Recollections of Captain Ralph Bally, MCS [Medical Service Corps], USN, staff psychologist at the National Naval Medical Center and head of the mental health team on board USNS Comfort (T-AH 20) during Operation Noble Eagle
Adapted from: "The Right Thing to Do." Navy Medicine 92, no.6 (Nov.-Dec. 2001): 8-12.
Friday [14 September] turned out to be a tough day. We all got to NNMC [National Naval Medical Center at Bethesda, Maryland] early in the morning and boarded the buses for the 4-hour ride up to Earl, New Jersey. Eventually, we all got unloaded, checked aboard, got our rooms, unpacked our seabags, and checked into our workstations. Then, within an hour of arriving, there was an announcement that there had been a change in the mission. The hospital ship was going to be used to provide comfort, meaning living spaces, food spaces, and showers for the rescue workers. And except for a very core crew, everybody else was told to pack their seabags to go home.
I can remember being very disappointed because I thought there was going to be a big mental health portion of this. And I was ready to go. When anything this terrible happens to our country, we all want to pitch in and help. Then, all of a sudden, you were being told to go home.
Then, CDR [Commander] Terry Dwyer, who is in charge of sick call operations, pointed his finger at me. I looked at myself and looked beside me as if to say, "Who is he pointing at?" He then said, "We need you and the rest of the mental health folks. You are going to be a part of this mission."
We were not actually on the ship as a SPRINT [Special Psychiatric Rapid Intervention] team. When the ship goes out configured as a 250-bed hospital, it goes with dedicated mental health assets. I and one of the psychiatrists are part of the mental health assets. The unit is composed of myself as a psychologist, LT [Lieutenant] James Reeve, a psychiatrist, and a psych tech. We actually work in the trauma area. When patients come in and they have psychiatric problems, they will be triaged to us. And if they need further acute kind of treatment, they are actually moved onto the medical wards awaiting transfer off the ship
It just so happens that on the 250-bed configuration there is also a psychiatric nurse, but she actually works on the medical wards. If the ship was going out in the 500-bed configuration, there is an extra psychiatrist and another psych tech that comes along. I asked for both of them to come out with the ship. What we actually had as mental health assets was myself, two psychiatrists, a psych nurse, and three psychiatric technicians. It also turned out that both of the chaplains who were out there were also trained in responding to disasters.
As the mental health people aboard the ship, I saw a dual mission. Part of that mission was to take care of the rescuers and part of the mission was to remember to watch the staff to make sure they were also taking care of themselves as they provided care for these folks.
I had a lot of mixed feelings as we neared our objective. There was a somberness and a pride. As we crossed the bay from Earl, NJ, we could see the smoke in the distance and that gave me a very somber feeling. We knew where we were headed. But as we went under the Verrazano-Narrows Bridge ... it is interesting. I am actually a little bit sad about this. Cars and trucks would slow down and you could see people wave and they would be beeping. Right away, you knew the ship was a tremendous symbol of comfort and hope coming to the people. The Navy was coming to really help out in this disaster. So I had a sense of pride that I was a part of this tremendous operation.
We were still far enough back so you could see the skyline of New York with some smoke. Unless you had a picture in your hand that showed you where the two towers stood, you would not know that something was missing.
We did not park right there by the World Trade Center. Our berth was about 2 miles further up the river. Immediately, we were interested in getting down and seeing "Ground Zero," and starting to make connections. The master chief came in and said, "Would you like to go down? I have made arrangements." And I said, "Absolutely." So I, the chaplain, the CO [Commanding Officer], the XO [Executive Officer], and, what turned out to be the Deputy Mayor, went down to see this first hand.
What I found rather striking was this tremendous sense of camaraderie. I am used to going to New York City and it is always a hustle and bustle of cars. Everybody is beeping horns. Everybody is impatient. And lots of people are rude. And all of a sudden there are people handing out fruit and water at the different checkpoints and people applauding you as you are driving down because you are coming to help. It was just incredible!
