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April 26, 2013

SPECIAL EDITION: BOSTON MARATHON TRAGEDY

From the Desktop of Kate Walsh

Kate Walsh, BMC President and CEO

Last week was like no other at BMC. The Boston Marathon bombings affected every one of us and all corners of our hospital. We rose to the occasion to care for and support the injured and their loved ones. We came together and displayed great strength in providing exceptional care and services to those who needed it most. Not only are we Boston Strong; we are BMC Strong.

In this special edition of the BMC Brief, we showcase that strength through photos, stories, and most importantly, your own words. What you did was nothing less than magnificent, and I couldn’t be more proud of you and this great hospital. Thank you, from the bottom of my heart. You are exceptional.

Kate

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Out of Darkness: BMC Shines in Light of Marathon Tragedy

On April 15, Marathon Monday, BMC hummed with its usual activity. Valet attendants parked cars, volunteers greeted and assisted visitors and clinicians treated patients and performed surgeries. In the Emergency Department (ED), staff geared up to receive marathon runners suffering from dehydration, muscle sprains and other common race ailments. No one was prepared for the horror that would come.

Flora Sam, MD
Flora Sam, MD, rushes to help in the ED. Photo courtesy of the Boston Herald

At 2:50 p.m., the first of two bombs exploded at the Marathon finish line. Hundreds were wounded and medical personnel rushed victims to hospitals around the city, including BMC. As ambulances arrived and patients poured into the ED, staff sprang into action. The ED quickly became a scene of organized chaos, with off-duty staff and employees from all areas of the hospital coming to assist in any way they could.

“Patients were bloody, missing limbs and in shock physiologically and psychologically,” says Joseph Bellabona, RN, a Nurse Manager in Renal Rheumatology Geriatrics who helped in the ED. “They had multiple shrapnel wounds and were being treated as though they had just been removed from the front lines of a war zone in Bosnia, Iraq or Afghanistan; instead, unbelievably, they were coming from only a few miles away in Boston’s Copley Square.”

“I saw so many doctors, nurses and other staff covered in blood, whose faces were filled with bewilderment and frustration,” he continued. “You could see them struggling, asking themselves, who and why, but they were professional and focused on the task at hand and did the extraordinary.”

With determination and resolve, BMC staff pitched in and did whatever was necessary. Surgeons pushed stretchers and fetched blood from the blood bank. Patient Transport staff staged themselves in the ED to make sure wheelchairs and stretchers were plentiful. Managers turned beds over between patients. Staff did everything they could to care for the 23 patients BMC received from the Marathon bombings.

“It did not matter what needed to be done, we just did it,” says Jaouad Boughadi, a Patient Transporter in the ED. “We did not wait to receive a page or a call to act. We all pitched in and just did whatever needed to be done."

“I did not care about a break or eating lunch,” says Gregorio Amado, a fellow ED Patient Transporter. “All I wanted to do was play my role as a team member.”

The disaster drills that had been practiced many times before became a reality as armed guards lined the entrances of the hospital as it went into lockdown. Trauma surgeons worked on 16 patients in 10 operating rooms while activity outside the rooms shifted into high gear.

Beyond the ED, the Menino lobby was quickly turned into a receiving area for the wounded, with wheelchairs, stretchers, IV pumps and linen carts populating the space. Occupational and Environmental Medicine staff joined caregivers in setting up the make-shift clinic, providing supplies and screen barriers to ensure patient privacy. Facilities Management staff arrived on the scene to test electrical outlets and provide power strips, while law enforcement personnel patrolled the first floor to ensure the safety of patients and staff.

Meanwhile, across the street in the FGH building, staff led by Patient Advocacy was busy establishing a Family Resource Center for the victims’ loved ones. By 4:30 p.m., an hour and a half after the bombs went off, the Center was up and running, serving sandwiches, coffee and snacks provided by Food and Nutrition Services to 100 people. Information Technology Services set up computers, phones lines, including an international line, and had chargers on hand for people to power their cell phones. Social workers, chaplains, patient advocates and volunteers from other areas of the hospital worked with families to meet their every need, including serving as liaisons to the clinical teams caring for the victims.

By the time the Center closed at 11 p.m., all families had been reunited with their loved ones.

“The Center was an incredible team effort under the most challenging of circumstances,” says Sheryl Katzanek, Director, Patient Advocacy. “The families were an inspiration to all of us.”

