Twenty-five years after September 11, 2001, Portuguese-American physician Paulo Pacheco remembers walking into the ruins of Lower Manhattan as a volunteer doctor on the morning after the attacks. Born on Terceira and raised in Rhode Island, he arrived expecting to help save survivors. Instead, he encountered one of the most haunting realities of that day: there were painfully few people left to save.
Hospitals are built around an expectation that the injured will arrive. On September 11, 2001, physicians at NewYork-Presbyterian/Weill Cornell Medical Center prepared for an avalanche of casualties from the World Trade Center. Beds, doctors and emergency personnel were readied. But as the hours passed, the expected multitude never came. For Dr. Paulo Pacheco, then working at the Manhattan hospital that housed New York City’s only burn center, that absence became one of the most devastating measures of the catastrophe. “The overwhelming majority of the people who were in the Twin Towers never had the opportunity to reach the hospitals,” the Azorean-born gastroenterologist recalled 25 years later in an interview with LUSO-AMERICANO.
Pacheco had been seeing a patient when his sister telephoned to tell him that an airplane had struck the World Trade Center. Soon afterward, non-urgent appointments were suspended and medical personnel were mobilized for what everyone assumed would be an enormous emergency. Only several dozen patients eventually arrived, some suffering catastrophic burns. The emptiness itself became unbearable evidence. Thousands had been caught in a disaster so sudden and destructive that medicine, waiting only a few miles away, could never reach them.
On September 12, Pacheco decided that waiting at the hospital was no longer enough. Wearing medical clothing, carrying his stethoscope and professional identification, he walked south through Manhattan until he encountered a fire truck. He told the firefighters he was a physician and wanted to help. They took him toward Ground Zero. What he saw along the way remains fixed in memory: nearly deserted streets; stores, pharmacies and food carts abandoned in haste; and dust and ash covering the city “as if it were snow.” Closer to the ruins came heat, smoke and the immense landscape of debris where two towers and thousands of human lives had existed only a day earlier. His presence among the emergency workers was subsequently captured in a photograph published by The New York Times.
When he arrived, Pacheco initially found only one other physician. Together they began organizing whatever medical resources were available. Other doctors gradually appeared, and over the following hours the improvised medical operation expanded until hundreds of professionals were assembled. They waited for survivors. Rescue workers would sometimes hear—or believe they heard—voices or cries coming from somewhere inside the mountain of twisted steel and pulverized concrete. Doctors, firefighters and police would rush toward those locations. Again and again, hope met silence. “The expectation was that we would find survivors among the debris,” Pacheco remembers. “But in the overwhelming majority of cases, there was no one who could be rescued.”
Medicine therefore turned toward those doing the rescuing. Firefighters and police officers came with cuts and other injuries, particularly eye problems caused by the extraordinary concentration of dust and debris. Pacheco treated them while confronting a professional paradox that has remained with him: he possessed the training and knowledge to save lives, yet stood inside a catastrophe whose scale had already placed so many lives beyond the reach of medicine. For a physician, accustomed to acting against illness and injury, helplessness itself became part of the trauma.
His presence there also belongs to the larger, often less visible Portuguese-American history of September 11. Pacheco was born on Terceira in 1967, the son of a father from São Miguel and a mother from São Jorge. His father worked as a civilian and translator at the American air base on Terceira; his mother was a teacher. While Paulo was still an infant, the family emigrated to the United States, first living in Middletown, Connecticut, and eventually settling in Bristol, Rhode Island, where he grew up amid a strong Azorean community. Science and an interest in people led him toward medicine, first at Brown University and later to medical training at Cornell in New York. He moved to the city in 1993 and made it his home.
Today, Pacheco combines clinical practice, teaching and healthcare management. He is a gastroenterologist in private practice and a clinical professor at NYU School of Medicine, while also working within a large Manhattan gastroenterology organization and participating in the management of endoscopy centers. Yet professional accomplishment has not erased what he witnessed in September 2001. Only recently did he visit the 9/11 Memorial & Museum, an experience that awakened emotions he had believed time had softened. A quarter century, it seems, is not always enough to create distance from certain mornings.
What September 11 ultimately left him was not only a memory of destruction, but a different understanding of time. “It is important to work and fulfill our responsibilities,” he says, “but it is also essential to make time for family, friends, experiences and what truly matters.” It is advice he now offers as both physician and father.
Twenty-five years later, the photograph of a young doctor amid the rescuers belongs to history. But behind that photograph remains something more intimate: an immigrant child from the Azores who grew up in America, became a physician, and when his adopted city was wounded walked toward the smoke carrying a stethoscope.
He went there to save lives. What he encountered instead was a lesson about their terrible fragility—and about the urgency of living them while there is still time.
Based on a story published in the newspaper Luso-Americano. The photo is also from LA.