Three weeks after disaster struck, people were still sweeping glass – a noise that has become all too common across neighborhoods in Beirut. Everyone has a story to tell, and in telling theirs, people hope to piece together an understanding of what had happened.

But what had happened is too painful to reckon with: More than 200 dead, 6,000 injured, thousands forced out of their homes, countless buildings reduced to rubble or under threat of collapsing. Hospitals at the epicenter were not spared, and patients had to be evacuated from those rendered non-operational.

At a little over three kilometers from the blast, LAU Medical Center-Rizk Hospital was one of the city’s main hospitals that were geographically close, and that, despite sustaining damage, had remained open. Shaken by the blast, but wasting no time to find out the cause, attending and off-duty physicians, nurses, residents and staff mobilized to receive casualties. Little did they expect the apocalyptic scene they would witness and the untold number of patients, more than 350, they would end up treating that fateful night.

Clinical Assistant Professor and Acting Chair of the Department of Radiology Daniel Mahfoud was at his desk in the hospital when the first explosion went off. As he leapt out of his chair, the second blast sent a window crashing down where he had been sitting. He rushed to check on his team, and once he had established that no one was harmed, his first thought were the patients who would come flooding in from the ER and the urgency of clearing the radiology floor from the rubble.

Neuroradiologist Michel Mawad – who is also LAU’s president-elect and dean of the Gilbert and Rose-Marie Chagoury School of Medicine – was already there, having had to sidestep shattered glass and debris, amid the chaos of ambulances, cars, motorbikes, and people in a panic.  

Within minutes, the radiology floor was overrun with patients sent from the ER for imaging. “There’s no way to describe what was going on in there,” said Dr. Mawad, “multiple stretchers, full of severely injured people, some unrecognizable. Their eyes were swollen, their faces lacerated by projectiles and glass shards, several head and neck injuries, and a lot of bleeding.  Ten to 15 percent were not responding – breathing but not responding.”

Meanwhile, Program Director of Radiology Residency and Acting Division Head of Interventional Neuroradiology Raghid Kikano, who was heading home, heard the blast when he had reached Mkallis. He began receiving messages on his phone that the hospital had been damaged, and turned back, not realizing the scale of the explosion.

“When I arrived at the radiology department,” he said. “I thought I had made a mistake and walked into the ER instead. There were people on stretchers, on chairs and on the floor.”

By then, the ER had reached capacity and radiology had turned into another triage area. “We had nurses and residents triaging patients in a cleared-out area, to identify who needed a head or body CT Scan, and who needed an X-ray,” said Dr. Mahfoud.

To expedite the process and avoid confusion, they resorted to using body markers to write the results of a scan on the patients’ chests, arms, legs for the attention of physicians in the ER and the Intensive Care Unit (ICU), or to identify whether they required a body/head scan or an X-ray.

“We even needed some form of security as some people barged in wanting to put loved ones on the CT Scan and we had to reason with them to adhere to the order of priorities, and organize all this single-handedly,” said Dr. Mawad. And there were those who were shell-shocked, “the quiet people,” who are the ones who usually warrant immediate attention.

Patients were scanned back-to-back, like in an assembly line, with two technicians on each modality: As one finished with a patient the other would prepare to receive a new one. And triaging, a critical step in the process, posed its own challenges. The medical teams had to make sure that no patient would need intubation while on the scanner, because then they could not be moved.

“We were working like machines,” said Dr. Mahfoud, “seeing patients in assembly, one after the other. Whenever I close my eyes, I can vividly see every step, every patient we had seen.”

All in all, the radiology floor completed 50 to 60 consecutive scans between seven p.m. and three a.m., and close to 200 CT scans that night. To put it in perspective, a busy 24-hour period would involve around 40, with each usually requiring 15 to 20 minutes to complete. A week later, the department was still matching scans to patients’ names.

Quick thinking and mobilization by Radiology Manager Jessica Saad ensured that the medical team was well-supported. Off-duty that day, Saad jumped into her car and drove all the way from Ain Saadeh, while calling in technicians, Registered Nurses (RNs) and transporters who were not on duty to report. There, drawing on her first aid training, she gave whatever assistance she could, lifting patients and helping nurses.

After spending an hour on the road from her home in Jdeideh, Radiology RN Ellisone Abou Serhal set straight to work, compressing arteries, moving patients with fractures on stretchers and onto the scanners, and making sure none lost consciousness.  “No amount of stretchers and transporters would have been enough to cope with the situation we had at hand,” she said. “Looking back, I don’t know how we were ever able to accomplish what we did that night.”

In spite of their many years of experience, the physicians were shocked by the nature of the injuries they saw, severe trauma to the face and head, more like injuries resulting from an earthquake than an explosion. Although they had gone into emergency mode seamlessly and managed to deal with the influx of patients, they were not unaffected by what they saw.

That night, Dr. Kikano dragged himself to the office every hour or so to remove his mask and collect himself, but he only realized the horrors of the incident the second day.

“I treated the mom of the three-year-old who didn’t make it. She had rib fractures. I told her that her injuries were not extremely serious, and her response was: ‘Yes, but my daughter is dying.’” It was only the day after, when he saw the photos of the daughter circulating on social media, that he realized who the mother was.

Third-Year Resident Rana Asmar will forever remember the 24-year-old she had to transfer to radiology for a brain scan when he started having seizures while she was suturing him in the ER. He had lost consciousness and woke up asking whether she was his sister. “I said yes, because I needed him to stay stable, and kept on talking to him as if I really was. This was very traumatic for me – I will never forget his name,” she said.

The atrocities Dr. Mahfoud had seen, the luck they had had, and the greatness of his team, only registered after he had sat down at four a.m. “We were each able to fit into his or her role perfectly – without disrupting each other’s line of work – it was truly a blessing.”

“While we all may be suffering from post-traumatic stress disorder,” he added, “I feel that we, as physicians, were able to disconnect from the blast, get to work, and help in saving lives.”