Typically, after a mass casualty event, an array of reporters line themselves outside a hospital, using our walls as the backdrop to their stories. Then, a press conference is held, during which, at some point, a surgeon will stand behind a pile of microphones, wearing clean scrubs and a pressed white coat describing the “how many’s”… How many patients, how many surgeries, how many injuries. Those numbers, however, are only a fraction of the real story that has occurred behind those walls of that backdrop.
This is the rest.
As trauma surgeons at Level 1 (meaning the highest level of capability) trauma centers, we are typically notified immediately after our law enforcement colleagues about an “active shooter situation”… before much or anything is actually known. And while the situation is evolving, then, the wait, the anxious anticipation, and the questions begin.
Resources are assessed. How many trauma surgeons are in-house (meaning in the hospital)? How many operating rooms have patients in them already? All open operating rooms are kept that way, explanations given to patients whose surgeries are held, with the barest of information possible. All to allow for as many available operating rooms as possible for as many injured patients as needed. The beds in the emergency department are reviewed – how many empty, how many full, where can we move our current stable patients? How many ICU beds do we have available for the critically injured? The blood bank is notified, as large quantities of blood may be needed. Triage areas are established for patients who come in cars instead of ambulances. Where will parents and family members be kept … waiting to find out if their child or loved one is there, and if so, what has happened to them? The Emergency Department becomes a hub, the center of a hive buzzing with energy, anxiety, and, most of all, determination.
The waiting happens, with minds and muscles tensed. You get information… slowly… piecemeal… a bit at a time… some of it correct, some of it not. The exact location. The number of people injured. The number of ambulances dispatched.
And then, the real crux. How many ambulances return, and are they full or empty?
After all, what is worse? Needing 10 ambulances or none… because they are all dead? What is worse? Having to witness moments you will never forget or never having the chance to change the outcome?
And when those 10 ambulances arrive, you hope… even knowing the high price to travel that road… a toll your soul will gladly pay… all for the chance, to save even one.
Those patients are unloaded and evaluated – all under the pressure of time.
Every second loudly making its presence known inside your head.
Tick.
Tick.
Tick.
Everyone’s eyes turn to you – wanting to help, wanting to be helpful, wanting to give this person another day.
Be quick, be efficient, be clear.
Be orderly, be organized, be thorough.
Be decisive.
This one needs surgery. This one doesn’t.
This person can be saved. This one can’t.
The lines are put in, the tubes placed, the blood transfused, and the surgeries performed.
Patients are identified, families are found, and families are told.
All amidst a visual and auditory cacophony of blood, pain, cries for help, and tears of sorrow. All images and sounds that can’t be processed now, but will be remembered forever.
And no one will be the same again… now a witness to that which we cannot unsee.
The surgeon you see behind that pile of microphones is not the same surgeon who walked into the hospital that morning.
The nurses who get in their car after work are not the same nurses who drove that car into work.
The environmental workers who mopped the floors, wiped down the walls… they erase the evidence of death and pain from the rooms, but not their hearts.
No one is the same. The EMTs, the ER physicians, the anesthesiologists, the radiologists, the nurses, the techs… all changed. Imprinted. Invisibly but palpably altered.
We aren’t represented in the numbers, the statistics that make the headlines. We are the invisible ripples, all created from the stones forcibly and uncontrollably thrown into our waters.
The next time you hear about another mass shooting, and your heart aches for the injured and the families, please let it ache a bit more… for us. Because we are still here, ready and waiting… to do it all again.
Jamie Coleman, MD 