Monday Morning Crisis Quarterback

Thursday night, a giant explosion ripped through a neighborhood in San Bruno, California.  The blast and subsequent fire, apparently caused by a ruptured gas line, leveled 38 homes and killed at least 7 people.  Six more are missing. 

I don't know about you, but if you gave me an hour to list all the horrendous things that could happen to me I could come up with a pretty long list, but I doubt a gas explosion destroying my neighborhood would be on it.  It certainly wouldn't be on the top.  We all know, in the back of our minds, that there are certain things that could happen to us -- car accidents, homicide, natural disasters (different ones, depending on where you live) -- but there are other things that just don't make the list because they are so rare we don't know about them.  Gas leaks?  Sure.  Gas explosions?  Maybe.  The entire neighborhood detonating?  Not so much.

I'm not sure whether that makes the typical person's reaction to this better or worse, but it does make it different.  When we hear about, say, a horrible car accident that killed multiple people, it may make us more afraid to drive.  We may lose our own sense of safety on the road.  We may imagine what it would be like to be a family member getting that call, or to be on the road and witness or be involved in the crash.

Our reaction when something so bizarre happens is a little bit different.  Yes, we probably are more sensitive to the smell of gas or more careful not to leave the stove on.  We probably don't spend a lot of time imagining what it would be like to be in the incident itself, largely because we just can't.  Even once it's happened somewhere, our minds can't yet process fully how such an event would play out.

The most important difference is the quality and amount of fear we may feel.  When we hear about a car accident, if we feel afraid we feel afraid when we drive, or when our loved ones drive.  The fear is specific to the incident.  An extraordinary incident like the San Bruno explosion, however, can cause two different kinds of reactions:  either it seems so unlikely that even though it's happened it doesn't seem possible, or it seems so random that the entire world seems less safe.  Our fears, if we have them, are not specific to gas lines or even to sitting in our homes.  They are about something completely random coming out of nowhere and hurting us.  We don't react to the sudden discovery that a specific situation is not safe, we react to the discovery that the world is not safe.

Most of us experienced this kind of reaction nine years ago, after the 9-11 attacks.  The fear we felt and the reactions we had were not necessarily about flying or working in an office building or even about the type of person we presumed to be the terrorists.  It was fundamentally about the notion that a day could start as normally as that day did, and turn into such a nightmare without warning.  Our worldview was violated not because we used to think flying was safe and now it wasn't, but because we used to think that life was safe and we found out maybe we were wrong.  The people of San Bruno found that out again this week, and in some small way, so did the rest of us.

Abby Guerra, 19, and Marlena Cantu, 21, along with three of their high school friends, were returning to Arizona from Disneyland on July 18 when the SUV they were riding in blew a tire, lost control and rolled over several times.  Reports on that day said that Guerra was killed at the scene and Cantu was in critical condition.  Another friend died at the hospital, and the remaining two were severely injured.  This, by itself, would be an awful situation.

Guerra's autopsy was a relatively low priority, and the county coroner was very busy, so it was scheduled for Friday, July 23.  On Saturday, July 24, her dental records were compared and the startling discovery was made that the body in the Maricopa County morgue was not Abby Guerra.  It was Marlena Cantu.  Abby was in critical condition in the hospital with Marlena's family surrounding her.  Abby's family was planning her funeral, but she wasn't dead.

This sort of thing should not happen, and for the most part it doesn't.  There was a similar case in Indiana in 2006, but such mix-ups are, as they should be, the exception.  This is the cruelest kind of mistake.

When someone we love is suddenly killed or seriously injured, the situation feels surreal.  The most typical reaction to the news is, "This can't be true."  Many people actually say those exact words, sometimes over and over and over.  In this incident, it actually wasn't true.  Guerra's family spent a week trying to grasp the reality of the situation, only to discover that they were, basically, right in the first place -- this wasn't real.  Cantu's family, has the awful reverse -- having spent the week very worried but grateful she was alive, they have found out that she isn't. 