We got down to the Battery, unloaded at the Coast Guard Station, and walked into the site. The first thing that struck me was a large group of folks who had lost people in the disaster. They all carried pictures with the names, looking for them. Has anybody seen them wandering around the city, in a hospital somewhere? And they were in shock and grieving at the loss.
Then we walked into the site. There were two huge five-story piles of rubble. One cannot grasp the immensity without standing there. You see a picture of the Grand Canyon and then you stand on the South Rim. Seeing the picture and then seeing it for real, you understand the immensity. The same thing there. You saw the pictures on television, but standing there amidst this huge amount of devastation and destruction...
Thousands of policemen, firemen, and rescue workers with a bucket brigade were trying to take this pile apart bucket by bucket and continuing to look for survivors and bodies. As you looked in their faces there was that determined focus that they were going to find someone alive, and they needed to get through the pile and get out the bodies of their comrades. But at the same time, there was a tremendous camaraderie and bonding taking place. People were talking and, in my view, this was very important. To get through these kinds of events, it is very important that people talk it out and percolate internally what has happened, and put the story together for themselves - to make some kind of sense out of the nonsense of it all.
We asked ourselves what we could do aboard the ship. We knew that policemen, firemen, EMTs [Emergency Medical Technicians], and other rescue workers from Ground Zero would be coming aboard. So we decided to offer formal debriefings, and advertised all over the ship. Here were times, and anybody who was interested could come and see us. We advertised as people came up the ramp. When you checked aboard there was a signup sheet for those who wanted to be part of this. We also had signs in the chow hall.
There was also a more informal approach. We provided onepage handouts on how to take care of yourself. "This is an upsetting event. It is upsetting for normal folks. These are the kinds of symptoms that normal folks have - loss of sleep, loss of appetite, nausea, feeling depressed, unsafe, angry, etc." And what to do to take care of it.
We looked for people sitting by themselves. We knew that one of the things that can help a person normalize what they have experienced is to have a support group. This is generally your friends. For those people who came from Idaho or Oklahoma or wherever to help out and came by themselves, they might not have a support group. In the chow hall, we gave them an opportunity to talk with us. We could both see how they were doing, and reinforce those kinds of things they needed to be doing to take care of themselves.
Therefore, the initial focus was working with individuals but we also worked with groups. We also worked in sick call. Often, when patients were being treated for minor injuries in sick call, a corpsman would engage them in conversation. And if the corpsman saw the need, we would come in and talk to the patient. This is where the majority of our interventions were done informally in the chow hall and in sick call.
As the days went by, we began seeing fewer people coming to the ship. We then began talking to some of the policemen and learned that they were making the transition from search and rescue to recovery. Even though it was not formally announced, you could see it was becoming more and more like a construction site. People who had previously been working 17 and 18 hours a day and were unable to drive home ended up eating and sleeping on the ship. Now they were starting to go home and be with their families. So fewer people were coming aboard.
At that time, we were able to contact a group of psychiatrists who respond to disasters. They were needing some help down at Ground Zero so we tied up with them and went down there on Friday and Saturday to do the same kind of informal talking with people. As I walked around Ground Zero and talked to the other mental health folks, I learned that much of what they were doing was just walking around and seeing how folks were doing and handing out information on anxiety reactions and Post Traumatic Stress Disorder (PTSD).
One night I was down at Ground Zero talking to a worker. I was not there more than 60 seconds when a man and woman walked up and introduced themselves to me. Clearly they were friends with the other man. At first I thought they all did the same thing, but when I started talking to the woman, it turned out she was a nurse. The other man was an administrator who worked for the police department. The common bond between all of them was that they had been there from the very beginning as rescue workers and had been part of the bucket brigade. They had seen parts of bodies and other things. They had formed a bond, and had been doing a lot of talking with each other, which was a very healthy kind of thing. I asked about their sleep and appetite and, after awhile got the impression that here, at week two after the incident, they appeared to be coming through it. As they walked away, the man from the police department lingered behind. He told me he had some concerns that his experiences might turn into PTSD. He was eager for some information. I explained the usual anxiety responses normal people have to abnormal situations, and we talked about his symptoms. I assured him that because of what he had already done to take care of himself, it was unlikely he would experience PTSD.
