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Boston Marathon Bombing

May 17, 2013 Today I discharged my last patient from the Boston marathon bombing. It has been almost 5 weeks since this tragic event, and I feel it an appropriate time to relate some of my thoughts on the event and our response. This is not an authoritative, all-inclusive summary of the events, the patients, their injuries, and their treatments but rather my observations and some of the lessons learned from the events that transpired. Undoubtedly, there will be future publications looking more scientifically at the injuries, their treatment, and outcomes. Patriots’ Day is celebrated on the third Monday of April each year to commemorate the Battles of Lexington and Concord. Other than being a Massachusetts state holiday, it is best known as the day on which the Boston Marathon is run; unofficially it is Marathon Monday. The Red Sox schedule a home game with a morning start in honor of the holiday, which allows fans to become Marathon spectators once the game concludes. This year, Marathon Monday was the 15th of April. It started out unusually in that I did not have any scheduled operating room (OR) cases. I took the opportunity to bring my fellow, Tom Douglas, MD, to the Red Sox game. The game ended about 2:00 pm and we took the subway back to my office at the Faulkner Hospital (FH). We arrived just after 3:00 pm, about 10 minutes after the explosions at the finish of the marathon. My partner Jeremy Smith, MD, the residents, as well as my staff were in front of the waitingroom television. When I inquired what was going on, my physician assistant responded that there had been a bombing at the Boston Marathon. The television was showing images taken from a helicopter looking down Boylston Street toward the site of the bombing. From that vantage point, little of the chaos or carnage present on the ground could be appreciated. I asked Jeremy to call Brigham & Women’s Hospital (BWH) to see if there was anything that we could do. Expecting the response to be something like, “Thanks, but we’ve got it covered,” I was surprised to hear, “Get down here as soon as you can.” As we left the FH parking lot in my car, a Boston Emergency Medical Services ambulance was pulling in. I turned to Tom and asked, “That couldn’t be a bombing casualty, could it?” We both concluded that none of the casualties would be brought to the FH. We would both be wrong. Minutes later, we arrived to find the BWH Emergency Department in full lockdown mode. Once inside, we found the BWH emergency room busy and less than organized but not chaotic. We quickly found our orthopaedic trauma colleague Michael Weaver, MD, organizing the triage of patients requiring orthopaedic care. Although things were moving quickly, we had the luxury of evaluating the potentially limb-threatening injuries as a team. Patients had open calcaneal fractures, open tibial fractures, dysvascular limbs, massive soft tissue injures, and burns. I had seen these injuries before both in numbers and severity when I was in Iraq. The sounds and sights did not disturb me. I remember feeling disappointed that this had happened at the Boston Marathon, marring the event that carries with it an extreme sense of pride for my city. But this was not enough to give me pause. The only thing that cut through the adrenaline was the smell of combusted sulfur mixed with singed flesh. As that acrid odor from the first patient wafted into my nostrils, tears welled up. That smell was too much like Iraq. I had to look up to the ceiling a moment to collect myself. Thankfully, that was the only distraction that evening. Mike assigned us each to separate patients requiring OR treatment. Tom, Jeremy, and I each started the remainder of the evening taking one of those patients to the OR. I rode down the elevator with my first patient, trying to comfort her with the anemic reassurance that we would do everything we could to make sure that she would walk again. By the end of the night, I had contributed to 6 operative cases, 2 of which were limb threatening. As I walked out of the OR just after 9:30 pm, I met my junior resident, who had been working with Jeremy on his case. He invited me to get a soda from the resident’s room. We reviewed the events of the day. Although exhausted and not having anything more that could be accomplished that night, I felt a need to stay. Knowing that there would be many more long hours over the following weeks, I peeled myself away from the hospital. As I drove home, I checked with my team and found that not 1 but 5 casualties had been brought to the FH. Four of the 5 had non-limb-threatening soft tissue injuries, while 1 had an open calcaneal fracture with tissue loss. One of my partners who specializes in sports medicine, 2 general orthopaedic surgeons, and the chief of general surgery at the FH teamed up and provided expert temporizing care for these patients. After I hung up, I scanned the FM dial to try to fill in the many blanks that remained in the events of the day and to determine what information delivered by the OR rumor mill had credence. Upon returning home, I checked on my kids and wife. My kids slept blissfully while my wife was unsuccessfully trying to nod off. I then checked the media spin-up that was 495811 FAIXXX10.1177/1071100713495811Foot & Ankle InternationalEditorial research-article2013