On the Front Lines of the Marathon Tragedy: A Physician’s Reflection

By Jacqueline DePasse, MD

As an internal medicine resident at Massachusetts General Hospital, many of my colleagues and friends were on the front lines. The following story comes from two co-workers who I spoke with as they tried to process the senselessness of these tragic events.

Dr. Zachary Landman, an orthopedics resident at Massachusetts General Hospital, had just finished examining a patient’s wound and was scribbling a note at the nursing station when he overheard rumors from the nursing staff of a bomb detonation at the Boston Marathon. He ducked into a call room and flipped on one of the rarely used televisions. After only a few seconds to take in the scene of smoke and chaos, he shut off the television and briskly walked towards the emergency department.

Dr. Elias Baedorf-Kassis sat in the Acute bay of the MGH emergency department. As a third year medicine resident on his ED triage rotation, his job that day was to evaluate patients in the emergency department and decide if they needed ICU level care, admission to an inpatient ward, or simply observation.

The day was fairly typical, and patients started to move from the ED to the inpatient units as the early afternoon wore on.  Suddenly the radio speaker crackled with an incoming report. Dr. Baedorf-Kassis expected to hear reports of an incoming med-flight or a cardiac arrest coming in via ambulance. Instead, over the speaker came reports of the attack. Everyone stopped what they were doing and listened. “At first we didn’t quite believe what we had heard,” he said.  “We weren’t sure if this was just a mistake…very quickly we realized that something serious was happening.” His thoughts flashed to his pregnant wife, who was one of the many spectators that day.

Dr. Landman had gowned up and was waiting by the ambulance door where he met the first wave of patients. “They just kept coming in through the door,” He estimates around twenty patients arrived in the first wave, the most critically injured among them. “The nature of the blast was such that it was a high temperature explosion and there was a lot of shrapnel. It’s difficult to quantify how many people came in, but I would estimate at least a dozen people had serious injuries and burns from the shrapnel.”

While Dr. Landman attended to the trauma victims, Dr. Baedorf-Kassis helped to coordinate staff members to clear the emergency department of any patients who were not involved with the trauma. Doctors began pouring into the emergency room. Some came from home wearing jeans and got straight to work assessing patients, sewing up lacerations, and getting beds cleared as quickly as possible. “We weren’t sure the extent of the casualties, if the first bomb was only the beginning, so we prepared for the worst possibility,” said Baedorf-Kassis.

As the ED was being cleared out by other specialties, the trauma surgeons and nurses organized themselves. In a typical day one or two trauma operating rooms may be running at a time. Now, there were six ORs open. A mass text page was sent out to all surgery residents to immediately stop any non-urgent work and come to the ED, where teams were formed with a junior and senior resident as well as an attending surgeon and nursing staff. “When an acute injury was found they would roll patients back to the OR and another team would step into place,” Landman recalls. Many residents repeatedly commented that the healthcare staff demonstrated incredible coordination and teamwork to safely and effectively treat the influx of patients.

The scene was described by anonymous residents as a “war zone” as patients with severed limbs and shrapnel injuries and horrific burns arrived to be treated. These injuries were unfamiliar to many staff members. The x-ray techs kept the machines constantly running to identify hidden shrapnel in patients’ bodies. Dozens of young, athletic runners and spectators appeared shell shocked, traumatized by what they had seen.

At this point there were overwhelming crowds in the ED. Police and security staff were placed at the entrance to the acute bay to only allow people in who were part of active trauma management. The internal medicine program director sent an email out to his residents to stem the influx of doctors, “Thanks to the many people who have already reached out to try and help. The current status is that the ED has more than enough doctors and is focusing on taking patients to the ORs and stabilizing people.  We appreciate the outpouring of support and hope everyone’s family and loved ones are safe.”

Dr. Baedorf-Kassis commented, “The medicine part was the easy part in a way. The harder thing about this experience was the fear of the unknown and the worry that your home was so vulnerable. Being able to focus on the medicine made things easier, we felt like we were being productive.” He breathed a sigh of relief when he found out that his wife was safely home.

With the crowds under control and most of the most critically ill patients in the operating room, the staff turned to the patients with lower acuity injuries. A significant number of patients were unable to hear because of the volume of the blast.  Many of the family members accompanying patients were also victims. As these patients were evaluated and treated, the ED began to return to normal, and by six o’clock thing had calmed down.

“There was a sense of teamwork and community…no jobs were below any member of the team.” Landman comments. “MGH had a huge influx of patients and two hours later the ED was empty with patients on the floors or in the operating room.”

It is challenging to see any silver lining in this horrific event. My colleagues and all of the members of the healthcare team rallied together in a phenomenal display of collaboration and teamwork. Though many were concerned about their own loved ones, they acted quickly in a professional and focused manner. I am incredibly proud to be working with many of the men and women at MGH who truly were heroes during this catastrophe.

Jacqueline DePasse, MD, is a first-year internal medicine resident at Massachusetts General Hospital. She has a B.A. from Stanford University and went to medical school at the University of California, San Francisco. Her professional interests include global health and technology, health policy, and writing. 

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