It started with a thundering noise and a prodigious shake to my car on my way to my call. It felt so close, but it turned out to be miles away. I am taken over by a sense of urgency. Something is wrong, very wrong. Drive on as fast as you can to reach the hospital. The phone starts lighting up with back-to-back notifications. “Are you safe? What was it? Where was it? Is it an attack? Is it an assassination attempt? Turn around and come back home.” Impossible.

I reach the outskirts of Beirut and start seeing shattered glass, occasionally at first, then more frequently, and then constantly. Every single facade of every single building is destroyed, blown away by a blast of epic proportions. “Code D full activation” resonates on my phone. When you live in a country such as ours, you are familiar with disaster protocols. This is the equivalent of an “all hands on deck” call with mass casualties expected. I rush on. I need to call and tell my colleagues I am on my way but phone lines are overloaded and I cannot get through. Maneuvering on doomsday roads, I have to go around smashed cars, fallen facades, and debris everywhere. I have to stay focused; I must reach the hospital at all costs. The emergency department and operating rooms will be flooded... it might already be the case. There is so much shattered glass on the road that it forms a thickness resembling snow. I hope my tires hold. The closer I get the more difficult it is to push forward. I hit a traffic jam, and my attention moves from the road to the surroundings. Nothing prepared me for what I saw; no science fiction movie can ever even come close to those visions of apocalypse. Streams of people coming out of whatever structures are left. Dazed, lost, bloodied, limping, screaming, and crying. My heart is pounding at what seems like a million beats per minute. Let me through! I have to get to my destination; this is where I can be of help. After what seems like an eternity, I reach the hospital and rush to the OR.

Pandemonium is the word that comes to mind. A constant, unstoppable flow of patients needing lifesaving surgery is at our doors. The recovery room is a new ICU/holding area while waiting for operating rooms to be freed. Left and right nurses, residents, and ancillary staff call for our attention. Desaturations, hypotensions, cardiac arrests…. Being a neuroanesthesiologist, I have never seen so many blown pupils, so many raccoon eyes, taken care of so many craniotomies/craniectomies at the same time. You have no time to take a breath, no time to change your blood-drenched scrubs, no time to even think about protecting yourself from COVID-19. Years of experience in anesthesia have molded us into highly efficient and precise working machines. That night we used every single ounce of that acquired experience. IVs, central and arterial lines, blind intubations—you name it, we did it. We gave it our all without thinking, and the adrenaline rush kept us going. While racing from one OR to the store to get more supplies I bump into my colleague and friend. We stop and our eyes meet. The background noise and activity fade away. No words are exchanged, but we understand each other. Is this possible? Is this really happening? Are we dreaming? “Doctor! Doctor! Patient arresting in room 3!” We are yanked back to reality and rush to see a patient lying in pool of blood receiving CPR. We need blood! Someone get us blood! My resident whispers in my ear, “doctor I just gave him the last unit we had. The blood bank has no more blood.” What? What do you mean there is no more blood! The nightmare continues. The patient does not survive. He was “unknown young male number 3.”

I cannot remember how many patients of mine passed away; in fact, a lot of what happened that night is somewhat foggy in my mind. Maybe that is for the better; maybe it is my brain’s protection mechanism in order to remain sane. I do remember vividly, however, receiving multiple phone calls from people I did not know who found out I was in the OR and who were looking for missing loved ones. “Please doctor, they told me you are on call, I am looking for my father, his name is X. Is he in the OR?” “I am sorry dear; we don’t have any names yet for most of the patients.” “Please doctor I will send you his picture. Can you see if anyone looks like him?” I searched every single OR and all the patients in recovery room, looking for that man and could not find him. I repeated the process for other missing persons as well. Those pictures and those pleas from family members I will never forget. They are forever imprinted in my mind.

That night ended and was followed by days where the flow of patients kept coming, this time for less acute and deferred procedures such as orthopedic and plastic reconstructions. Few are the colleagues or residents who have since talked about those hours. I know I have not. These few written words might be part of my catharsis. It is impossible for me to foresee a return to any kind of normalcy in my life; however, I am acutely aware of the mixed emotions that run through me at this time. There is an unshakable feeling of unease, of chest oppression; a feeling that you are being crushed by an invisible weight and that you are in a constant fight to breathe. Those feelings blend with bouts of anger and rage at the senseless loss of life and the avoidable destruction of a beautiful city for which I weep multiple times a day. You then think about how lucky you are to still be alive, uninjured, able to care for your children and shield them from those horrific images. You feel proud to see people of all backgrounds come to the aid of total strangers, proud to see selfless healthcare workers care for patients at the risk of being injured themselves or disregarding their own injuries while treating others. Resilience also comes to mind. How else can you explain the will and strength people have to go on, to clear out the rubble, the glass, the destruction, to patch the injuries, and to think about rebuilding? Near complete destruction is not new to Beirut; it has fallen many times throughout its history, and we shall add to that history the devastating events of August 4, 2020. Nevertheless, not unlike the human spirit that can be beaten up, damaged, but never entirely broken; let us hope that Beirut will rise again.