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From the Los Angeles Times

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School releases YouTube post from Loughner

Jared Lee Loughner, now accused in the shootings of Rep. Gabrielle Giffords and 18 others, walked through campus last fall rambling about his 'genocide school.' The video led Pima Community College to suspend him.

(Video on site)

by Rong-Gong Lin II, Maeve Reston and Rick Rojas, Los Angeles Times

January 15, 2011

Rambling and agitated, Tucson shooting suspect Jared Lee Loughner strode through Pima Community College, camera in hand — alternately laughing and voicing anger at his "genocide school," which he called "one of the biggest scams in America" in a video released by college officials late Friday.

The nearly four-minute video, which was posted on YouTube on Sept. 23 and later removed, appeared to show Loughner on campus at night, moving briskly through buildings and a series of open courtyards.

"All right, so here's what we're doing. We're examining the torture of students," Loughner said as he began his narration of the video. He broke off when he appeared to recognize a man leaving a nearby building. "How's it going?" Loughner shouted. "Thanks for the B – I'm pissed off."

Breathing heavily and laughing softly as he walked up a dark set of stairs, Loughner said: "I lost my freedom of speech to that guy and … this is what happens. And I'm in a terrible place. This is the school that I go to. This is my genocide school, where I'm going to be homeless because of this school. I haven't forgot the teacher that gave me the B for freedom of speech."

The video, which prompted Loughner's suspension last fall, offered a window into the suspected gunman's frustrations and his anxiety about his future, three and half months before he was accused of opening fire outside a Safeway grocery store, killing six people and wounding 13, including Rep. Gabrielle Giffords (D-Ariz.).

At one point, walking past the bookstore, he said: "They're controlling the grammar."

A few moments later, he lingered in front of the campus police office: "This is where the whole 'shaboozie' goes down with illegal activity," he said, his face briefly reflected in the glass of the station window.

Near the end of the video, while walking through a courtyard, he said, "All the teachers that you have are being paid illegally and have illegal authority over the Constitution of the United States under the 1st Amendment. This is genocide in America. Thank you. This is Jared from Pima College."

The video was released to The Times after a public records request. It had been cited in campus police records as among the reasons college officials suspended the 22-year-old student.

The video was uploaded to YouTube the same day campus police officers were called to a biology classroom after Loughner protested when an instructor told him he would only receive half credit if he turned in an assignment late. His increasingly loud outbursts caused his biology instructor to call campus police.

A campus police officer who saw the video "positively recognized the voice and the reflection in the window as student Jared Loughner," according to a school police report. It was the same officer who had removed Loughner from the biology class.

Within hours of viewing the video on Sept. 29, campus police officers hand-delivered a notice of immediate suspension to Loughner and his father, Randy, at their Tucson home.

Meanwhile, law enforcement officials offered more details Friday into Loughner's last actions before the Jan. 8 shooting.

Authorities said they had photos that Loughner allegedly developed less than 10 hours before the rampage, depicting him holding a 9 mm Glock 19 pistol next to his nearly naked buttocks and crotch, a law enforcement official said. It is the same type of weapon that police say was used in the shooting.

A timeline released by the Pima County Sheriff's Department said Loughner dropped off the roll of film at a Walgreens at 11:35 p.m. on Jan. 7, then checked into a Motel 6 near Interstate 10 at 12:29 a.m. He picked up the developed photos at 2:19 a.m. At 4:12 a.m., according to the timeline, he posted on his MySpace page: "Goodbye friends."

After 7 a.m., Loughner headed to Super Wal-Mart in suburban Marana, where he bought ammunition and a black diaper bag.

At some point between 7:31 a.m. and 9:40 a.m., Loughner returned home and was confronted by his father. Loughner fled on foot from his house with the black bag, the timeline stated.

He was picked up by a cab at 9:41 a.m. at a Circle K convenience store, and arrived at the shopping center shortly before 9:54 a.m.

The shooting began at 10:10 a.m., the timeline said.

An Internet gaming website released postings Friday that company officials believe were written by Loughner. Some of the posts were first reported by the Wall Street Journal. The company, EarthEmpires.com, released a version of the postings in which players' user names were redacted.

David McVittie, a website administrator, told The Times that Loughner played the game for the first half of 2010, and made the postings on a private forum that players on Loughner's team used to strategize and build a virtual nation. McVittie said that two players who knew Loughner outside the game site told company officials earlier this week that the person writing under the name "Dare" was Jared Loughner.

The posts depict a young man frustrated with rejection from women and employers and with his poor grades. The disjointed, rambling posts, however, startled some of his online teammates when he talked about striking the mentally disabled, and asserted that most people approve of rape and that educators are "pigs."

Initially, "Dare" was welcomed by his teammates, but they eventually began to ridicule his rambling posts. On April 24, "Dare" wrote that 50 out of 100 female college rape victims enjoyed "beating and sex," adding, "The loneliness will bring you to depression. Being alone for a very long time will inevitably lead you to rape."