The worst of it, for Marlena Cantu's family, is not just that she is dead.  That by itself would be bad enough, and by itself would cause them to say "this can't be true."  But, on top of that, they have a very real reason to believe that it might not be true.  After all, if Guerra can be thought dead and actually be alive, why can't Cantu?  And while you and I, looking from the outside in, may know that's not going to happen, and while the Cantus may know it on some level as well, one can hardly blame them if they have trouble accepting it.

Aside from disbelief, I would expect the Cantus to also be experiencing some anger.  First of all, for obvious reasons, they are probably mad at emergency personnel, medical personnel and the medical examiner for getting this wrong in the first place.  It would be understandable as well if they were mad at the Guerras on some level.  This is a zero sum game -- one woman is dead and one is alive -- and so, on some level, the fact that Guerra is alive appears to cause Cantu's death.  That isn't a rational statement, but people who have just suddenly lost a loved one are not in a particularly rational place.  If they're like a lot of people, they're mad, they know they shouldn't be mad, and they're mad at themselves for being mad.  That doesn't help much, but it's hard to avoid.

My heart certainly aches for both of these families, for the mix up, for the accident, for the struggle Abby Guerra is now engaged in for her survival, and for the emotional roller coaster they will be on for a long, long time.

Anyone who's ever had any kind of emergency training at all has heard some version of the same speech.  "Before you try to help," it goes, "make sure that you yourself can assist safely.  Do not become a casualty yourself."  In a Red Cross CPR class, this comes in the form of the reminder to "Check, Call, Care," that is, check to make sure it's safe before you do anything else.  In a lifesaving swim class, it takes the form of "Reach or throw, don't go," meaning don't get into the water if you can help the struggling swimmer any other way.  CISM has a similar principle, usually expressed along the lines of, "If the incident is personal for you, get someone else."

I bring this up because on Tuesday I was assisting with a response and became a casualty myself, although not, perhaps, in the way you would think.

Earlier this week, a family from Ann Arbor was involved in a major car accident in Virginia.  The mother, Theresa Supica, and one of the daughters, Samantha, were killed, and two other daughters are in the hospital.  The girl who was killed was a student at Slauson Middle School in Ann Arbor, where I am the training coordinator for the CISM teams.  Tuesday night, the team leader for that part of the district had organized a crisis management briefing and general get together for the middle school community as well as the associated elementary schools and the high school the sisters attend.  It was outside on a large patio in front of the middle school.  She asked me to attend as one of the supporting members of the team, which I was happy to do.

Tuesday was a pretty hot and humid day in Ann Arbor.  After work I went to a weight lifting class and, despite the air conditioning, we were all sweating profusely.  About three quarters of the way through the class I started to feel somewhat nauseous, so I sat out in the hallway (where it was a little cooler) for the end of class and felt much better.  I hopped in my car and headed towards Slauson, about 10 minutes away.

Half way there, my stomach started to feel icky again.  I realized I probably should stop driving, and that I wasn't going to be much use at the CMB.  My cell phone was dead, so I thought I'd get to Slauson and find someone I knew to call my husband to come get me.  I pulled into the parking lot, got out of the car, sat down in the grass near my car and, not seeing anyone I knew in the immediate vicinity, flagged down a stranger who was just arriving.

I don't know what I looked like at this point, but it can't have been good, because the woman immediately looked alarmed and said, "What's wrong?"  I asked her to call my husband, and she went to get her cell phone out of her car.  By the time she returned, I was vomiting in the grass, breathing very heavily and losing feeling in my hands.  The woman called 911.

At this point I was pretty much doing a face plant in the grass.  I could hear everyone and I knew what was going on, but I couldn't move and felt just ghastly.  I could hear the woman trying to give directions to where we were, estimating my age ("middle aged" -- I was a little disheartened) and asking if I'd ever had a stroke "before."  When the paramedics arrived and got me onto the stretcher, I was shocked to see that quite a crowd had gathered.  It hadn't occurred to me that I was causing such a ruckus.

