Tim Counihan, chief of surgery at Central Maine Medical Center in Lewiston. Daryn Slover/Sun Journal

LEWISTON — The scene at Central Maine Medical Center Oct. 25, 2023, reminded Chief of Surgery Dr. Timothy Counihan of his time treating service members during his 24 years in the Army Reserves. The shooting left 18 people dead at Just-In-Time Recreation and Schemengees Bar & Grille and 13 others injured.

Patients coming in that night were struck by a gunman using an AR-10 style Ruger SFAR rifle. Counihan was aware of the kind of damage such a military style assault rifle can cause to the human body. The injuries to shooting victims that night looked like those of the injuries he treated on deployed service members as a surgeon in the military, he said.

“I thought I’d put that chapter of my professional career behind me,” he said. “… You don’t see this kind of stuff typically unless you’re in a military environment because these were military weapons that were used. So, yeah, it was kind of a ‘back to that again.’”

He had to make tough decisions that night based on the limited number of providers present compared to the number of victims coming in, such as quickly evaluating the extent of patient injuries and determining who is likely to be saved and who is unlikely to be saved, he said.

There were some victims who had such extensive injuries that he had little hope they would survive, but they did, he said. Though doctors could not save all the victims who came in that night only one person died during surgery.

Setting emotions aside in the moment was something he already learned how to do during his time treating traumatic injuries in the military, he said. But he never imagined he would have to use those skills in a mass casualty event involving civilians.

That night, he did what most trauma surgeons do: stuff his emotions into a little box inside himself and file it away so he could focus on treating the traumatic injuries in front of him, he said. He avoided situations that might trigger an overwhelming emotional response, but he does remember some things happening that made some of his emotions bubble to the surface.

After performing surgery to the first patient to come in from the shooting that night, he made rounds through the hospital providing assistance and advice as needed to other surgeons working on patients, he said.

Things settled down at the hospital in the early morning hours of Oct. 26, 2023, with Counihan helping with surgery on the last patient that night, he said. He went home later in the day Thursday, caught up on sleep and was back to providing regularly scheduled surgery Friday — as was the case for many other providers and staff.

“I don’t know of anybody who took any time off,” he said. “You know, this is what surgeons do and our team members … we have traumas here all the time, not in this number but the mentality is — bring it. And otherwise, you wouldn’t be in this business. So, it’s expected that you’re going to suck it up.”

‘Controlled chaos’

Ann Howe, CMMC Emergency Department nurse leader, had only been in a leadership position a few months before Oct. 25, 2023, she said. When she arrived at the hospital that night she saw people gathered outside the locked-down Emergency Department doors and noticed the line of stretchers sitting alongside the build.

She started feeling emotional but pulled it together once she got inside and saw all of the staff working to prepare for patients and providing treatment to those already at the hospital, she said.

“As I came through the door I just took a deep breath and I was like, ‘it’s you, like, you have to be there for your team,’” she said.

Immediately she started working to get needed supplies, putting staff to work retrieving items, she said. Once she finished looping around taking inventory of what was needed, providers in almost every Emergency Department room needed blood, it was the most requested thing. Providers also needed fully equipped mass casualty carts. She gathered staff around and gave assignments.

“I just kind of stood in the middle of the trauma bays and get everyone’s attention and we just kind of started divvying up roles real quick,” she said.

Hospital staff got organized, with everyone having a task or role and focusing on fulfilling that duty, essentially acting as cogs in a larger machine, she said.

“We call it controlled chaos because it is like that. We do run drills, we do trainings, not to this extent, right, like, there’s no amount of training that can truly prepare you for what it will be like in the moment but your adrenaline kind of kicks in but so does your skill set. This is why we became emergency medicine providers,” she said.

Patients with low acuity went upstairs while people with more serious injuries stayed in the Emergency Department, she said.

She did not leave until 2:30 a.m. the morning of Oct. 26, 2023, she said. Though things had calmed down in the hospital providers were still preparing for the possibility of an influx of more patients, as the gunman was still at large. It is what set this mass shooting incident apart from many others across the country.

“So, it was just waiting, like, is he (the gunman) going to come in as a patient, or is there going to be another shooting,” she said.

Despite working long hours that night, everyone who was scheduled to work the next day showed up, she said. Day shift staff that stayed well into the night to provide assistance still showed up for their shifts the following day, getting little sleep that night but unable to stay away.

“They could have called out sick because it was 95% all of the same nurses and nobody would have held that against them but every single one of them came in and what they all said was, ‘I love my family but I have to be here with the people who know what we just went through,’” she said.