Dr Palmer Bessey: Out of the flames, a chance of life for the wounded few

On Wednesday 12 September at 6.35 in the morning, Dr Palmer Bessey began cutting open patients. They had been so badly burned that up to eight gallons of saline fluid had to be pumped into each, putting intense pressure on the lungs. The surgery was the only way they could breathe.

"All the guts fall open. It is very unpleasant and we normally have to do it very, very rarely," he said. "But that day I had to do four, one after the other. They would have died otherwise."

Whether many will survive in any event is open to doubt. The burns unit at the Cornell University Medical Center received the very worst of those who had fallen victim to the inferno of Twin Towers. Burns of more than 15 per cent of the body's skin are categorised as severe, and here they were getting cases of 70 per cent to 85 per cent.

There was one man who came with 100 per cent burns. He died soon afterwards. But since then the unit had lost just one other patient. Twenty three others have been saved, for the time being.

The William Randolph Hearst Burns Center, to give its full title, is recognised as foremost in its field in the Western world. But there was no way staff could have been prepared for what happened the morning of Tuesday, 11 September.

"It was an awful, awful thing. Not just the medical aspect, but the emotional one as well. We knew people who were in there. It was unbelievable. How could anyone do such a thing?" Dr Bessey shook his head.

The Medical Center is 100 blocks from what is now called Ground Zero. "Frankly, we were expecting more patients," said Dr Bessey, 57-year-old associate director of the Center. "They did not come – that was the most awful thing. We realised just how many must be missing."

Since then the doctor has been working around the clock, with only three hours sleep a night. The fact that he and his colleagues have managed to keep so many of the victims alive has been described as miraculous.

Standing in the corridor of the unit, a slim, silver-haired figure, tiredness engraved on his face, Dr Bessey is careful not to raise hopes. "What we have here is as bad as it gets," he said. "We can only do our best..." He raised his palms.

Around him are the cubicles where the patients lie. Each door has taped to it a piece of paper bearing sketches of the front and back view of a human body, with the burnt areas shaded. The amount of shading varied. One woman's chart showed 82.5 per cent. Everywhere but her chest, one thigh and the front of the pelvic area were shaded. There were other shades on other diagrams. The only constant figure was the date of the admissions – "11/9".

The cubicles were whitewashed, bright, with dashes of colour from framed prints on the walls. There were televisions and the New York skyline loomed through the large, spotlessly clean windows. One looked at all those things, not really wanting to look at the figures who were lying on the beds. Once one did, there was a glimpse of just how utterly terrible their experience must have been. One of the patients raised his heavily bandaged hand in greeting. A visitor sitting beside the bed – a young woman – perhaps his wife, looked up and smiled.

"It does not matter how long I am a doctor, the human spirit never ceases to uplift me," said Dr Bessey. "The injuries I saw were pretty awful. A lot of them had bad bruising to their chests. That was caused by the sheer force of the explosion, it was as if they were hit very hard with a heavy weapon. There were others who did not appear to have any signs of burns. Then you saw that what had happened was the heat was so intense it had melted synthetic clothing on to their bodies. There was one woman badly burned on the thighs and buttocks from her stockings. There are about twice as many women casualties here than men."

The patients' rooms are kept at a constant 85 degrees fahrenheit – with so much skin tissue having been scorched away, the body can no longer provide the correct functioning temperature for internal organs.

In such a heated room lay Manu Dhingra. At 27 he was the youngest of the victims. His entire face, both his arms, his stomach and his back had been severely burned and he had undergone several operations to remove the dead skin.

Mr Dhingra was on the 83rd floor of the North Tower of the World Trade Center, on his way to the offices of Andover Brokerage, when the first plane crashed into the building. Dragged along by his colleagues, who lied about the distance covered to keep him going, he made it down the stairs. "I am lucky," he mouthed, swathed in bandages.

"He has about 35 per cent burns and I think there is a good chance that he will pull through," said Dr Bessey. "While he was going down the stairs, he saw firefighters going up in the other direction. This is something which has been troubling him.

"The oldest patient we have got is a woman of 60. She has 70 per cent to 75 per cent burns. It is a very painful process, recovery, all we can do is hope."

Vasana Mututanont, a mother of three, was already well into her journey of pain. Severe burns result in the body's nerve endings being deadened. But that does not last. Ms Mututanont, who worked at the Thailand Board of Investment, was on her way in through the turnstiles of the World Trade Center when she saw flames seeping through the elevator doors.

She ran back out on the street and should have escaped – but, as she ran, she snapped a tendon and fell, lying helplessly as terrified people streamed past her. The flames then reached her.

Over the past week, Dr Bessey and his colleagues had been carrying out multiple skin grafts on Ms Mututanont. They shave a thin layer of healthy skin from unburned parts of her body and cut perforations into the healthy skin to stretch it out. These patches are then attached to the places where no skin is left.

Dr Bessey and his colleagues continue with this kind of surgery on the patients day after day before returning home, exhausted. "I try not take my work home with me," he said. "But my wife Sarah and our two children, they are both grown up now, are obviously deeply affected and we have been talking about what happened a lot."

The burns unit has a long-standing association with the New York Fire Department, which is one of their sponsors. "A lot of firefighters I knew died there," said Dr Bessey. "There was one man in particular who had been badly burned tackling a fire and we treated him here. He actually recovered and returned to duty last week. I believe he was lost last Tuesday."

In its promotional literature, the burns unit once used a picture and words of support from Timothy Stackpole, a New York firefighter. Last week, there was a notice in the New York papers of a funeral mass for firefighter Timothy Stackpole at the Good Shepherd Church, Brooklyn.

"We can only grieve for the dead," said Dr Bessey as he walked off to do his rounds. "But we must fight every inch of the way for those who have a chance, however slight, of staying alive."