Juan Castro had just killed a woman, police said, but trauma surgeons and nurses at Erie County Medical Center then saved his life.
If they hadn't moved swiftly, chances are Castro would be dead from a bullet that blew open his stomach two weeks ago.
Dozens of people suffering from bullet wounds, beatings and stabbings are rushed each year to the region's only state-designated trauma center and brought back from the brink of death.
If not for those doctors and nurses, Buffalo's homicide rate -- there were 55 last year -- most certainly would have been even higher.
Police are the first to say that, if it weren't for ECMC's medical staff, the annual homicide rate would balloon.
"They perform miracles every day. People should know about that," Police Commissioner Daniel Derenda said. "They save so many people, year after year after year."
When a dying 17-year-old was brought into the medical center's emergency room late last year, there was no time to waste.
"He'd lost a lot of blood and was on the edge. The bullet went through his abdomen, hitting his stomach, liver and colon before it ended up in his lung," said Dr. William Flynn.
"I took out part of his spleen, liver and intestines."
After an extended stay in the intensive care unit, the youth was discharged.
Last year, 312 victims of criminal violence arrived at the medical center with serious, often life-threatening, injuries. Gunshot wounds were the most common, at 121. But there were other kinds of wounds, too: 115 assaults involving blunt force and 76 stabbings.
Of those, 12 gunshot victims died, as did two assault victims.
Another dozen people with bullet wounds were declared dead on arrival.
To grasp the enormity of the bloodshed, imagine a battalion of Marines serving in Afghanistan -- roughly 300 members -- all suffering various types of wounds within the span of 12 months. That's what ECMC's emergency medical teams encountered last year.
And that doesn't include the approximately 60,000 other patients who visited the emergency room throughout the year.
Motor vehicle accident victims, people who fell and fractured bones, burn victims, and heart attack and stroke victims were all in that mix.
"It's really heart-stopping to watch. You'd think it was chaos, but everybody has a job, and they work like a machine," said Peggy Cramer, an emergency room administrator and nurse for three decades.
When a seriously injured patient arrives at the emergency room, as many as 10 staff members converge on the person in a trauma resuscitation room o assess and stabilize the patient.
"The first thing is to check the airway to make sure it is clear, then look for life-threatening problems in the chest area. If there is bleeding in the chest, we put in a tube and drain it of blood and re-expand collapsed lungs," Flynn said. Then, he said, "intravenous blood and other fluids are started, and a diagnosis is made to determine what operations, if any, are required."
When surgery is needed, the medical center's suite of a dozen operating rooms is about 150 feet away down a bright hallway, unlike in other hospitals, where operating rooms might be on another floor, requiring a time-consuming ride in an elevator.
Flynn, with other medical personnel, has raced down that well-lighted hallway many times taking a patient to surgery.
Yet treatment often begins before the patient arrives at the hospital.
"We will get calls from emergency medical services personnel on a dedicated phone line. We may be able to provide assistance on what to do and what not to do out in the field as they are bringing the patient in," said Dr. Michael Manka, emergency department director.
For instance, emergency room doctors could order an electrocardiogram of the patient inside the ambulance and have the results faxed ahead to the hospital.
If it is obvious that a heart attack has happened or is occurring, the patient can be more swiftly sent to the cardiac catheterization unit.
"Time is muscle," Cramer said of the need to perform an angioplasty to unclog arteries and get blood and oxygen flowing through the heart muscle, before it dies off.
Often ambulance dispatchers will phone ahead to the emergency room and give a heads-up of what's on the way. At that point, the pagers carried by dozens of trauma and emergency room personnel buzz to life with a text message.
"It's a continuum from when we first hear about it as it is happening in the street," said Dr. Ronald M. Moscati, an emergency room physician. "The page lets the blood bank, operating room, radiology, the trauma intensive care unit and clergy all know."
It also provides a brief window of time for medical workers to "prepare psychologically" for what is about to happen at their end, Cramer added.
And because this scenario happens so frequently, Manka explained, doctors, nurses and other staff constantly improve.
"What makes us unique is we do it so often that it becomes routine for us, as opposed to other hospitals that don't care for trauma routinely," Manka said.
Every day of the year, 24 hours a day, the hospital is in a state of readiness, according to Flynn.
"There's no question of who's going to care for the patient. We have several layers of physicians, a trauma team, orthopedic surgeons and an in-house crew of general surgeons. We can't save everybody but we do our best."
>One of the saved
Alonzo Fayson is one of the people who was saved.
The 42-year-old Buffalo man was stabbed several times last May inside a Crossman Avenue house. He managed to run away from his attacker and up to the intersection of Genesee Street.
"I sat on a newspaper box and told a guy who just came out of a store to call for an ambulance," Fayson later recalled.
