14th street had been closed off. Walking on 1st Avenue outside the office, I could see the smoke and dust clouds rising into the air from downtown Manhattan (Figure 1). My family and my fiancée in the UK, when I telephoned them, seemed to know more than I did about what was going on. The streets around the Chief Medical Examiner's office were sealed off to civilians, and police and fire department officials began converging on the area, their faces grim in the knowledge that up to 350 of their colleagues were missing, presumed dead.
That night, the work of the Office began in earnest, and I was assigned to one of the four teams that were to identify the bodies of victims. In any disaster this is a vital part of the operation, since the pathological evidence of identity, coupled with investigations into clothing and possessions, provides grieving relatives with a degree of ‘closure’. Clothing is searched for personal papers, credit cards, identity cards and so on; and, where there are no such papers, the investigation focuses on the colour, style, make and size of the clothes. Tattoos and jewellery also offer vital information, especially when there are inscriptions of any kind. Information recorded on the body itself includes hair colour, texture and style, eye colour, skin colour, scars and teeth; also, each body or part was sampled for DNA profiling.
Over the next 24 hours it became clear that the pathological details gathered so carefully at the Office of the Chief Medical Examiner would be the only means by which many people could receive definitive information about their missing relatives. In this sense the work was immensely rewarding. Within a few days another medical student and I were given a lead role in identifying and cataloguing body parts, so that the medical examiners could focus on the whole bodies.
As the days drew on, team structures changed and eventually I found myself being assigned to ‘triage’ the large amount of incoming body parts. By introducing an additional ‘sorting’ stage into the process, it was hoped that the pathologists and their identification teams would not be overloaded by fragments that were too small to catalogue in detail, but which could still be sampled for DNA. There were a large number of non-human remains — from kitchens and elsewhere — and my own experience of meat inspection was helpful in removing them from the overburdened system so that the identification teams could concentrate on what was important.
As medical students we were fully integrated into the identification process, and were accepted without question as ‘part of the team’. I found it difficult to leave.