Sandy Hook pediatricians share grief, advice, hope 6 months after tragedy
- Copyright © 2013, The American Academy of Pediatrics
At 9:30 a.m. last Dec. 14, a fateful phone call interrupted the day off for Newtown, Conn., pediatrician Laura Nowacki, M.D., FAAP.
It was her office nurse calling to say a shooting just occurred at Dr. Nowacki’s daughter’s school. They needed to triage.
Although emergency calls began going out all over town, parents couldn’t have realized the magnitude of those alerts in the quiet, tight-knit community. Dr. Nowacki grabbed her keys and made her way to Sandy Hook Elementary School.
“I got about a half mile from the school and couldn’t get any closer. It was just crazy — police cars, fire engines, cars everywhere. So I sprinted that last half mile and came to the firehouse. A police officer stopped me and said the kids are coming out to the firehouse. So I went in there first, and my daughter stood out among all these kids squished in this little room, and I just hugged her.”
Seeing her daughter provided quick relief, but Dr. Nowacki knew she had to hurry to the school down the road to help out. “And then I left. It was the hardest thing I’ve done.”
To the residents of Newtown, “12-14” became their 9-11.
On that day, 20-year-old Adam Lanza massacred 20 first-graders and six adults inside Sandy Hook school before turning a gun on himself. Earlier, he had killed his mother at home. The events set off a nightmare for the whole town.
Waiting for the wounded
Her daughter safe, Dr. Nowacki made her way to the door of the school, where she found Raul Arguello, M.D., FAAP, chief of pediatrics at Danbury Hospital and parent of a second-grader and a fourth-grader.
Dr. Arguello rushed over after receiving a text from his wife. “Obviously, as a parent, I panicked,” he said.
At the firehouse, Dr. Arguello found a chaotic scene, with kids looking for their parents, and parents yelling their names. “I was one of them,” he said. “My mother-in-law saw me and tapped my shoulder and said, ‘The kids are OK.’” He located his wife and children, and they hugged.
Dr. Arguello then “flipped the switch,” ready to help where he could. He treated a wounded teacher but strangely, no one else emerged. “It never occurred to me that there were dead kids at the school — never.”
Back at the hospital, medical personnel expected a surge of patients. Only three eventually would be transported there. The staff watched news reports, and the horrible reality sunk in. It was afternoon before they knew not to expect additional victims.
Some hospital employees had direct connections to the victims, which Dr. Arguello described as a horrific experience. The chair of psychiatry quickly arranged for counseling for the staff. “We all cried,” Dr. Arguello recalled. “There was not one adult who didn’t cry.”
Summoning a team
At the hospital, Greg Dworkin, M.D., FAAP, in-patient pediatric director and chief of pediatric pulmonology, organized the pediatric emergency response. He contacted the offices in town, lining up pediatricians to be part of trauma teams.
Within 15-30 minutes, five pediatricians were on their way to the emergency department, another 15 were ready to go, with others on standby. “And then just like Sept.11, we prepared for a lot of things that didn’t wind up coming to us,” Dr. Dworkin recalled. “So I needed to get back to the pediatricians and tell them to stand down.”
Ana Paula Machado, M.D., FAAP, medical adviser to Sandy Hook school, was working in her practice’s satellite office that day and knew her son’s high school was on lockdown. An office partner was called away for pediatric trauma response, and appointments had to be cancelled.
“About an hour later, my head nurse called and said my partner was back because he got there (the hospital) and was told he was not needed because all the children were dead. When I heard those words, that’s when I totally collapsed.”
Six months after 12-14, Newtown continues to grapple with ongoing concerns, despite an initial outpouring of support and counseling. The AAP Connecticut Chapter, based in nearby Hartford, has been working to arrange for a coordinator of mental health services, plus additional coverage for services.
Chapter leaders helped draft a late resolution for the Annual Leadership Forum in March. The resolution, Promoting Education of Families about the Culture of Violence in the Media and its Effects on Children, was ranked No. 1.
The town’s physicians — representing various specialties — came together to start United Physicians of Newtown, now at more than 100 members, to advocate for greater access to mental health care, medical research into gun injuries, stronger gun safety laws and more. Drs. Arguello and Dworkin are on the steering committee.
Individuals have taken up causes as well. Said Dr. Dworkin: “Everybody seems to be involved in something in order to help the town heal.”
Eight of Dr. Nowacki’s patients died on 12-14, and she went on to organize Team NewtownStrong to run in the Boston Marathon. One mile was dedicated to each of the 26 lives lost in the school. When the bombings hit, she had just left the finish line, and all the team members and families were safe. While traumatic, the experience left Dr. Nowacki with greater resolve.
“I’ve never spoken to the media until all of this happened. But I really believe I have to stand up. I have to use my voice. I used my legs for Boston and ran the marathon. But you realize ‘this is where I’m supposed to be; this is what I’m supposed to do.’”
Post-traumatic stress disorder in children remains a concern and even has affected kids in neighboring towns. A lot of pediatric office visits to Dr. Nowacki turn into mental health visits. “(For) everybody who comes in the door — you don’t know, is it really just strep throat, or is it, ‘I’m not sleeping at night’ as well?”
Preparing for, coping with disasters: advice from some Newtown pediatricians
Have a well-coordinated emergency preparedness plan in place.
After a disaster, support each other and tap into community services immediately. Speak out if you detect gaps in resources.
Contact your state AAP chapter.
Pursue various methods of delivering mental health care.
Include anticipatory guidance on public health issues whether you are a general pediatrician or subspecialist.
For school physicians, take notice of students with lengthy excused absences who may be at home with untreated mental health issues.
Advocate to reduce the pervasiveness and glamorization of violence.
Encourage other physicians to pursue public health advocacy with their own professional associations.