Behind the scenes, Operator Services was hard at work, handling a large influx of calls from families inquiring about their loved ones and others just looking to help. Calls came from generous strangers inquiring how to financially support marathon patients and from nurses in other states hoping to come to Boston to lend a hand. That day, Operator Services answered 500 more calls than usual for a typical Patriots’ Day.

“The calls that came into Boston Medical Center for donations, volunteer services and blood donations made my heart flutter,” says Kristin Jeffes, Lead Telephone Operator. “It was at that point that I wished I could reach through the phone and express my thanks to them through a hug or a simple smile and say, ‘thank you.’”

“I may never speak to these callers again,” she continued,” but they left me with the impression that we are all united as one.”

Throughout the afternoon, evening and following days, BMC staff banded together to process the horror that had occurred. They spoke of the extraordinary strength displayed by physicians, nurses, first responders and one another despite the gravity of the situation.

“What helps me deal with this tragedy is knowing what BMC as a whole is capable of,” says Iman Bunton, Assistant Director, Transport. “Every employee gained a new-found appreciation for the duties of others. I am so proud of BMC staff.”

As patients emerged from surgery Monday, Operating Room and Post Anesthesia Care Unit (PACU) staff coordinated the transfer of patients directly to the Surgical Intensive Care Unit (SICU) and Intermediate Medical Care Unit (IMCU) to ensure the safe hand-off of the critically injured. Once there, SICU and IMCU staff sprang into action, with Materials Distribution staff providing dressing supplies, IV fluids and burn dressings to clinical staff. Environmental Services staff made sure rooms were cleaned, trash removed, and linens replaced quickly, while Anesthesia staff remained in the SICU and IMCU until each patient was settled in.

Those not directly involved in patient care soon discovered that they, too, would play an important role.

BMC Emergency Department
Staff wait for the influx of patients outside the ED. Photo courtesy of the Boston Globe

“As a pathologist, my role was not to comfort and stabilize the victims, but rather to take care of the parts that were taken from them,” said Cathryn Byrne-Dugan, a Pathology resident who documented the damage done by shrapnel and other objects to the patients’ amputated limbs. “We know what they lost. We may not have been able to be with them in the Emergency Department, but our thoughts and prayers will be with them forever.”

“It is often said that the best of people emerges in the worst of times, and this was never more evident than Monday inside the ER of Boston Medical Center,” wrote Roberta Gately, RN, in an open letter detailing her experience treating the Marathon patients in the ED. “As patients were saved and soothed and comforted, and tiny rays of hope and light broke through the darkness, I was reminded once again how great this city, this hospital, this country is, and how proud I am to be a small part of all of that.”

BMC’s phenomenal efforts in the face of tragedy have captured the hearts of people all over the country, with support pouring in commending staff on their heroic response.

“I can only imagine the complexities of treating the seriously injured, fielding inquiries from concerned family and friends, providing information to the media, and working to continue the vital services that BMC provides each day to your community,” read one letter.

“The thousands of individuals who are a part of your organization are heroes,” read another. “While I recognize your organization saves lives on a regular basis, on April 15 your preparation, responsiveness and diligence saved dozens of lives. As an American, I thank you.”

As Marathon patients leave BMC this week to continue their healing journeys, BMC staff also will move forward with a greater sense of unity.

“It was controlled chaos,” summed up Andrew Ulrich, MD, Executive Vice Chairman, Department of Emergency Medicine. “In my 20+ years, I’ve never been more proud to be a part of BMC than I was on Marathon Monday.”

BMC resources for staff wellness are available on the BMC intranet.

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Amputee Marines Provide Comfort, Relief to Marathon Bombings Patients

Hope. Inspiration. Support. That's what Marines who lost limbs in Iraq and Afghanistan provided to amputee victims of the Boston Marathon bombings when they visited BMC April 21. The Marines, members of Semper Fi Fund, a veteran non-profit organization that supports critically injured soldiers, met with five patients who lost limbs.

Semper Fi visits BMC
Semper Fi Fund thanks ED staff for their heroic efforts caring for patients.

“As soon as we heard about the bombings, the Marines were texting me that we had to come to Boston and visit with the amputee victims,” says Karen Guenther, President and Founder, Semper Fi Fund. “They knew they could help.”

The five Marines flew in from around the country and visited with each patient for 30 minutes, answering questions and providing vital reassurance. Will I be able to drive? Can I wear heels with a prosthetic leg? Will I be able to go to the beach and swim in the ocean? Their response to each question: yes.