To make what is already a long story a little shorter, after 5 hours in the ER and all sorts of tests, the only thing wrong with me was dehydration.  I should know better.  Apparently, however, I don't.  I was embarrassed to have caused such a scene. 

More than anything, however, I knew that I had caused a scene in a place where people did not need more drama.  A community reeling from the sudden death of one of its own does not need the image of a relatively young (OK, middle aged), relatively healthy person being wheeled into an ambulance.  They don't need to hear sirens.  They are working on believing that the world is a safe place once again, and my little episode underlined that maybe it isn't.

To the friends, neighbors, teachers and family of Samantha Supica, I send my heartfelt apologies.  I became a casualty myself.  You have my deepest sympathies and my sincerest regrets.  Thank you for helping me when I should have been helping you.

In the early 1980's, Rom Houben, a Belgian 20 year-old, was in a horrific car accident.  He was in a coma, and then diagnosed as being in a persistent vegetative state.  For 23 years, his family refused to accept his diagnosis and insisted he was conscious and aware of his surroundings.  Finally, with advances in brain scan technology, doctors were able to more thoroughly examine his brain and determine it was essentially normal.  Over time, they were able to help him communicate using a single finger and a keypad. 

Houben wasn't in a vegetative state at all, but rather suffering from "locked-in syndrome," a state where he was able to hear and feel and understand, but unable to move or speak.  The medical journal article that detailed his story estimates that up to 43% of people diagnosed as being in a vegetative state are actually conscious.

I'm sure this case will be the subject of much political debate.  The news coverage is rife with mentions of Terri Schiavo, the Florida woman whose husband's battle to remove her feeding tube made its way all the way to the United States Congress.  I acknoweldge that this case raises ethical questions, and I also acknowledge that I am completely unqualified to discuss them.

This story also raises questions for the families of those diagnosed as being in persistent vegetative states.  On the one hand, accepting the reality of their loved one's situation is important, regardless of what people decide to do about it.  Holding out unrealistic hope can trap people in the common trauma reaction of feeling like the situation isn't real.  On the other hand, if this study is accurate, about 4 times out of 10, it truly isn't real.

This story is very encouraging to those left behind by traumatic accident victims in vegetative states.  I truly hope that as many of them can be "unlocked" as this story predicts.  I just worry about the 6 out of 10 situations or more where this research will prevent survivors from accepting reality.

Eight people were killed in a three car accident about 20 miles North of New York City today.  Unless you know the people involved, you probably read that and were not particularly affected by it.  But it's all in the description.  Do you feel differently about this one?  Four children, as well as four adults, were killed in a three car accident in New York State today.

Conventional wisdom tells us that traumatic incidents involving children are harder than those that only involve adults.  We all know that instinctively, but why is it true?  It all comes down to the ever-present worldview.  Most of us hold a set of beliefs on a gut level that are something like these:

• Children do not die
• Parents do not outlive children
• Bad things do not happen to good people
• Children are inherently good
• Parents have the obligation to keep children safe, and we can accomplish that goal
• Short lives are a waste

When a child dies, it violates the first five of these beliefs, and stimulates our sadness about the sixth.  Trauma involving children takes things that we think we know to be true and turns them on their head.  And when one closely held belief is challenged, it seems like everything is challenged.  How can we carry on in the fact of such uncertainty about how the world works?

But with the possible exception of "children are inherently good" (and we can argue about whether short lives are a waste -- I really do not believe they are), none of these things are actually true.  And in fact we know they are not true.  So why are they so important to us that we lead our lives relying on them being true?

I find myself reminded of the scene in the movie Men in Black where Tommy Lee Jones' character says,

There's always an alien battle cruiser, or a Corellian death ray, or an intergalactic plague intended to wipe out life on this miserable little planet. The only way these people can get on with their happy lives is that they do not know about it!

In other words, as you've heard me say before, we base our lives off of what is likely, not what is possible.  We choose to ignore what we know to be true -- that tragedy is possible -- because if we lived in the shadow of tragedy all the time we would not be able to live at all.  We choose not to know what we know.  Until we read headlines like the one today, and we remember.