A Firsthand Account From Inside Fort Hood

A letter a blogger friend forwarded:

Dear Family and Friends,

Thank you for your thoughts and prayers for us and the Fort Hood community, a community that has been deeply wounded both physically and spiritually. The past day and a half have been very challenging. I write to share my somewhat-insider perspective on the events. Please know these have been humbling hours for me and I write not to glamorize myself or this tragedy. I hope my personal experience is helpful as you all are processing the events.

At about 1:40 pm local time on Thursday, I was informed that a mass casualty situation was evolving at Fort Hood. At that time I was working in a trailer adjacent to the hospital. The only information I had was that one or more gunmen had opened fire at a SRP site, a type of processing facility where many soldiers pass through daily. Knowing the high density of soldiers at the SRP site, I braced myself mentally for the possibility of a large number of casualties. Upon exiting the trailer, I immediately heard sirens and saw several ambulances driving up to the ER bays, dropping off casualties, and turning right around to pick up more. I ran up to the hospital.

The hospital has pre-designated areas for personnel to report to in the case of a mass casualty/disaster situation. Ours (family medicine docs) is the family medicine clinic, located on the first floor of the hospital, about 100 feet from the ER. All casualties were going initially to the ER, where they were quickly triaged and dispersed from there to the operating room, our clinic, or elsewhere. There were already casualties being treated when I got to the clinic. We broke up quickly into teams, with one or more docs and nurses with each patient. All the patients had bullet wounds-not a common site in a family medicine clinic. Fortunately or not, several of the staff had extensive trauma experience from prior deployments. Initially there was no morphine available, so the halls were filed with shouts of pain as the patients were examined.

My first patient was a young second lieutenant. Her uniform trousers were cut almost completely off, a standard practice during trauma evaluation, designed to avoid missing any injuries. A bullet hole can be pretty small, and one injury can easily distract from others. The less immediately obvious wound can become deadly if not appreciated on the initial assessment. I had never treated a patient with a gunshot wound before Thursday. Thankfully the Army has sent us all the Ft. Sam Houston to an ATLS (Advanced Trauma Life Support) course, a course designed for exactly this setting, where a non-trauma-surgeon is evaluating and stabilizing a trauma victim.

When we asked the 2LT what happened and she was able to tell a sensible story in complete sentences, I knew that for the moment her airway, breathing, and circulation were intact. She had a tourniquet and some bright red blood on her left thigh, and said the shooter had looked her in the eye, then shot her in the leg. “He could have shot me in the head, but he didn’t.” I left the tourniquet in place, since it seemed to be working fine. I swept my arm under her body, looking for any blood when I pulled it out. Her vital signs were good. Her heart and lungs sounded good. She had IV access with fluids running. She had no other pain other than her leg where she was wounded, and she had good pulses and sensation in that foot, all encouraging signs. We gave her some morphine, removed the dressing and saw an entry wound, but no exit wound was visible. We got ready to take her to get x-rays.

Then, here comes the cavalry-the orthopedic surgeons arrived! They quickly examined the 2LT, agreed she was stable, and moved on. X-rays showed a bullet near her hip with no fractures. Much later in the night, after reviewing the patient’s x-rays with ortho again, she was released to go home with instructions to come back to our clinic in the morning for a re-check. A couple ER physicians came through to offer their help; not satisfied at saving lives in their own area, they offered their expertise to us as well. We were glad to have it.

We moved from patient to patient, making sure everyone was accounted for and getting the appropriate treatment and that their loved ones were contacted, to know that they were safe. Soldiers barely out of high school were dying in the ER. A new, young mother died on the operating room table. A family medicine intern with a baby of her own was there. There was no time to pause or grieve.

Based on the numbers you have heard, the vast majority of victims were treated at our hospital, but the flow of patients eventually abated. I was hearing little bits and pieces of what had happened; there were conflicting reports on the number of soldiers killed, the number of shooters, and the number of locations. A patient told me the shooter was in uniform, a Major, a field-grade officer, and he had called everyone to attention before opening fire.

