Category: Virginia Beach

A Neuroscientist’s Look Back on his July 4th Ambulance Ride-Along

On July 4, 2013, Dr. Paul Aravich joined TeamLouka on the ambulance as an observer.  He was asked to jot down a few thoughts on his experience.  His essay is shared below.


Reflections of a Virginia Beach Volunteer Rescue Squad Lay Observer, July 4, 2013. 

Paul F. Aravich, PhD
998839_10151588264079545_313081585_nStephanie Krebs and Amir Louka are two VBVRS volunteers and EVMS medical students who are “social change agents and leaders for the greater good of the community.” They invited me to run with them at Station 8 on Independence Day, 2013. I saw 2 other EVMS students that day who I also admire: an exceptional paramedic who is a new medical student, and a Navy veteran and physician assistant student who is as gentle as he is tall. I witnessed great respect between VBVRS, fire department and ED personnel in almost every instance. And I saw cutting-edge wireless technology and state-of-the-art equipment—although I am still not sure if it the ambulance is a box or a truck.

At the station I hung-out with a volunteer from York County who served at the World Trade Centers and Katrina, a new EVMS graduate student, a senior volunteer who is a builder of persons as well as of homes and barbecues, a critical care nurse from Chesapeake, and an accountant. We talked about abandoned older persons, defensive medicine, how to read an ECG, challenging behaviors, not getting T-boned at intersections, altruism, family, political turmoil in Egypt, and who catches a baseball better, the bulked-up waiter at IHOP or a nerd like me who, like Winnie the Pooh, is actually a “bear of little brain.” We also wondered if we heard the dispatcher correctly that a person got stabbed in the cheek with a fork. At one point Stephanie bravely gave me her humerus (which is pretty funny) and Amir gave me his stethoscope and cuff so I could learn the proper way to take a blood pressure. Thankfully, Stephanie’s paresthesia lasted only a few minutes. At the nearby Oceania Fire Station we laughed with an Army veteran who has seen more than his fair share of tragedies, discussed the merits of Cheryl Crow as a History Channel commentator, and had a surprising conversation about the nutritional problems of hot dogs that made me worry that firefighters may someday eschew donuts. I saw camaraderie being built during the down times as well as during the calls. And, I talked with a squad member and former court official about the ones that were saved, the ones that got away, and an aging parent with dementia. I was reminded that all of us have to hold on to our victories, let go of our defeats, and understand that we’re in this together.

Dr. Aravich & us outside Sentara Virginia Beach General Hospital

Throughout the day I was humbled and inspired by consistent displays of commitment and professionalism, humanism and compassion, and collegiality and mutual support. I saw a successfully aged person with a rare and serious injury that causes significant pain in others but did not in her and wondered if it would steal her independence. I saw an isolated older woman and cancer survivor with depression and abdominal pain and hoped that her GI cancer was not coming back. I saw a frightened young mother fighting addiction and hoped that today will be the first day of the rest of her life. I saw an injured skateboarder who should have known about helmets. I saw a scared older person with breathlessness and fatigue and a family history of heart attack who should not have been cutting grass in the middle of a hot day. I saw the basic life support team immediately recognized the severity of this situation and calmly and effectively take precautions before the paramedic arrived. I saw the paramedic take an ECG in the truck and learned later that it showed the more severe type of heart attack called a STEMI (ST Elevation Myocardial Infarction). I saw the paramedic taking care of this person inside the moving and turning ambulance by, e.g., drawing blood, giving nitroglycerine, sending ECG telemetry to the ED, and offering words of encouragement. Finally, on the 4th of July I saw a crying spouse, caring neighbors, and engaged citizens volunteering to help others when almost everyone else was relaxing.

If, in the Jeffersonian tradition, the pursuit of happiness importantly involves pursuing the greater good, then the VBVRS is full of happy people. And, if people are not distinguished by doing what they have to do but are distinguished by doing what they don’t have to do, the VBVRS is full of very distinguished people. Thank you Stephanie, Amir and the VBVRS for allowing me to see the important volunteer work you do without charging patients. Lives do indeed need saving, both physically and emotionally. All of you saved lives today. Is there any greater compliment? Meantime, a few words about hot dogs: it is OK to bad-mouth hotdogs—but not on the 4th of July.