On April 24, the writings included a diatribe against the mentally disabled.

"Would you hit a Handy Cap Child/Adult?" the post said. The writing is incoherent: "They're possessing teachers that are typing for money. This will never stop.... The Principle of this is that them … educators need to stop being pigs."

On May 14, "Dare" expressed frustration with his job hunt after telling other users in an earlier online conversation that he was "below poor." He listed 21 establishments where he had applied for minimum-wage jobs — among them PetSmart, Domino's Pizza, Wing Stop and a series of clothing stores including Urban Outfitters, J. Crew and Victoria's Secret.

He said he been fired from jobs at a Chinese fast-food eatery, Peter Piper Pizza, Red Robin, Quiznos and Eddie Bauer. "6 months.... No Pay check," he wrote.

In a later thread, "Dare" gave an update on his job search: "Currently at 65 applications. No interview."

"Dare" stopped posting in mid-June.

http://www.latimes.com/news/nationworld/nation/la-na-arizona-shooting-20110115,0,6932026.story

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Second disabled woman is identified in abuse video

Authorities said they have located a second victim shown on a gruesome video showing disabled women being sexually abused by men.

Los Angeles County Sheriff's Department officials said Friday that they served search warrants at three residences as part of the ongoing investigation.

Ernie Lloyd, 37, of Los Angeles was arrested Saturday after he turned himself in to Los Angeles police in Hollywood in connection with the assault of an unidentified 25-year-old woman shown in the video.

The video, given to sheriff's deputies by an anonymous source, shows men having sex with women, many of whom appear to be disabled, with some in wheelchairs and wearing diapers.

But prosecutors said the tapes alone are not sufficient evidence, telling Sheriff's Department detectives that they need to provide more facts about the women's medical histories, level of disabilities and other information.

"In order to effect a filing, we would either have to prove that the victim did not consent to the sexual acts or she was unable to consent to the sexual acts," the district attorney's office wrote in a memo. "There is insufficient evidence to prove either of these theories beyond a reasonable doubt."

The Sheriff's Department did not directly comment on the district attorney's decision. But in a statement issued after prosecutors had turned back the case, sheriff's officials said they had gathered large amounts of evidence, including an intensive interview with an alleged victim, who told them she was sexually assaulted at a residential care facility in Los Angeles.

The department said the woman specifically named Lloyd and a second suspect, Bert Hicks, as being among those who assaulted her, according to the statement. Hicks is serving a state prison sentence.

http://latimesblogs.latimes.com/lanow/2011/01/2nd-disabled-woman-identified-in-abuse-video-la-sheriff-serves-warrants.html#more

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Al Qaeda's tentacles

President Obama has placed considerable pressure on Osama bin Laden and his gang with drone strikes in Pakistan, but the group is remarkably adaptive, agile and resilient.

by Bruce Riedel

January 14, 2011

Al Qaeda has just released the latest in its series of how-to guides for jihadists in the West who want to murder without the bother of flying to Pakistan to be trained. This time, the offering is an English-language manual explaining in detail how to build a bomb, and it demonstrates how nimbly Al Qaeda has adapted to become the world's first truly global terrorist organization, able to recruit and train fanatics on the Internet as well as on the ground.

Almost 10 years after the most devastating attack on the American homeland by a foreign power since the British army burned Washington in 1814, Al Qaeda remains alive and deadly. President Obama has placed considerable pressure on Osama bin Laden and his gang with drone strikes in Pakistan, but the group is remarkably adaptive, agile and resilient.

Al Qaeda today has four faces. The first is familiar: the core group that includes Bin Laden and his deputy, Ayman Zawahiri. From its base in the badlands along the Afghanistan-Pakistan border, this nucleus still provides strategic direction to both the group itself and to the worldwide jihadist community. The largest manhunt in human history, which has included a punishing drone offensive, has damaged Al Qaeda's core, but it has by no means destroyed it.

The second face of Al Qaeda is the syndicate of terror networks aligned (either openly or covertly) with the group in Pakistan and Afghanistan. The Pakistani Taliban, responsible for the failed Times Square car bomb attack last May, is openly allied with Bin Laden. Lashkar-e-Taiba, which orchestrated the Mumbai attack two years ago, is more clandestinely allied with Al Qaeda, but the two organizations are known to have plotted together on a failed 2009 attack in Denmark. That same plot resurfaced this winter when the Danes arrested four well-armed terrorists aiming to attack a newspaper office on New Year's Day because it had published cartoons mocking the prophet Muhammad.

The Afghan Taliban remains Al Qaeda's essential partner in Afghanistan. Although the Taliban often operates independently, it also coordinates joint actions with Al Qaeda, as in the deadly strike on a CIA base in Khowst on Dec. 31, 2009. That attack, which killed seven Americans, was a joint operation of Al Qaeda, the Afghan Taliban and the Pakistani Taliban.

