In the hospital, the agony of not being able to rescue the victims of the school shooting: Gunshots

On Monday, people walk past the Monroe Carell Jr. Children’s Hospital at Vanderbilt in Nashville, Tenn., where victims were taken after a Covenant school shooting.

John Friends/AP

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John Friends/AP

On Monday, people walk past the Monroe Carell Jr. Children’s Hospital at Vanderbilt in Nashville, Tenn., where victims were taken after a Covenant school shooting.

John Friends/AP

By Monday morning, Dr. Joseph Fusco had started what seemed like a normal work week at Monroe Carell Jr. Children’s Hospital in Vanderbilt, where he specializes in childhood cancer and neonatal surgeries.

Shortly after 10 a.m., after his routine morning rounds, the pediatric surgeon was heading to the operating room when a page alerted him: An ambulance was en route to Nashville Hospital carrying a gunshot victim. seriously injured.

Then came another page, and another, and another, and another. Three of the victims, he soon learns, are only 9 years old.

Four miles from the Vanderbilt campus, a 28-year-old shooter opened fire on Covenant School, a private elementary school on the grounds of a church in the Green Hills neighborhood of Nashville. Six were killed: school principal Katherine Koonce, caretaker Mike Hill, substitute teacher Cynthia Peak and three third-grade students – Evelyn Dieckhaus, William Kinney and Hallie Scruggs.

A total of five of the victims of Monday’s school shooting were transported to Vanderbilt University Medical Center and its affiliated children’s hospital, hospital officials said.

“You’re kind of in shock when you get something like that,” Fusco said, recalling his reaction upon seeing the pages. “This should never happen to children.”

In the blink of an eye, the machines at the Level 1 trauma center swung into action: the operating rooms were prepped with surgical instruments and blood for transfusions. The administrators have prepared a family space. Hospital security was alerted. Staff of all kinds gathered—nurses, nurse practitioners, doctors, surgeons, spiritual leaders, social workers—all ready for action.

Dr. Joseph Fusco (left) was on call Monday as an emergency pediatric trauma surgeon at Monroe Carell Jr. Children’s Hospital in Vanderbilt. Dr. Alex Jahangir (right), who directs the Vanderbilt Center for Trauma, Burn and Emergency Surgery, helped lead changes to Vanderbilt’s mass casualty response plan.

Erin O. Smith, Susan Urmy/Vanderbilt University Medical Center

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Erin O. Smith, Susan Urmy/Vanderbilt University Medical Center

Dr. Joseph Fusco (left) was on call Monday as an emergency pediatric trauma surgeon at Monroe Carell Jr. Children’s Hospital in Vanderbilt. Dr. Alex Jahangir (right), who directs the Vanderbilt Center for Trauma, Burn and Emergency Surgery, helped lead changes to Vanderbilt’s mass casualty response plan.

Erin O. Smith, Susan Urmy/Vanderbilt University Medical Center

Fusco, on call that day as an emergency pediatric trauma surgeon, was among the doctors who saw the patients arrive for a quick initial assessment.

But by the time they arrived at the children’s hospital, the three young patients were already dead.

“The wounds that are present on the bodies of these children – I mean, not to be horrific, but I think it’s enough to say that the wounds caused by these weapons are essentially insurvivable for children,” he said. he declares.

Children’s bodies are particularly susceptible to damage from high-powered weapons

Police say the shooter, identified by authorities as Audrey Hale, used three firearms in the attack, including an AR-style rifle.

Most firearm deaths and injuries are caused by handguns, the bullets of which generally pass directly through targets. In contrast, military-style rifles shoot with such power that their bullets can shatter bones and vital organs.

“As a trauma surgeon, I can tell right away if someone’s been shot with a handgun versus a high-powered assault rifle,” said Dr. Alex Jahangir, who directs the Vanderbilt Center. for Trauma, Burn and Emergency Surgery. The rifle “is exponentially worse, obviously,” he added.

Children are even more likely to sustain serious injuries from military-style guns, doctors said. Their bodies are more compact, their vital organs smaller and closer together, making it easier for a single bullet to cause catastrophic damage.

Gunshot wounds are a reality for trauma surgeons in major American cities, even for pediatric surgeons like Fusco – guns are the leading cause of death among children in the United States, killing thousands every year .

Still, despite more than a decade of training and experience as a surgeon, Monday’s shooting was the first time he’d seen a child “attacked with something like that,” Fusco said.

“It goes against all the training I’ve had for so long,” he said. “Throughout the residency, the fellowship, you see thousands and thousands of patients. You are taught to help and to do whatever you can to help them.”

Finding out that he couldn’t leave him and his colleagues in despair.

“You’re so prepared. We’re so well prepared to help you. We’ve had nurses come from your home to the emergency department. Everyone’s here,” he said. Instead, all they were left with was “the feeling of sheer helplessness when you have patients coming in with injuries that are simply insurmountable.”

Hospital staff were prepared but left emotionally drained

VUMC officials revised the hospital’s mass casualty response plan after a man opened fire on a music festival in Las Vegas in 2017, killing 60 people and injuring hundreds.

The hospital is located in downtown Nashville, a city famous for its own vibrant music culture. “We said, you know, we’re not immune to that,” said Jahangir, who helped lead changes to the plan.

Since then, Vanderbilt has put the plan into action a handful of times each year, Jahangir said. Sometimes the event that causes many victims is a tornado. Other times it’s a serious accident on the highway. Sometimes it is a mass shooting, although school shootings are rare.

Photos of the victims killed in a mass shooting Monday at the Covenant School are attached to a memorial by Noah Reich (left) and David Maldonado of the nonprofit Classroom of Compassion, near the school Wednesday in Nashville , Tenn.

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Photos of the victims killed in a mass shooting Monday at the Covenant School are attached to a memorial by Noah Reich (left) and David Maldonado of the nonprofit Classroom of Compassion, near the school Wednesday in Nashville , Tenn.

Seth Herald/Getty Images

“It became apparent that it was serious and it was maybe a little bit different from what we had experienced before, in that that’s what I think a lot of us, especially those in ‘between us with young children, always dread,’ he said of the alerts. Monday.

On Monday, the alert had ended by early afternoon, once it was clear that no more casualties would arrive, meaning that standby staff and facilities – surgeons, nurses , the blood bank, the operating rooms – would no longer be needed.

About 20 doctors and nurses gathered in a conference room near the emergency department to deal with the morning’s events. Some sat quietly. Others cried. “To be in this room, with people who are exceptionally upset, expressing this emotion, is difficult,” Fusco said. “The silence is deafening.”

“I’ve been a doctor for 20 years. You’re trained, especially back then, to kind of be tough and deal with it. And I think we’ve realized that’s not the right way to approach it” , said Jahangir. “We are not immune to the emotions that occur.”

As the city mourns the six shooting victims, plans for their funerals have been made. The first, for third-grade student Evelyn Dieckhaus, will take place on Friday afternoon; she will be buried on Saturday in a private family funeral. Others will continue over the weekend and into next week.

“Everyone is still shaken in the hospital, just like we are in the community,” Jahangir said. “It hits home.”