One Saturday night in Pakistan

It was two years ago this month on—for me—a typical Saturday night. It was about 8 p.m., and I was sitting on my sofa watching TV when the noise came and the apartment windows shook so hard I thought they would explode. I immediately ran to the radio and called the Marine on duty to tell him I was standing by, because I knew that—whatever this was—it was really bad.

Almost immediately, my cell phone rang. It was the physician I worked with at the U.S. Embassy’s health unit in Islamabad. We quickly formed a plan. I was to call the other nurse practitioner and ask her to go to one hospital while he went to another. Their goal would be to seek out injured Americans. Since I lived on the embassy compound, and was about 30 seconds away from the medical unit, I would go there, in case anyone came. Before I could get my shoes on, the Marine called to say that injured were coming through the gates, and they would be escorted to the medical unit.

My professional history included more than two decades in emergency departments and intensive care units, so I was prepared for the chaos that emergencies always bring. But this night would stand out as unique in my experiences. The initial injured that were arriving had sustained minor injuries, abrasions and scratches from flying debris. People were also arriving who had not been at the location of the bomb. Some came to assist, some to look for friends, and some because they were in shell shock from the enormity of the event and weren’t sure where else to go.

The blast was from a truck bomb in front of the Marriott Hotel. The resulting explosion killed 60 people and injured nearly 300 more. The blast concussion blew out windows and doors in much of the surrounding area, and some of the people coming to the medical unit were victims of that effect.

For the first hour, until the medical unit RNs could be escorted in, I worked as the lone medical provider. Several Marines came to help and were instrumental in taking names, triaging wounds, handing out water and bringing supplies to the exam rooms. However, the atmosphere was uncannily orderly. People spoke in hushed voices and wept silently. And, as I would go to the front room to seek the next victim I could assist, those waiting had already sorted out who might need to be next and patiently waited their turns.

A gentleman I did not know, and never saw again, came to answer the phone and relay messages. When a badly injured man was brought in, and it was apparent he needed immediate critical attention, I had only to announce the need for someone to accompany him to the hospital in the embassy’s ambulance. Immediately, a serviceman volunteered.

By the second hour, the other NP and the clinic’s three RNs had come, as well as a physician’s assistant who was in the area. We all worked steadily: cleaning wounds, suturing, dressing, comforting. A second critically injured person was diagnosed and we sent him off to the hospital.

Around 11 p.m., I received a call from a consular officer that a gravely injured American had been located at a government hospital. I left with the ambulance and another military volunteer—“I can’t let you go by yourself, ma’am”—to assess the situation. The man was badly injured and in shock. He had been partially stabilized but needed a head CT, which could not be done at the present facility. I used my very best diplomatic skills to thank the staff for all they had done and moved the injured man to our ambulance so we could take him to a facility with a CT. This hospital, not equipped for trauma cases, was a terrible scene, as many injured and dead had been transported there, and the staff was doing the best they could under appalling circumstances.

At 6 a.m. the following morning, I finally went to my apartment to catch a couple hours’ sleep, then headed back to the medical unit to see victims in follow-up, or new ones with minor injuries who came to be checked out. My physician colleague had spent the entire night at the hospital and finally went home when one of the clinic RNs came to relieve him. The other NP went to the morgue to sit with deceased Americans until the air transport arrived. On Monday, we would all be in the clinic for regular work responsibilities.

I have many times reflected on that Saturday night. I still marvel at the orderliness, the compassion for one another and the solidarity of everyone who came to the health unit that evening, in spite of the horrific event that brought them there. I would not call it fate or providence, but it was one of the few times in my life that I knew, without a doubt, I was exactly where I was meant to be and doing what I was meant to do.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.