Amherst Magazine

The Surgeon

By Elizabeth Chiles Shelburne ’01

 
 A year after the shootings at Virginia
 Tech, the mother of one survivor called
 David Stoeckle '68, who operated on
 her son, "an angel- at the right place
 at the right time." 

At 2 a.m. on April 17, 2007, David Stoeckle ’68 got out of the bed he’d been in for only a few minutes. He walked into the study adjacent to his bedroom and sat down with his laptop. His mind was racing too fast for sleep. He began to type a letter to the CEO of Montgomery Regional Hospital in Blacksburg, Va., where Stoeckle is chief of surgery. Two hours later, the surgeon was still at the computer. He woke up his wife, Margaret, and had her read the letter. Then he went back to bed, but he never fell asleep. He got up at 5 to shower and head back to work. That morning, he handed the letter to his boss. In part, it read:

Today was surreal. Mass shootings occur elsewhere, but not in Blacksburg. Disaster drills are “staged” in Blacksburg, they do not really happen in Blacksburg. Today was different. Today changed all that. Today a terrible tragedy struck Blacksburg, Montgomery County, Virginia Tech and Montgomery Regional Hospital.
But today something else truly awesome happened for which we can all be proud. Today an incredible team of wonderful, dedicated people came together very quickly and professionally to save lives, as well as to help the loved ones and victims so horribly touched by this awful tragedy. . . . The flood of mixed and overwhelming emotions was unimaginable—horror, fear, sympathy, tension, concern, caring, compassion, love, tears, sorrow and joy for saving a life. I stand in awe of and admiration for all of you.


Stoeckle had become a central player in the story of the massacre at Virginia Polytechnic Institute and State University, better known as Virginia Tech, in which Seung Hui Cho, a senior at the university, killed 32 students and professors before turning a gun on himself. There have been at least 100 attacks at primary and secondary schools and colleges in the United States since 1891, the vast majority of which have been shootings, according to Wikipedia, the most comprehensive source available for this information. (The Washington Post and The Indianapolis Star-Tribune have also compiled statistics on school-based attacks, but neither as comprehensively as Wikipedia has. The U.S. Department of Education publishes an annual school violence report, but it covers only elementary and secondary schools.) Children as young as 11 and adults as old as 70 have picked up firearms and killed at least 300 people and injured more than 430, often before killing themselves. The Virginia Tech massacre, on April 16, 2007, occupies a sad position at the top of this list, as the deadliest school shooting in American history.

David Stoeckle '68
Stoeckle on a regular surgery day 

 

 

Gunshots aren’t the usual fare at Montgomery Regional Hospital. Situated in the rolling mountains of southwestern Virginia, the hospital is in an area where people come to get away from city crime. The ER mostly treats people injured in car crashes and college students who’ve discovered there really is a limit to the number of Jell-O shots one should consume. The few gunshot victims who do enter the hospital have usually been involved in hunting accidents or suicide attempts, although Stoeckle has treated two would-be John Waynes who are lucky to be alive after practicing their quick draws in the mirror and accidenttally shooting themselves.

Stoeckle spends three days a week following up with patients who’ve had surgery and calming the fears of those about to go under the knife. Tuesdays and Fridays are surgery days, which begin at 8 a.m. His surgical schedule might mix a few colonoscopies with a gallbladder removal or a chemo port replacement. On those days, he walks like a speed demon, rushing from the OR to rounds upstairs, to his office across the parking lot and back again. (He once wore a pedometer for a day that clocked him walking nearly four miles. That day was a slow one, he says, because he had medical students who couldn’t keep up.) One Friday morning, an older woman comes in to have a chemo port removed from its knobby position under her collarbone so she and her husband, another of Stoeckle’s patients, can go to Disney World with their grandchildren. The patient, still groggy from the anesthesia, pats Stoeckle’s hand where it rests on the bed rail and says, “You did such a good job, as usual.”

If Stoeckle is liked by his patients, he’s beloved by the hospital staff. At 8 a.m. on a surgery day, his OR is filled with at least three nurses and an anesthesiologist, and the jokes are flying in a southwest Virginian twang. At six feet tall, Stoeckle literally stands above them. He’s mostly quiet, but for instructions and an occasional laugh, when his eyebrows shoot up and his eyes crinkle above his operating mask. The hospital’s only complaint about him, one person told me, is that he might someday retire.

