Monthly Archives: April 2013

On the marathon.

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Patriots Day, or Marathon Monday is an official holiday in the state of Massachusetts.  It occurs on the third Monday of each April, and every year, thousands of runners converge on the city of Boston and surrounding towns to run 26.2 miles.  Thousands more travel to the city to be part of this special day.  Businesses are closed, bars are open, and everyone is out, celebrating the occasion.

The weather can be finicky – let’s face it; it’s spring in the northeast.  April can be cold with snow, or it can be in the 80’s like it was last year, which imposes some interesting medical dilemmas from an emergency medicine standpoint when 26,000 people are running a marathon.  Last year during the marathon, I worked in the ED, and saw patient after patient with dangerously low sodium levels.  It was crazy.

I was excited this year to be able to volunteer at the medical tent right at the finish line for the marathon.  It wasn’t 80 degrees this year, it was a cool, brisk 58-59 degree day – perfect for running, but I was still pretty sure I’d get to take care of some marathon runners who needed medical attention.

I arrived around 7:30 in the morning, met up with the 10-12 other physicians from my hospital – Boston Medical Center – that were working the tent with me.  We got our white volunteer jackets, we picked up our medical ID badges, we strapped on our black and yellow B.A.A. physician vests and grabbed our free bagged lunch to snack on while the race started.  We still had about 2 hours until the elite runners would be crossing the finish line.  We went over last minute details on what we could do for patients that came into the tent – check their vital signs, their electrolytes, give intravenous fluids – and then a few of us went to the finish line to take some photos and to pretend to cross the blue and yellow striped ground before the runners came through.

And then the runners came.  We were ready.  We were bored, in fact.  We had arrived at 7:30am and had been pretty much chatting and checking our email on our smartphones for the last few hours.  When the elite runners cross the finish line, they are escorted straight into their own medical tent in order to be drug tested.  And to get to their medical tent, they walk right through the main tent – my tent.  So when the first person came through – the men’s wheelchair winner – we were elated!  It was so exciting to see these elite athletes come through.  We all clapped, and cheered.  First the men’s wheelchair athletes, then the women, and then we got to see the female elite runners, followed by the male elites.  It was amazing!  It was such a fun, exciting time.  Everyone was smiling, everyone was cheering.  We still had no patients though.  So we waited.

The “regular” runners began to cross the finish line – and by “regular”, I mean, they run a marathon in under 3 hours – which, for those that don’t know, is a phenomenal time, and translates to just under a 7-minute mile.  It’s fast.   So we got our first patients – some leg cramping, some dizziness.  Nothing too crazy.  But at least I was starting to assess patients and be involved.  Around 2:45pm, I think I had seen about 8-10 patients in my pod in the medical tent.  It had been a good, relaxing, exciting day so far.

And then I heard the explosion.  I felt my body shake.  It was loud, it was really, really loud.  I had never heard anything like that before.  I looked up at my colleague Liz, another physician from my hospital, and saw the same look in her eyes – we didn’t have to say anything, we both knew.  That sounded, and felt, like a bomb.  The tent got silent.  We all, in some way or another, told ourselves internally, “oh maybe it was just fireworks, some celebratory cannon or something, for the marathon.”  It’s the only conceivable thing to tell yourself when you hear a terrifying sound like that.  And then 12 seconds later, the second explosion.

The announcer inside our tent – who previously had been saying things like “we need a rectal temp in zone 11” or “can a get an IV nurse to zone 6,” came on the microphone and said “everyone stay calm, we don’t know what that was.  Continue to take care of your patients and we will keep you updated on any situation that arises.”

But we had to know what those sounds were.  A friend of mine, a nurse – Evan, had just come back in the tent and said “there’s been an explosion.”   She had a look of panic on her face.  My heart dropped, I was frozen for a few seconds.  The next few moments are a bit of a blur.  I know I texted my fiancé with the message “love you” at 2:53pm.  I know I went over to Liz, told her there was an explosion.  I know we started running towards the front of the medical tent.  When we got to the front, there was a woman being brought into the tent in a wheelchair with blood trickling down her face, and a trail of blood behind her.

So we continued to run.

