The BMC Brief
December 21, 2011 Volume 1, Issue 16
From raising a record-setting $2.5 million at the BMC Gala to the BMC HealthNet Plan launching in the commercial market, 2011 was a year of “firsts” for the hospital. Take a look back on highlights at Boston Medical Center during 2011.
Patrick Matheson was working on a new house on Nantucket Dec. 1, nailing plywood on the second floor, when he made what he calls a “rookie mistake.”
“I was holding the gun at an angle when I shot it and the nail bounced off the wood,” says the 31-year-old carpenter. “I felt the nail hit me but there was no blood. I couldn’t see it and I could breathe and talk. I slowly climbed down the ladder, alerted my coworkers and then walked out to the end of the road to wait for the ambulance to arrive.”
What Matheson didn’t know was the three-and-a-half-inch nail had entered the base of his neck and plunged directly into his chest.
Matheson was rushed to Nantucket Cottage Hospital and then quickly transported by MedFlight helicopter to Boston Medical Center. He arrived in the Emergency Department (ED) where he says staff made sure he was very comfortable, before meeting the man who would be his surgeon, Michael Ebright, MD, Cardiothoracic Surgery.
Ebright’s first task was to determine the extent of the injury. The nail, which had been traveling at 1,400 feet per second when it entered Matheson’s chest, had pierced his trachea and esophagus before lodging in his vertebral column.
“My chief concern was whether the nail had injured any of the large arteries branching directly from the aorta above the heart,” says Ebright.
Ebright obtained an arteriogram that revealed the nail had miraculously, and narrowly, missed the large arteries sitting within the trajectory of the nail. In fact, a large artery supplying the brain and right arm actually was nudged over to the side, yet remained intact.
In surgery, Ebright discovered just how close to death Matheson had come. Had the nail entered his chest just a millimeter to the right, it would have severed this major artery and he would likely have bled to death at the construction site. And had the nail been just one inch longer, it would have pierced his spinal cord, possibly leaving him a paraplegic.
Ebright also discovered something else: the nail lodged in Matheson had barbs coming off the shaft, making its removal past the artery it was nestled against that much trickier.
“We operated through an incision at the base of the neck and were able to tease the major artery off the nail,” says Ebright. “We wanted to make sure the barb didn’t catch the artery, so we put a gauze buffer between the nail and the artery. There was no major bleeding, no problems, and we repaired the trachea and esophagus.
“Patrick is very lucky to be alive and walking,” he adds.
Following his two-hour surgery, Matheson recuperated on 8 East Newton Pavilion for a week. He says his whole experience at BMC has been terrific.
“Everyone has been amazing,” he says. “Nurses have been checking on me even when they have a lot going on. Dr. Ebright has stopped by every day. The level of care and professional, from top to bottom, has been terrific. It’s really lifted my spirits.”
He looks forward to going home and spending time with his girlfriend and baby. And he plans to take a few weeks off from the construction business.
BMC operates the longest, continuously verified Level 1 Trauma Center in New England. Read some of its patient success stories.
BMC and Boston University School of Medicine (BUSM) researchers have found that misinformation about access to emergency contraception is common in low-income neighborhoods. These findings appear as a research letter in the Dec. 19 online issue of the Journal of the American Medical Association.
In 2009, the U.S. Food and Drug Administration facilitated access to emergency contraception among adolescents by making it available over-the-counter to individuals age 17 and older.
For the study, female research assistants posed as adolescents who recently had unprotected intercourse. They randomly called every commercial pharmacy in Nashville, Tenn.; Philadelphia; Cleveland; Austin, Texas; and Portland, Ore., between September and December 2010. The cities were chosen in geographically diverse states without pharmacy access laws that supersede uniform federal regulations. The callers followed standardized scripts to simulate real-world calls and elicit specific information on emergency contraception availability and access.
Researchers then examined same-day availability of emergency contraception, (regardless of reason), whether emergency contraception could be accessed by the caller, and whether the pharmacy communicated the correct age at which emergency contraception was accessible over-the-counter.
Although the researchers found the availability of emergency contraception did not differ based on neighborhood income, in 19 percent of calls the adolescent was told she could not obtain emergency contraception under any circumstance. This misinformation occurred more often (23.7 percent compared to 14.6 percent) among pharmacies in low-income neighborhoods.
When callers queried the age threshold for over-the-counter access, they were given the correct age less often by pharmacies in low-income neighborhoods (50 percent compared to 62.8 percent). In all but 11 calls, the incorrect age was stated as erroneously too high, potentially restricting access.
“Even though we found approximately 80 percent same-day availability of emergency contraception in these metropolitan cities, misinformation regarding access was common-particularly in low-income neighborhoods,” says lead author Tracey Wilkinson, MD, MPH, a Fellow in the Division of General Pediatrics pediatrician at BMC/BUSM.
While the study design did not determine why disparities in access to emergency contraception exists, the researcher believes possible explanations include differences in pharmacy staffing or training, frequency of requests for information or organizational cultures around customer service. “Our study assessed only telephone calling and not in-person visits. Despite this limitation, the finding that misinformation regarding emergency contraception access is more common in neighborhoods with the highest teen pregnancy rates suggests that targeted consumer or provider education for consumers and pharmacy staff may be necessary,” she says.
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Patients share their BMC experience
Yesterday I received a call from the Office of the Chief Medical Examiner (OCME). The office was reaching out for help to deliver some extremely delicate news to a Mandarin-speaking family regarding the tragic death of their young daughter.
Fortunately, I connected with Sigfredo Salguero in Interpreter Services. Mr. Salguero stepped up and owned it. He quickly contacted Yina Chen, a Mandarin interpreter, who reported to the OCME to deliver the difficult news. Ms. Chen was described as incredibly empathetic and compassionate in explaining to the parents the circumstances surrounding the death. The family was comforted by Ms. Chen's demeanor and the fluency at which she shared the information.
Sharing information of this kind with a grieving family is always a difficult task, as anyone in my profession will attest. Ms. Chen’s interaction with this bereaved family was remarkable and extraordinary. She truly went above and beyond the call of duty.
Child Witness to Violence Project receives federal funding
Farraye named a leading gastroenterologist
Trysha Ahern, Section Administrator, Pediatric Infectious Diseases, recently received the third annual Barbara Levy Caring Award. Barbara Levy was the first volunteer coordinator for Pediatrics and this award is given to a member of the pediatric staff who exemplifies Barbara's caring spirit and commitment to BMC’s youngest patients. Ahern was nominated for her “years of dedication and effectiveness as an advocate of the special needs children at the SPARK Center.”