AURORA, Colo. — Dr. Tien Vu was fixing up a child's cut when the first victim was rolled into the emergency room. He was slumped in his wheelchair, his face gnarled in pain, his leg bloodied. A bullet had ripped into his thigh.
Something's off, Vu recalled thinking.
The emergency room at Children's Hospital Colorado, where Vu has worked for nearly a decade, mostly tends to kids' broken bones and stubborn fevers, though the staff has handled its share of ailing adults too. But a gunshot wound was unusual.
It was just short of 1 a.m. Friday. The victim said a friend had sped him to the ER — Children's Hospital was the first "emergency" sign they'd spotted — from a nearby movie theater.
A movie theater?
He said a shooter had sprayed bullets into a crowd. Vu was skeptical. The ER staff hadn't heard anything. But just as Vu and another doctor began to cut away his clothes to reach his wound, dispatchers alerted the hospital.
An ambulance was on its way with a second victim.
It would be hours before Vu understood the scope of the massacre at the Century 16 theaters. A shooter clad in a gas mask and body armor stunned the Theater 9 audience — gathered for the 12:05 a.m. screening of the new Batman movie — with some kind of gas. Then he opened fire.
The 12 people killed ranged in age from 6 to 51, and all but two of them died in the theater. Dozens more were shot in the head, neck, torso and legs, some injured in the chaos of trying to escape, and ferried to local ERs. At least six remained in critical condition Tuesday.
Gunshot wounds often require surgery, so even a handful of shooting victims can quickly overwhelm an emergency room. Friday morning's massacre tested the limits of the area's mass-casualty response.
Doctors said their approach to such catastrophes had been transformed by lessons from the Sept. 11 attacks and shooting rampages such as the one at Columbine High School, only 20 miles away.
"What it's specifically changed is not necessarily triage … but that there is the capacity and the preparedness for mass-casualty care. It's now part of vernacular of every hospital and every emergency department," said Richard Zane, chief of emergency medicine at University of Colorado Hospital.
The hospital holds a monthly drill to test its response to various disasters, he said. What if there were too few surgeons to treat the wounded? Or part of the hospital caught fire? Other medical institutions do the same.
"So ... when this happened, although no one expected there was going to be mass gunshot victims, this was not the first time anybody had thought about how they would act," Zane said.
About 1 a.m., emergency rooms around the region were suddenly flooded with the shellshocked and wounded. University of Colorado Hospital eventually juggled 23 victims; Medical Center of Aurora, 18; and Denver Health Medical Center, seven.
"My first thought was, 'Oh my goodness, not again,' " said Dr. Chris Colwell, Denver Health's emergency medicine director, who also tended to gunshot victims after the 1999 Columbine shootings.
"The initial message was, 'We've had a report of shooting with multiple victims at a theater.' And just exchange 'school' for 'theater' and that's the message we got from Columbine."
Hospital officials made frantic phone calls, rousing off-duty doctors and nurses from their beds. Dr. Gilbert Pineda tossed on his scrub shirt and jeans, grabbed the bag with his stethoscope and raced to Medical Center of Aurora. He walked into bedlam.
One man's injuries to his torso and neck were so severe that police, not wanting to wait for an ambulance, brought him to the hospital in a squad car. He'd been whisked to the operating room. Another man was splayed in the hallway, his leg cinched with a makeshift tourniquet: a belt. A third had a wound to her face, and Pineda feared a bullet had burrowed into her brain.
All the while, someone howled, "Give me more morphine!"
Vu had left the first victim, who was in stable condition, in another doctor's hands. She waited for the second victim.
The shooting story is real, she thought.
She told a clerk to alert the staff: We're in mass-casualty mode.
The charge nurse moved stable patients out of trauma bays to make room for new patients. They didn't know how many would be coming. Rooms were cleared, equipment set up.
Vu, who is married and has a young daughter, was weary from the seven hours she'd already worked. But now she felt a whoosh of adrenaline.
The second victim arrived in very bad shape. Her torso was riddled with bullets. The paramedics who wheeled her in were already performing CPR, meaning she wasn't breathing and her heart had stopped.
The trauma surgeon was elsewhere. So Vu and at least five other physicians took over efforts to revive the patient; five to 10 nurses and some technicians joined them. The room buzzed with people fetching supplies and medications and barking orders. Their faces were pinched in concentration.
The team kept at the chest compressions. Ten minutes passed. Then 20.
In her years of practicing emergency pediatric medicine, Vu had treated many traumatic injuries, and had repeatedly drilled for catastrophe.
But nothing prepared her for one emotion. "Part of it was anger that this had happened. I remember just being very angry at the shooter and at the situation," Vu recalled. "Not that you don't feel horrible for victims of accidents but … this was an intentional harming of people."
After half an hour or so, the patient was moved to the operating room. She was pronounced dead there.
Vu remained in the emergency department, where workers were practiced at bottling emotions. Tonight was different, though.
They had very little information about the shooting. Was there one gunman? Two? Was the hospital staff in danger?
While Vu had been trying to resuscitate the dying patient, a third victim had arrived.
Then a fourth. A fifth. A sixth. Would there be more?
Other physicians took care of those patients.
Vu joined a group of doctors, nurses and technicians huddled in the ambulance bay outside for a debriefing, which is standard practice after an ER death. Workers can vent their feelings or raise concerns.
Tonight, they hugged each other. And wept.
Vu tried to comfort them. She praised their efforts to revive the patient. Her words were met with silence.
"I don't think people were ready at that point to share what they were feeling," Vu said.
After a few minutes of quiet, the group trickled back inside. They had no choice. There were shooting victims to tend to. The sixth one to arrive was the last of the night.
For the rest of the morning, Vu pushed aside thoughts of the massacre. She briefly checked on a patient whose hand had been injured, possibly from shrapnel. But she also tended to people with no connection to the shooting; one had a fever. Another was coughing.
About 5 a.m., Vu finally shuffled out of the ER. She drove home, walked inside and turned on the TV. For the first time, she realized the magnitude of what had happened in Theater 9.
She cried. And cried.
Powers reported from Aurora and Khan from Los Angeles.