I open my slant-top office desk searching for an article to share with a patient. My early 19th-century post office desk may seem like a useless storage space, but both my patients and I love it.
When I close the desk doors, its back collapses to the floor, taking with it my stapler, stethoscope, and emergency bag of peanuts. Because I embrace an orthodoxy for early American furniture, I have tried to hammer its old square nails into the brittle wood, which proves too warped to lay flush against the back of the desk. Sadly, ultimately, I had to break tradition and use today's long nails to secure it. So far, so good.
I have not cleaned the inside of this desk for years. Dusty memorabilia reveal 20 years of my life as a psychiatrist who specializes in working with pregnant and postpartum women. There are two green 5-pound barbells I had intended to use between patients for strengthening exercises, recommended to counter the aging process. There are eight baby pictures from my patients, which I cloister to protect confidentiality. I also have 20 years of baby pictures in charts, along with these few that have fallen out over the years, which crowd the back of my desk.
Recently, I found in this treasure chest desk of memories, a DVD entitled "9/11 World Trade Center" pictures. My patient, Sergeant Nancy Rosado, gave them to me some years ago on the last day of her treatment. They are photos that did not appear on the news: images of people holding hands and jumping from the burning tower into the clear blue sky of that day. While I cannot look at the DVD, I will not discard it.
Nancy came to me through the Columbia Psychiatry 9/11 police program. She was 49, a sergeant in the NYPD, and a first responder at Ground Zero. She was an Hispanic, gay woman with a John Wayne swagger -- a Bronx social worker who joined the NYPD 20 years earlier. After many winters on foot posts or in patrol cars, the police department granted her permission to run an evening trauma group for police officers who were shot in the line of duty. She prided herself on caring for the injured.
When she turned to me for help, Nancy saw herself as "damaged goods." She considered herself as one of the 9/11 injured. She felt ashamed. She was surprised at the symptoms that overwhelmed her without warning: unremitting anxiety, nightmares, and sudden tears. She would experience an approaching garbage truck as the rumble of a falling tower. I understood these as symptoms of post-traumatic stress disorder (PTSD). But more importantly than any diagnosis, I understood these were what she carried in her mental backpack from 9/11.
Nancy had lost her police uniform hat on 9/11. She had also lost a memory, later retrieved in our work, of the sight of shoes -- hundreds of them all over the street, no longer worn by those who had fallen.
When the second tower fell, she grabbed her two rookie cops and fled down familiar streets that she could no longer recall. The building became a landslide at their heels. As Nancy tugged at their arms, one rookie bent to snatch up a police radio -- a female police officer was calling for help from the tower. The caller was the only female police officer to die that day.
Nancy worked through her trauma in her own way. She painted pictures of "The Towers." She recorded Albinoni's "Adagio" as the soundtrack to the WTC video -- the one in my desk. She organized groups for first responders, made referrals to the police program at Columbia, and like so many other police and firemen, dug every night for months in the pile at "Ground Zero" looking for remains of family members, fire fighters and policemen.
In December of 2001, she received a telephone call from an elderly Jewish man. He had found her hat. They had lunch. He had boxed the hat without brushing off the white ashes of the dead and the residue of concrete dust from the towers. Nancy put this 9/11 object in the back of her closet.
Treatment with Nancy was complicated for me. I come from a family of police officers, detectives and first responders. I know how cops think. I was, in a way, kin to Nancy. It was as if I was helping my family or friends from my old neighborhood in Brooklyn. I wish I had accepted her invitation to her award ceremony. I would today.
Over time, Nancy realized that in her job as a cop, in a city where 9/11 can be inescapable, she would continue to face the tragedy of that day. For some, this powerful trauma can be indelible. Towards the end of the treatment, Nancy was able to put 9/11 in the back of her mental closet, with her hat. She retired from the NYPD. She and her partner, Myrna, moved to Florida.
On September 11, 2011, I received a text. "It's Nancy. I am in town." She was in New York City for the 10th anniversary ceremonies at Ground Zero. Nancy, Myrna and I had pizza at a place called Posto in the Village. I was well beyond the traditional rules of psychotherapy that said don't do that. For psychiatrists, boundaries may be part of the treatment process. But in tragedy, disaster or other special circumstances there needs to be flexibility about the rules -- bending them without breaking them. Like Nancy, I too, had learned a lot from 9/11.
Nancy texted me a colorful, incandescent, "2014" on New Years Eve. Her good wishes appeared at midnight. She was saying to me "I am here. I am okay."
Who knows if Nancy and I will share another pizza? What I do know is that the passage from 9/11 to today, the remnants of her pain, the evolution of both of our lives and hearts, and our collective memories remain in my beloved desk, where I keep and treasure them for both of us.
Margaret Spinelli, MD, is a Clinical Professor of Psychiatry and Director of the Maternal Mental Health Program at the Columbia University College of Physicians and Surgeons; and a Research Psychiatrist at the New York State Psychiatric Institute