Dr. Paul Aravich is a behavioral neuroscientist and Professor of Pathology & Anatomy, Internal Medicine, and Physical Medicine and Rehabilitation at Eastern Virginia Medical School (EVMS). He is the former of the Virginia Brain Injury Council and its Ad Hoc Neurobehavioral Committee. He also chaired the Virginia Governor’s Public Guardian & Conservator Advisory Board and sits on the Boards of the Mary Buckley Foundation for brain injury survivors & their families; the I Need a Lighthouse Foundation for suicide awareness; and Alternatives, a nationally recognized youth empowerment organization. He won an AOA Glaser Distinguished Teacher Award. It is the highest award for medical education in the United States and Canada and is presented at the annual meeting of the Association of American Medical Colleges. He also won a Virginia State Council of Higher Education Outstanding Faculty Award, which is Virginia’s highest award for research, teaching and service.
EVMS Graduation, May 2014
You can view his 2009 TEDTalk here:
To learn more about volunteer opportunities with the Virginia Beach Rescue Squads, visit

TeamLouka 2015: Our Virtual Christmas Card

Friends & Family,

We are trying something new this year.  Maybe it will stick, maybe not.  We’re providing a virtual Christmas card, our 2015 in review.  Just a few highlights to share some of our favorite moments.

Year 2 of 3 of our Residency Training

We stayed very busy with work this year, transitioning from Interns to “Upper levels” within the Emergency Department.  We studied for and passed Step 3 of our medical boards, and even ran simultaneous “codes” (cardiac arrests) which both resulted in “conversions” (return to a regular heart rhythm).

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Love in London

In February, we had a week of vacation, but opted to do a “staycation” and throw a London-themed Valentine’s Day party.  Jackie and Chrissy made us some amazing cookies.  We were joined by old friends, family, neighbors, and even The Queen herself!


Bought a New Car

CarMax never knew what hit ’em!  We sold Amir’s old 1999 Mercury Cougar and upgraded to a 2011 JEEP Grand Cherokee.  After all the snow last winter, we knew we needed a more reliable way to get to work in bad weather.  The Emergency Department (ED) never closes, so we go in during hurricanes, floods and blizzards.


Phoenix & Sedona, AZ

In April we both flew to Arizona for a national emergency medicine educators conference where Amir presented a patient he saw in the ED. We rented a JEEP named Jennie and went off-road.  Amir’s write-up of the adventure was published on!

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18th Annual Krebs/Louka Crab Bake

In May, we co-hosted the 18th Annual Crab Bake with The Krebs, and lots of help from Amir’s mom, Julia.  A later date meant more plentiful crabs, better weather and the return of Giant Jenga.  The highlight was when little Zee crawled out on the pool cover.  Thankfully with 20+ paramedics and doctors at the party, a rescue wasn’t far off.  Ray Jr. to the rescue!


Cara & Sean’s Wedding

If you know me, you’ve almost certainly met Cara Reske, one of my two best friends since elementary school.  One of the highlights of the year was October 17, the wedding of Cara to Sean Monahan, a wonderful guy she met up in Baltimore.  Sean works as a real estate agent and is a diehard Orioles fan.


FloydFiesta Block Party 

Every day we grow to love Richmond (or RVA as locals call it) even more.  Part of that is because of our amazing neighbors.  Each year we have an old-fashioned block party where we shut down the street and bring in bands, food trucks and friends.  We’ve also come to be known for our mobile bar on wheels.  Last year we made Dark N’ Stormies; this year we made friends serving Orange Crushes, a Virginia Beach classic, and now a favorite of The Fan District.


UCI Road World Championships

Before September, I knew nothing about professional cycling, except bits and pieces of the Lance Armstrong scandal.  The Tour de France is actually part of a “triple crown” in professional cycling.  The other two events are the Tour de Vuelta, held in Spain, and the Road Worlds, which rotates locations each year.  This year it took place in our city, Richmond, VA.  We were able to participate on many levels, working the medical tent, assisting with drug testing, riding around in the “Doctor Lexus,” the chase car following all of the cyclists, and of course as spectators.  The event brought an extra 650,000 people to Richmond, and introduced us both to an amazing sport.


