|Aftermath. Artwork by Hala Masri, August 2020.|
It was six in the evening and we were finishing our hematology board virtual meeting. Because COVID-19 cases were again on the rise, the hospital staff was working at half capacity, with the other half at home. The chemotherapy unit patients had finished their treatments and the nurses were writing up their notes. We felt a small shake, an earthquake-like trembling. I did not give it much thought but then we heard a loud noise. Everything slowed down.
My friend grabs me by the hand, and we run out of the office right before the window smashes on the desk. People are screaming and glass is everywhere from the shattered windows. Luckily, no one is wounded. Is it a terrorist attack? A car bomb parked outside the hospital? I cannot tell.
Worried we will lose phone service, I hastily inform the virtual meeting attendees that there has been an explosion nearby and that we are all unharmed. I call my parents: “There was an explosion at the hospital, I am safe and OK.” I check on the oncology inpatient floor where the scene is the same—shattered windows, but staff and patients unharmed. I start calling friends who live nearby. They are all safe, but their houses are damaged. What had happened? “Careful, don’t go anywhere!” the nurses tell me. “We might be getting bombed, and it’s safer to stay here.” My attending calls and tells us that there has been an explosion at the port. An explosion at the port? We were not that close!
My friend tells me we need to go to the emergency room, where help is needed. “We can’t go,” I tell her. “We need to clean and try to fix the chemotherapy unit. It’s a complete mess and we have patients coming in tomorrow.”
“They need help,” she insists. “Disaster code has been activated.” Disaster code? Is it that bad? We run to the emergency room and the smell of blood is everywhere. Hundreds of injured people, all covered in blood, are screaming for help and more are begging to be let in. It feels like an apocalyptic scene fresh out of a horror movie, worse than any disaster code!
Focus, I try to tell myself, but everywhere I look I see blood. I freeze, unable to help, feeling stupid and useless. People start reaching out to me, asking for help. I am a white-coat wearing physician, after all. The infection control nurse calls to me, handing me a protective gown and two masks. Not yet vaccinated and with COVID-19 cases on the rise, as an oncology fellow I had been extremely cautious to not get exposed. But today is different, the pandemic secondary. The first few patients I examine seem to be stable, their bleeding resolved. They beg me to clean their wounds, but I do not have access to the supplies. “Watch out, she’s three days old!” A family medicine resident is holding a newborn tightly and running to radiology.
My phone keeps ringing, but I filter the calls. My parents know I am safe and can update the others. But some calls I cannot avoid. My attending calls, asking for someone to examine an injured patient in the laboratory. “I’ll go,” I reply, happy to get a break from the heartbreaking scene in front of me. In the laboratory, the hematologist helps me clean the wound and the phlebotomist asks if I need assistance. I wonder about my apartment, only a few blocks away—is it all shattered? I call my sister and ask her to have someone check it out, worried that the front door is broken and the house robbed. I cannot deal with this right now.
I go back to the emergency room, where in ten minutes the hallway has become even more packed. I quickly forget about the house. Patients keep coming in, some very badly injured. A woman my age is lying on the floor, bleeding and screaming, and I imagine her as myself or one of my sisters. I am not well. I see two men carrying a woman, heading towards the ER. They see me and they ask if I can help her. They do not know her but had brought her here on a motorbike while her husband and son were sent to another hospital. She has more wounds than I can count and cannot stand without assistance. “Yes, but I need help carrying her,” I reply. One of the men asks for my gown and he wraps her in it and carries her to the closest chair we can find. She is in bad shape and needs a stretcher. “Let me in,” I yell to the ER nurses. “We can’t let anyone in, there is no room!” Lost cause. I see a resident who tells me I can take my patient directly to radiology for imaging and take it from there. At last, something I can do to help her, but it is a long way to radiology. I cannot carry her all the way there. A nurse brings me a wheelchair and we run to radiology, which looks like a second ER.
My patient is tired, in pain, and worried she might lose consciousness. I try to remember her triple name, not willing to let her become a Jane Doe. She needs an IV line. “We have some material here,” an internal medicine resident tells me. I have not inserted a peripheral IV line in a long time, but there is no time to think. I put in the IV and start a saline infusion. In pain, my patient vomits what seems like blood, but I still do not have access to analgesics. Our turn for imaging finally arrives and my patient receives full-body CT scans. The resident and the radiology attending read the imaging on the spot: no intracranial or intraabdominal bleeds but multiple rib fractures and a left sided pneumothorax. I type the info in my phone; I cannot rely on my memory today.
I see my friend, a surgery resident. “Do you think she needs surgery for wound closure? She has so many, and some look deep,” I ask. She tells me I need to explore her wounds first, but where to go? I need to get her on a bed urgently. My phone rings again: “Come to the chemotherapy unit, we need help. We’ve opened the unit to treat patients who had no room in the ER.” Perfect, I can take my patient there! The elevator is out of order and my patient in no shape to walk. My friend came from home to help and she goes with us to another elevator, which is also full. Finally, we try the last elevator and it is working and empty. We arrive at the chemotherapy unit, which has been transformed into another emergency room and reminds me of a military field hospital. The oncology nurses are running around carrying dressing sets and betadine. Wounded patients everywhere are being cared for by fellows, residents, students, nurses, and attendings. Staff I have not seen in a year, residents and students who had graduated, all have come back to their home institution to lend a helping hand.
Surgery residents deal with the severe cases, and everyone else is suturing or stapling the more minor wounds. We find a bed for my patient and finally give her analgesics. We clean her wounds with saline and find they are deep and need surgical management. The hallway outside the operating rooms is packed with patients awaiting their turn for surgery. We tell a surgery resident about our patient, making sure he notes her allergies, her triple name, her husband’s phone number, and her radiology results. Back at the chemotherapy unit, we start suturing patients and taking care of minor wounds. Everyone receives a tetanus shot and a prescription for antibiotics. Things finally begin to quiet down: patients with minor wounds are sent home, those who need monitoring or surgery are admitted to floors or sent directly to the operating rooms. It will be a long night for the surgeons.
I get home at 2 AM. I cannot sleep. My phone is filled with horrific content filmed by people all over Beirut. I start to cry—it is too hard to watch. I try to sleep. Tomorrow I might need to help clean the mess. My thoughts go back to my patient and I pray she makes it. For the first time in a long time, I do not care about COVID-19. But I feel the burden of being a physician. I was not ready for this. No one was. It was August 4, 2020, in Beirut.
NOHAD MASRI is a Lebanese American University MD graduate. Like any Lebanese citizen, she has been deeply scarred by the Beirut blast on August 4th, 2020. She tried to write down her experience a few days after it happened as a form of catharsis. She knows that for anyone who witnessed the explosion, there will always be a “before” and an “after.” In the meantime, she continues her Hematology-Oncology fellowship training and hopelessly waits for a miracle to save her country.