Today marks three months since New Zealand's worst ever mass shooting. Authorities will this week review Christchurch Hospital's response. Kurt Bayer reveals how March 15 unfolded in the wards.
It had been a quiet Friday for Emergency Department specialist Dr Dom Fleischer. The usual sprains and strains, nothing major.
At 1.50pm, a breathless fella came running in, with cuts to his hands. He said there'd been a shooting at the mosque; he'd broken a window to escape.
His claims were met with some disbelief. ED staff hear it all.
But when another man rushed in minutes later, with the same story and similar injuries, Fleischer and his staff took note.
He grabbed some senior nurses and colleagues and formed a quick huddle. They decided it could be big.
The hospital's major incident plan was activated – a rare move that was done during the February 22, 2011, which killed 185 people in Christchurch eight years earlier.
Pagers buzzed and people ran.
All hands to the pump
With watery early autumn sun streaming through the seventh floor windows, Dr Hayley Waller thought her kids might like an icecream after school.
Outside below, the leaves had yet to change in sprawling Hagley Park, or across the meandering Avon River, in the Botanic Gardens.
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Jackhammers and drills working on the new post-quake CBD buildings scattered birds and broke the otherwise calm of a Friday afternoon, with a Canterbury weekend looming with possibilities.
Just some 1200m from Christchurch Hospital, was the Masjid Al Noor mosque.
Back towards town, intensive care unit nurse manager Nikki Ford was enjoying lunch. Registered nurse Ruth Deal was driving to work, hoping to pick the librarian's brains for her post-graduate studies, while surgical nursing manager Nicky Graham was sorting the latest issue to crop up on her ward.
Their worlds were about to collide.
Time is of the essence
Trauma nurse Mel Evans told a patient she was talking to that she had to go. She got a message to the on-call general surgeon James McKay that he'd better get down to ED.
McKay was in the middle of an operation. When nurses passed him the message, he handed over the reins to a surgeon colleague and headed downstairs.
ED was cleared of everyday patients – back home, to GPs, medical centres, other wards - and within 2-3 minutes, scores of doctors, surgeons, nurses and other staff were coming into the emergency department. Fleischer thought it was because they had activated the major incident plan, but the hospital's jungle drums had been beating loud and clear. It was pure word of mouth.
The ED was soon in "chaos", Fleischer says. The first victims were being stretchered in – scooped up by passing members of the public, electricians and off-duty nurses. Armed offenders squad police officers laid dying victims in the back of their squad cars. Paramedics raced in, ambulances stacking up.
Then there were reports of a "gunman loose" in the ED, which later proved to be unfounded. Armed policemen sprinted around searching for a shooter.
The hospital was in lockdown, armed police at every entrance and exit point, patrolling perimeter.
And time was critical. The only way to save their lives was to get them into an operating theatre.
But there was a problem. The same one that arose during the shaking of the quakes. Who were these people? They were mainly men, although one of the first worst-injured patients was a little girl, which hammered home the immensity of the situation, especially to Evans who saw her being carried in. Since they had been at Friday prayer at the mosque, they'd taken off their shoes and dumped their phones and wallets. They had no identification. Who was who? A mix-up could prove fatal.
Evans gave them each a number and alongside head of surgery Greg Robertson assigned them to a bay. One critical piece of paper – even in this technological age, it was still the best way - floated around the department, saying who each was, and whether they were to be assigned to get a CT scan or straight into surgery.
Within two hours, ED was cleared. Everyone pitched in. The usual egos and patch protection pathos disappeared.
Deal chucked a gown over her civilian clothes and set up the SPCU (Surgical Progressive Care Unit) to receive trauma patients straight from ED and get them ready for either surgery or the 23-bed intensive care unit (ICU).
ICU was Nikki Ford's baby. She had worked through the quakes and immediately began drawing on that knowledge of working in extreme situations. She was thinking ahead. It was Friday afternoon ... there would be no deliveries over the weekend ... looks like supplies could be running out. She phoned one of the hospital's private partners and begged for a chest-reopening kit. Then she hit up Timaru Hospital for a renal replacement machine to be sent up. They both arrived, and she still has no idea how.
While it was all hands to the pump, and time was of the essence, there was also the nagging thought in the back of the hospital staff's heads, that outside a major catastrophe could be unfolding in their city. Rumours and misinformation was rampant. Sirens blared. Schools were in lockdown. A guy in military clothing was arrested outside Papanui High, and later freed without charge. Reports of bombs in abandoned vans. Mayhem in all directions.
And the hospital staff, especially those with kids themselves, wanted to know if their own loved ones were safe. Ford phoned her son and told him to stop biking around the city and to get straight home. Some nurses found out their teenage children were traumatised after inadvertently seeing a livestream video on social media.
Waller, who was heading to ED, phoned her husband who said he'd pick up the children from school. Racing down the stairwell, she remembers seeing an anaesthetist carrying a clear shopping bag full of syringes and medication.
"I said to her, 'What's happening?' and she said, 'I don't know, I was just told to bring all of this to the emergency department'." When Waller got to ED, the enormity of what was happening hit her. "There were just people everywhere and patients just continuously arriving and you just thought, 'Oh my gosh, this is going to be really big'."
She spoke to her colleague McKay who directed her to one of eight operating theatres that was opened up. She had two of the most critically-injured patients to deal with.