Back at the ship, one of the ship's officers heard one of the folks talking about some of what he had seen and that he was having a lot of difficulty sleeping. The officer suggested that he come talk to me. He was an administrator who worked in disaster preparedness in one of the buildings near Ground Zero. He was at the base of the building when the first plane hit and debris began raining down. But then, as he told me, people came out and said things would be okay; people needed to go back to their offices. He was on the 53rd floor of his building looking out the window and saw the second plane hit. Later he saw some of the people jumping from the building and watched them hit the ground. Needless to say, he was having intrusive thoughts, losing sleep, and having nightmares.
In his case he did not have a lot of people to talk to. He lived in an apartment by himself. There was a next door neighbor he helped take care of, an elderly woman, not someone he could talk to about this. So I was really the first person he had an opportunity to sit and be able to tell his story to.
There is something else worth mentioning. Sick call is right below the flight deck. There were people with carts taking supplies across the flight deck and a few times there was a rumbling noise. As I talked with him, I could see the fear on his face as he looked up. I reassured him that they were just moving supplies. And he said, "That is the sound the building made when it came down."
On another occasion, some policemen were providing supplies to the ship. One was very badly dehydrated and fainted. As his buddy went to grab him, he twisted his knee. We got them both up to sick bay. The one who fainted was in one bed and his buddy in another. As we took care of them, we learned they had lost one of their bosses in the collapse of the towers. And they had been working tremendously long hours - 18, 19, 20 hours. They were not getting to go home. And now both were feeling very guilty. "I am not out working but maybe after a couple of hours." Here was this man with a splint from his hip down his leg taking care of his knee saying, "Gee, I will be back in a couple of hours." And here is his buddy, terribly dehydrated, saying, "I need to get back."
While all this was transpiring, five or six of their comrades showed up. We got them to talk about their loss. It was almost as though we were having an intervention with them right there - with the two buddies in bed and them. Part of the reason we could do this was because of the existence of this close-knit group.
When the two were well enough to go, we would not let them leave the ship until they ate. The whole group went to the chow hall accompanied by two of our officers. We watched them from a distance and could see them getting back together as a group, joking and talking.
The departure from New York was a tremendous experience. We were all out on the flight deck on either side all lined up at parade rest. I was facing up toward the George Washington Bridge. The Office of Emergency Management pier was right there. There were cars parked on top and you could see a couple of police cars and a few reporters with TV [television] cameras. It was II am on Monday I October. The tugs come in and the untying began. As we pulled away from the pier, we all saluted and held the salute. And people on the pier began to applaud, wave, and yell "Thanks a lot." It was a very emotional experience.
As we went down the Hudson River, we all moved to the port side of the ship to salute the World Trade Center and the people there as we went by. But just before we got there, a fireboat pulled up on either side and let loose a huge spray their way of saluting us! Then, as we approached directly across from the World Trade Center, we all stood at attention and saluted. As we did so, police boats put color in the water - red, white, and blue. It was just phenomenal and very moving.
I do not think anyone could say that sending the Comfort to New York was not the right thing to do. I spent a lot of time in the CASREC (Casualty Receiving) area where people arrived and departed and talked to hundreds of them. To a person, they were all extremely grateful for the comfort we provided in terms of the Navy being there. Not only providing them with a place to get away, and a place to sleep in quiet, but a place where they could get regenerated before going back down to Ground Zero. But the one thing they all commented on was the tremendous care and hospitality that all the staff on the ship showed them. No matter what they wanted people would go out of their way to get it for them or help any way they could.
As I was getting ready to go on the mission, and even after I had gone, many neighbors asked my wife how I she felt about my being away. And her response was, "That is what they are trained to do. And he has an opportunity to do what he should be doing."