The third face of Al Qaeda can be seen in its regional franchises around the Islamic world. These include organizations in North Africa, Yemen and Indonesia. Al Qaeda in Yemen, widely viewed as the most dangerous of the group's regional operations, staged both an attempted Christmas 2008 airliner bombing and the foiled parcel bomb attacks aimed at Chicago in October. Across the Gulf of Aden, Al Qaeda's proteges in Somalia pose an increasing danger to other parts of Africa, as they demonstrated during the World Cup when they sent a suicide bomber to Uganda. Even the much-diminished Al Qaeda franchise in Iraq continues to strike periodically and has claimed credit for an attempted suicide bombing in Sweden last month.

In the meantime, Al Qaeda franchises have learned from the mistakes of their sister organizations and adapted. In Iraq, for example, Al Qaeda tried to take over the Sunni insurgency and was rebuffed. In Pakistan and Afghanistan today, it lets the local Talibans lead the war effort while it stays in the shadows.

Self-initiated jihadists without formal ties to terrorist groups are becoming a fourth face of Al Qaeda. The massacre at Ft. Hood, Texas, was the work of one such individual. Sometimes these self-starters get in touch with Al Qaeda, usually in Pakistan or Yemen, and offer themselves as potential bombers, receiving training from the group. This was the case with three Americans who were trained by Al Qaeda in Pakistan to build bombs and planned to blow themselves up on the New York City subway system a few days after the anniversary of 9/11 in 2009, a plot that was disrupted by the FBI. But even when terrorists take on freelance missions, such as the one at Ft. Hood, they are often deeply influenced by the group's existence and its goal of global jihad.

The many tentacles of Al Qaeda are united by the group's narrative and ideology. First conceived by Bin Laden and a long-dead Palestinian partner named Abdallah Azzam during the war against the Soviets in Afghanistan in the 1980s, the idea has always been for global jihad, a war against the United States and its allies to be waged across the planet to force America to get out of the Islamic world and abandon Israel.

Al Qaeda has been undeniably tenacious, but we should keep its successes in perspective. The organization is not Nazi Germany or the Soviet Union. Smart policies that isolate it from the majority of Muslims, along with continued attacks on its havens and its ideology, are likely to eventually bring about the group's demise.

Obama has embraced such an approach, attacking Al Qaeda's narrative and ideology. His speeches in Turkey and Egypt, his peace initiative with the Israelis and Palestinians, and his efforts to reach out to the great majority of Muslims who reject Al Qaeda have all been part of the effort. Indeed, only a very small minority of Muslims believes in global jihad today, but even a handful of determined suicidal murderers can change the fate of nations. We all learned that nine years ago.

http://www.latimes.com/news/opinion/commentary/la-oe-0114-riedel-al-qaeda-20110114,0,3643445,print.story

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From the New York Times

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From Bloody Scene to E.R., Life-Saving Choices in Tucson

TUCSON — The moment Tony Compagno stepped off his fire engine, frantic people spattered with blood began running up to direct him to gunshot victims.

Among the wounded was Representative Gabrielle Giffords, who had been shot in the head. Mr. Compagno was one of the first paramedics to reach the scene of the shooting rampage at a shopping center in Tucson last Saturday.

“Lots of people were laying on the ground,” said Mr. Compagno, from Fire Station 30 the in Northwest Fire/Rescue District of Tucson.

“The congresswoman, I could tell that she was still alive. People were giving a little girl CPR. My mind went away. I started counting, and then I thought, ‘What am I counting, injured or dead?' ”

There were 19 victims. Mr. Compagno's job was triage: to assess the severity of injuries and label victims so that ambulance crews would know whom to tend to first.

He realized instantly that there was no time to write labels. Ambulances and fire engines were roaring up.

The victims dropped where they stood, forming a row 20 or 30 feet long.

Mr. Compagno could see quickly that five were dead, seven were “immediates,” needing help right away, and the rest could wait.

The child receiving CPR was not responding, but Mr. Compagno was not about to write her off.

“The little girl, I counted her as an immediate,” he said.

Instead of using labels, he simply directed each rescue team to a victim.

The goal was to stabilize them and get them to the hospital as quickly as possible, because people with severe gunshot wounds need trauma surgeons.

The first two patients were ready to go even before the helicopters landed: Nine-year-old Christina-Taylor Green, who had been receiving CPR, and Ms. Giffords were loaded into ambulances.

Ten patients were sent to the trauma center at the University of Arizona medical center. The first to arrive was Christina — still getting CPR, still not responding.

By normal standards, a gunshot victim who is unresponsive after 15 minutes of CPR has almost no hope of surviving and can be declared dead. Christina had already received 20 or 25 minutes, according to a report radioed in.

“This was a 9-year-old girl,” said Dr. Randall S. Friese, 46, a trauma surgeon. “Even though she had CPR beyond our guidelines, I decided to be aggressive.”

Dr. Friese said he could not be certain the radio report was correct. But he could not afford the minutes it would take to verify it.

“You decide, and you do,” he said. “It's a personal decision, and I decided to be aggressive, just because she was 9.”

