Editor’s Note:  The original version of this Fast Fact was released in 2001 after the September 11th attacks.  It was revised and re-released as a 2nd edition in 2005 after Hurricane Katrina.  While specific to a certain time and place, these reflections on living, working, and caring for patients in the immediate aftermath of horrific events are timeless.  Even though they are similar in many aspects, both editions of Fast Fact #50 were combined into a single document in April 2009 so readers will be able to see each iteration.  Inevitably, these words will be timely all too soon. 

September 11, 2001

This is a very difficult time for each of us individually, for our community and for our country.  The terrorist attacks of September 11 are a profound tragedy. Each of us is, no doubt, experiencing many different feelings – sadness, anxiety, anger, helplessness, a sense of unreality, insecurity, profound grief.  Strong feelings are normal. Whatever you are feeling is OK. 

Many of us may also have some difficulty concentrating throughout the day.  We may find ourselves suddenly tearful at unexpected moments.  We may have difficulty sleeping at night.  These are normal reactions to a major loss.  Be gentle and accepting with your self, and understand that these feelings and experiences are your way of coping.

Our strong feelings and reactions to this tragedy may last for an extended period of time.  This is normal following a major disaster.  At this point in time we don’t have important information. Who has been injured and who has died?  How did these tragedies come about?  Who is responsible for planning them and carrying them out? As we learn more about what has happened, what we have lost, and who is responsible, we will continue to experience a range of emotions. The magnitude of this tragedy will be imprinted in out hearts and minds.

Be aware that some members of our community will suffer a very personal loss-the injury or death of a friend, colleague or family member.  Some may already know about such a personal loss, while others may learn of the injury or death of family, friends or colleagues in the coming hours or days.  If you know someone who has suffered such a loss, offer them your support and love.  If you have suffered such a personal loss yourself please reach out to friends and colleagues.

The importance of doing our job

At a time like this it is important to remind our selves that each patient who walks in our clinic door is seeking our help as they cope with their own illness, injury or concern.  What we can offer to each of our patients is a healing relationship.  The first step in creating this healing relationship is giving our complete attention to the individual patient. In spite of the turmoil in the world around us, our job remains tending to the healing of the individual, serving witness to the individual’s suffering, treating the individual’s disease or injury, sustaining the individual’s health. 

In the coming days we will need to work to maintain each patient’s concerns as our top priority, and resist the temptation to be distracted from this mission by the swirl of events around us.  As we face this challenge, let us rededicate ourselves to providing a compassionate, friendly and supportive environment to each patient.

What can you do:

It is natural to feel helpless at a time like this.  Here are some steps you can take to help yourself and others.

• Talk with friends, family and coworkers about what you are feeling and thinking.
• Listen to and read the news.  Obtain accurate information, as it becomes available.  At the same time allow yourself to break away from the intense news coverage for periods of time.  Each of us needs accurate information, but we also need time away from the media coverage to think and digest what we have seen and heard.
• Seek professional help for yourself or others if you are concerned that your emotions and thoughts are out of control, leading to depression or anxiety that inactivates you.  Contact your Employee Assistance Program, your primary care physician, or a local mental health clinic.
• Guard against prejudice and racism.  Early speculation has focused upon a link between the attack and terrorists that are political extremists and fundamentalist Muslim.  Our Islamic patients and our Islamic community in the United States will feel especially vulnerable at this time.  Islam is not a violent religion and does not promote terrorism. Extremists carried out these acts of terror.  Speak out if you hear prejudice or racism.  Caution others to avoid inappropriate generalizations about any religious, racial or ethnic group. 
• Make sure that your own inevitable anger serves the cause of justice and fairness, not prejudice and blind revenge.
• Think about what has ultimate importance and meaning in your life.  If you are religious or spiritual, seek out the comfort and perspective that can come from spiritual literature, prayer, meditation, and your religious community.
• Reflect on fundamental principles of our democracy.  This attack is an assault against our civil government and other democracies throughout the world.  What is it we value in our system of government?  What principles and ideals do we want to nurture and strengthen through this crisis?
• The U.S. Department of Health and Human Services has activated the National Disaster Medical System.  Health care professionals may contact their local hospital to find out how they might participate.
• Parents can find advice for children at the National Association of School Psychologists web site: http://www.nasponline.org
• Donate blood at your local blood center.
• Contact the American Red Cross to donate money and ask about the need for clothing, food, etc.  The Red Cross takes a central leadership role in disaster relief efforts.

