Emergency room nurse Jane Muir woke up that Saturday morning before 6. She told herself not to turn on the TV.
Instead, she focused on her daily yoga and 10-minute meditation to ground herself for what might lie ahead.
It was Aug. 12, the day people in Charlottesville had been talking about for weeks. Groups of neo-Nazis and other white supremacists from around the country were converging to protest the removal of the Robert E. Lee monument from Emancipation Park downtown. The night before, she’d gone out with friends to the downtown mall, which was usually hopping on a Friday night.
But it had been ominously still, she said, as if the college town were holding its breath.
Even now, getting ready for her 7 a.m. shift, she could hear the fwap, fwap, fwap of helicopter rotors. Through her apartment window, she could see the landing pad for Pegasus, the University of Virginia Medical Center’s helicopter. But the noise wasn’t Pegasus, she would discover. It was the rotors of state police choppers hovering near the rally site about a mile away.
Meanwhile, Beth Mehring was driving in to work at the medical center. She’d had a restless night. Mehring serves as emergency services manager for the UVA Blue Ridge Poison Center, Life Support Learning Center and Medical Emergency Response. She’d spent 30 years as a nurse in the burn center, intensive care unit and emergency room. Mehring does not scare easily.
But thoughts of what might come that day made her uneasy. By 11 a.m. she was sitting in a massive conference room watching television monitors pipe in live video streams from the rally site. Though the event wasn’t scheduled to begin until noon, protesters and counterprotesters were already hurling bottles, shouts and fists, and the scene looked on the verge of exploding.
Mehring knew anything was possible with crowds both on the move and jacked up on hate. Leading up to the day, she considered all types of scenarios, even thinking about the terror attacks on crowds in Nice, Berlin and London last year. What if someone in Charlottesville decided to turn a car into a killing machine and drive it into a body of defenseless people?
Amid the chaos that developed on Aug. 12, leaving one woman dead and scores of people injured, the University of Virginia Medical Center became a hub of needed calm.
Administrators knew it would have to be. The Southern Poverty Law Center had predicted that the day could be the “largest hate-gathering of its kind in decades in the United States.”
The medical complex is one of the few Level 1 trauma centers in the state, meaning that it is capable of handling around-the-clock surgical and critical care. Medical center staff knew it was within walking distance of the disturbances that were likely that weekend. But it was also still the community’s hospital. People would still have babies, suffer asthma attacks and visit family members, despite what was playing out on the national news.
Staff at the center had spent weeks monitoring internet chatter, meeting with law enforcement officials and connecting with other medical facilities like nearby Sentara Martha Jefferson to prepare for the worst. In the end, the hospital staff’s years of experience created a safety net that provided more than just critical care.
Tom Berry, emergency management director for the University of Virginia Health System, had little sleep the night before but was at his duty station around 8 a.m. He had left the hospital only six hours earlier, keeping an eye on news of the torch-bearing marchers who congregated on Grounds. The display was reminiscent of Ku Klux Klan Night Riders of the Old South and Nazi gatherings in 1940s Germany. The evening had been relatively quiet for the hospital, however. Berry, a retired Army officer, had gone home, catnapped and returned.
By 11, Berry was sitting near Mehring in the command center that he helped set up across the street from the hospital entrance.
Berry had been preparing for this day since the KKK rally on July 8 at Justice Park. The crowd of a few dozen members of the North Carolina–based White Knights of the KKK was much smaller than what was anticipated for this August rally. In July, the group dispersed, and there were arrests but no major injuries from the skirmishes. But the August rally was expected to bring in thousands.
To prepare, Berry helped form planning groups to look at what was needed for the hospital staff, for potential patients and their families. The groups considered everything from pharmacy services and information technology to parking.
Berry monitored websites of the white supremacist groups, as well as those of groups planning to counterprotest, to get an understanding of their intent and their methods.
He knew that he needed to have both a plan and a process of coordinating with key players. Before joining UVA in 2007, he spent 22 years in the Army as a Medical Service Corps officer. He managed health care services for Special Forces and Army Rangers and served with deployable units overseas, where every few days they experienced an MCI—a mass casualty incident.
He’d even been in one of America’s worst. Berry was working at the Pentagon on Sept. 11, 2001. Berry reported to a 9 o’clock meeting that morning but was told that the person in charge wasn’t there yet; he could stay and wait or come back.
Berry remembered that he needed to update his life insurance in an office on the other side of the Pentagon; he’d do that and return.
He was watching events unfold in New York on TV and didn’t even hear or feel when American Airlines Flight 77 slammed just outside the Pentagon perimeter, where he’d been 45 minutes earlier.