He tried a desperate last-ditch maneuver. Within about two minutes, he had cut open her chest, inserted a tube to fill her heart with blood and massaged the heart with his hand to try to start it beating again.

“I had her heart in my hand,” Dr. Friese said. “We filled it with blood. It still didn't want to beat. So, it was over. We're finished.”

At that moment, a resident stepped in to tell him a second patient had arrived, assigned to Trauma Room 5: Ms. Giffords. It was the first time Dr. Friese had heard that she was among the victims.

He told the resident assisting him to fill Christina's heart and try once more to make it start beating again.

By the time he reached Room 5, the resident had tried, and failed. Christina was gone.

The team in Room 5 had already begun assessing Ms. Giffords when Dr. Friese arrived.

“I walked in and held her left hand, held it in both of my hands, and I thought to myself, ‘I need to communicate with her,' ” he said. “I was uncertain if she would hear me, that she would process my words. It turned out later that she probably did. That was my reward. I leaned in close to her, and I said, ‘Ms. Giffords, you are in a hospital. We are going to take care of you.' ”

He expected no response. Next, he asked her to squeeze his hand. She did. A few moments later he asked her again, and again she complied. It was cause for hope. But when he tried the same thing with her right hand, there was no response.

Because a brain injury can suddenly impair a person's ability to breathe, Dr. Friese had a breathing tube inserted into her throat. Then he ordered a chest X-ray and a CT scan of her brain.

Dr. Martin E. Weinand, a neurosurgeon, was ready to operate, but Dr. Friese thought that the chief of neurosurgery, Dr. G. Michael Lemole Jr., who was supposed to have the day off, should also be involved.

“I called Lemole,” Dr. Friese said. “That would be a special thing for her. I wouldn't have done that if it were a regular patient, because one neurosurgeon could do the operation. That to my mind was a political thing, and I wanted another neurosurgeon, particularly the chief neurosurgeon. I felt like I was doing a courtesy to the chief of neurosurgery letting him know the political aspect of what was going on.”

Ms. Giffords needed surgery immediately. She had skull fractures, dead brain tissue that had to be removed, and increasing pressure from swelling that could further damage her brain as it expanded and pressed against her skull. In addition, her eye sockets had fractures.

Dr. Lemole and Dr. Weinand studied the CT scans, tracked the path of the bullet and decided where to cut. The bullet had passed through her skull. Fortunately, it had not severed arteries or veins. The surgeons plucked out bits of broken skull and dead tissue, and removed part of her skull — less than half on one side — to avoid pressure from swelling. Also to relieve pressure, they expanded the opening that the bullet had made in the dura, the membrane covering the brain. The skull bone, fractured by the bullet, came off in pieces, which are being kept in a freezer and will be put back during reconstructive surgery, probably months away.

A bullet hits the skull like a meteor, Dr. Lemole said. Both start to break up, and shards of bone and metal can be driven into the brain.

“The old thinking was to chase after them and pull them out to reduce the chances of infection,” he said. “But we learned from the military that it can be worse to chase them” than to leave them there. Digging around in the brain can damage it further. In any case, he said, the heat of the bullet may have sterilized the embedded fragments.

“We certainly will watch for infection,” he said, adding that the greatest risk would be in the first two months.

A Strange Voice Summons

As Bill Hileman ended his Saturday morning workout, he saw a message on his cellphone from his wife's number. But the voice belonged to somebody else.

“Bill, this is Nancy. I am with your wife. She was in an accident along with Christina Green,” the woman's voice said, with urgency but not quite panic. “She asked me to call you and let you know that they will be taken to UMC hospital. And if you could, please notify the Greens that Christina will also be taken to the hospital. UMC hospital.”

She did not hang up right away and a garbled commotion went on for several seconds. Then, impossible to identify, a high-pitched voice pleaded for help.

Ms. Hileman had taken Christina, the daughter of a neighbor, to meet Ms. Giffords.

They must have had a fender bender, Mr. Hileman assumed. How serious could it be if his wife was aware enough to instruct a stranger to dial his number and urge him to call Christina's parents? He rushed to the hospital.

He walked through the glass doors into the emergency room lobby just after 11 a.m., noticing people clustered around a television.

“I'm told Suzi Hileman is here,” he said to the woman at the front desk. But the hospital had not identified all the victims. Nobody could tell him anything about his wife.

Shots fired, several dead, the news said. This was not a car accident.

He knew that Safeway. He was certain it was where his wife had taken Christina to see Ms. Giffords — the event had been on her calendar for weeks.

“I'm frantic at this point,” Mr. Hileman said. “I am just jumping up and down, and I can't get an answer.”

A woman who seemed to be in authority grabbed his wrist. She assured him she would find out what was happening. He still did not know if his wife was alive.

By 11:45, Christina's mother, Roxanna Green, arrived. Her father came sometime later. The moment she identified herself, officials ushered her into a private room.

As Mr. Hileman watched this, he said, images of his wife bleeding crowded his mind, and he paced around the emergency room waiting room. Dozens more people began coming in. There were plenty of seats, but few sat down.