“Studycation” to The Inn at Tabbs Creek

In early October, we spent5 days and 4 nights at a little B&B on the Chesapeake Bay while we studied for part 3 of our medical licensing exam. The breakfasts were delicious, the crabbing plentiful, and relaxation abundant.


Tariq & Anna’s Wedding

Just this weekend, we were fortunately enough to spend a lovely evening celebrating the wedding of Amir’s brother, Tariq (the lawyer), to the lovely and wonderful Anna Kozicki. They’ve had a difficult year, so it was great to see them both smiling ear to ear.


And like most years, the days in between were filled with random dinners with friends, rescue shifts, studying to be better doctors, writing blog posts, and spending time with family.  We wish we could have seen everyone this year, but even if we didn’t, know that we think of you often.

Wishing you love & joy this holiday season,

Amir, Stephanie & Winston


A few thoughts on drowning events

For 8 amazing summers, I worked as a lifeguard at Ocean Breeze Waterpark in Virginia Beach, VA.  Some of the best memories in my life are from those days.  However, unlike most lifeguard jobs – we actually saved drowning people, and A LOT of them, roughly 10-12 per day. I stopped counting my “saves” somewhere around 300.  Looking back, this job was what lead me to EMS, and ultimately to becoming an Emergency Physician.  The training provided by  Ellis & Associates (E&A) created a great foundation of water rescue, first aid, CPR and leadership skills.

E&A Eastern Regional Lifeguarding Competition - Summer 1998
E&A Eastern Regional Lifeguarding Competition, 1998

On a side note, you may be wondering how so many people can get into trouble at a water park.  It’s not like the ocean, right?  Well, I think as a society we have an inherent respect, and maybe some fear, of the ocean.  Pools however, are clear and don’t have critters, so how dangerous can they be?  People and parents let their guard down and get into trouble.

Are you a good lifeguard?

Before you read any further, I encourage you to take a little test.  The two videos below both feature wave pools where there are active drowners.  It’s like a high-stakes Where’s Waldo – can you spot the drowning victim?  See if you could do the job.

Did you see the kids before the lifeguard blew the whistle to jump in?  The kid in the first video has pretty obvious flailing; the kid in the second video – much more subtle.  There’s been a great article circulating around Facebook the last few months creating awareness that drowning doesn’t always look like what we expect.

Drowning Definitions

Before we get too deep into the medicine, let’s first talk terminology.  Many of the terms I learned as a lifeguard have fallen out of favor in the medical community.

Drowning: a process resulting in primary respiratory impairment from submersion/immersion in a liquid medium

The Drowning Process: the period beginning with submersion into liquid, followed by breathholding.  As oxygen is depleted and CO2 can’t be expired, the patient begins developing hypercarbia (high CO2), hypoxemia (low O2), and acidosis.  As water is inhaled, the larynx spasms shut, blocking the exchange of air.  As oxygen drops further, the laryngospasm relaxes, and the patient breathes water into the lungs. Recovery from the drowning process depends on when interventions are made and the resultant level of hypercarbia, hypoxemia, acidosis and encephalopathy.

drowning process
The Drowning Process

Terms no longer used:

“Dry drowning” versus “wet drowning”: all drownings require some level of liquid, so they are all technically wet.  What was traditionally called a “dry drowning” was just someone who made it to the laryngospasm step but no further because they left the water.  “Wet drownings” went through a laryngospasm period, but advanced in the process to include inhalation of water into the lungs.

Managing Drowning Victims

You should of course follow your local protocols, but let’s talk about how the drowning mechanism affects care.  Clearly if the victim has no pulse, you’ll follow ACLS/BLS guidelines and start CPR.  If you get to a victim but can’t initiate chest compressions right away because you are oh I don’t know – in the middle of the ocean or a wave pool – at least try to give rescue breaths as you bring the victim to a more suitable place.  Remember, drowning is primarily an airway issue, so any early airway interventions will be beneficial until you can start CPR.  As of the 2010 AHA CPR updates, abdominal thrusts in a coding patient have been discarded for good old chest compressions.  So, if your drowning victim isn’t breathing, even if they have a pulse you may need to do chest compressions for management of A&B.

