In Blacksburg, An ER Physician Still Tries to Heal

I tried to encourage the staff, particularly the younger nurses. The tears I struggled to hold back sneaked down their cheeks as they cared for the injured.

Finally, things slowed down as some victims were diverted to nearby hospitals. We were relieved and went to grab a bite to eat in the break room. Many local businesses had sent food to us. We turned on the news and realized just how many had died. The number of victims continued to rise steadily as we stared at the television, transfixed.

I needed to talk to my family again. I wanted to talk to my son, the last one to make it home from school.

Relief washed over me when I heard his high-pitched "Hi, Mommy!" over the phone. Knowing my own brood of four young children was safe and sound with my husband gave me a sliver of peace. It was what I needed to finish the rest of this shift.

The worst of it had passed almost blindingly fast, in a little over an hour. I was left with a series of searing images imprinted in my mind, loosely connected by a thread of disbelief.

Fatigue hit when I arrived home. My own adrenaline was depleted, but I could not sleep. I kept seeing their eyes. I struggled to comprehend.

My husband turned on a fan to drown out the noise of those awful winds, which now seemed ominous and menacing. Again, I slept only fitfully.

The following day, I worked a night shift. It did not occur to me to change my schedule. The day after that, my infant son was sick, pulling me back to reality. He was wheezing loudly, so I took him for treatments to ease his breathing. I felt guilty for waiting to get him evaluated. Was I too caught up in my own grief to notice my son's plight sooner? But he rapidly improved and was back to his cheery self.

A good friend called to ask how I held up, how the hospital held up. At least I have that comfort: We did all we could. That was of some solace. Cards poured in from emergency departments all over the country.

Most simply said thanks for being there.

It felt strange for us to be thanked and publicly recognized for just doing our job the best we could, as we try to do on a smaller scale every shift we work.

I opened an e-mail from a friend with three simple words: "Are you O.K.?" And I really didn't know. Even for a fairly seasoned veteran of the emergency department, I had been really shaken up.

I had nightmares, rerunning the scene in my head, seeing the wounded students. I kept seeing their eyes, dilated with fear. Submerged in the drone of daily life, the images resurfaced at night -- and continued for months. So did the grief.

I recently walked into the trauma room to assist with a very young infant who had been shaken, allegedly abused, and I felt such a physical reaction of shock and grief that I came close to vomiting. I saw his tiny body lying on the stretcher and I desperately wanted to take him home and protect him. It is the same grief sensation I still feel when I think about the shootings.

Those of us who work in emergency rooms must be able to function and make objective decisions even in the most horrific cases. We must strive to create order out of chaos. We have to be able to call out the right medicine, the right amount of fluid, the right size tube to assist breathing as we resuscitate young and old alike. We have to stay distanced and process the relevant details so we can best treat the patients, give them the best outcome.

I know a part of me has changed, though. I have become more prone to expect that something violent has happened.

Shortly after the shootings, a man arrived at the ER gasping for breath, his arms draped around a fellow police officer. I ran to grab gloves to assist him to the trauma room, jumping to the conclusion that he was injured, possibly shot. But he was short of breath from pneumonia and exhausted from all the long hours spent working in the aftermath of the massacre. I had overreacted.

The fear lives with me. I even have to admit that I almost dread the strong winter and spring winds now. Though I know they are not inherently evil, I find them disquieting. I worry they could unsettle disturbing thoughts in people's minds, that they may herald the breakdown of a human mind and the fallout that results.

I chose not to talk to the crisis counselors, although maybe I should have. I felt I had to stay strong. I continued to work hard and take care of my family, not taking time to sort out my own reaction for months to come.

I don't think I have post-traumatic stress disorder, though sometimes I feel caught between survivor's guilt and the constant fear of being stuck down by disease or violence.

And so I struggle to come to terms with the random unfairness of living. Through my dealings with people as they face illness and their own mortality, I must, to some extent, face mine.

Moments of joy carry me on. Seeing the peaceful expression on my infant son's face as he nurses himself to sleep. Watching my toddler spontaneously dance to music that touches her. Seeing my feisty, curly-headed daughter master a new skill in gymnastics. Watching my shy older son learn to read his favorite book about airplanes.

On a windless day that promised the return of the warmth of spring, my husband and I walked my baby boy, now an energetic toddler, down a mountain trail. I watched him delight in the simple pleasure of running, of throwing pebbles, of dipping his hands in a cold mountain stream, and I couldn't help thinking we should all be like him, innocently unaware of the evils that may befall us.