Massachusetts Medical Society: Boston Marathon Caregivers Reflect: Looking Back and Moving Forward

Boston Marathon Caregivers Reflect: Looking Back and Moving Forward

One Year Later

Vital Signs April 2014 - Boston Marathon
Medical workers wheel the injured across the finish line during the 2013 Boston Marathon following explosions during the race on Monday, April 15, 2013. Photo courtesy of Associated Press.

For emergency medicine physician Christina Hernon, M.D., healing has come through yoga, raising money for The One Fund, and processing her emotions with other marathon medical volunteers.

Boston Athletic Association (BAA) co-medical director Aaron Baggish, M.D., is restored by physical activity and the support of his family.

For emergency physician Liz Mitchell, M.D., solace arrived through writing a song that captured the duality of the day — the horror versus the strength and courage that met it head-on.

As the one-year anniversary of the Boston Marathon approaches,Vital Signs spoke with physicians and others who cared for bombing victims about how they’re faring, whether they’ll return to the April 21 race as medical volunteers, and what they learned from the tragedy.

Vital Signs April 2014 - Aaron Baggish
Aaron Baggish, M.D.

“I think there’s a huge range in how people are doing,” said Dr. Baggish. “Many, many people are moving on and feeling confident about returning to the marathon without residual trauma. For others, they are still struggling. The BAA has been very proactive in giving people the out if they have any concerns about volunteering this year. It’s not a sign of weakness and it will have no impact on our welcoming them to volunteer in the future.”

A ‘Cowboy-Up’ Culture

The stereotype of the physician, especially those with specialties in emergency medicine and surgery — disproportionately represented among the people who treated marathon victims — is one of “seen-it-all” equanimity. For several of the physicians interviewed for this story, including Carlo Rosen, M.D., who cared for six marathon victims in the Emergency Department at Beth Israel Deaconess Medical Center, there is a lot of truth to the cliché.

“I’m a hardened criminal, so to speak. I’m older. I’ve been in a number of mass casualty situations before. I’m pretty experienced in taking care of trauma patients with blunt and penetrating trauma,” said Dr. Rosen, who is also BIDMC’s residency director in emergency medicine. “The event definitely had a bigger impact on our junior physicians. They’re a group that hasn’t seen these types of events and hasn’t taken care of many patients like this.”

The downside of what psychiatrist Steven Adelman, M.D., terms the “cowboy-up” culture is that the approach can backfire for some people. “Stuff festers and the person might get re-triggered,” said Dr. Adelman, the director of MMS’s Physician Health Services. “Not talking about something might have unseen downstream effects.” Dr. Adelman said that after the marathon PHS did see some physicians for whom the bombing “was a significant contributing factor in their distress.”

Talking About It

University of Massachusetts Memorial Medical Center ED physician Dr. Hernon, who cared for bombing victims at the finish line, said that a debriefing session for medical personnel shortly after the marathon was a critical step in her healing. “I was consumed with self doubt. Did I do enough? Did I make a difference? I was stunned to hear 41 of the 41 people at the debriefing talk about those same feelings. It was so liberating. I went home and slept well for the first time all week.” It’s been a slow trek back to normalcy, she said, and it’s only in the last couple of months that she’s been able to say, without tearing up, that she will return as a volunteer.

Vital Signs April 2014 - Beth Lown
Beth Lown, M.D.

Internist Beth Lown, M.D., the medical director of The Schwartz Center for Compassionate Healthcare, heard that feeling of guilt expressed over and over during the four special “rounds” sessions her organization sponsored this fall, bringing together medical personnel from multiple institutions who had treated bombing victims. Because there still seemed to be a lot of residual distress among attendees, the Schwartz Center scheduled follow-up sessions in March and April.

“I’m personally a little worried about people feeling they didn’t do enough and wanting to return so they can do more,” said Dr. Lown. “I’m concerned that some will be re-traumatized.”

Returning to the Scene

Beth Meister, a Belmont psychologist who has worked in the medical tent for eight years, said she is not concerned about people returning. “I think it will be more of a way to work on the original trauma,” said Meister, who comforted bombing victims as they were brought into the tent. “When you have a negative experience, you are not necessarily made worse by repeating the experience and this time having a positive outcome.”

Vital Signs April 2014 - James Broadhurst
James Broadhurst, M.D.

Meister said many of the medical volunteers have been serving at the race for years and have a strong support network there, which can be very therapeutic. James Broadhurst, M.D., a family physician and nine-year marathon medical volunteer is one of those people.

“I love the people I work with and I love the work we do there,” said Dr. Broadhurst. “It makes a difference to the runners who have been working so hard for months and years. They need care and this is what we do. We’re there that day for them.”

Nevertheless, the Boston Athletic Association isn’t taking any chances. There will be a large team of psychologists there — perhaps as many as 60 — to ensure that anyone who needs emotional support receives it, according to BAA medical coordinator Chris Troyanos. The number of medical volunteers will also be much larger because the field size has expanded from 27,000 to 36,000 runners, not including “bandits,” who may also be out in greater force this year, said Troyanos.

A Teaching Moment

For Jeff Kalish, M.D., a Boston Medical Center vascular surgeon who operated on bombing victims, the tragedy provided “teaching moments” that have shaped the way he thinks about care. “The bombing was a life-altering and career-altering event for me,” he said. “Everyone came together — organically — across all aspects of health care delivery to make the best experience possible in the midst of an awful tragedy.”

He subsequently worked to institutionalize the cross-disciplinary collaboration at BMC that he saw occurring spontaneously and reached out to all of the services involved in amputations — including physical therapy, social work, and psychiatry — to better coordinate in the future. New multi-disciplinary collaborations have sprung up in other areas of the hospital as well, according to Dr. Kalish.

The marathon experience also reminded him of the original reason he went into medicine. “For many of us, as time goes on we get so busy and so consumed by the economic and time constraints. Now, if I’m in a busy clinic, I take a step back and make sure I’m there for the patients and families.”

—Vicki Ritterband
Vital Signs Staff Writer
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