“I want to be independent,” said one patient who lost both legs through tears. “I don’t want to be in a wheelchair and need my family to take care of me.”

“You are going to go right back to your life,” said a Marine who lost both legs in Afghanistan in 2010. “You will be more independent than you were before.”

The Marines were quick to remove their prosthetic legs and hand them to patients to touch and examine. Smiles and laughter emerged from patients as they bonded with those who know best what they are going through.

“You’re part of a special group now,” one Marine told a patient. “You now have the same badge of honor that we do and celebrate another birthday, what we call our Alive day.”

The Marines also visited with BMC staff, thanking providers for the care they have given to the victims of the Marathon bombings.

“Thank you for everything you did and continue to do,” the Marines told Emergency Department, OR and SICU staff.

“Thank you for what you have done for us,” said one nurse who burst into tears while she hugged a veteran.

The Marines say they will continue to support the patients long after they leave BMC through the Semper Fi Fund.

“They are part of our family and we will support them in every way possible,” says Guenther.

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Staff Process, Connect on Healing Journey

Self-care is an important part of any person’s well-being, but it becomes vital following difficult events such as the Boston Marathon tragedy. Since the bombings, employees have been processing their experiences, often with the help of their medical professional peers.

Comfort

Over the past two weeks, hundreds of staffers have participated in both group and individual debriefing sessions facilitated by members of the Psychiatry, Social Work, Pastoral Care and Human Resources departments. These groups also have been deployed to various units responsible for caring for the victims to check-in with staff to see if they need additional resources, such as counseling, and if so, are referred appropriately.

“People in the medical profession who are used to taking care of others many times put themselves on the back burner,” says Claire Murphy, Senior Employee Relations Specialist, Human Resources. “Some of the things we have been discussing in the sessions include tips on self-care for dealing with stress of the bombings, ways to ease anxiety when a traumatic event strikes, how to talk to children about the bombings and how to cope with random acts of violence.”

Murphy says employees have experienced physical and emotional reactions, including fatigue, exhaustion, first-responder guilt about being spared in the bombings, and guilt felt by those who were not on duty in the ED on Marathon Monday but wish that they had been so that they could have helped.

“Staff have expressed great appreciation for these sessions and the chance to process with their colleagues,” she said.

Senior leaders also have increased rounding on floors to check-in with employees and see how they can provide assistance.

Other BMC resources for staff include:

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Story of Strength: Finish Line Becomes Frontline for ED Doctors

By: Elizabeth Mitchell, MD
Emergency Medicine

I grew up in Watertown a block and a half from where the second bomber was captured and where my parents still live. On Marathon Monday, I was in the main medical tent less than a block from where the first bomb exploded. Posing for a group photo with other volunteers from BMC’s ED that morning, we had no idea what we would be facing later that day. I was assigned to tent A near the finish line, along with several of my colleagues. We arrived early, prepared our areas, then waited until the elite runners came through, followed by a steady stream of manageable patients. When that first explosion came, a sound none of us had ever heard before, we stopped and the entire tent became silent. It sounded like a bomb. Then the second boom and someone yelled, “They need doctors!” and before we could stop to think, we ran out into the acrid smell of explosives toward the injured.

BMC Marathon Volunteers
BMC volunteers pose for a photo on the morning of the Marathon before staffing the medical tents.

I will never forget that scene; people lay in disarray, their clothes and shoes blown off, the sidewalk covered with blood. They lay soundlessly, but family members, friends and strangers held them, held their torn limbs, pleaded with them to hang on. Miraculously, almost every patient I went to had already been tourniqueted with a torn pant leg, a belt or someone’s shirt. Their faces were unlike any traumatized patients I have seen: blank, silent, shock. In retrospect I wondered if they could even hear us, if their eardrums had been injured in the blast. Smoke hung in the air, a store alarm rang and amid all that chaos, we worked as we’ve never worked before. We used scattered debris to splint legs that were barely hanging on. We rolled people onto boards. Boston EMS was everywhere with stretchers, backboards and helping hands. Boston Athletic Assocation volunteers, police and bystanders helped to evacuate patients as quickly as possible in any way they could.