Regarding when to intubate, per UptoDate, “in the symptomatic patient, indications for intubation include the following:

  1. Signs of neurologic deterioration or inability to protect the airway
  2. Inability to maintain a PaO2 above 60 mmHg or oxygen saturation (SpO2) above 90 percent despite high-flow supplemental oxygen
  3. PaCO2 above 50 mmHg” which is typically unavailable prehospital.

Whether someone was pulled from fresh or salt water is not particularly relevant to prehospital care as it doesn’t change management. Consensus used to be the patients in salt water were at risk for massive pulmonary edema and electrolyte imbalance in the blood as the high sodium content of the salt water shifted in the body.  The risk and consequences of these shifts are now less worrisome than once thought.  In a 150lb (70kg) person, it actually takes inhaling 5.5 cups of water before you’ll see osmotic water shifts in the body, and twice that before you’ll see electrolyte shifts.

The greatest risk of drowning of any type is hypoxemia leading to brain damage, and they key strategy is drowning prevention.

Drowning Prevention

Prevention is by far the best strategy in managing drowning, and in the last 20 years, smart safety measures and public education programs have helped drop the overall incidence of drowning by 9%, which includes a 45.6% drop for infants (< 1 yr of age).  In fact, my good friend David Andrews who runs a water park out in California, told me that since the water park industry implemented a policy requiring kids <48″ to wear life jackets, active drowning events have declined roughly 50%.

So, if you are taking care of a drowning victim in your ambulance or ED, just follow your ACLS protocols.  And, next time you are at the water park or pool, thank the lifeguard for their diligence and dedication, and please don’t complain that your kid has to wear a lifejacket.


A Decade Gone: Remembering the Night 3 Lives Were Taken Beneath my Feet

Time is an interesting thing.  Sometimes it feels as if it’s flown by, other times the same memory can seem quite distant – or both.  For me, I can’t not write about an experience 10 years ago that’s left a forever imprint on me.  And for the record, this was an experience that occurred outside of my EMS or medical duties, when I was spending time with friends in my own home (so it’s not a HIPAA violation).    I’m writing about it because I need to, and because I want other people to know that critical incident stress affects everyone.

I had been in EMS right about the worst length of time.  Not long enough to have any experience with a gunshot wound, but long enough to know how bad – how ridiculous, how severe and rare this all was.  When he told me “5 people were shot point blank in the head. I’m pretty sure they are all dead,” I knew.  I had been in EMS long enough to know those people were dead.  To know that what was going on in my home was larger than anything Virginia Beach had seen in a long time.  There would be tons of cops and SWAT teams and helicopters.  I knew the enormity of what was amassing around me.  I wanted nothing more than to see a familiar face with more medical experience than me.

Virginia Circuit Court Case Information
A list of the charges against Marcus Valentino Garrett as a result of his actions May 28, 2005
First off, let me say that I think about the people hurt and killed in this incident, while no longer daily, I’d still say monthly.  Three young individuals at the prime of the lives were killed senselessly.  No matter how much time I spend attempting to process this, that fact still perplexes and bewilders me.

I’m deliberately posting the unedited documents I have from the event (my written account of events, transcript of my call to 911) so you can appreciate exactly where my mind was at the time things were going on. I had been an EMT only 5 months, and this was the first gunshot wound I had ever seen.

 Account of the Events of the Morning of May 28, 2005

1:00 am – I get home from airport and meet friends out at Luna Sea on 22nd Street

2:00 am – We leave Baja Cantina when it closes

2:10 am – We reach my condo at 315 24th Street.  There were four of us present, myself, Jackie Johnson, Kristin Horgardt (male, unsure of spelling) and a friend of a friend, Shane.  I got out my keys to open the door for all of us.  We were coming in the 24th Street (side with our parking lot) entrance.  We noticed that the residents of 110 were awake and partying.  It’s normal for them to have their windows and drapes open with only the screen.  Their cat usually sits there.  Like us, they seemed to have been out at bars and were having a few drinks at their place after everything closed.  The music was not tremendously loud.  I only noticed male voices.  No one was arguing; all seemed to be normal.

