'Something I’ll think about forever': Trauma surgeons recall Walmart shooting, aftermath
Dr. Susan McLean was operating on a patient when pagers sounded around her, one chirping after another, each reading, “Mass casualty incident, active shooter, go to the emergency department.”
McLean had to focus — there still was work to be done.
“Take your time, do this, we have a few minutes,” she thought to herself in the operating room at University Medical Center of El Paso.
A few minutes was all she had. Instead of finishing and closing the routine surgery herself, McLean passed the task to the chief resident. By the time she walked the 20 steps from the operating room to the emergency department, UMC was at Level One, its highest level of activation.
A surgeon, a nurse, and an emergency physician staffed each of the hospital’s three trauma bays. Anesthesia specialists, blood bank servicers, lab technicians, and radiologists poured into the critical care area, some sprinting into the hospital from the parking lot.
Admitting nurses printed stickers with placeholder names and medical identification numbers, anticipating an unknown surge of patients. More than 160 people across 15 departments activated to prepare for the first patient.
But there wasn’t a first patient. There were six first patients.
“There were just so many at once, coming in at every entrance,” McLean said.
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Patients entered through the main bay just wide enough to fit two stretchers, through a back door, and even a side door from the operating room.
“They were pulling up and bringing people in any way they could,” McLean said.
A trauma center typically cares for four critical trauma patients in an hour. On Aug. 3, 2019, UMC had 14 patients arrive over 34 minutes.
“It was definitely a surge of adrenaline,” McLean said.
The hospital had drilled for an event like the Walmart mass shooting: The October before, it had simulated a citywide response to an active shooter at the airport who had injured 100 people. They knew to be ready.
McLean directs the surgical intensive care unit at UMC and is a Texas Tech University Health Sciences Center of El Paso physician. She had trained 25 years for that day, all the while hoping El Paso never would experience anything like the mass shooting that left 23 dead and dozens more injured.
Just six days earlier, McLean, who has lived in El Paso for 21 years, had watched news coverage of the mass shooting in Gilroy, California, and thought, “Oh, that will never happen in El Paso.”
She watched anyway, wanting to learn what happened and how responders acted.
“It was a shock to have it actually happen,” McLean said. “None of us expected it.”
A desperate flight to get home
More than 700 miles away, Dr. Alan Tyroch was enjoying a buffet breakfast by himself in the basement of his Las Vegas hotel. The UMC chief of staff and TTUHSC El Paso physician and his family were on vacation, celebrating the 90th birthday of his mother-in-law.
At 10:53 a.m., he received a phone notification: “active shooter, Walmart, GWW, unknown number casualties.”
Uncertain if the alert was a drill or a false alarm, he called the administrator on duty, the nurse overseeing the hospital at the time. UMC had received its first patients, but it “could be nothing,” Tyroch was told.
Minutes later, though, Tyroch knew that it was something.
“We’re getting at least 10 or 12 (patients), maybe more. It’s a real event. There’s going to be multiple casualties,” he was told.
As Tyroch ran back to his hotel room, he activated all of the hospital’s faculty and surgery residents, from pediatric surgeons to nurse practitioners, and told each of them: “Just get to the hospital. I’m going to need you.”
His wife booked him a flight on his way to the airport, which he bolted through with just his phone, wallet and glasses. “You don’t understand. I've got to go back to El Paso. People are being killed right now,” he recalls telling an airline employee.
Tyroch barely made his flight. It was filled with El Pasoans returning to a hometown that had been hit by a tragedy of still unknown scope, and rumors spread down the aisles of the plane. Before the plane took off, the last thing Tyroch heard was that there were three shooters and the scene still was active, with 40 people already injured or dead.
“As I was turning (my phone) off, I was like, ‘Oh my gosh, how many more people are going to come to our hospital; can we handle all this?’ ” Tyroch said.
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The 90 minutes from Las Vegas to El Paso were excruciating.
At 3:20 p.m., Tyroch arrived at the hospital and saw the victims' wounds. They reminded him of the 2008 Juárez drug cartel wars, when UMC cared for victims with terribly devastating injuries from assault rifles.