Blacksburg is, in many ways, a small Southern town, but the presence of the university lends it a diversity one might not expect in this corner of Virginia. At the Virginia Tech visitors’ center, the receptionist happily provided me with a parking permit and a bit of town gossip, along with directions to a local restuarant using the First Baptist church as a landmark. Situated alongside the 50 or so Catholic and Protestant churches that one might expect to see in any Southern town, however, are two Islamic centers, a synagogue, a Greek Orthodox church and a Baha’i worship center. (Having grown up not far down the road in Tennessee, I can attest to the fact that such a diversity of faith is unusual.)

Blacksburg was often called the “most wired town in America” in the 1990s, and it remains a center for technology companies, thanks in large part to Tech. The university and its associated jobs provide much of the employment in town, but there are also a large number of manufacturing jobs nearby. “It’s rural, but it’s not rural,” says Stoeckle.

Stoeckle grew up in Darien, Conn. He spent his high school years swimming and was good enough to attract the eye of Amherst’s swim coach at the time, Hank Dunbar ’44, who directed the summer waterfront program at Darien’s country club. Stoeckle was committed to Wesleyan and applied nowhere else. But after a visit to Amherst, he realized he didn’t want the spot for which he’d already paid a deposit at Wesleyan. He quickly applied to Amherst, and he turned down Wesleyan before he’d even heard back from Amherst. Luckily, he got in. His sophomore year, he lived with seven other guys in two Social Dorm rooms. They called themselves “the Straight Eight,” says his roommate, Jeff Miller ’68. In those times, a hard-working swimmer was pretty straight, even if he did protest against the Vietnam War.

Stoeckle’s father, a salesman who always worried about being fired or passed over, advised his son: “You’ve got to work for yourself, and the best way to do that is to be a doctor.” After some initial resistance, Stoeckle took pre-med courses at Amherst and applied to medical school. As it turned out, his father was right: medicine was a good fit. Stoeckle focused on pediatrics during medical school, but when he took his first surgical elective, he promptly fell in love with it. “I was tired; I’d never worked so hard in my life; I got no sleep at all for a whole month. But I came away and said, My god, what am I doing? I can’t go into peds. I love surgery.” Since then, he’s treated hundreds of people and saved many lives, but the decision to be a surgeon would prove most consequential on an unusually cold day in Blacksburg last year.

 

Our minds are primed to follow the rule known as Occam’s Razor: all other things being equal, the simplest explanation is the best one. The cops, EMTs and hospital staff understandably reached the simplest conclusion when two Virginia Tech students were brought into the hospital’s emergency bay shortly before 8 a.m. on April 16, 2007, one dead on arrival, the other dying from her gunshot wounds. Everyone assumed this was the result of a lover’s triangle gone bad—tragic, of course, but a situation that typically doesn’t escalate beyond those intimately involved. It occurred to no one that at that moment, there might be a man with two guns walking across the campus and into a classroom building crowded with students. And so, understandably, no one contacted the student body, alerted parents or cancelled classes. At that moment in history, no one suspected that the man who killed those two students, for reasons that no one completely understands, would go on to kill 30 more. The simplest explanation is the best one—until it no longer is.

This assumption was so prevalent that none of the doctors or nurses with children at Tech thought to call their own kids. One of Stoeckle’s five children, his daughter Kathleen, was taking a class at Tech that semester toward her master’s degree, and Stoeckle had assumed (mistakenly, as it turned out) that she was on campus that morning. “I certainly didn’t think about calling her up,” he says. But then word came through to the hospital that there’d been more shootings, this time at the university’s Norris Hall.

According to the Virginia Tech Review Panel report, after killing the first two students in the dorm where he had his mailbox, Cho returned to his own nearby dorm, stopped at the post office to mail a package to NBC News and made his way across the sprawling Gothic-style campus to Norris Hall, a building that housed the engineering department and other classrooms. He chained the main doors on the first floor from the inside. Then he walked up to the second floor and began an 11-minute shooting spree that ended only after he’d shot off 174 rounds of ammunition, wounding 17 students, killing 30 students and professors and, finally, killing himself.

For many of his victims, death was immediate. For others, however, there was a chance of survival if they could make it to the area hospitals, of which Montgomery Regional was the closest. At 10:05 a.m., the first of the Norris Hall survivors arrived at Montgomery with a broken leg from jumping out of a window to escape. By this time, the hospital had issued a code green, or disaster code, which closed the emergency room to any traffic other than that from Tech. The hospital called in all available staff. At 10:09, the EMS brought in a student from Norris Hall who was suffering an asthma attack from stress. The emergency department staffers might have taken a breath at that point—a broken leg and an asthma attack are not traumas—if they hadn’t heard what was coming their way: 11 victims with multiple gunshot wounds.