As he waited, he could see white spots popping in front of his eyes, "like I was going to die. I didn't know what was happening. My life was leaving me."
By the time he arrived at the hospital, he had lost a significant amount of blood, and his left lung had collapsed. He was rushed into surgery, and his seven stab wounds were closed.
"They stapled my wounds, the right side of my chest and around the left side of my back behind my heart," Fayson said.
Fayson, who still has nightmares about the attack, says he has nothing but accolades for the doctors and nurses who saved him.
"Every time I returned to the hospital for my appointments I thanked them," he said.
His attacker is now serving eight years in state prison.
"I wish he'd gotten more than that," Fayson said.
Then there is Detective Kim Monteforte Tomassi.
She was critically injured in 2002, when her patrol car crashed, as she and her partner pursued a Metro Bus on Delaware Avenue for a possible armed robber.
"I had a broken left hip and broken bones in my left foot and a mild concussion," said Tomassi, who was rushed by ambulance to ECMC.
"From the beginning to the end, they were very thorough," she said, recalling that she was not the only critical case in the emergency room at the time.
There was her partner, Officer James Shields, whose injuries claimed his life, and an injured motorcyclist, who also later died.
"They had me on hold. They kept checking on the blood flow to my leg so that I didn't lose it, while attending to the other two," she recalled.
During all of this, on-duty and off-duty officers and family members showed up at the hospital to offer support and to grieve.
"They accommodated all of the parties present with rooms and private areas," Tomassi said. "There were a lot of healing hands involved in my assessment and recovery. I can't even tell you how many, but I'm grateful to all of them. Because of their quick response, I have my leg."
The shock of violence often draws large numbers of family members and friends of the patient to the hospital, and they, too, must be cared for, according to Cramer.
To handle that, the trauma unit has its own social worker, Neville Francis, and chaplain, the Rev. Francis X. Mazur.
About a week ago, some 80 people showed up at the hospital when a young man was shot. Thinking quickly of how he could best gain control of the situation in a more manageable setting beyond the emergency waiting room, Mazur took them all up to the ECMC chapel.
They wanted information, and in his role, he was able to let them know when their loved one was out of the emergency room, in surgery, and so on.
"My responsibility is to bring calm. When you have a gunshot wound or other violent situation, there's a high level of anger. So you try to bring a calming sense," Mazur said.
In this case, the Catholic chaplain led the group in prayer and asked them to share stories about the young man. The outcome, tragically, was not good. The victim died.
More needed to be done to soothe the raw feelings.
So Mazur spent hours accompanying them, in pairs, into the trauma intensive care unit, where they could spend a couple of moments at the young man's bedside.
Madonna Lakso, a charge nurse in the trauma ICU, says that the priest also works with the staff to help them once the immediate emergency has passed.
"He will debrief us, and we will debrief ourselves. I can tell you there are many tears, but what a great opportunity to have a job like this and see people who received a hundred units of blood live," said Lakso, who has worked in the trauma unit for nearly a quarter of a century.
And though the medical center has gained a high level of proficiency in caring for the traumatically wounded, Moscati said the institution realizes the best treatment comes in the form of prevention.
>Prevention and equality
Whenever a patient with a "penetrating wound" arrives at the hospital, a procedure is in place to call 911, which, in turn, contacts the Erie County district attorney's violent crime intervention program.
A program worker is sent out to meet with the patient and family members. By establishing "an early positive criminal-justice connection," said Sharon M. Simon, the DA's homicide/witness protection coordinator, steps can be taken to guide people away from lifestyles that put them in danger.
This effort, Moscati said, started in 2008 and has brought good results, with a drop in the recidivism rate among individuals making return trips to ECMC with gunshot and other assault wounds.
But when victims of violence do return, they are in capable hands.
"Everybody gets treated equally here, no matter where they came from," said Cramer, the nurse who over three decades has risen to vice president of trauma and emergency services.
That certainly was the case for Juan Castro.
After he allegedly killed his girlfriend, Maria Pagan, and critically wounded her 15-year-old daughter, Zayra, with a samurai sword in their Normal Avenue home, he repeatedly refused the orders of two police officers to put down the sword, witnesses said.
When he made threatening gestures at police with the weapon, one of the officers shot him in the stomach at close range. He fell onto the ground in a fetal position, and witnesses said they thought he was dead.
But after being rushed to the medical center and undergoing surgery, he survived. Now listed in stable condition in the hospital's lock-up unit, the 63-year-old faces charges of second-degree murder and assault.
"We've seen, in cases like this, individuals looking for a 'suicide by cop.' I don't know what his motive was, but now he is in a position to face the justice system," Derenda said, in praising the life-saving medical treatment Castro received.