Jacqueline DePasse, MD, is an internal medicine resident at Massachusetts General Hospital. Many of her colleagues and friends were on the front lines in the hours after the April 15 tragedy at the Boston Marathon©. She wrote the following story based upon interviews with two co-workers who she spoke with as they tried to process the senselessness of the tragic events.
Dr. Zachary Landman, an orthopedics resident at Mass General, had just finished examining a patient’s wound and was scribbling a note at a 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 taking in the scene of smoke and chaos for a few seconds, he shut off the television and briskly walked towards the MGH Emergency Department (ED).
“We weren’t sure the extent of the casualties, or if the first bomb was only the beginning, so we prepared for the worst possibility.”—Dr. Baedorf Kassis.
Dr. Elias Baedorf Kassis was already there, in the ED’s acute bay. As a third-year medicine resident on his ED triage rotation, his job that day was to evaluate patients and decide if they needed ICU level care, admission to an inpatient ward or simply observation.
Early on, the day was fairly typical. Patients started to move from the ED to the inpatient units as the afternoon wore on. Suddenly the radio speaker crackled. Dr. Baedorf Kassis expected to hear reports of an incoming med-flight or a cardiac arrest arriving via ambulance. Instead, came word of the attack. Everyone stopped what they were doing. “At first we didn’t quite believe what we had heard,” he remembers. ”We weren’t sure if this was just a mistake.” His thoughts flashed to his pregnant wife, who was one of the many spectators that day.
They Just Kept Coming
Dr. Landman had gowned up and was waiting by the ambulance door when the first wave of about 20 patients arrived from the Boston Marathon©. Some of the most critically injured were among them. “They just kept coming in through the door,” he says. “The nature of the blast was such that it was a high temperature explosion and there was a lot of shrapnel. I would estimate at least a dozen people had serious injuries and burns from the shrapnel.”
Dr. Landman had gowned up and was waiting by the ambulance door when the first wave of about 20 patients arrived from the Boston Marathon©.
While Dr. Landman attended to victims, Dr. Kassis helped to coordinate staff members as they cleared the ED of patients not involved with the trauma. Doctors began pouring into the emergency room. Some came from home wearing jeans. They 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, or if the first bomb was only the beginning, so we prepared for the worst possibility,” says Dr. Kassis.
Trauma surgeons and nurses organized themselves. During a typical day, one or two trauma operating rooms may be running at a time. On that day, there were six open. A text was sent to all surgery residents advising them to immediately stop non-urgent work and come to the ED. There, 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,” Dr. Landman recalls.
Some residents described the scene as a “war zone” as patients with severed limbs, shrapnel wounds and horrific burns arrived. 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.
An Outpouring of Support
At this point there were overwhelming crowds in the ED. Police and security staff were placed at the acute bay’s entrance to limit access to people in who were part of active trauma management. Hasan Bazari, MD, the internal medicine program director, sent an email 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.”
“The medicine part was the easy part in a way,” Dr. Baedorf Kassis says. “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 other injuries. A significant number were unable to hear because of the volume of the blast. Many family members accompanying patients were also victims. As these patients were evaluated and treated, the ED began to return to normal. By six o’clock, things had calmed down.
My colleagues and all of the members of the MGH healthcare team rallied together in a phenomenal display of collaboration and teamwork.
“There was a sense of teamwork and community. No jobs were below any member of the team,” Dr. 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.”
During this horrific and unthinkable event, it is challenging to see any silver lining. My colleagues and all of the members of the MGH 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.