Furiously, the people in the room sent and received text messages. They spoke in hushed tones of fear. They exchanged somber, silent glances, aware that their fate was already somehow tied together, but each in a private shroud of misery. In the back corner, a young woman sobbed inconsolably. Her cries, Mr. Hileman recalled, were often the loudest sound in the room. He later learned she was Kelly O'Brien, the fiancée of Gabriel Zimmerman, an aide to Ms. Giffords who was killed.

Others gathered with families, but Mr. Hileman was alone, still uncertain of his wife's fate. A social worker from the hospital approached and took his hand. She offered a prayer. The words almost did not matter.

“I am not a religious man,” he said. “But at that moment it was the right thing for Suzi.”

Then, words flashed across the television screen: Gabby Giffords dead.

The panic spread with a vicious wave. It somehow silenced the room, by then crowded with friends, local leaders and onlookers. It would be nearly an hour before they knew the report was wrong.

By then, hospital officials had ushered the family members of the victims into a private area in the cafeteria. Again, Mr. Hileman stood alone.

Mr. and Mrs. Green came into the room just minutes later. With one look at Mr. Green's face, red with grief, Mr. Hileman knew what had happened to their daughter. A bear of a man, Mr. Green “looked like John Wayne collapsing,” Mr. Hileman said.

“My whole world changed,” Mr. Hileman said. “My whole world changed on the spot.”

A priest had just performed last rites for Christina.

Much Trauma, Some Luck

Dr. Peter Rhee, 49, the director of the trauma center at the hospital, was out running, listening to rap music, when a text message landed on his cellphone: 10 patients, multiple gunshot wounds, on the way to the hospital. University Medical Center is the only Level 1 trauma center in southern Arizona, meaning the only one that is accredited, with trauma specialists and operating rooms available around the clock to treat severe injuries.

Standing by the roadside, Dr. Rhee called in. Several trauma surgeons were already at the hospital, along with two groups of residents. Anesthesiologists and surgeons from other specialties were volunteering to pitch in. Since it was a Saturday, operating rooms were free.

“Much fortune occurred out of luck,” he said. “It was a sunny day, a Saturday, there was no rain or snow, it wasn't 4 a.m. If it had been a Tuesday at 4 a.m., we would have had one surgeon there.”

Satisfied that things were under control, Dr. Rhee ran the three miles back home, showered and headed to the hospital.

By the time he arrived there, a stream of ambulances was coming in. A trauma surgeon waited in the ambulance bay to assess patients and assign them to rooms. Teams of doctors and nurses had quickly assembled in each of the center's seven trauma rooms. Unidentified patients were given “trauma names”— like Agave, Bubble, Cactus, Deer, Egg or Falcon — for medical record-keeping, until their real names could be found.

“I am running the mass casualty, making personnel assignments,” Dr. Rhee said. “Somebody has to be in charge. I'm checking on the congresswoman in the operating room, looking at her brain. It looks viable to me. I'm making sure the anesthesiologist has blood, and the neurosurgeons have what they need.”

The new patients had a daunting array of injuries. Suzi Hileman came by helicopter, minutes behind Christina and Ms. Giffords. With gunshot wounds to her abdomen, chest and thigh, Ms. Hileman was one of the most vulnerable patients. Within 30 seconds of looking at her, Dr. Bellal Joseph, another trauma surgeon, knew she should go into the operating room.

Ms. Hileman was talking — frantically, distractedly, but speaking in a full voice. That meant her airways were clear, a good sign.

Dr. Joseph ignored what she was saying so he could stay focused. But he knew Ms. Hileman was in shock and petrified.

Ms. Hileman does not remember this. She told her husband her last memory was being in a helicopter, feeling humiliated when doctors began removing her clothes.

“The first thing I say to people is always the same,” Dr. Joseph said. “You are in the hospital. You are going to be fine. You have lots of people doing lots of things for you. This is normal; this is what we do. This is something we know.”

At least four more shooting victims were coming in, and it was unclear exactly what they would need. But the more quickly Ms. Hileman's surgery could begin, the more quickly the trauma room could be cleared and cleaned for the next patient.

They placed intravenous lines in her arms and gave her a chest X-ray. There was no sign that any bullets remained in her body. An ultrasound showed no blood gathering around her heart, indicating no serious damage.

In the operating room the purpose was clear: “All we are trying to do is control the bleeding,” Dr. Joseph said. “We have to control the shock and basically stop her from dying.”

As he made a long incision down Ms. Hileman's stomach, Dr. Joseph quickly saw that there was not much internal bleeding.

“That already, your heart rate goes from 130 to about 100,” he said. “That's the thing about trauma, you never know what you are going to get dealt.”

Within moments, Dr. Joseph made a small incision to examine Ms. Hileman's heart. There were no signs of damage. But there were six bullet holes in her chest, abdomen and legs. He followed the possible trajectories, making sure that he was not missing any damage. He ran his fingers down her intestines, making sure that there were no holes that could potentially cause bleeding or infection.