Hurricane Katrina, August 2005

The impact of Hurricane Katrina reaches far beyond the gulf shores of Louisiana, Alabama and Mississippi.  As people in Katrina’s path struggle to survive and recover, and volunteers and aide workers rush to respond, we are aware that the entire country is profoundly touched by the tragedy that has befallen our southern neighbors.  At a time like this it is natural to experience many different feelings— sadness, anxiety, anger, fear, helplessness, a sense of unreality, insecurity, grief.  Strong feelings are normal in the face of human suffering—respect whatever feelings you are having.

Some of us may have difficulty concentrating during the day.  We may find ourselves lost in thought about the disaster or suddenly tearful at an unexpected moment.  Some may have difficulty sleeping at night.  These are normal reactions to a major loss.  Be gentle and accepting with your self, and understand that these feelings and experiences are a part your way of coping.

Be aware that some members of your community will suffer a very personal loss—a friend, colleague or family member who has experienced the wholesale destruction of a home or livelihood, injury, death.  Some may already know about such a personal loss, while others may learn of the injury or death of family, friends or colleagues in the coming hours or days.  If you know someone who has suffered such a loss, offer them your support and love.  If you have suffered such a personal loss yourself please reach out to friends and colleagues.

Our feelings, thoughts and reactions to this tragedy may last for an extended period of time.  This is normal following a major disaster.  At this point in time we do not have important information.  Who has been injured, who is missing and who has died?  How extensive is the damage to cities and towns in the hurricane’s path?  What is the true extent of the environmental damage?  What else could happen that might magnify the tragedy?  As we learn more about what has happened and what we have lost, we will continue to experience a range of thoughts and feelings.  The magnitude of this tragedy will be imprinted in out hearts and minds.

The importance of doing our job

At a time like this it is important to remind our selves that each patient who walks in our clinic door is seeking our help as they cope with their own illness, injury or concern.  What we can offer to each of our patients is a healing relationship.  The first step in creating this healing relationship is giving our complete attention to the individual patient. In spite of the turmoil in the world around us, our job remains tending to the healing of the individual, serving witness to the individual’s suffering, treating the individual’s disease or injury, sustaining the individual’s health. 

In the coming days we will need to work to maintain each patient’s concerns as our top priority, and resist the temptation to be distracted from this mission by the swirl of events around us.  As we face this challenge, let us rededicate ourselves to providing a compassionate, friendly and supportive environment to each patient.

What can you do:

Here are some steps you can take to help yourself and others cope.

• Talk with friends, family and coworkers about what you are feeling and thinking.
• Listen to and read the news.  Obtain accurate information, as it becomes available.  At the same time allow yourself to break away from the intense news coverage.  Each of us needs accurate information, but we also need time away from the media coverage to think and digest what we have seen and heard.  Some people will prefer to limit or avoid television news coverage because the video images are too intense and upsetting. 
• Children, depending upon their developmental stage and individual temperament, may not have the intellectual and emotional tools to understand the vivid and intense coverage on TV and cable news.  Parents should monitor and limit children’s television as appropriate.

·Seek professional help if you become concerned that your emotions and thoughts leading to depression or anxiety that inactivates you or makes you ineffective at work or home.  Contact your Employee Assistance Program, your primary care physician, or a local mental health clinic.  Seeking help early is more effective than trying to be tough.  People who begin developing problems with anxiety after a traumatic event recover more rapidly when they seek help immediately.

• Think about what has ultimate importance and meaning in your life—people, relationships, spiritual beliefs.  If you are religious or spiritual, seek out the comfort and perspective that can come from spiritual literature, prayer, meditation, and your religious community.
• Parents and teachers can find advice for children at the National Association of School Psychologists web site: http://www.nasponline.org
• The American Psychological Association, http://www.apa.org/, has excellent resources on coping with disaster.
• The U.S. Centers for Disease Control and Prevention have good resources on hurricane recovery:  http://www.bt.cdc.gov/disasters/hurricanes/index.asp.
• Donate blood at your local blood center.
• Contact the American Red Cross, http://www.redcross.org/, to donate money and ask about the need for clothing, food, etc.  The Red Cross takes a central leadership role in disaster relief efforts.

Version History:  This Fast Fact was originally edited by David E Weissman MD.   2nd Edition published August 2005; 3rd Edition May 2015. Current version re-copy-edited April 2009; 1st and 2nd editions combined (see editor’s note); edited again May 2015.