Ten years ago today I ran to the trauma bay at the Hospital, after being paged “Trauma Team to the Trauma Room”. I was a third year medical student in my first month of clerkship, which happened to be Trauma Surgery. The junior resident and I were the first people in the room that morning, and I can still feel the vibrations of the multitude of ambulance stretchers rolling in the door. I can still hear the chaos forming around me, and I can still sense the bubble of calm I felt descend upon me as I realized this was no regular trauma – this was a Code Orange: a multicasualty disaster. This, was a college shooting.
Not long before, a gunman had opened fire in the cafeteria, where I sat and ate daily for a year, in the place where I went to school just ten years prior. Now, his victims were finally being brought to us at the hospital.
They rolled in one after another, into a space where usually we see at most 3 patients at a time, for a total of 13. Somehow, by transferring patients out of the the main ER and up to floors or out to other hospitals, we made room for all the kids (that’s what they were) and their various degrees of gunshot wounds. I remember diving right into the work – even preparing to intubate a young man who had a gunshot wound to the head (I believe it turned out to just have grazed his scalp). I remember the attending emergency and surgical staff advising me, directing me, and in fact letting me work quite independently. I remember the ER residents standing in the open doorway surveying the scene, deciding where/how to dive in and help – they had just come back from their academic half day and looked quite like lost puppies.
Most of all, I remember that through the noise, and the tumult around me, inside I felt calm, peaceful, directed. I knew what to do, knew how to do it, knew how to multitask in a safe way in this kind of situation.
How did I know this as a third year medical student? I teach third year students in the ED, who are in their first month of clinical work, and most of them know nothing. They don’t know anything at all. They know book learning, but put them in a resus room with sick patients and they are clueless.
I was a different breed – I had spent a year and a half plus some more summers as an ambulance medic in Israel during the second intifada. I had worn bulletproof vests to the scenes of bus bombings, putting my gloves on and my gear together in the back of a screaming ambulance. I had been in the midst of disasters of human making, and I had taken care of patients just like these kids – victims of despicable acts. So my brain, heart and hands knew what to do.
I suppose, however, that even though in the moment I find it easy to handle medical care in a disaster situation, the after effects are lifelong.
Today might be the ten year anniversary of the College shootings, but yesterday brought back other just as grim memories.
Out of nowhere, a man contacted me on Facebook and threw me back 13 years, to 2003. I was finishing my shift on ambulance 64 in Jerusalem when it happened. In fact, I was in the bathroom with my pants around my ankles, when a siren went off in the station. Jumping up I ran outside to see all the medics and volunteers rushing to the ambulances, so I did the same. Off we drove at high speed, my driver one of the first ones on the scene of a horrifying bus bombing – of the bus I would have been on if I hadn’t stopped to use the toilet.
My driver grabbed the stretcher and told me to stay with the truck, charged me with protecting it with my life from others who might try to take it or load it with patients. He dove into the scene, and while I waited and watched the horror in front of me, another medic ran up with a man on a stretcher. Lifeless. I could do nothing as he pushed the stretcher into the ambulance, but as I bent down to care for the patient it was clear he had not survived. It’s the first time I learned the word “X” in Hebrew – meaning, triage code black, already dead, do not transfer. My driver came running with another patient on his stretcher, and pulled the first patient’s stretcher back out to wait on the side.
I learned, in that moment, the true meaning behind multicasualty disaster triage.
Leave the dead, we cannot help them. Save the living. Quickly.
In the back of our ambulance with me lay a fellow ambulance volunteer – a young man, younger than I was, still in his ambulance uniform. Covered in tiny shards of glass and shrapnel. Crying in pain, afraid. I tried to wipe the mess off of him instinctively, and remember clearly looking down at the palm of my right hand to see a giant tear in my glove and blood on my hand. I spent the next many long (but really short) minutes of our lives examining him, but mostly holding his hand as we sped through the streets. Then I remember giving him to the doctors in the trauma room at the hospital, and going back outside to scrub down the blood and glass filled ambulance.
Yesterday, that patient found me on Facebook. 13 years older and an ocean apart, he looked me up. He’s now married with 2 children, and works as an ambulance driver himself. Looking at his pictures online, I felt myself melt into a mess of tears and joy. We saved a life that day, and here are the fruits of that – a marriage, 2 children, and a man who is saving others’ lives daily. So by saving him, we did in fact save entire worlds – his, his wife’s, his children’s, and that of every patient he helps over the course of his life.
Medicine is a crazy world, and what a blessing that it is part of mine.
I am grateful every day for all these experiences I continue to go through. Sometimes it’s easy to lose sight of what it is to be a physician, but then little things happen like a former patient finding you on social media, and it lights the way back to the reason I became a doctor in the first place.
I wanted to make a difference.
I wanted to help people.
I wanted to bring peace and solace in a time of darkness.
It turns out, in fact, that times of darkness in my own life have brought peace and meaning to my future.