2:15 am – Melissa Ozmar, a girlfriend of mine, showed up downstairs for me to buzz her in.  She had been out with us earlier, but drove a friend home and then came back.  We buzzed her in without issue.

2:25-2:40 am – Melissa and I were out on my balcony that overlooks 24th ½ Street and the 25th Street parking lot watching people get their cars towed.  Kris and Shane were in the living room watching a movie on DVD.  Melissa and I spoke to a few people from the balcony.  The only suspicious people we encountered were two guys that were a part of a group of 8-10 black guys.  One of the two men asked us if he could come up and charge his cell phone.  We found that odd and dangerous and said no.  The other guy broke away from the group (that has been walking west on 24 ½ Street) and headed east back towards us.  At the point Shane had come on the balcony, and the guy asked Shane if he knew where he “could get laid.”  I jokingly said 17th Street, and the guy continued in that direction, away from his group of friends.

Kris and Shane decide that they are going to walk to the 7-11 on 24th and Pacific to buy cigarettes for Kris and candy for Shane.  I asked Shane to pick me up a Payday.  I told them to hit the buzzer when they got back and I would let them in.

2:45-2:50 am –  After a quick 5-10 min max trip to 7-11, Kris and Shane hit the buzzer on the 24th Street entrance and I let them in.  They walked right past Apt. 110 and did not notice anything odd.  They sat back down on the couch to finish watching their movie.  Melissa and I never saw anyone enter or leave the building through the 24 ½ street entrance.  At least one of us was on the porch the entire time.  No more than 2-5 minutes later, Kris called to me to tell me someone was knocking on my door.  I went to the door and asked who it was.  A guy told me he was hurt and needed to call 911.  I opened the door and saw a young white male (John from CA) with blood on his hands and face.  I told him to come in and sit down, that I was an EMT, and asked Melissa to dial 911 (2:55 am).  I grabbed some spare gloves that I had and some clean washcloths.  Patient stated that he had been shot.  I initially could not find the entry and exit wounds.  Melissa was a bit nervous and was not answering the call-takers questions well, so I grabbed the phone and relayed information to 911.  I noticed a large amount of blood on the back of the patient’s shirt, so we removed the shirt.  I was then able to see an entry would located behind the left ear, closer to the lymph node.  I then located an exit would in the hair line, just left of the patients spine.  I applied direct pressure while trying to minimize any spinal movement.  The angle of the bullet was such that the wound appeared to affect only muscle tissue and not the vertebrae or skull.  Patient’s ear was also bleeding.  After examination, the bullet had grazed his ear before entering the neck.  I then applied a second wash cloth to apply direct pressure to the ear.  Patient complained of inability to hear out of left ear.  Patient denied ever losing consciousness, denied back pain, shortness of breath or any other injuries.

During the course of treating the patient, he told me a lot of information about the events of the evening and what he saw.  He told me he had been in the bathroom and his friends were in the apartment.  He said the shooter shot him in the head and ran out of the bathroom.  He did not see which way the shooter ran beyond that.  He gave a vague description which I relayed to the call-taker: black male, mid twenties, dreadlocks to just above the shoulders.  He said he recognized him from earlier in the evening when they were all out.  The shooter knew Rachel, brown hair, a girl in their party (one of the people shot in 110).  He did not know if tonight was the first time Rachel and the shooter had met or not.  There was no argument between them early in the night that he saw.  He did say that the shooter seemed attracted/interested in her.

He said that when he came out of the bathroom, he saw his four friends motionless on the ground, they had all been shot in the head.  He was pretty sure they were all dead.  He said he ran up to the 3rd floor to look for help because he thought it would be safer than going outside and was farthest away from Unit 110.  He also remembered that the gun was “squared off” at the end.