“I have held every piece of her organs in my own hands,” he said. “Her heart was in my hand, her spleen was is in my hand. Her liver was in my hand. There is no better scan that that.”

Hours later, Bill Hileman would see his wife for the first time, connected to a tangle of tubes. Hours after that, she would begin calling out for Christina.

Patients by Number

Dr. Rhee described additional patients, but could not name them because they had not given permission.

Patient 4 was shot in the leg, and had a cheek and neck wound that Dr. Rhee described as “scary.” But a CT scan revealed that the facial injury was not so bad, while the bullet to the leg had severed a major vein.

“I was taking care of Patient No. 5,” Dr. Rhee said. “It looked scary, like he would need the biggest surgery of all.”

A huge swelling near the man's collarbone made it look as if a major artery had been damaged, an injury that would require an exceedingly difficult operation — one that Dr. Rhee said he loved to do. As it turned out, the artery was intact, but the patient's neck and spinal cord were full of bone fragments, and he was lucky not to be paralyzed. In addition, he needed vascular surgery for another bullet wound, one that put him at risk of losing his leg.

Patient 6 was shot in the chest and leg, and needed transfusions. “He kept bleeding,” Dr. Rhee said. “I'm wondering if I have to take him to the operating room. But I know that if we can keep his blood pressure a little lower than usual, the bleeding could stop on its own.”

He kept his eye on Patient 6, while Patient 5 went to the operating room.

While patients were in surgery, Dr. Rhee called a quick huddle of all the doctors still in the trauma center, and they reviewed the list of patients, with each doctor calling out additional information for all the others to hear.

More patients were rolled in. One was shot in the ankle, and needed an orthopedic surgeon.

Another was “initially scary,” Dr. Rhee said. “She had two holes in her chest, she was shot in her wrist, and when we examined her we could feel a bullet in her back.”

The bullet had grazed one breast, entered the other and somehow swung around into her back, possibly hitting her intestines along the way. She needed laparoscopic surgery to find out if her intestines had been damaged; it turned out they had not.

“Relatively, we were lucky that day,” Dr. Rhee said

Within three hours, every patient was on the way to a hospital bed. The immediate trauma was over. Now, it was Dr. Rhee's task to identify the patients' families and tell them what happened during surgery.

He walked into the conference rooms in the cafeteria area and pulled aside family groups one at a time. For some patients, there were five people keeping vigil; others awaited news alone.

He began with basic questions to make sure the identity was correct. What is your family member's name? What does he look like? How old is he?

“We have to be absolutely sure which patient is which, because a lot of patients can't tell you their names,” Dr. Rhee said. “When you think you are telling them a particular piece of information, you can tell them something completely wrong. Sometimes a family member can come here thinking that they were shot, when they were actually at a movie or something else.”

Dr. Rhee made his way down the list quickly. This time, it was simpler, the patients he was talking about now were expected to do well. “This time it was fairly good news,” Dr. Rhee said. As he finished the list, he noticed one more family sitting on the benches.

Who are you? Dr. Rhee asked. They replied that they were the family of Gabe Zimmerman.

Dr. Rhee looked down his list.

“I don't have this patient here, so that must be lucky for you,” he recalled telling them. “I think if I had you on my list, that would have meant you were shot and injured.”

“It didn't dawn on me that they could have been killed in the field, and that's indeed what happened,” Dr. Rhee said, who was once a Navy surgeon. “I gave them a false sense of hope at that stage, before they got the real news.”

Roughly an hour passed before the family knew what really happened.

Mr. Zimmerman, an aide to Ms. Giffords, had been pronounced dead at the scene.

A First Funeral

Dr. Friese does not remember seeing any of the patients come through the doors of the trauma center last Saturday — except for Christina.

Five days after the girl's death, his secretary told him he was invited to Christina's funeral. He did not ask from whom the invitation came. Was it from the family? Or did the nurses planning to share a bus to join the thousands of mourners seek him out? It did not matter. Without hesitating, he decided he would go.

There was no time for Dr. Friese to meet Mr. and Mrs. Green on Saturday. He was too busy attending to other patients, so it fell to a pediatric specialist to tell them the outcome. And he did not meet them Thursday either.

“I'm very glad that I didn't meet her parents,” he said. “I think I would have had trouble. I would have had emotional ...”

His voice trailed off.

“I would have embarrassed myself,” he said. He closed his eyes for just a moment and sighed once more. “I usually don't get upset.”

He add, “I don't know why, it's just tough.”

When he showed up at the funeral in his blue scrubs and his white surgeon's jacket, police officers helped him move through the overflow crowd waiting outside the church. He was ushered right in.

It was the first time he had ever attended a patient's funeral.

http://www.nytimes.com/2011/01/15/us/15medical.html?_r=1&hp=&pagewanted=print

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Homeland Security Cancels ‘Virtual Fence' After $1 Billion Is Spent

The Department of Homeland Security on Friday canceled a project to build a technology-based “virtual fence” across the Southwest border, saying that the effort — on which $1 billion has already been spent — was ineffective and too costly.