Later we heard the unthinkable, that this was indeed an Army officer, but worse, a physician, entrusted to heal but causing great harm instead. This man had on occasion worked at the hospital, covering on weekends. Sometimes the family medicine inpatient service admits patients that have intentionally overdosed or are drunk and saying they want to harm themselves. Once these types of patients are cleared medically, they need psychiatric evaluation to determine if they are safe to go home; one of the family medicine staff physicians, Dr. K., had consulted this psychiatrist (the shooter) on such a patient only 2 weeks ago.

When she heard who the shooter was, Dr. K. was besieged with guilt, saying that she knew he wasn’t quite right, that he seemed depressed, that she should have done something. She broke down in sobs in the middle of the clinic. A couple of us sat down in a clinic room with her and listened. My mentor, a female Major and West Point grad, hugged her and let her cry. It was probably the first hug she’d had since her husband deployed to Iraq in September. They got 10 days notice.

I have never been so proud of our clinic. There wasn’t a nurse in that clinic that wouldn’t run to the other side of the hospital to get something if a patient needed it. The cleaning lady was unreal-I thought some of that blood would never come off, and by the time she was done (quickly!) I would’ve eaten dinner of those tables.

Things were letting up for us in our area, so we went to other floors of the hospital, helping do things like write admission orders for patients so there medications could be brought up from the pharmacy. The general surgeons were doing yeoman’s work. They were cutting open chests and bellies and battling their mightiest to repair the damage done by the bullets. They mostly succeeded, doing the work of specialists in cardiothoracic and vascular surgery, simply because they were it, they were our best hope.

My fellow residents and I did what we could to help; most of us left around 9 pm simply because there wasn’t anything else to do. I was so proud of those guys and their families; they would have stayed the whole night if there was a way they could help out. A good friend of mine stayed to carry the Internal Medicine on-call pager; I went home to xxx, then went back around 2 am to take the pager back from him. No matter, no one was going to the ER, so there were no admissions. I think they thought, “You know, I’m not shot, I think I’ll be okay.” I did what I could to help out in the ICU.

Another patient died in the time I was at home, a clean-cut 21-year-old. He had extensive chest and abdominal wounds, the worst to his aorta. When he arrived to the ICU from the OR, he had what surgeon’s call the “unhappy triad” of hypothermia (his rectal temperature was 88 degrees), acidosis, and coagulopathy. It is rare to survive after reaching that point. He got 50 units of blood. Hospital workers were donating their blood. He was getting 4 IV medications to raise his blood pressure. He went back to the OR. He had cardiopulmonary arrest, was successfully resuscitated once, but not the second time. They gave him everything they had, even when it was probably futile, because what else can you do but everything? This is a kid who will never know what it’s like to fall in love and marry, to have children, to grow old. There is no tomorrow for him.

There was another young 20-year-old private with a bullet in his chest, only it inexplicably stopped at his sternum, and one in his back, only it never made it past the muscle. When I saw him up on the wards, all he was worried about was when he could go downstairs and smoke. A little walking miracle with a pack-a-day habit, no clue how lucky he was and, for the moment, some extra metal in him.

Friday, there were a lot of generals at our little hospital. They visited every single injured soldier. George W. Bush, the former president, visited the hospital in the evening. Say what you will about his politics, but that man was here, and that counts for a lot in my book.

Keep everyone at Fort Hood in your prayers, especially the families of the fallen. There are not words to describe how sad and tragic this is. As a Christian, it is difficult to understand and hard to accept. Abstract ideas about the effects of sin on creation, the depravity of mankind as a whole, and the presence of evil forces in the world give way quickly to the concrete reality that mothers will bury their sons and daughters in the days ahead, and everyone knows that is not the way it’s supposd to be. If I can offer you hope in the midst of this darkness, it is that I have seen all around me in these troubling hours people realizing their potential to do great good and to come together in unity to sacrifice for others. We as Christians must always remember that our God, not willing to allow us to suffer alone, took the form of a man and suffers along with us. When His friend Lazarus died, John 11:35 tells us that, like us, Jesus wept, and I know He still weeps along with us tonight..

God bless you all and we love you,
xxx and xxx

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