Medical Miracle #3
Problem: Fifty-three-year-old FDNY ﬁre chief. Working in North Tower on 9/11 when South Tower collapsed. Narrowly escaped death; saw many colleagues killed. Post-traumatic stress disorder symptoms include nightmares, sleep loss, and severe anxiety. Experiments with cutting-edge virtual-reality therapy.
Doctor: JoAnn Difede
Patient: Stephen King
FDNY Battalion Chief Stephen King was in the lobby of the World Trade Center’s North Tower when the South Tower collapsed. “I always said to myself, I’ll never die in a fire because I know my job too well. I’m too smart. But I remember thinking, This is it. There’s no way you escape this.”
The force from the collapse shattered the building’s windows, covering King and his colleagues in dust and debris. King, now 57, couldn’t breathe or see; he and other firefighters grabbed each other’s coats and formed a chain to escape. The men began running once they got outside, but King, who had injured his left knee, couldn’t keep up. “What was running through my mind then was, Now I’m going to get hit by something and get killed in the street.” As the North Tower collapsed, King ducked into a subway station. He sat on the floor and waited until it was safe to leave. He survived, but many of his colleagues, including his aide Robert Crawford, who had arrived at the scene with him that morning, did not.
King began having nightmares within days. In one, he was back at the scene, and the only things holding up the structure were pillars. “I’m in there, going to myself, You gotta get out—it’s gonna come down. And then the whole thing just drops.”
When he wasn’t having nightmares, King couldn’t sleep. His head spun with memories of his lost friends. He worried about his 29-year-old son and his son-in-law—both firemen. King, who lives on Long Island, no longer liked to come to Manhattan, and if he had to come, he would take bridges, not tunnels, and race across them at 70 miles per hour. Even from the sidewalk, high-rises made him anxious. “I was always looking up, like maybe an air conditioner was going to fall out of a window and crush me. I just felt like some freak thing was going to happen,” he says. Survivor’s guilt set in: Why did I have to live? Why couldn’t I have died with them?
At first, King thought the nightmares and fears would go away with time. His family doctor gave him Ambien to help him sleep. When King ran out of his 30-day supply, he went back for a refill, but his doctor declined to write the prescription. He suggested King see a psychologist instead.
Even from the sidewalk, high-rises made king anxious. “I felt like some freak thing was going to happen,” he says.
In November 2001, King started to see JoAnn Difede, a psychologist with New York Presbyterian–Weill Cornell Medical Center, who diagnosed him with post-traumatic stress disorder. As it happened, Difede was pioneering a new type of therapy for acute PTSD that combined a traditional technique called Imaginal Exposure Therapy with a virtual-reality 3-D simulation geared toward September 11 victims. IET requires patients to repeatedly retell a therapist about a traumatic experience—the more realistically the better. The goal is to diminish the power of the trauma by forming a coherent memory of it. “You’re creating a memory that’s part of your life,” Difede says. “It doesn’t intrude when you don’t want it to anymore.” But IET is limited by the fact that some patients simply can’t recall very much; others don’t want to.
Difede, who knew that virtual reality had been used successfully to treat Vietnam veterans with PTSD, worked with another researcher to create a computer simulation that would reconstruct the sights and sounds of 9/11. Using computer-generated graphics and sound from ABC News tapes, they made a remarkably lifelike facsimile of 9/11. When King first heard about the therapy, “I thought it was like PlayStation,” he says. “What’s that going to do for me?” But after several months of talk therapy including IET, King believed he’d hit a dead end. A psychiatrist had put him on trazodone and Zoloft. “I was beginning to feel that I was never going to feel good again,” he says.
Later that winter, Difede fit King with a helmet and headphones and hooked him up to a computer for the first of eleven sequences to be viewed in weekly 75-minute sessions. In the first session, King found himself looking straight at the World Trade Center that sunny September morning. As he moved his head, he could see from the base of the towers up to the top. On another day, Difede played a sequence in which the first jet hit the towers—ambulances wailed and people screamed in the background. Even though the simulations weren’t entirely lifelike, they were plenty vivid. King’s heart would race, and he’d sweat. During one session, he remembered being in his car, going over the Brooklyn Bridge on the way to the Trade Center. He recalled pulling up to the building and seeing people jumping out of the windows. In the final session, the second tower collapsed into a cloud of smoke. As the simulations played, Difede would sometimes ask King questions meant to help him process what he was seeing, and if the therapy became too intense, they would stop. “She would say, ‘I think we did enough,’ and I would say, ‘No,’ ” says King. “I didn’t want to admit that it was too much.”
King says the treatment has made all the difference for him. He’s no longer taking any medication, his nightmares have stopped, and he’s sleeping normally. As for his fear of bridges and high-rises, “I’m not 100 percent comfortable, but I’m pretty darn close.”
Because of his injured knee, King was forced to retire after the attacks. But he still works on committees promoting safety equipment for firefighters, including new uniforms to protect against bioterrorism. Without the virtual-reality therapy, he says, he’s not sure what would have become of him. “I was in a shambles,” he says. “Now I’ve got my life back.”