Janet Napolitano, the homeland security secretary, said she had decided to end the five-year-old project, known as SBI-Net, because it “does not meet current standards for viability and cost effectiveness.” In a statement, Ms. Napolitano said border agents would instead use less expensive technology that is already part of their surveillance equipment, tailoring it to the specific terrain where they will be scouting for illegal border crossers and drug traffickers.

Ms. Napolitano's decision brought a long-expected close to a project carried out by the Boeing Corporation under a contract first signed in 2005 under President George W. Bush, which had been plagued by delays and cost overruns. Originally estimated to cost more than $7 billion to cover the 2,000-mile length of the border, it was the subject of more than a dozen scathing reports by the Government Accountability Office.

In a pilot program in Arizona, it cost about $1 billion to build the system across 53 miles of the state's border. Officials said the new approach, using mobile surveillance systems and unmanned drones already in the Border Patrol's arsenal, would cost less than $750 million to cover the remaining 323 miles of Arizona's border.

Ms. Napolitano suspended financing for the project in March and ordered a review, which was just completed.

But officials moved slowly to cancel the project because it had been ensnared in the contentious debate over border security. Many Republican lawmakers have accused the Obama administration of being lax on enforcement, and they have said they would not consider an overhaul of immigration laws that President Obama supports until the border is tighter.

Anticipating criticism, homeland security officials released documents on Friday showing big increases in the Border Patrol — to 20,500 today from 10,000 in 2004 — and other border agents, and a steep decline in the number of immigrants detained at the border, indicating fewer illegal crossings. About 463,000 illegal crossers were detained last year, compared with 724,000 in 2008, according to the figures.

Ms. Napolitano said she had concluded that the original concept of the project, to develop a single technology that could be used across the entire border, was not viable. Boeing had built a complex system of sensors, radars and cameras mounted on towers that was supposed to lead border agents to the exact location of illegal crossers. But the system functioned inconsistently in the rough terrain along much of the border.

“There is no one-size-fits-all solution to meet our border technology needs,” Ms. Napolitano said.

The announcement came in advance of the expiration of the Boeing contract next Tuesday, a homeland security official said.

In a statement, Boeing noted that officials said they would continue to use equipment it had designed. “We appreciate that they recognize the value of the integrated fixed towers Boeing has built, tested and delivered so far,” the company said.

Representative Peter T. King, the New York Republican who is the new chairman of the Homeland Security Committee, criticized the administration for being slow to end the program. “I continue to have very serious concerns about the Obama administration's lack of urgency to secure the border,” he said.

http://www.nytimes.com/2011/01/15/us/politics/15fence.html?ref=us&pagewanted=print

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Helpless in the Face of Madness

The second semester French class began a little after 9 on the morning of April 16, 2007. The weather that day was unusually cold for April. A light snow was falling.

One of the students, Colin Goddard, now 25, recalled what happened that morning in a new documentary film, “Living for 32.”

“We started hearing loud banging noises outside of our classroom,” he said. “The teacher went to the door to look into the hallway to see what was going on. ... As soon as she opened it, she shut it back again and said, ‘Everyone get underneath your desk and somebody call 911.' I pulled out my phone and dialed 911, and I said, ‘We're in Norris Hall. There's a shooting going on.' And as soon as I basically got that out, we saw bullets coming through the door.”

Norris Hall is one of the main academic buildings on the campus of the Virginia Polytechnic Institute and State University, known as Virginia Tech. The gunman was a crazed student named Seung-Hui Cho, who was armed with a pair of semiautomatic pistols. It was not the first class he had visited that day.

Goddard remembered being shot in his left knee and feeling the blood, warm, seeping down his leg. The gunmen apparently left the panicked classroom momentarily. But the sound of gunfire continued.

“And then,” Goddard said, “the bangs just got much louder again, and you could tell he was back in our room. This time he more methodically came down each of the rows, and he was still firing. At one point he was standing at my feet, and that's when I was shot a second time, in my left hip. Then he shot me a third time, in my right shoulder, and it flipped my whole body around and exposed my right side. And I was shot a fourth time, in my right hip.”

In case we hadn't noticed, a photo and a headline on the front page of The New York Times this week gave us some insight into just how sick our society has become. The photo showed 11-year-old Dallas Green weeping and using his left arm to wipe his eyes during the funeral for his sister, Christina-Taylor Green, who was 9 years old and was killed in the attack in Tucson that took the lives of five other people and left Representative Gabrielle Giffords gravely wounded.

Beneath the photo was the headline: “Sadness Aside, No Shift Seen On Gun Laws.”

What is the matter with us? Are we really helpless in the face of the astounding toll that guns take on this society?

More than 30,000 people die from gunfire every year. Another 66,000 or so are wounded, which means that nearly 100,000 men, women and children are shot in the United States annually. Have we really become so impotent as a society, so pathetically fearful in the face of the extremists, that we can't even take the most modest of steps to begin curbing this horror?