"The first patient I looked after, it was obvious from the second I saw him that he was critically-injured and needed an operation. He had lost a lot of blood and he wasn't going to be someone who was going to be able to be stabilised without an operation," Waller says.
She had never experienced gunshot wounds before. The biggest mass casualty she'd ever been involved in was an Arthur's Pass bus crash with 20 injured people – most of them not seriously injured.
"I remember one of my first questions to the ambulance officers was, 'Did they lose much blood?' and I look back and think it was a stupid question but I just didn't understand the context. They just said to me, 'We don't know, we just literally scooped this person up and put them in the back of the ambulance'," Waller says.
"I felt this tidal wave of information and just a disbelief of, 'How has this happened to these people? How has this happened in Christchurch?' I never for a second thought that in my career I'd be dealing with a mass shooting in New Zealand, but here we are. You just have to go on your training and the gut instinct that this is best for them. You make a decision and you go."
Hospital staff stunned things weren't worse
On and on it went. McKay operated overnight on one of the sickest patients. He finally got home about 5am but couldn't sleep. His mind was buzzing. And besides, he had to be back in two hours for the morning briefing. For most of the hospital staff, their work was only just beginning.
In the first 24 hours, 31 surgeries were performed. Over the following days and weeks, surgeons would spent 174 hours in theatre, while patients spent 3132 hours in ICU, and a staggering 19,566 hours on surgical wards.
Of the 48 shooting victims who arrived at Christchurch Hospital ED who were able to be resuscitated, 47 survived. And three months on, all but one person has now recovered to the point where they are well enough to be at home.
All of the hospital staff interviewed by the Herald were stunned things weren't worse.
"That is something we've become progressively more proud of," McKay says.
An official clinical debrief – how it went; how things could've been done better – will be held this week. But the unofficial ones, the late-night pub sessions, quick coffee breaks, water cooler how-are-you-doings, have been happening ever since what Prime Minister Jacinda Ardern called "one of New Zealand's darkest days". Everyone says they have been crucial in handling the incredibly traumatic events.
"On the night of March 15, the local hotel stayed open and our nursing staff went down there," says Ford. "I arrived at about 10pm and it was a really nice debrief: Didn't we do well. How sad it was. It was really important to stay connected."
Some nurses who witnessed the carnage of ED have spoken of having flashbacks, Ford says. They have been offered wraparound care.
Canterbury District Health Board chief executive David Meates says his staff, while being "extremely resilient in the face of adversity", are not immune to the after effects.
"We are very conscious of their wellbeing after such a traumatic event," he says. "I never dreamed our city would be impacted by such events, but it happened and even now, three months on, it still feels surreal. I'm incredibly proud of the health system response to the attacks, which has been nothing short of extraordinary."
Support services have been increased while staff have been getting ongoing incident check-ins and one-on-one sessions with specialist psychologists.
All staff interviewed by the Herald for this story praised the genuine teamwork and camaraderie during the hospital's response, and believe that can be attributed to their success in saving lives. From the surgeons to sterile services, radiology to blood bank, orderly staff, communications, social workers, from top to bottom. A lot of that esprit des corps was forged in the tremulous moments of the 2010 and 2011 earthquakes. And those relationships have not been forgotten.
"What got us through it was the teamwork," Graham says. "Working through adversity actually brings people closer together. You work together, support each other, and become stronger as a team."
They talk of operating in the hospital's "bubble". Many actively ignored media coverage of the shooting during that first week. They had a job to do. It was too distracting; upsetting. And many of the patients would spend several days, even weeks into months, in hospital. Dealing with them and their families and friends over a prolonged period, getting to know them, and helping them with issues as they arose – transport to and from hospital, filling out ACC forms, getting social workers involved, finding prayer mats and rooms to pray at the hospital – all came naturally to the hospital teams. And they found it a rewarding experience.
"They were the kindest, most humble, delightful people to look after, so easy to care for," Deal says. "We're scrambling to ensure we are being sensitive to their needs and their cultural beliefs, while they are trying to make us feel at ease constantly, saying, 'Have you had your tea break', 'Are you okay?' They're just such wonderful people."
Surgeons McKay and Waller also enjoyed that engagement – something they don't often get to do.
But it was also tough watching the families go through some traumatic events. Some spoke of it being "emotionally taxing", especially once the initial danger was cleared.
"I feel like I hurt a lot for them and their community," Waller says. "They were so lovely to us, and I thought, someone in our community has done this to you. It was hard. You can appreciate the psychological trauma that these people have been through, and along with the physical injuries, they have a really long road to recovery."
The staff only slowly became aware of the wider public's response to the shooting. During lunchtime walks, they'd see the mountains of flowers and tributes spreading along the Botanic Gardens wall nearby, and the masses of messages and bouquets left at Al Noor across the park. They found all it very heartening.
Driving home the day after the shootings, Waller saw people carrying flowers to lay as tributes and "just about lost it". "I just thought, 'Oh my gosh, people actually care'. And long-term I hope that is going to matter and that it's going to make a difference," she says.
"I think we all spent a bit of time soul searching and thinking about some of that unconscious bias that creeps into your life, I certainly did, and a lot of other people that I've spoken to have. I'd like to think that, as terrible as this was, that it's going to make a difference, that it's not going to happen again. That might be a bit ridiculous of me to think that, but at the end of the day if anything good is going to come out of it, is that we can respond and change."