He immersed himself in response efforts and didn’t see his family until a couple of days later.
Now, years later at UVA, hate was threatening again.
By noon, a few people with minor wounds like head cuts had come into the emergency room. They were quickly treated. So far, the day was no different from a typical Saturday in the ER.
Muir watched the video feeds on computer monitors with everyone else. Be mindful, she reminded herself. The staff couldn’t afford to allow anxiety or fear to distract them from their purpose.
Muir can easily exist on adrenaline. She was an athlete at her Chantilly, Virginia, high school and editor of her student newspaper. But through her time as a student at the University, she’d practiced lessons of mindfulness.
She’d graduated from the University’s nursing program in 2016 and learned the importance of mind over matter, of taking care of yourself so that you can take care of others.
The medical center’s preparations were making that easy. Security measures had been instituted. Most of the center’s 60 entrances had been closed to funnel people through just two. Elective surgeries that week had been rescheduled, and patients who could go home had been discharged. This provided more bed space—and also freed up the nursing staff and doctors to be ready. The lobby had been converted into a triage area with surgical staff dressed and on standby. A row of stretchers was parked outside the entrance.
Counselors from the company’s employee assistance program floated around the emergency room, keeping an eye on staff and making sure they felt secure and were OK.
Then the call came.
At 1:44 p.m., multiple alerts flowed into the command center: A car had crashed into a mass of people on Fourth Street.
Mehring touched a telemedicine monitor on her right that connected her directly to the emergency room.
“Stand ready,” she said.
Staff at a family support center were alerted. The center was stocked with comfortable sofas, chaplains, cookies and pretzels for family members waiting on the news of loved ones rushed to the ER.
First reports of casualties were being called in:
A few minutes later, a revision:
Thirty to 40.
In the emergency room, the charge nurse called out a possibility of mass casualties. On cue, Muir joined the staff as they moved to the trauma bays.
Muir wasn’t nervous. She wasn’t scared. She felt prepared.
The resident trauma surgeon in her bay, Dr. Zach Dietch, also set the tone.
“All right, you guys,” he told their team, “We’re going to speak in low voices, we’re going to listen to EMS give their report, and we’re going to move everything along, and everything will go smoothly.”
It did. Muir worked as a scribe as the patients came through, noting what was being done and said.
When crying patients came in, the staff held their hands and calmed their nerves. Compassion was dosed out along with pain medicine.
While CNN looped the footage of a gray car plunging into the crowd, hitting another car and then counterprotesters, the staff at the medical center processed 28 people in the next 51 minutes. Twenty of those were from the crash and the others from the rally. Several were in critical or serious condition and would be admitted.
One patient, 32-year-old Heather Heyer, would die from the trauma she suffered from being hit by the car.
By 4 p.m., staff in the emergency room began to exhale. The flurry of activity had calmed down, though the staff was told to remain on alert. The police had shut down the rally, but the command center was hearing reports that more rallies and vigils might be springing up in other parts of the city.
The evening remained quiet, though, and Muir, Berry and Mehring started to process the day.
Muir finished her shift at her usual time, a little after 7 p.m.
She checked her phone, which was choked with text and voicemail messages from worried friends and family.
Muir could only think of how proud she was of what the staff accomplished that day.
“You spend so much time going through potential situations—it’s heartbreaking but it’s heartwarming when we can come together to execute,” she said. “It was a glimmer of positivity in all this chaos.”
Mehring stayed until midnight and would return at 7 the next morning.
She wasn’t surprised at how well the staff performed; she’s always known that her co-workers are some of the most capable in the field. It was the events of the day that left her numb.
Mehring grew up in a part of Albemarle County where everybody was working class and no one had time to worry about race or skin color, she said. In addition, hers was a family that took care of others. Both her parents worked in volunteer emergency rescue, and she started working with them when she was 18.
She was born at this hospital and gave birth to her son there.
This was her beloved hometown, and she felt violated that hate groups had come to use Charlottesville as their ground zero.
Berry also stayed late only to return the next morning. He was already making note of what worked well and what needed to be tweaked. The planning went so well, however, that he’s been asked to speak at conferences about it.
He doesn’t like the attention but says he’s representing the staff when he talks about how well the center did that day.
“The biggest reward is seeing hundreds of people come together,” Berry said. “We do take preparedness very seriously to empower people and to minimize suffering, and I’m very proud of that.”
White nationalist groups have since returned for smaller rallies and have said they will continue to come to Charlottesville to protest the ongoing debate about the removal of the Lee statue.
Whatever happens, the medical center will be prepared.