Where is the leadership? We know who's on the side of the gun crazies. Where is the leadership on the side of sanity?

For starters, assault weapons should be banned. Their raison d'être is to kill the maximum number of people — people, not animals — in the shortest amount of time.

In “Living for 32,” the 32 refers to the 32 students and faculty members who were killed by Cho at Virginia Tech. Goddard, during a filmed visit to the site of the shooting, remembered that when the police showed up, they had to call out to the survivors inside the classroom for help in opening the door, which was blocked by bodies piled in front of it.

He said it was only when the police cried out, “Shooter down!” that he realized that Cho had killed himself. Then came the awful process of triage: “I remember hearing them walk up to people, saying, ‘This person's yellow. This person's red.' And then I heard, ‘Black tag. Black tag. Black tag.' And that's when I realized that there were other students in here who didn't make it.”

The professor, Jocelyne Couture-Nowak, 49, was also killed.

The film, produced by Maria Cuomo Cole and directed by Kevin Breslin, chronicles Goddard's recovery from his wounds, his return to Virginia Tech to get his degree, and his commitment to fight for stricter gun laws. He is now working with the Brady Center to Prevent Gun Violence.

Goddard does not want guns banned and has no desire to deny people their constitutional rights. But he believes there are sensible steps that could be taken that would make the U.S. a safer and better place, a place where college students and their professors do not have to worry about getting shot to death in the classroom.

http://www.nytimes.com/2011/01/15/opinion/15herbert.html?ref=opinion&pagewanted=print

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EDITORIAL

Prison Suicides

The New York State prison system has greatly improved mental health services since 2007 when it settled a lawsuit that had accused it of mistreating mentally ill inmates. A troubling increase in prison suicides suggests that all of the problems have not been solved.

State records show that there were 20 suicides in 2010, double the number in 2009 and the highest since 1978, the first year for which records were released. The figures inched higher in the 1980s, then even higher in the '90s. The decade that just ended was the worst on record, with more than 125 inmates taking their own lives.

The increase is both troubling and puzzling, especially since the prison population has declined by 20 percent in the last 10 years. In addition, the Department of Corrections has improved conditions for the mentally ill, creating new therapeutic programs and retraining staff. It has also placed fewer severely disturbed inmates in solitary confinement where they were at a much greater risk of taking their own lives. Most important, entering inmates are screened by mental health professionals.

Advocates for the mentally ill say that suicide prevention programs are being poorly implemented. Others have even suggested that prison officials in some locations may be encouraging staff members to misdiagnose the most severely disturbed people since they would be entitled to intensive — and costly — therapy. The fact that some who had committed suicide were not even listed on the mental health caseload as needing close attention is certainly worrying.

The rising suicide rate must be investigated and remedies quickly found. A prison sentence for a mentally ill person should not be a sentence to death.

http://www.nytimes.com/2011/01/15/opinion/15sat3.html?ref=opinion&pagewanted=print

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From the White House

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MLK Day: What Are You Doing for Others?

This Monday, Americans across the nation will honor Dr. King and mark the 25th anniversary of the holiday that bears his name.  Sixteen years ago, Congress passed legislation transforming the King holiday into a national day of service.  We've seen it grow from a handful of local events to well over 13,000 projects taking place this year in all 50 states.

In Philadelphia, more than 70,000 volunteers will come together to beautify schools, refurbish computers, and serve meals to the homeless.  In Los Angeles, more than 1,000 community and corporate volunteers will revitalize the campus of an elementary school and AmeriCorps members will help to transform a hangar at the Compton airport into a multi-person service center to help those in need.  

In Atlanta, Dr. King's hometown, the King Center and Hands On Atlanta are leading an effort to feed 10,000 hungry Georgians.  Projects like these are planned across the country.  They are a way to honor Dr. King's legacy and keep his dream of “the beloved community” alive.  

Undergirding everything he did and everything for which he stood was Dr. King's belief that as a nation, we are more united and at our best when we serve others.  To show how Dr. King's legacy of service continues to inspire us today, we have produced a new video that features service leaders and civil rights luminaries including Congressman John Lewis, Rev. Dr. Joseph Lowery, and Ruby Bridges.  This inspiring video shows us that Dr. King's legacy of service endures today and that all of us have a role to play in making America stronger.

As the federal agency charged with leading the MLK Day of Service, we are using this silver anniversary of the holiday to encourage more people to serve, not just on the King holiday but all year round.  

To mark the 25th anniversary of the holiday, and to continue the momentum for the MLK Day of Service throughout the year, on Monday we are launching the MLK 25 Challenge: What Are You Doing for Others? This initiative calls on Americans to honor Dr. King by pledging to take at least 25 actions during 2011 to make a difference for others and strengthen our communities.

If you haven't yet decided where to serve on Monday, it's not too late.  Visit MLKDay.gov to find a project in your community.

http://www.whitehouse.gov/blog/2011/01/14/mlk-day-what-are-you-doing-others

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