3:00-3:05 am – Police arrive and bang on my door.  We open it, and they search my apartment for the shooter.  A lead officer asked me if I had any medical training, and I let him know I was an EMT with Station 14.  I gave him a status update on the patient’s condition, and the SWAT Medic arrived very soon after.  The medic quickly assessed the patient and asked me to remove pressure so he could see the wounds.  He then called for a c-collar from 1421 to be brought up to us.  We applied gauze to the wounds and secured the patient’s neck with the collar.  Scene was not safe, so backboarding was not an option.  SWAT Medic walked the patient down the stairs and out to the ambulance.

3:10-3:15 am – Medic knocks on door again to verify that patient never lost consciousness.  Medic stated that he was now having CNS issues.  Medic also asked me not to dispose of any of the towels or gloves used to treat the patient.

I gave a verbal account to two detectives around 7 am and 12 am respectively.  The second detective collected the patient’s blood-stained shirt, which had been lying on my kitchen counter.  She interviewed Kris and me, and asked that I write an extremely detailed account of the events.

911 Transcript

vb911_logoThe following is a taped 911 call between Virginia Beach Communications Dispatcher Charles M. Simpson and caller Stephanie Krebs [Louka], which occurred 05/28/05, 02:56 hours reference DR# 2005-031807. Victim JKT can be heard in the background.

CS: Dispatcher Charles M. Simpson, SK: Stephanie Krebs, JK: JKT

CS:       Virginia Beach 911, where’s the emergency?

SK:      Hi, um, we are – Apparently there’s an individual that’s come upstairs –Hi, my name is Stephanie Krebs. I’m actually an EMT with Virginia Beach Volunteer Rescue Squad.

CS:       Where are you at?

SK:      Um, I’m at 315 24th Street

CS:       And what is wrong there?

SK:      Um, I live in apartment 320 on the 3rd floor. Can you get me a towel? Sorry, a guy just came in. He’s telling me that there were four people on the first floor. Um, the man that’s here that I’m treating right now – Now what happened to you? That man treating, that I’m treating right now is bleeding from the back of the neck. Do you know how – what the status of the people on the first floor is?

JT:       (inaudible)

SK:      He said that the people downstairs on the first floor were shot in the head.

CS:       Do you know if anyone is alive or, what status is on anything?

SK:      Um, did you, did you see the people downstairs? Was anyone alive or…

JT:       (inaudible)

SK:      People were shot in the head. They don’t seem to be moving. The guy up on the third floor here. He’s talking to me. He’s conscious, breathing, um, doesn’t seem to have neck or back pain. Um –

JT:       (inaudible)

SK:      He can’t hear out of his left ear.

JT:       (inaudible)

SK:      No, that’s okay. Did you know the people downstairs?

JT:       Well, I just came in from California. They’re my friends from college.

CS:       Do you, do you know anything about the status of them?

SK:      Um, I, I don’t and obviously _________I’m not gonna go down there. Um, he said he thought they were all shot in the head, four individuals.

CS:       Do you know anything about who did it?

SK:      Do you know who did it at all?

JT:       No.

SK:      You just saw the people?

JT:       One guy.

SK:      It was one guy. Did you, did your friends know them or…

JT:       No.

SK:      No.

CS:       Can you tell me what he looks like, where, where he went?

SK:      He thinks it was someone they had met tonight. Was he black, white?

JT:       Black.

SK:      A black guy. Do you know how old?

JT:       Maybe mid 20’s.

SK:      Mid 20’s. Did he have any tattoos or piercings?

JT:       Um, nothing ___________.

SK:      Dreads or maybe dreadlocks to about shoulder length.

CS:       Uh, ma’am, I can’t hear you.

SK:      I’m sorry. Um, the shooter seems to have dreadlocks about shoulder length.

JT:       (inaudible)

SK:      Sure they’re coming right now.

JT:       (inaudible)

CS:       Okay. Anything else about his dress?

SK:      What’s that – Do you know what he was wearing?

CS:       He’s on the third floor with the caller I’m – Not the – I mean the victim. One of the victims is. The suspect I’m trying to get information on.

SK:      Sure. Um, the one __

CS:       Ma’am, where did the guy go? Can you tell me that, anything?

SK:      Did he – Which direction did he run – Did he run out 24th ½?

JT:       I don’t know. I was in the bathroom when ________________.

SK:      ______________.

CS:       So he don’t know where he went?

JT:       __________shot me___________.