We put a patient on a backboard and ran, a group of us carrying him back to the tent where we found a scene that resembled a MASH unit. Doctors and nurses moved from patient to patient, assessing, placing IVs, bandages, whatever was needed. Boston EMS triaged with number cards or simply by writing on people’s foreheads, apologizing as they did so. I can’t say enough about Boston EMS; they worked furiously to get people organized and get patients moved out to hospitals with incredible speed.

And in between all this was my BMC family. We looked at each other in disbelief and despair as we worked. We gathered together after we had done what we could and worried about our department. When we finally made contact with the ED, they said come in. And we did. By bike, ambulance, walking, whatever way we could. And when we got there we found our department filled with people who had come from every part of the hospital, every part of the city and state, to help where they could. There were embraces for those of us who had been at the scene. Then we did what we could, until we were just getting in the way and told to go home.

At the end of the day, I leaned over to unlock my bicycle to ride home. The bottoms of my sneakers were caked with blood. I could not rid my mouth of the taste of explosives and I was more tired than I have ever been. I looked up and there waiting beside me on the street was an EMS supervisor. He rolled down his window and asked if I would like a ride home. I could have cried. I smiled and thanked him for his kindness. Then I got on my bike and rode home, from one family to another, numb with grief and shock, awed by the incredible people I work with, and inspired by the people of the city of Boston, rising up to face terrorism like they face most things: straight ahead, with conviction and without fear.

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Story of Strength: Everyone Had a Job to Do

By: Cathryn Byrne-Dugan, MD
Pathology Resident

Last Monday, after hearing the news of the bombing followed by the endless stream of ambulances coming to the ED for what seemed like hours on end, I, like so many others, felt helpless. I wanted to be there, in the ED, taking care of patients and helping people in any way I could. This was the first time since choosing to become a pathologist that I was acutely aware of the fact that I would not be directly working with patients; sewing their wounds and providing comfort. I am a first-year pathology resident, and throughout medical school, I wanted to be in internal medicine. But at the end of my third year, I did a rotation in pathology and fell in love with the problem solving and diagnosing that happens in pathology. Nevertheless, I am saddened by the fact that I do not see patients on a daily basis. Last Monday I felt the pain of knowing that if I went to the ED, I would probably just be in the way.

Pathology staff collage
Pathology staff collage

I realized then that this is how everyone who was not working in the ED last Monday felt: helpless and at the whim of a rapidly unfolding situation filled with fear and uncertainty. I packed up my bags and went home to be with my soon-to-be-husband in our apartment.

On Tuesday morning, they arrived in the Pathology department. Of course I could have predicted it—things that are removed during surgeries always come to the Pathology department. Of course the limbs of those injured Monday would be on our table on Tuesday, but still, to see them all together, seven amputations, I was overwhelmed by sadness and felt tears welling up in my eyes with empathy for all those killed and injured. There were countless containers filled with shrapnel, pellets and twisted metal. This was real. I realized that I did have a job to do. As a pathologist, my role was not to comfort and stabilize the victims but rather to take care of the parts that were taken from them.

No one ever thinks about what happens to something after it is removed. Where does it go, what happens to it? I wanted to write this note to explain that the limbs and shrapnel from Monday’s terrible events came to us in the Pathology department. We carefully washed each limb, took detailed pictures and meticulously described the shrapnel in the containers. We noticed the carefully painted toenails and grieved for the loss of your limbs. We cared with our whole hearts for each one of your limbs. We know what you lost. We may not have been able to be with you in the ED, but our thoughts and prayers will be with you for every day to follow in the future.

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Story of Strength: Furry Friend Delivers Moment of Compassion

Mike Hurley and Dexter
Mike Hurley and Dexter

By: Janet Eagan, RN
Nursing

This week I saw Mike Hurley, an engineer in Clinical Engineering, with his dog Dexter at BMC. Mike brings Dexter to work every Wednesday to visit with patients as part of the Healing Paws program. Once a rescue dog, Dexter now rescues others by bringing a smile to their faces. It’s a chance for patients to escape for a moment from a medical condition and an opportunity to visit and share the common bond of a love of animals with another.

Mike had just spent time rounding on the floors that received patients injured at the Marathon. In an effort to help them, he had brought Dexter in for extra duty. Mike shared the story of one of their visits that day. They visited three members from a family affected by the tragedy. Two of them had been seriously injured at the Marathon and were recuperating together in the same room. He and his furry companion were a bright spot in the family’s day. This was an ordinary intervention, and a moment of compassion, delivered in an extraordinary way.

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