“It wasn’t just one or two little body parts. (The Walmart victims) were shot multiple times, with extensive damage to their bodies,” Tyroch said.
UMC receives about 10 patients in a month with injuries from low-caliber weapons, so he and other surgeons were experienced with gunshot wounds, but “we don’t see the extent of soft tissue damage or the terrible broken bones that you would see from, say, Iraq or Afghanistan, when we had those wars,” Tyroch said.
Hospital staff stay focused though 'surreal' weekend
When hospital staff knew they would receive no more patients, McLean and Tyroch evaluated what was to come.
McLean had operated on two patients — one for 25 minutes, and another for an hour. Tyroch had finished a news conference, where he wore a nurse’s borrowed scrubs after coming off the plane wearing shorts — the temperature in Las Vegas climbed to 102 degrees that day.
Both worried about UMC’s 15 patients, all in various conditions, and whether they had missed any injuries in the immediate post-shooting triage. Other patients were taken to nearby Del Sol Medical Center.
McLean and two residents walked around the hospital, trying to consolidate a list of patients and matching placeholder names against actual names. Because she oversaw all admissions that day, McLean needed to see each individual patient and ensure that she knew who they were, what their injuries were, and what ongoing needs they would have.
All McLean’s patients were conscious — a relief of sorts, though not a salve for the unfolding tragedy.
In the hospital's pediatric wing, McLean encountered a family and a priest praying over a patient. The family was crying.
“Oh, my God, I can’t believe I’m interrupting,” she thought. The patient was stable, but McLean felt strange during the examination.
Tyroch spent the day planning for future surgeries, while also checking on patients. “It took us so long to identify one patient that day. The family kept saying, ‘No, he’s here.’” He had passed at the Walmart.
McLean completed the list of patients at 4:30 p.m. She sat down at her computer, entering notes for each patient and still in a state of disbelief.
She turned to a resident sitting next to her.
“I said, ‘Wow, can you believe this is happening here?’ She looked at me. She said, ‘No, this is surreal, did you know this is now the eighth biggest mass casualty incident in U.S. history?’ ”
Two days later, it would become the seventh. When Guillermo "Memo" Garcia died in April, it tied for sixth.
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When Tyroch left the hospital that Saturday, he thought: “I need to rest because Sunday is going to be a miserable day.”
Deadly mass shooting in Dayton, Ohio
He didn’t make it to his bed when he arrived home, instead falling asleep on the couch as the TV played back what he had just seen. Tyroch woke up in the middle of the night. The anchors were now talking about a mass shooting in Dayton, Ohio, that left nine dead and dozens more injured, only 13 hours after the attack in El Paso.
Tyroch returned to the hospital the next morning, instructing the surgeon previously assigned to work Sunday to take the day off. He operated on two patients from the shooting — planned definitive surgeries after Saturday's initial "damage control" surgeries — while other surgeons stepped in for "nonevent" operations.
Routine surgeries had continued despite the shooting — McLean had operated on two patients with unrelated trauma injuries at 2 a.m. and 3 a.m.
“A hospital doesn’t just shut down because you have a disaster,” Tyroch said. “The regular workload doesn’t just stop.”
But at the same time, he had to shuttle politicians from patient to patient.
In one patient's room, Tyroch felt they had stayed too long, crowding her bed. He was ready to give her some space and start moving people out.
Then, “listening to her tell her story about seeing the shooter, I was just getting so angry and feeling like killing that guy myself. I realized that at the end, she said, ‘We have forgiveness.’ That struck me a lot.”
The patient's words stayed with Tyroch throughout the day. When he finished work, he watched the sunset behind the chapel on UMC’s campus and decided to pray in its empty pews.
“It was so relaxing," he recalled. "I didn’t want to leave. It was like a respite.”
After praying, Tyroch walked to UMC’s parking garage, which was empty aside from his car. When he opened its door, everything hit.
“All the grief, all the pain, all that stuff. Man, it really hit me,” Tyroch said. “I was about to burst out crying.”