Liz and I, outside into the sunlight.  There was smoke, there was screaming, there were police yelling something but I don’t remember what they were saying, there were a few people running towards us.   We made our way towards the finish line about 100 yards away.  The smell, I remember the smell of smoke.  And as we crossed the finish line, we could start to see the blood.  There was a crowd of maybe 20-25 people, some kneeling, some sitting, many motionless on the ground.  I looked up and saw the windows of the Lens Crafters store shattered and missing.  I saw a woman sitting, propped against the doorway to Marathon Sports, unable to move.  I saw 2 EMTs doing CPR on a woman as others were simultaneously lifting her onto a stretcher.  I saw bystanders ripping off their clothing to make tourniquets for severed limbs.  I saw severed limbs.  Too many.

I heard the fire alarm screeching from Marathon Sports.  But other than the alarm, it was quiet.  It was eerily quiet.  None of the victims were crying.  None of them were screaming in pain.  I will never forget their faces.  Stunned, shocked, silence.  Nothing.  They were missing limbs, and they were silent.

Before I had time to process the horror, however, I felt something else.  Extreme terror.  I had heard 2 explosions go off in the last 5 minutes, and I had no idea if there was going to be a third.   It was the single most terrifying, frightening moment in my life.  Part of me wanted to run far, far away.  But something pushed me forward.

We got victims back to the medical tent by wheelchair, stretcher, or simply, someone’s strong arms.  What had once been a post-race resuscitation center turned into a mass casualty tent with areas sectioned off according to priority level.  The EMTs brought out their triage tags – triage 1, 2, and 3.  Those triaged as level 1 needed immediate transfer – they were the victims that had been receiving CPR, those that looked ashen, pale – those on the brink of death.  We went around the tent, applying pressure to wounds when we could, applying tourniquets if needed, and making sure everyone had a triage level.

And still, the victims were silent.  I would ask them their names, to make sure they were awake, and to assess their mental status.  I’ll never forget their names.  I found a pair of scissors from one of the podiatrists that was in the tent and started cutting off clothing, to try to get the victims exposed to see if there were any other injuries.  I remember one woman worked for a large company nearby, and she wanted to make sure no one saw her naked.  I assured her we would keep her covered up, and also tried to reassure her she would be fine.  I triaged her a level 3.  I found a woman diaphoretic (sweaty), ashen colored, with a bleeding leg.  She seemed very sluggish and lethargic when I tried to talk to her.  I triaged her a level 1 and called EMS over.  They took her right away.

There was definitely chaos, but there was a structure to it.  Everyone put their egos aside, and worked together.  There were podiatrists and medical scribes giving kind words of support to victims.  There were nurses putting IVs in everyone that came into the tent.  The EMTs were quickly getting patients onto stretchers and transporting them to multiple different area hospitals – including mine.

If you had told me at that moment that there would be only 3 fatalities from this horrific event, I wouldn’t have believed you.  It is only by sheer luck that the explosions happened 100 yards from the medical tent housing EMTs, medical professionals, and ambulances capable of taking them to definitive care.

As an emergency medicine physician, my training has obviously exposed me to some horrific events.  I have seen bad car accidents, gun shot wounds, even amputations from injuries.  Seeing blast injuries on this scale was clearly something I had never been exposed to.  Being a first responder was a new role for me.  I’m usually the “second” responder – I receive the patient in the safety and comfort of my Emergency Department with all of my tools at my side.  That being said, I have a newfound respect for first responders.  This was an absolute eye opening experience for me.  EMTs, police officers, firemen – first responders by training, they run into danger without a second thought.

As it turns out, it’s going to take some time for me to wrap my mind around this senseless tragedy.  Sleep has been difficult, headaches have been constant.  And given the events of the past 3 days, it has only become more clear that I have some deeply seeded emotions that I’m slowly trying to deal with.  I will never forget the silent, somber faces of the victims, or the terrifying sound of that explosion.  But I will also never forget all those that rushed to help.  I have so much pride in my city, in my hospital, in my fellow citizens of Boston that I am bursting.  If this nightmare has provided me with anything, it is, as the great Dr. King said, that “darkness cannot drive out darkness; only light can do that.  Hate cannot drive out hate; only love can do that.”

There is a lot of light here.  And a lot of love.