[Ann Emerg Med. 2009;54:473-474.]
Three AM, November 30, 2007. Attending Emergency Service Assistant Dr. Kildiran calls, “A flight has crashed—we are on alert, and you may be called at anytime.” The long and silent wait—5:15 AM, and still no call—means no survivors.
It is 6:00, morning in the hospital. The time has come for organization of the Emergency Services Department and the hospital. Confirmation comes: no survivors. The only service we will be able to offer now is to identify the victims and provide morgue facilities, and I hope we can manage moral support.
The weather is frigid. Most of the victims' relatives will come directly from the scene of the disaster, cold, hungry, tired, and, most important, devastated by their loss. Some of them will not want to be outdoors; they'll need shelter and we must provide it. We'll need to warm them up, so we have tea and coffee machines set up at many points. Many will be hungry, so we provide food. Some will be elderly and infirm, and this will be a significant strain for them, so we arrange for extra emergency services staff, and for medicine and other necessary consumable goods. Most of them will have traveled long distances from other cities, and will be far from home, so we have the Guest House ready.
And then…the victims. We only have 9 morgue beds available, and there are 57 bodies coming. The weather is cold, but it won't be enough to keep the bodies in good condition, so we seal off the passage between the morgue and an adjacent area of the hospital. With the air conditioners on, we're able to cool it down enough that we'll have enough room for them all. We have also outfitted our makeshift morgue with clipboards, marking tags, and computers in preparation for the arduous identification process we'll be facing. It can be said, from a technical standpoint, that we are ready.
It is 12:15 PM. The rush begins, as victims and relatives start arriving simultaneously. Both the Emergency Services Department and the morgue become very crowded, and everyone wants the same thing: to be reunited with their relatives' bodies as soon as possible. It isn't as simple as that, though. Before we can begin returning any of the victims to their families, we must finish identifying all of them. The identification process is under way but cannot be completed until all bodies have arrived at the hospital. Over and over again, family members are comforted and calmed; they are convinced of the need to wait. Victims continue to arrive after hours that pass like years.
After the bodies have finished arriving, it is time for the most challenging part: identification. It is critical that each family be absolutely confident they have received the correct body. They must feel no doubt about whether they are burying the wrong person.
I learned much about antemortem care from colleagues arriving from Istanbul Forensic Medicine. This job demands the highest level of responsibility and attention to detail. The most difficult part is to approach the grieving family members with probing, clinical questions: “What are the physical properties of your relative? What is his or her height and weight, and what color and type hair does he or she have? Are there any missing teeth or any fillings? Has he or she ever had any surgeries? Are there any distinguishing marks, such as moles, scars, or tattoos? What type of clothing and accessories do they usually wear?” In order to minimize the suffering these simple questions inflict, they are always posed in the present tense; past tense is never used. The task carries a huge weight of responsibility and must be performed to a rigorous standard, as the information that is gathered will be used to match body parts with victims and victims with their families.
The next step in the process is even more challenging psychologically. Bodies and parts are removed from body bags, and the antemortem information obtained is used to match them to one another. They are rearranged into the nearest possible semblance of the person they used to be, and their identities determined. It is hoped that the condition of the body will at least be whole enough that relatives called to claim the body will recognize it.
Sometimes, in addition to a body in very poor condition, we are faced with another problem: some of the next of kin may have seen the person only a few times in their lives, and they've done the best they can, but they're not sure about the information they've provided. So now what should we do? How can the rest of these bodies be correctly identified?
When all else fails, we use technology. We obtain the images from the security cameras at Istanbul Airport. We hand them out to the victims' relatives. With a name written on them, these become very helpful tools. In cases where the victim's face is obliterated, unidentifiable, we are able to match clothing to the photographs taken before they boarded.
Finally, the identifications are completed, and we are able to return each of the victims' bodies to their true relations. It has taken 36 hours. During these 36 hours, forensic medicine specialists have been taking dental records, recording fingerprints, and saving tissue samples for DNA analysis.
After 36 hours, I am psychologically and physically exhausted, but filled with peace, and confident in the knowledge that each of the victims will be going home with the right family.
After 36 hours, I have learned something else. In a disaster such as this one, it is not only the physically wounded for whom we care. Our services are just as important to the psychologically wounded, to those ravaged by grief, and emergency services must be ready to provide needed services to these people as well.
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