Keeping Track of How We Die

I am writing this on September 11, 2018.  Across the United States today, memorial services are being held to honor those who died on that fateful day 17 years ago. Honoring of the dead is one way the living heal their trauma and make sense of the unimaginable.

In the immediate aftermath of 9/11, officials were confronted with how to identify the dead and injured.  In some cases there were no bodies.  Data had to be collected over months and pieced together in order to get an accurate count of those lost.

CDC           The Centers for Disease Control (CDC) collects information on mortality and morbidity here in the United States.  These figures are shared with the World Health Organization (WHO) and studied world-wide to identify the many ways we humans shed our mortal coil.  There are specific protocols used to identify the different categories of death and dying.  Here in the U.S., this coding is done by medical personnel and coroners in every state and sent to the CDC using specific codes.

Almost immediately after 9/11, states were contacting CDC for guidance on how to classify deaths associated with the attacks and hospitals were seeking guidance on how to classify injuries.  Never before on American soil had so many people been killed as a result of an act of terrorism.  Yes, smaller numbers had been killed or injured in riots, due to shooting or bombs or poison gas, but not by using planes to crash into buildings.

The CDC pondered questions including how to code for the cause (plane crashing into a building) with the intentionality of the act (terrorism)? And how do you address the subsequent deaths attributable to unanticipated consequences, such as the breathing in of toxic ash?   No such codes existed.  So, the CDC convened an ad hoc committee to address this and other issues, such as how to identify injuries associated with First Responders, long-term consequences of illness and injury that are attributable to the events on 9/11.    Here is a selection of what they came up with:

U01 Terrorism

Includes: Assault-related injuries resulting from the unlawful use of force or violence against persons or property to intimidate or coerce a Government, the civilian population, or any segment thereof, in furtherance of political or social objectives

*U01.0 Terrorism involving explosion of marine weapons

*U01.1 Terrorism involving destruction of aircraft

Includes: Aircraft used as a weapon

Classification for Morbidity

E979 Terrorism

Injuries resulting from the unlawful use of force or violence against persons or property to intimidate or coerce a Government, the civilian population, or any segment thereof, in furtherance of political or social objective

E979.0 Terrorism involving explosion of marine weapons

E979.9 Terrorism, secondary effects

Excludes late effects of injury due to terrorism

E999 Late effect of injury due to war operations and terrorism

E999.0 Late effect of injury due to war operations

E999.1 Late effect of injury due to terrorism

            This is just a brief excerpt from the very detailed listing of ways we humans cause pain, suffering, and death in other humans in the name of some cause.  It is, to me, a sad acknowledgement that no matter how advanced we become technologically, we find ways to use those tools as weapons.

These classifications are useful for statistical analysis.  They do not, however, capture the full arc of pain and suffering experienced by those who witnessed the events, who lost loved ones, and who each year, on this date, may be re-experiencing what they endured.  Today, as the names of those who were killed are read aloud, I find myself wondering about the individual lives that were irrevocably changed that day.

As a child, my grandfather, who was a World War I veteran, taught me to face East at the 11th hour of the 11th day of the 11th month in honor of the Armistice signed.   Reading about that war in history books did not carry the emotional weight my grandfather felt. My sole connection to those events was through his honoring of his comrades.  It has remained with me because of my grandfather placing value on that observation.  These memories echoed as I watched the solemn ringing of bells across the nation.

JFK-Arlington
John F. Kennedy grave, Arlington National Cemetery

Similarly, walking among the headstones in Arlington National Cemetery and standing before John F. Kennedy’s perpetual flame carries with it the “re-membering” of those events.  Just as today’s children remember where they were when the planes flew into the Twin Towers, I remember sitting in music class and being told that President Kennedy had been shot and killed.  I remember being sent home for days as the black and white TV coverage of the funeral took place.  More funeral corteges and more TV coverage came after students were killed at Kent State, after Robert F. Kennedy was assassinated, and after Martin Luther King was shot down in Memphis.  Ours was a generation raised on TV coverage of violence and threat.

We are better today at identifying who and how individuals die.  The CDC and the WHO keep records that provide us with statistics in excruciating detail on how many people have been lost to terrorism.  Rarely do the numbers tell the whole story.  Today I watched as grandchildren of one of the passengers killed on Flight 93 in Shanksville, Pennsylvania, read their grandfather’s name out loud.  They were too young to have remembered the event, but they were old enough to feel the loss of their grandfather.  I wonder what their memories will be on this day in future years?

It takes the soaring eloquence of Abraham Lincoln to fully capture the effects of loss due to terrorism.  In the Gettysburg Address he said:

            But, in a larger sense, we cannot dedicate — we cannot consecrate — we cannot hallow — this ground. The brave men, living and dead, who struggled here, have consecrated it, far above our poor power to add or detract. The world will little note, nor long remember what we say here, but it can never forget what they did here. It is for us the living, rather, to be dedicated here to the unfinished work which they who fought here have thus far so nobly advanced. It is rather for us to be here dedicated to the great task remaining before us — that from these honored dead we take increased devotion to that cause for which they gave the last full measure of devotion — that we here highly resolve that these dead shall not have died in vain — that this nation, under God, shall have a new birth of freedom — and that government of the people, by the people, for the people, shall not perish from the earth.

Thanks for reading.

3 comments

  1. Every war in human history has come to an end eventually. Why not simply agree to non-lethal ways of settling disputes? We could have paintball or taser battles. The first country to “lose” 1000, 10,000 or 100,000 soldiers, has lost the dispute. Then we make peace, without the carnage that currently results.

    1. “Why not”, Mark asks. Well because decisions aren’t made for whole-world well-being. We don’t have a benevolent set of parents with the power and wisdom and omniscience. Ponderings like this make such good sense…until you consider the inherent impossibility. Would that you, Mark, had the power. You certainly have the wisdom.

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