A team of medical specialists surrounded each tray, moving in the highly synchronized choreography that you see in an operating room, an ER-or a morgue. The noise was overwhelming as the workers shouted to one another over bone saws that whined like dentists' drills. Clerks wearing hospital scrubs stood by, passing labeled folders to the pathologists each time a new body bag was loaded onto their table. And over it all hung the heavy smell of death, along with diesel fuel from the nearby reefers.
I wanted to stop for a closer look, but my colleagues were making their way to the tent labeled DMORT. Inside, their twenty-by-twenty-foot nylon tent was crammed so full of people and supplies that there was barely room to move. The side walls were stacked with boxes of disposable surgical gloves and gowns, while along the back were paper towels, notebooks, and office supplies. I noticed some military-issue canvas cots where exhausted morgue workers might catch a catnap during breaks, and in the center of the tent were a half-dozen folding chairs surrounding a makeshift table-a large wooden spool normally used to hold a coil of steel cable. It remained me of something you'd have at a fishing camp.
This table held the sign-in sheet that each of us had to initial each day before we scattered to our various assignments. The DMORT supervisor on duty, Cliff Oldfield, knew that this was my first day, so he told me to stand by. In just a few minutes, he promised, he'd tell me everything I needed to know.
When Cliff brought me over to the morgue, Amy Zelson Mundorff, the forensic anthropologist who worked full-time for the city's chief medical examiner, was ready to greet me. I saw immediately how personal this tragedy was for her and her colleagues-although she was smiling brightly, large purple and green bruises ringed her eyes, and her forehead sprouted a lump large enough to cast a shadow. Cliff had told me that she, along with Dr. Hirsch and several other OCME staff members, had rushed to the Twin Towers shortly after the first plane hit. They were in the process of trying to establish a site for a temporary morgue when Tower 2 had come crashing down. The blast blew her headfirst into the marble pillar of a nearby building, while Dr. Hirsch escaped death by inches. One staff member suffered a massive concussion and fractured ribs, and another's leg was shattered, leaving bone and muscle exposed to the air.
However, Amy, just barely five feet tall and sporting a head full of curly black hair, was still very much alive and eager to get on with the business of victim identification. After she gave me a whirlwind tour of the medical examiner's office, we wound up at ground level in the morgue tent, where she took her place at the first autopsy table, the one designated for triage. As she worked, she quickly explained the overall recovery and identification protocol.
The protocol we were using was based on the emergency plans that the OCME had developed well in advance of September 11, with modifications that Dr. Hirsch had added when the scope of the disaster became clear. This protocol fascinated me: It was both different from and similar to the setup at the other incidents I had worked.
Most mass-fatality morgues are set up in sort of an assembly-line format. Rescue personnel bring in bodies or body parts to be photographed, x-rayed, and preliminarily identified by careful scrutiny of superficial characteristics such as hair color, skin color, clothing, and perhaps jewelry.
If the body is relatively intact, the forensic pathologist will conduct an exam that is not too different from normal autopsy protocol. He or she will photograph, weigh, measure, and describe the body in painstaking detail, including observations on its overall condition and any old scars or other evidence of surgery that the preliminary exam might have missed. The pathologist will also document the acute injuries that most likely caused the person's death-documentation that would eventually include photographs and a detailed written or dictated description.
In some cases, as in the Oklahoma City bombing, living perpetrators are involved who may eventually stand trial for murder. The medicolegal details of autopsies might well have ramifications for their criminal prosecution.
But the attack on the Twin Towers was a completely different situation. There was no reason to conduct traditional medicolegal autopsies: Millions of people had witnessed the events as they happened. We all knew that these were deaths by homicide and that none of the hijackers could have escaped alive. It would be virtually impossible to identify the specific causes of death for each victim. All that mattered was identifying the victims themselves-but that task was difficult enough.
Here, the first step in the identification process was triage, a French word that means “to separate.” The term is used primarily in battlefield or medical situations, where patients or victims are separated into categories based on how urgent it is to treat them. This triage process began with a forensic anthropologist who had to identify and separate every single bit of human tissue that came through the morgue door. If a bag came in filled with a twenty-pound mass of muscle, skin, and bone, we had to be able to tell either by feel or by sight if the tissues were connected. If a bone led to a tendon, and then to a muscle, and the other end of the same muscle was connected to yet another bone, then the entire specimen could stay together and be processed as a single set of remains, because the “connections” established the fact that these were the remains of one person. But if we determined that there was no physical connection between one part and another, then we'd separate the remains and give them two different case numbers. Hopefully, DNA analysis could later link the two, but for now we kept them separate.
Triage could also reunite body parts. If we found two ends or sides of a fractured bone in this mass of tissue, the broken surfaces of which we could match or “reapproximate,” then we could say with all confidence that these two pieces were from the same victim. Our ultimate goal was to match all of the remains with a name, but much of that would come later, through DNA analysis.
Sometimes, an entire body arrived. More often, we had to sort through mangled remains-shards of bone, shredded flesh, the fragments and pieces that remained after the conflagration-identifying them as best we could.
Once an anthropologist had completed that first step, morgue workers carried the remains over to the pathologists working at the other end of the morgue. These men and women assigned each body or body part a case number, examined the tissue, and collected samples for DNA analysis. Morgue staff would then label the samples. They had already started an individual case file on each body or body part, documenting everything we did with it along with everything we could find out about it.
An escort then took custody of the tissue, making certain that the body or remains arrived wherever the pathologist thought they should go next. Perhaps the fingerprint expert could provide further help in identifying a finger or a hand, or the dental identification unit might analyze a tooth that had emerged intact. Maybe an x-ray could determine whether a bone or bone fragment revealed previous evidence of breaking or surgery. Any of these steps might be crucial in ultimately identifying these precious remains.
When the specialists had finished their analysis, an escort would hand-deliver the remains to Memorial Park, where everything was stored pending DNA analysis. Hopefully, that analysis would ultimately enable these bodies and body parts to be returned to their grieving families. Meanwhile, a huge team of investigators upstairs at the medical examiner's office was busily trying to match the reports from the pathologists with the missing persons reports, hoping to get results to the families even before the DNA results came back.