When the code was called, Stoeckle was in his office, about to begin routine appointments. He tore across the parking lot to the ER. A few minutes later, ambulances came screaming in, carrying the first two gunshot victims from Norris Hall. The patients—one shot three times through the leg and arm and the other shot once through the arm—were wheeled into the trauma rooms in the ER, as might be done on a regular day. When he saw them, Stoeckle quickly realized that their injuries were not life-threatening. The patients were tying up much-needed trauma equipment, including heart monitors, so he ordered the patients moved.

Stoeckle understood at that moment that the ER needed a triage center, a place to assess injuries, check the trauma tags attached at the scene and assign rooms based on the severity of the injuries. When patients come into the ER through the ambulance bay, they pass through a set of automated doors, into a small entryway, and then through another set of doors. Along with two nurses and a technician, Stoeckle set himself up in that small entryway. When Mike Hill, director of emergency services, rounded the corner, he saw Stoeckle standing at the door, shouting instructions about which patients should go to which rooms.

That system worked well until the 10th patient arrived from Norris Hall, 51 minutes after the first, with a bullet in his thigh that had torn out three centimeters of his femoral artery. Stoeckle was the only surgeon available with the expertise to fix the wound; the others were already operating on other patients. Kevin Sterne—who would become known to the world after photos showed him being carried from the hall—lay on a gurney, two tourniquets wound tightly around his thigh. Stoeckle assessed him at the makeshift triage area and then ran alongside as Sterne was wheeled straight to the OR. Later, the story emerged that Sterne, an Eagle Scout, had wound an electrical cord around his leg as a tourniquet. While Sterne’s tourniquet likely helped, it was the ratchet tourniquet applied by EMTs at the scene that saved his life. However, his leg had become ischemic—deprived of blood. The four-hour surgery was painstaking. It required Stoeckle to stop the bleeding, to use one of Sterne’s veins to replace the torn artery and to check for nerve damage.

During Sterne’s surgery, Stoeckle dissociated himself from the tragedy: he had a job to do. But after the surgery, he saw that part of the hospital had filled with dozens of students, parents and Tech officials. “Oh, it was awful,” he says. “Families knew to come to the hospital, but they didn’t know whether their student was dead or not.” He was shaken to realize that it could have been his daughter lying there on the stretcher; that some of these parents were about to get the news that no parent ever wants to hear.

By the end of the day, the staff at Montgomery Regional had seen 17 patients from Virginia Tech. All but two, the victims of the initial dorm shooting, survived and are doing well today. For a 146-bed regional hospital with a low level of trauma capabilities, that outcome is astounding. “I tell you,” Stoeckle says, shaking his head, “it all happened so fast. It just happened. It just flowed.”

  
After the shootings, Stoeckle couldn't
sleep, so he retreated to his study to
write down his thoughts.  

 

Everyone I spoke with in Blacksburg, both in and out of the hospital, said the same thing: “This kind of thing doesn’t happen here.” This sentiment is particularly pronounced among the hospital staff, inured as they are to seeing the worst that their town has to offer. “We realized that those are our kids,” says Amy Woods, director of surgical services at Montgomery. “They don’t belong to Tech; they don’t just have one set of parents; they’ve got a whole town that feels responsible.”
   
Driving around Blacksburg, nearly every car has a Virginia Tech memory ribbon on its trunk. On a typical day this winter, three-quarters of the students on campus were wearing maroon and orange—somewhat incredible, considering that the Associated Press voted Virginia Tech’s colors among the five ugliest in college football in 2006, writing, “Even Crayola wouldn’t put orange and maroon together.” Citizens of Hokie Nation responded by saying that you only have to look at the hills in the fall to know that God himself is a Hokie. This is Virginia Tech territory, and one can only be a fervent patriot.

Stoeckle’s office and waiting room are littered with Tech paraphernalia. In part, this is because his son runs a business that produces the gear, but it’s also because he’s a fan. He came to Blacksburg after two years with the U.S. Army and 11 years in a small town in Maryland. He was looking for a new professional challenge and a hospital that would let him do more laparoscopic surgery at a time when that practice was in its infancy. He answered an ad for a surgeon position at Montgomery Regional. “We rapidly found that the communities where we wanted to raise our kids and that we liked the most were those that had colleges or universities. There’s just more going on,” Stoeckle says. He moved to town in 1990 with his wife, Margaret, and their children. They live in a comfortably rambling home filled with antiques, seven dogs and the detritus of a busy family, with five cars in the driveway. His youngest child is in high school, and an older daughter is living at home while she finishes her master’s degree. One of his adult sons lives nearby. His mother-in-law lives next door.

