As a veteran nurse at New York City's William Randolph HearstBurn Center (New York Weill Cornell), Barbara Ritchwood, MS, RN, had seen plenty of severe burn victims before Sept. 11.

It was 8:45 a.m. that day when she looked up at the television in a patient's room and noticed the smoking World Trade Center. Then the phones started ringing. An hour later, burn victims began pouring in. "I've worked here for 11 years and I'd never seen people that badly burned," she said.

For Ritchwood, the experience that followed highlighted an aspect of nursing that can get lost in the day-to-day grind. She witnessed a newfound sense of camaraderie with co-workers, an acceptance of one another's strengths and weaknesses and a new sense of pride in nursing.

Two other nurses who were in the trenches Sept. 11 in New York or at the Pentagon agreed that the events of that day left an imprint that not only has changed the way they view their own jobs, but also the way they are treated by the public.

Elizabeth Ayello, Ph.D., RN, an associate professor at New York University, took nursing students with her to volunteer at the makeshift triage center at Chelsea Piers Sports & Entertainment Complex, just 20 blocks north of the World Trade Center.

Maj. Gen. Marianne Mathewson-Chapman, Ph.D., RN, was at the Pentagon for a meeting when the door blew open >> from the impact of the plane that plowed into the building. She was recruited to tend to victims on a grassy knoll outside the government building.

Sobering tasks

Whether in New York or Washington, D.C., nurses had to respond instantly to new situations. Ritchwood quickly discovered that she needed to ask victims to provide their names and allergies as soon as they walked into the burn unit. If she delayed, their air passages could swell so fast that they wouldn't be able to breathe or speak.

One of the first women to walk in had been at a bus stop near the World Trade Center. Her clothes were burned off, her facial hair was singed and she was already swollen beyond recognition.

"Everyone looked the same-really red, or ashen and gray," Ritchwood remembered.

Jewelry such as wedding bands also became a hazard as the patients' tissues swelled, and one of Ritchwood's proudest accomplishments was successfully prying a wedding band off a man's hand.

A more sobering task for her was talking to the families of the victims. "It was so eerie," she said. "They would say it didn't look like their loved one. They would insist it wasn't the person they knew."

Some of the victims who'd been badly burned went on to recover, but others, such as the woman who'd been at the bus stop, died after a couple of months.

Despite the painful losses, Ritchwood said she witnessed an inspiring facet of nursing.

"We really came together as a team," said Ritchwood, who moved into a hotel near the hospital to make it easier to work extra hours for seven weeks after the disaster. "We were proud. We saved people that had been 80 percent burned. It also made us look at our own mortality, and we became more accepting of each other."

Ritchwood also believes the tragedies drew attention to the field of burn care. "I think it put us on the map. Your skin is your largest organ, and it usually isn't recognized as an area of special care."

'A different day'

Like Ritchwood, Ayello was impressed with the medical community's quick response Sept. 11, but this achievement was tempered with the painful realization that there were few survivors to take advantage of the services.

Ayello was carpooling to work with a nursing colleague when the two looked up and noticed that something had hit the World Trade Center. She was trying to remember which day that week her husband had a meeting in the twin towers when she saw the second tower erupt in a ball of fire.

"I didn't know what was going to happen to me that day, but I knew it was going to be a different day than I had planned," Ayello said.

She arrived at New York University and took 29 students with her to the school's medical center. When they walked in, they quickly learned that people with medical backgrounds were needed at emergency sites near the World Trade Center. So, Ayello piled into a van headed to Chelsea Piers.

"While we were in the van, it was so strange," Ayello said. "We were trying to explain to the nursing and medical students what they would see. We told them they might see people with burns or missing body parts. There might be crushing injuries."

For once, though, there were plenty of health care workers and not enough patients, Ayello said. "The hardest thing for me was realizing that there were not going to be survivors. I found that really upsetting, especially as I thought about the people I knew who might have died."

She and the other volunteers treated rescue workers for eye irritation from the smoke or minor burns. In addition to treating these minor physical ailments, Ayello said the volunteers realized it was most important to listen to the rescue workers' stories.

"We helped them understand that it was OK that they were alive," she said. "It really confirmed to the nursing students that they wanted to be nurses. It reaffirmed that it can be about talking to people."

Ayello saw that the health care system was capable of galvanizing workers and supplies to help potential victims, and she would like to see that continue. "If there were some way in our health care system that people could sustain the willingness to go the extra mile, that would be great."

The events of Sept. 11 also have translated into increased attendance at New York University's monthly seminars that inform people about nursing as a career. More than 60 people showed up for the seminars in the months following the attacks, compared to the average attendance of about 10 people, Ayello said.

Quick response

While Ayello waited to treat survivors in New York, Mathewson-Chapman did the same outside the Pentagon. Her ordeal started just after 9 a.m.

Recently elected to the Army Reserve Forces Policy Committee, Mathewson-Chapman was at the Pentagon for a quarterly meeting. The group heard the news about the World Trade Center just after 9 a.m. Initially, they thought an airliner had accidentally struck one of the towers. They returned to their meeting when they heard a violent explosion. The doors of the room flew open, and they were ordered to leave.

Medical personnel were instructed to follow a security guard, and Mathewson-Chapman followed the guard to a clinic inside the Pentagon.

"I had never been in there and I had to get familiar really quickly," she said.

Suddently, she heard that she had to leave the clinic because another plane was heading toward the Pentagon. A triage area was set up outside, and Mathewson-Chapman worked to label people who were being loaded in cars headed to hospitals. She'd write down the hospital destination on a piece of tape. Other medical workers helped set up IVs and treat people for burns and smoke inhalation.

"We were expecting more casualties, but the fire was so intense that firefighters weren't finding many people," she said.

Although few survivors were found, Mathewson-Chapman said that the quick medical response captured the attention of nonmedical military leaders.

"It was a real eye-opener for commanders who aren't medical," she said "They realized that the medical community not only plays a role in treating people on the battlefield, but also people in the United States."

Elizabeth Norman, Ph.D., RN, professor of nursing at New York University, said this kind of respect for nurses has rippled throughout the nation as a result of Sept. 11.

"Normally, nurses tend to be rather humble about what they do, and the tragedy helped nurses realize how important they are and how vital their skills are," Norman said. "They also developed a really wonderful sense of camaraderie with other nurses and doctors."

Although there is a risk that these realizations will last only as long as a crisis exists, Norman believes the challenge now is to figure out a way to sustain it.

Contact Heather Stringer at heathers@nurseweek.com