A gunman shot and killed an emergency physician, a pharmacy resident, and a police officer at Chicago's Mercy Hospital in November, leaving the emergency physicians there reeling from the experience. They cycled through every emotion imaginable, from fear to guilt, but they were able to glean some lessons from their harrowing experience.
Keep Yourself Safe
Basem Khishfe, MD, was working in the ED opposite Tamara O'Neal, MD, for eight hours that day. After learning that she had been shot in the parking lot, he and others wanted to run to their dying friend. “Our first instinct as physicians is to save lives,” he said.
But the shooter was moving toward the ED. The police urgently insisted that they barricade in a break room with other staff and a patient.
One physician started toward the parking lot, but Dr. Khishfe prevented her. “I remember hugging her and telling her I want to run also, but we need to make sure everyone is safe so we can go help Tamara.
“The most important thing is to protect yourself so you can help others when the incident is done,” he said. “You can't help someone if you're dead.”
Training Saved Lives
Dozens of lives were saved because people recognized the crisis and followed their training, said Patrick Connor, MD, the director of the ED at Mercy Hospital. He watched the hospital security tapes after the shooting, and saw the shooter move through the halls toward the ED, where dozens of people had been only seconds before.
“Everyone stepped up and barricaded. People protected themselves and patients and visitors,” he said. “When [the shooter] walked down the hall to our main ED, there was nobody there. Everyone had the courage to think right and do the right things. That's what prevented more catastrophe.”
Those life-saving events were set off by a person running in from outside to report that Dr. O'Neal had been shot, Dr. Khishfe said. “They called a Code Silver immediately. The police showed up really fast. The receptionist in the Family Health Center who used to be a security guard barricaded people. When [the shooter] got to the lobby, there weren't a lot of people there.”
You're Not to Blame
Some Mercy emergency physicians are battling guilt in the aftermath of the shooting. Dr. Khishfe himself can't shake the image of Dr. O'Neal lying unattended while he and others were following police orders to hide for their own safety. “What if we ran to her earlier? Could I have saved her? I don't know.”
Dr. Connor said he was struggling too. “Tamara was notorious for leaving late,” he said. “She didn't leave until a couple minutes before she was murdered. We should have kicked her out.”
Dr. Khishfe agreed, saying he wished he had picked up more patients on her side so she could have left early. “Maybe if I left with her, she wouldn't be dead,” he said.
But both physicians are quick to redirect themselves from that line of thinking, noting that trauma survivors have to accept that feelings of guilt are normal but irrational.
Dr. Connor encouraged his staff by sharing the words of a colleague who preferred to remain anonymous. “You guys could not have possibly carried her back into the hospital,” the colleague wrote in an email. “[E]ven if you could, there would be NO ONE to assist you, and you probably would have gotten killed because you would immediately have become the target. Just remember that there was no other option.”
Dr. Connor stressed to his staff that they had actually succeeded. “There are faces and names still walking on this earth [because of] your rapid actions,'” he said.
Dr. Khishfe said it is normal to feel guilty. “You just have to know you're not,” he said.
Dr. Khishfe went back to the ED the day after the shooting to be with his friends, overcoming mixed feelings about returning to the scene of the shooting. “I wasn't excited to go to a place where I saw a bloodbath,” he said. “But I sat with everyone in the department. We're coming together, checking on each other. We're talking to each other, taking care of each other. It was helpful for me to come.”
Talking with colleagues is important, Dr. Connor said, because outsiders may never understand the intense emotions and sense of guilt. “You have to be a voice of reason and encouragement,” he said. “You have to listen every day. Explain [to your family] as best you can, but don't ruin your relationships because you're frustrated they don't get how everything has suddenly changed. Don't get angry.”
He also recommended talking to the hospital's Employee Assistance Program professional despite his own initial reluctance to do so. “I found it very cathartic to talk and vent my frustrations to an active listener who was willing to hear my voice in the rawest sense of the word,” he said.
Let Others Help
Emergency physicians must make a mental shift to recover from trauma, Dr. Khishfe said. “We're trained to think of everyone else before ourselves. But now this is about you. You were injured in all of this. You need to recover so you can come back and do the thing you love to do.”
Mercy ED is faced with the practical matter of covering Dr. O'Neal's shifts, but Dr. Connor said it was not the time for his regular physicians to pick up extra shifts. They received many offers, including from a local ED director who covered gaps in the schedule, he said.
Fortunately, Dr. Connor had kept up to date with credentialing part-time physicians. “You should have more staff than you need,” he said. “Convince them to stay on staff even if they're not working. Those people can step in” to fill the gaps and let recovering physicians take time off.