The truth about school shootings is that they do happen in towns and at universities like Blacksburg and Virginia Tech, no matter how close-knit the community or how spirited the students. “Unfortunately,” Stoeckle told me in February, “it’s going to happen again somewhere.” In fact, days after our conversation, a former student at Northern Illinois University, said to have been behaving erratically since he stopped taking antidepressants, killed five students and then killed himself on Valentine’s Day.

The shooting at Northern Illinois highlighted the one good consequence of Virginia Tech’s massacre: the implementation of college-wide notification systems. Over the past year, colleges and universities—including Amherst—have tested such notification systems (see “This is Only a Test,” page 25). Virginia Tech has established a method that alerts students via text message, instant message, phone and e-mail. Montclair State University in New Jersey employs perhaps the most technologically advanced system, mandating that students carry a school-issued phone with a GPS system and other safety features built in.

These new alert systems are important, but they’re meant to deal with an emergency in progress, not to stop it from happening in the first place. Colleges are also focusing on preventing attacks through behavioral interventions. Cho’s conduct had raised red flags within Virginia Tech, as well as at his high school and in the states judicial and mental health systems, but there was confusion over the legal ability of these organizations to communicate with one another about his condition. Colleges and universities are governed by a complex array of federal statutes and professional guidelines, in which some information cannot be shared. There is widespread confusion over these rules.

To navigate this statutory jungle, Amherst relies on a team of administrators—the Counseling Center director, the Health Services director and two members of the Dean of Students’ office. The team serves as a locus to pull together all the pieces of information about particular students who might be in need of a mental health intervention. Dean of Students Ben Lieber is quick to emphasize that the team’s discussions occur within the limits of confidentiality, except in situations where a student poses a threat to himself or herself or to others. In such cases, Lieber says, “we don’t hesitate to breach confidentiality.”

The difficulty arises in judging when a student poses such a threat. It is not always a clear-cut decision. “Our own sense is that one errs on the side of caution,” Lieber explains. “If you have any belief that someone is dangerous or in danger, then you have an obligation to act on it.” W. Scott Lewis, a consultant to the National Center for Higher Education Risk Management and a member of a similar behavioral intervention team at the University of South Carolina, is also cautious. “At the end of the day, if someone’s going to sue me, I’ll take the lawsuit from the living mad kid [over one] from the dead kid’s family,” says Lewis, who is assistant vice provost at the university. (In March, the Department of Education proposed new regulations to one of the acts that govern colleges and universities. The change would clarify when administrators can intervene and free them from fear of retribution for disclosing information.)

The reality is that even the best systems cannot always prevent a determined and troubled individual from attacking himself or others. The systems help, of course, but they are not perfect.  As Stoeckle says, this will happen again.

 

The day after the shootings at Virginia Tech, news clips showed Suzanne Grimes, Kevin Sterne’s mother, tearfully thanking the staff of Montgomery Regional. When I spoke with her this past March, the same emotional gratitude remained, particularly for Stoeckle. “He was an angel, at the right place at the right time,” Grimes said. It struck me as an unusual statement, since her son had unfortunately been in the wrong place at the wrong time. “We were blessed,” she said simply, to have Stoeckle there to operate on her son. “That connection will always be there. To say that we are grateful is an understatement.”

For Stoeckle, the emotions of that day are no less strong. “I can’t remember the name of anyone I operated on last week, but I’ll never forget Kevin Sterne’s name,” he says. “Any time Kevin comes in, I’ll drop whatever I’m doing to talk with him.”

A year after the shootings, Stoeckle struggles for words to describe that frenzied day. Partly, this is the surgeon’s need to compartmentalize, I suspect, but it would be difficult for anyone to describe the emotions that result from seeing a stream of bullet-riddled college students enter the ER. “They were going to class, doing what they want to be doing, learning—and bang!” he says, shaking his head. He is a doctor who was previously best known on Google for his presentations on “The Laparoscope Revolution”; a doctor who, in the course of his job, found himself in the midst of extraordinary circumstances. Stoeckle is now back to his regular working life, performing his duties as chief of surgery, juggling a schedule of general surgeries and procedures that require his expertise in laparoscopy. His days are, as always, intense and physically draining, but thankfully, they lack the emotional wallop of that April day. “I hope I never have to go through that again,” he says.

Not long ago, Stoeckle found himself driving toward Virginia Tech. He was on his way to a candlelight vigil being held on campus to honor the victims, families and students of Northern Illinois University. Shortly before he reached campus, however, he got a call from work. An emergency had come in; the patient needed surgery. Stoeckle turned around and headed back to the hospital.

Elizabeth Chiles Shelburne ’01 is a freelance writer based in the Boston area. Her last piece for Amherst was a profile of Edwin Macharia ’01 (Fall 2007).

Photos by Samuel Masinter '04