SK:      Okay. Where did he shoot you? I think he grazed you. Hang on for a second. Melissa – Hey, buddy, I’m gonna have to cut your shirt off, all right.

CS:       All right. Listen, the guy that’s with you, where is he hit at?

SK:      Um, I’m – That’s – I’m gonna cut off his shirt right now ‘cause I think it’s – He’s not bleeding too severely. If you can take it off –

CS:       Can you tell me from where?

SK:      Yeah, I’m looking right now. It’s not visible. He says he got shot, but.

CS:       In the torso area, head?

SK:      No, no, no, no he has like a small ________ on his lower head.

CS:       _____________.

SK:      Actually, I see the entry wound, and he’s very lucky. He got grazed. He has an entry wound.

CS:       Where?

SK:      On his – It’s just below the patient’s left ear, and it’s probably entered and exited only through about one inch of skin.

CS:       And you, and the guy has no idea where the guy did the shooting went?

SK:      No, he – He was using the restroom.

CS:       All right. Does he know why the guy did it?

SK:      Where he did it?

CS:       Why? Why did the guy shoot them?

SK:      Um—Do you know—I know you said you thought you met them earlier in the evening.

JT:       (inaudible)

SK:      Uh huh.

JT:       (inaudible)

SK:      Do you know what it was about?

JT:       No.

SK:      Uh, apparently one of the women in the –

CS:       I’m trying to get information.

SK:      Okay. Apparently–________dispatcher—–

CS:       Male subject shot just below the ear. He’s on the third floor.

SK:      They’re coming in here.

CS:       Let me know when police get there.

SK:      Okay. Can someone go down to the, um – Well, actually never mind, don’t, don’t, don’t. Don’t go down.

JT:       (inaudible)

SK:      Okay. Can you – Is the door locked?

CS:       _______________.

SK:      You locked them, okay? Um, apparently, the, um –We’re not sure of the motive of the shooting, but the assailant was talking to a woman named Rachel earlier who is a brunette, long curly hair. Um, they had met earlier in the evening and didn’t know each other prior.

CS:       And the shooting started, uh, while they were talking to her or do you know where Rachel is at?

SK:      Uh, we think she might be one of the victims on the first floor. Are you sending, um, Station 14?

CS:       Yes ma’am, we got. I don’t know what rescue unit. Just a moment, I’ll check.

SK:      Okay. Sorry. I __________. I’m supposed to be on duty tonight. ________ my shift.

CS:       Yeah, 14____ should be there.

SK:      Okay.

CS:       I imagine they’re all pretty much –

SK:      They’re probably –

CS:       –downstairs waiting for police to clear them.

SK:      Sure. Sure. Um…Actually, there’s – Hey Melissa – Will you __________the cops out there. Yeah, let ‘em know it was 110.

CS:       What is 110?

SK:      110 is the apartment number where we believe all the victims are.

CS:       What about your apartment number?

SK:      I’m in 320.

CS:       On the third floor?

SK:      Correct. And – Hey, Kris, can you make sure that deadbolt is locked on my front door. We got –Who is it? Lock the door. Okay.

CS:       Now, I’m getting a little ____________.

SK:      Who are you? 110.

CS:       Who are you talking to?

SK:      Police are here now.

CS:       The officers are there.

SK:      Okay, is it okay to hang up with you know?

CS:       If you are with the officers, yeah.

SK:      We are with officers.

CS:       All right. Well, thank you for your help.

End of recording.

I’ve learned a lot from this experience, in no particular order of importance:

  1. After the police leave a crime scene, you are on your own.  What they never show you on TV is that after the crime tape is peeled away, the blood and biological hazards are left for the property owner to address.  There are private cleaning companies that drop off fliers and business cards at murder scenes.  Sort of like ambulance chasers, I suppose.  The expense belongs to the property owner.  Many insurance policies have exceptions for acts of violence, so owners have to pay out of pocket.
  2. Police carry more than one type of gun.  Anyone that knows me knows that I hate guns.  I literally cried the first time I saw one at a neighbor’s house in 6th grade.  I knew police carried handguns on their hip, but I had no idea they also carry machine gun like rifles.  Big guns.  Big guns in my house, opening closets, looking in my dryer for hidden threats.
  3. Memory is fallible.  As the case went to trial, I was called in by Harvey Bryant and Colin Stolle for witness prep.  I would have bet you $10,000 that I had a full, vivid recollection of the events of that night.  They felt so vivid in my mind I assumed they had not faded or twisted.  To jog my memory, they played the audio of my call to 911 and showed me photos of JKT’s injuries.  I was wrong on a few small things, and it will forever make me question witness testimony in court.
  4. Trials and long and exhausting for all involved. Companies are required to allow employees to attend jury duty, but there’s no provision for people who are subpoenaed as a witness.  Some companies cover witness testimony if it’s company related, but most do not.  Good Samaritans who attempt to intervene can be rewarded with mandatory court appearance, without pay or protection of their jobs.  Fortunately I was able to negotiate my contract with Launch Interactive to include paid leave for testimony in the trial.  I imagine not everyone is so lucky.
  5. I’m pretty good in an emergency.  I know this sounds silly seeing as I’m now an Emergency Medicine Physician, but 10 years ago I was an inexperienced EMS provider that had never really been put to the test under stress.  When I listened to the 911 call, I was surprised and a little proud of myself in how clear and calm I seemed.  That’s certainly not the way I remember feeling.
  6. Amber Alerts save lives beyond just the kidnapping victim.  The way Marcus Garrett was ultimately apprehended was thanks to an Amber Alert.  On his way to flee, Garrett scooped up his daughter, activating an Amber Alert across the state.  A law enforcement officer, aware of the alert and on the lookout for Garrett’s car, ultimately apprehended him.  Who knows how many lives that officer may have saved that day.
  7. “Maximum Security Prison” is no cake walk. After his conviction, Garrett was sentenced to life in prison at Red Onion State Prison in the most western part of Virginia.  For years I pictured in my head, Garrett shooting hoops on a basketball court, chatting with fellow inmates at a lunch table, meeting with visitors behind a clear plastic wall.  Like on TV.  VCU Medical Center, where I work, has a whole secure floor dedicated to inmates.  One day I heard a guard mention he worked at Red Onion.  Curious as to the actually quality of life there, I asked.  Apparently they spend 22 of 24 hours in a day locked in solitary confinement with no windows, no activities, no interaction with others, but  LOTS of time to think.  Huh.

So how do I feel about everything now?  It’s still hard to say.  My thoughts are still all over the map.

I do know that I’m glad I opened the door that day.  JKT ended up getting married and has since had children.  That makes me smile.  When I met with Bryant and Stolle, I learned just how close my friends and I came to being victims ourselves.  That’s a thought I tuck way way back in my head and prefer to forget whenever possible.  And most of all, I still want to know “Why?”  Cliche I know, but I really am curious what motivates someone to do such a thing, or allows them to lose control and change the course of history for so many good families.  I admit that on many occasions I’ve Googled Garrett, his prison, his status, his contact information.  I worry about myself that I’d ever want to reach out to such a creature, even if to gain closure for myself.  I’m not sure what I’m looking for, but I’m pretty sure I’ll never find it.

Lastly, I do want to thank John Carey and Norvel Allen for looking out for me after this happened.  Since I wasn’t technically on duty for this event, I wasn’t included in the Critical Incident Stress Management debriefings that took place after the shooting.  When I drive around Virginia Beach, I can point to a hotel where a woman overdosed on heroin at her best friend’s wedding; the roadway where 3 kids were driving too fast and paid the ultimate price.  After 10 years in EMS, nearly every block has a story.  I think everyone in public safety does that, 911 dispatchers included.  But it’s different when it’s your home.  You leave for work and still can’t help but look at the oddly cut out square of carpet that replaced the original bit that was soiled with an 18″ diameter and 2″ tall pool of clotted blood.  You come home and retrace those same steps you took that night – passing by that window with celebratory voices, yet now so silent.  You get an at least twice-a-day reminder of the horror and violence that entered your home that warm Friday night.  It’s never normal, just slightly less obvious.  On this 10 year anniversary I hope that the families of all involved find peace and warmth.