Tyroch thought that he had collected himself until he was driving down Interstate 10. Every few miles, he passed electronic billboards, yellow-orange letters glowing “El Paso Strong.” The knowledge that everybody on the interstate saw the signs moved him.
“That really hit me," he said. "I finally had a little bit of time to catch my breath that Sunday.”
Trauma of Aug. 3 stays with hospital staff and patients alike
The attack reverberated far beyond that weekend.
McLean saw the same patients in the days, weeks and months following — the average length of stay was 13 days, and the longest was 62. About 60% of the patients had surgeries, resulting in an average of 2.4 operations per patient. One patient had a final surgery 153 days after the shooting.
“The patients themselves are very strong. All of them had undergone this terrible tragedy. They saw things no human should ever have to see,” she said. “The patients had to work very hard to get back to their lives, and they all did. They should be all commended for that.”
McLean witnessed the strength of her own hospital community as well — one that fulfilled its mission to the larger El Paso community that day and the days following. Four weeks later, when the hospital learned of a mass shooting in Midland-Odessa, they braced for the possibility of caring for those victims, knowing that they had more time to prepare and that this was their mission.
“This is what we’re here to do, we’re going to do it, we’re going to do it on overtime. It was really amazing to see all the people coming together and all the caring,” she said about the group mentality. “This was a big event for me, and something I’ll think about forever."
Tyroch, too, realizes that the effects of Aug. 3 will last a lifetime.
For subscribers: Inside the 911 call center the morning of Aug. 3, 2019
He has testified to Texas legislators and spoken to national conferences about the shooting. Earlier this year, he had a surgery meeting in Las Vegas. When he arrived, everything flooded back.
“As soon as I got to the airport, I could just feel pressure on my chest. I saw where I jumped out of the cab,” Tyroch said. “I was like, ‘How the heck did I accomplish that?’ It was just a blur. I started reliving it. That was very painful for me. I felt just intense pressure at that time.”
Tyroch knows that caregivers also need care — about a third of caregivers experience post-traumatic stress disorder, and he always emphasizes that to his “flock.” He tells them: “(PTSD) may get you out of the blue, months to years later, so be careful. Don’t think you got to be tough. It’s human nature.”
As things started to settle, Tyroch could not help thinking, “ ‘Thank goodness. I don’t think I can handle this anymore; this is just a little too much.’ I was feeling guilty, like I get to talk about it while other people are suffering or died.”
Little rest as hospital faces new crisis
El Paso now faces a new fight: the coronavirus pandemic.
Since March, hospitals around the nation and in El Paso, including UMC, have battled the pandemic by employing strategies not unlike those used on Aug. 3.
“We’ve enhanced our ICU footprint by expanding down into other areas that can take patients but they don’t. The hospital has given it extra staff. Those two principles of using your surge capacity areas, as well as enhancing your staff, have been what we have done to knock that challenge and also this challenge,” McLean said.
The response to the pandemic is also much longer.
“It’s not the adrenaline rush. It’s a long-term thing,” Tyroch said. “It’s a different type of crisis, but we’re all in it together. It’s like a world war.”
The coronavirus pandemic has been so all-consuming that it almost made the shooting fade into the background.
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When Tyroch saw the looming anniversary date, he thought, “Oh gosh, maybe we’ll just forget about Aug. 3 this year; maybe that’s sort of a good thing — but it’s not a good thing.”
He thought that — even though days after the shooting he had advised residents and junior doctors to write down what had happened: every experience, every feeling, every thought.
"Ten or 15 years from now, your kids are going to say: 'What happened in El Paso in 2019? Were you there?' You want to be able to tell that story," he told them.
His own mentor texted him that day: "I know you’re busy. Just write down some notes, because you’re going to want to remember. You’re going to forget some stuff. Just scribble stuff down."
Caught in the whirlwind of Aug. 3 and the days that followed, Tyroch didn't.
But two weeks ago, he stumbled upon a series of somehow unopened text messages from Aug. 3 — digital snapshots suspended in time, memorializing the day.
He read them, then printed out each message, determined to hold Aug. 3, 2019, close.
Kalley Huang may be reached at firstname.lastname@example.org and @KalleyHuang on Twitter.