Dr. Michael Morkin was in the emergency room when word came that as many as 80 patients could be on their way to Reno hospitals from a fiery Amtrak crash in the Nevada desert. He was there the day after Labor Day when a man with an assault rifle shot a dozen people at a pancake restaurant in nearby Carson City. Then, last week, a nurse poked his head into the room and said, "Mike, we have mass casualties."
"What is it this time?" asked Morkin, the chief emergency room surgeon.
Such disbelief was present across northern Nevada last week after the air race crash that killed at least 11 people - the third deadly tragedy to strike the Reno area in recent months. The episodes have inflicted a severe emotional toll on people, but also instilled a greater sense of community as people came together in the face of crisis.
Minutes after the plane crashed at the air races, volunteers rushed out of the grandstands to tend to those maimed on the tarmac or to carry stretchers to the waiting air ambulances. Paramedics made tourniquets out of streamers from the box seat railings and from belts offered up by healthy spectators. Residents offered up homes and rides to the hospital to grieving victims. Donors stood in lines that snaked outside the building to give blood.
"Literally thousands of people we have never met have contacted us and we want them to understand we appreciate that," said Jim Elvin of Atlanta, who lost his mother but whose father, two brothers and sister-in-law survived the crash and are faring well. "We are confident that is part of the reason that all four of them are still here with us."
He also said that "complete strangers have been offering us whatever we need - rides, a place to stay in their home. It's incredible."
Five people were killed and 30 injured in the Amtrak crash in June and five more died at the IHOP in Carson City on Sept. 6, including three members of the National Guard. The timing of the military killings added another layer of grief - memorial services were held the following Sunday on the 10-year anniversary of the Sept. 11 attacks.
But neither incident turned into the large-scale disaster that Morkin faced at 4:30 p.m. on Sept. 16.
"As the calls starting coming in it was clear it was going to be a legitimate mass casualty incident, not like Amtrak where they said we could get 80 but ended up getting only five or six," Morkin said in an interview with The Associated Press.
Over the next three and a half hours, nearly 70 seriously injured spectators were rushed to three hospitals in Reno and Sparks - more than two dozen of them through the doors at Renown Regional Medical Center. Within two days, the death toll had grown to 11, including the pilot. The same hospital treated National Guard members after the IHOP shooting.
But while images of the horror overtook the annual celebration of aviation and ran over and over on television and the Internet, the real story behind the scenes was how many lives were saved and emotionally scarred family members and friends were comforted, according to doctors, patients, volunteers and others who saw the events unfold.
"Thanks to the quick, selfless actions of both trained medical personnel as well as complete strangers, lives were saved that evening," said Allen Martin Elvin, another member of the Elvin family that lost Cherie Elvin, 71, Lenexa, Kan.
"And no one is looking for any recognition," added Mike Houghton, director of the Reno Air Races Association. "It's about helping each other, that's what it is all about right now."
Hundreds were expected to attend a public memorial service on Sunday at a city park where city officials also planned to plant a tree and dedicate to the victims.
By all accounts, each of the incidents could have been worse. The passenger cars on the Amtrak train could have derailed. The IHOP shooter had piles of ammunition and more guns waiting in his van at the time he shot himself. The P-51 Mustang came within a stone's throw from taking out dozens and possibly hundreds more victims in the grandstand. And there was no fireball from the crash.
Morkin said one of the surgeons in his emergency room was watching a video of the crash on the Internet as the first wave of patients started to arrive. He said the hospital's response was made easier by the fact that there was no fireball.
"What really helped and was a pleasant surprise is there were no burn victims," he said. "Burn patients are incredibly resource intensive. Just one or two severely burned patients really grind your ability to function and can shut an emergency room down."
The tragedy in Carson City is two weeks further removed, but Sgt. First Class Erick Studenicka said people in Carson City are "still getting used to dealing with it." Carson City is 30 miles away from Reno, but many residents commute to work from one town to the other.
Just weeks before the Sept. 6 shooting, Studenicka had completed the research he needed to write a 10-year retrospective for a base publication about what had happened to the local unit since the Sept. 11 terrorist attacks.
"We had only lost three in the war in the last 10 years and then to lose three right here in the capitol city where our headquarters is - it was just shocking," Studenicka said. He said part of the reason for the big impact on the local guardsmen, is there are only 150 members in the local unit and 3,000 statewide "so chances are almost everyone knows everyone else."
"I think now 9/6 is another date that guardsmen here are going to remember along with 9/11."
"People are in a combat zone. They are constantly in danger," he said. "But at an IHOP in Carson City, there's not that sense of danger. Then all of the sudden out of left field comes this shocking news."
Carson City Sheriff Kenny Furlong, whose calming Old West style became familiar during live local television briefings in the aftermath of the IHOP shootings, said there's no denying "northern Nevada has suffered a great deal in September."
"While time may help heel," he said, "the scars of this month will never fade."