Rhode Island Hospital President Joseph Amaral slumps back in his office chair, rubbing both hands through his salt-and-pepper hair, his eyes tightly shut.
It’s 3:30 on the afternoon of Feb. 21. By now the hospital is out of the hurricane’s eye. Sixty-four victims of the West Warwick nightclub fire have streamed through the emergency department. Forty-three have been admitted – 35 of them critical, whisked up to the intensive care unit. A few have severe burns over half their bodies; others fight for their lives on respirators, their lung tissue charred from smoke inhalation.
As Amaral had told reporters at an earlier press conference, it is the biggest catastrophe the 140-year-old hospital has ever seen. Now, Amaral, a Pawtucket native, grasps for words when reflecting on the day.
“The best description I have, it’s like a pit crew at a race track,” Amaral says, faint dark circles under his eyes betraying sleep deprivation. “Everybody knows what to do and how time is of the essence. There’s this incredible focus.”
A small television in the corner of his office flickers with images from the fire, interrupted only by grim proclamations of new death tolls. Clips show emergency personnel wheeling burn victims from ambulances. Footage of Amaral himself appears, relaying to reporters the extent of victims’ injuries.
By now he’s done interviews with CNN, Fox News, MSNBC, the BBC, RTP, a Portuguese TV station (Amaral is the son of Portuguese immigrants). He sits dressed in the clothes that were hanging on the hook in his bedroom when his pager went off 15 hours earlier: faded blue jeans and a brown sweater. He wears shoes with no socks.
Amaral has been paged out of slumber plenty of times. But when he turned on the television while brushing his teeth to find live coverage from the fire scene, at 1:30 a.m., he sensed the magnitude of the disaster.
That sense was hammered home when he arrived at the hospital a short time later to glimpse about 100 people – friends and family of the victims – amassed in the lobby of Hasbro Children’s Hospital next door, waiting with a mix of hope and horror.
“When I see this, it’s just weighing on me, this general sense of helplessness I feel for those people,” Amaral said.
The feeling was fleeting, out of necessity.
The most frenetic activity at the 719-bed hospital unfolded during those wee hours. More than 200 extra doctors, nurses and other workers had been called in. Amaral conferred with key staff in the incident-command center, an emergency communications hub stationed in a conference room at Hasbro.
Initially, administrators were focused on resources. Were there enough respirators and sedation medications? Enough intravenous fluid and burn dressing?
Much of Amaral’s time was spent moving back and forth between patient areas. He made rounds to each patient’s room. Twice. He popped in and out of the emergency department, where Dr. William Cioffi, the hospital’s chief surgeon, and chief nursing officer Jan Metzger were managing the flood of casualties.
“I go down to the ER and it’s all under control,” Amaral marvels. “Every question I ask has an answer.”
Amaral is a trauma surgeon, accustomed to the controlled frenzy of an operating room. It helps him on days like this, he says. Only there’s never been a day like this.
The volume of acute patients that swamped the ER was unprecedented, as was the number of critical patients admitted. Two Rhode Island Hospital employees – used to dodging gurneys in busy hallways – now occupy them, victims of the fire. Many of the hospital’s nearly 5,000 employees will suffer their own emotional wounds, likely to know at least one of the dead or injured.
Those thoughts, however, initially took a backseat.
“At the time, you’re really more focused on what’s right in front of you,” Tara Howard, a registered nurse, said days later. Howard had just finished her shift in the trauma ICU around 11 p.m. when word came that dozens of critical patients were being transported. She helped clear the seven existing patients out of the unit to make room, and stayed on the entire night.
But the waves of activity eventually recede, giving way to emotions.
“The engine has been running at such a high pace, and now you come down,” Amaral says. “All the patients are in a bed. They all have doctors and are being cared for. The ER is empty. We don’t have to worry about more patients coming in. So the event is, in terms of the acute part of it, over.”
That moment came around 6:30 a.m.
Slipping past a crush of reporters, Amaral made his way to his car and went for a drive around the neighborhood in the breaking light of dawn. He needed to clear his head.
By then, news flowing from the fire site was firming up. Nearly 40 people were dead, the radio report said, and the death toll was expected to rise. The magnitude of the tragedy begins to register.
“Until then, I was sort of devoid of the event,” Amaral says. “And there is a moment when it sort of all hits you, and I start to understand how many people really are dying.”
Hospitals plan exhaustively for crises that never seem to happen. Intricate disaster-management plans are prepared. Incident-control centers are constantly at the ready. Procedures to handle mass casualties from a terrorist attack are drawn up, rehearsed, revised, rehearsed again.
For Rhode Island and other hospitals that handled victims of the West Warwick fire, the day was a validation of those efforts. As of a week after the tragedy, not one victim admitted to any area hospital had died – a fact that many in the medical community have marveled at.
“It’s what you’re supposed to do and it worked,” Amaral says, the hours of adrenaline and coffee now beginning to ebb.
“When I sit here today, and I know how those people performed,” he says. “To me, it’s a pride in knowing that these people working here really are who they say they are.”
The hospital staff has risen to the occasion in the past. They have handled victims of explosions and bus crashes. There have been power outages. On all those tense days, Amaral explains, there is an accompanying sense of relief once the storm passes.
But today there was no relief, he says. Only the raw reality of 97 dead and more than 100 injured.
At the end of the interview, around 4:30 p.m., Amaral is asked what he’ll do for the rest of the evening.
“I’m going to sleep,” Amaral says. He pauses. “I’m gonna try to go to sleep.”.
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