LEWISTON — Central Maine Medical Center’s health insurer brought in mental health professionals to support hospital staff after the Oct. 25, 2023, mass casualty event, but staff found the most support from each other, according to Ann Howe, Emergency Department nurse leader.

Hospital staff have mostly leaned on each other for support in the year since the mass casualty incident, she said. They have helped each other through ongoing struggles caused by the events of that night when a gunman killed 18 people and injured 13 more at Just-In-Time Recreation and Schemengees Bar & Grille.

In the days after the incident, staff kept in close contact with each other, often texting one another to check in, Howe said.

Making matters more stressful for providers was the fact that the shooter remained at large immediately after the shootings, so hospital staff were also worrying about their own loved ones’ safety while meeting the demands of their job, Chief of Surgery Timothy Counihan said.

“Health care in general, both physicians, nurses, everybody in the team, there’s an emotional toll to it,” he said. “These kinds of specific events take that daily emotional toll and times 1,000.”

Once the gunman was found, staff could not only stop worrying about their own families, but could relax and not worry about a possible second wave of victims, Howe said.

As routines got back to normal in the Emergency Department pretty quickly, hospital staff relied on each other for support maybe more than they should, she said. She does not know how many of the staff used the counseling services made available to them, but one of the popular resources was the therapy dog that was brought in, she said.

Another helpful resource came from staff at the University Medical Center in Las Vegas, who video chatted with staff at CMMC, she said. It was helpful to talk to other nurses and doctors who had gone through their own tragic event.

In 2017, a gunman opened fire on the crowd at a music festival in Las Vegas from his upper-floor room in a nearby hotel. He killed 60 people, wounded at least 413 and in the panic that ensued more than 400 others were injured. The gunman was later found dead in his room from a self-inflicted gunshot wound.

“I think that meant more to the team than anything else — in fact, I know it did,” she said. “That’s literally what people told me.”

They talked about feelings and gave CMMC staff words of wisdom about how to process the traumatic event as time goes on, she said.

“Like in six months from now, or a year from now, or two years from now, you might see something and just fall to pieces,” she said about the advice the Las Vegas providers gave. “And it’s OK, like we’re all human and it’s going to hit us.”

CMMC staff will have another opportunity to talk to the Las Vegas team in another video call this week, she said. She is excited to touch base with them again because they have become like friends, even if they do not know each other well.

The community also rallied around providers in the days after the incident, doing what they could to help out, including local restaurants that sent food to providers, she said.

Dunkin’ and Olive Garden Italian Restaurant gave food to staff in the Emergency Department the day after the mass casualty event, a small but impactful gesture, Howe said, as many of the hospital’s staff had not eaten or even thought to nourish themselves in a day or more, instead focusing on caring for patients.

“I just hope that those two places know how much that meant to the team because nobody had eaten since breakfast the day before, like it was too busy,” she said. “They didn’t really get a lunch, they were just grazing during the day and they didn’t get to go home to have dinner. And the next morning like the adrenaline hadn’t worn off so they were all just running and they were too tired to think about feeding themselves.”

INVISIBLE VEIL

Often there seems to be an invisible veil that medical providers keep their personal feelings and reactions behind while treating and interacting with patients. Patients often aren’t aware of the emotions providers feel after they treat traumatic injuries or give traumatic diagnoses to patients.

Out of a sense of professionalism, providers will embrace this disconnect because they feel the service they provide comes above themselves, Counihan said. Providers will rarely ever let the public see their own private struggles on the job.

“You have to put yourself aside because we’re servants, you now, we’re serving the public,” he said. “… We’re trained to do that but that’s why we’re in the business, because we want to help people.”

But then there comes the matter of how to deal with the stress that comes with the job, he said. Usually providers learn to deal with job stress over time in their own ways. Humor is one way to relieve stress in the medical field. It also helps to talk to co-workers and family members on stressful days.

Counihan comes from an Irish-American family from Boston and his family members also had tough jobs when he was growing up, with his dad serving in the Korean War, he said. Having family members who work in stressful professions is part of his family experience.

Howe still has some long-term struggles after the events of Oct. 25, she said. Talking about the incident makes her sad and she feels shocked that a mass shooting happened in the Lewiston community.

She gets nervous sometimes when she hears pages overhead or when dispatch gives the hospital a heads up about injured people coming to the hospital, she questions what is coming next, she said. She also questions if she could have done something better on Oct. 25.

Some people with traumatic injuries have come into the Emergency Department this year and their blood has gotten on the floor, prompting her to think about how much blood she saw during the Oct. 25 incident, she said.

“I’ll just stand there and I’m just like ‘this isn’t even close to the same amount of blood,’” she said. “When you have other traumas come in it kind of takes you back to that night.”

There was a power outage at the hospital recently and “code triage” was called overhead, which was the same code called the night of Oct. 25. And after 30 seconds the lights came back on and providers got their bearings back, but some of those who had been present during the mass casualty event did not feel OK after that, she said.

All too aware of the toll the job can have on some medical providers, Howe is constantly thinking about her team and striving to meet their needs, she said.

If you pulled back that invisible veil most providers keep their emotions and personal experiences behind, you would see individuals trying to manage the demands of their job and their personal lives, she said.

“You would see people that are trying to find this balance between their professional demands, which is caring and serving our community, and who they are on the other side and not having a very good balance of that,” she said.

“Our job is who we are to the core. Even if we’re not 100% and even if we don’t seem like we’re very caring and empathetic, at the end of the day, being your nurse is who we are.”

OVERWHELMING RESPONSE

Because there were so many other medical professionals who came in to provide help Oct. 25, the providers already scheduled to work that night were supported and a lot of patients were able to be saved, Counihan said.

“I had my whole department around me,” he said.

Though there were some tough lessons to learn from the mass casualty event, such as the need to provide adequate translation services to patients coming in who were deaf and hard of hearing, the response from doctors and providers across all hospital departments was overwhelming.

Counihan praises all of the providers who came back into work to help save and treat patients. Many of the doctors were on their way home or had not been home long before they got word of the shooting and turned around to come back into work.

From the Intensive Care Unit to gynecology, surgeons were coming to the Emergency Department to help with surgery or care as much as they could, he said. Sometimes multiple doctors were doing surgery on different areas of one patient’s body, he said.

“Like every hour that went by we were winning,” he said. “Like, this guy goes to the packing table, resuscitated, operated on by three to four different surgeons, multiple injuries and boom — those wins were happening all night. That’s why we’re in the business.”

Counihan feels fortunate that the shooting did not happen during the day when beds in other departments would likely have been full or that it was not in the middle of the night when doctors would have struggled to get out of bed or missed calls entirely, he said.

Howe also feels fortunate that the call came in when it did during shift change at the hospital so many members of the day and night crews were at the hospital at that time, she said. Sometimes the events of that night replay in her head and she feels proud of how efficient staff members were in those moments.

For Howe, it is important that the people they treated on Oct. 25 and their loved ones know that hospital staff remember them, she said. She still thinks about them often.

“The whole team is thinking about all of the patients that they cared for that night,” she said. “… We have not forgotten them.”