Bright Spots in a Dark Week
Normally, it doesn’t matter much where I’m from. But, last week, being a long-time resident of the Boston area suddenly came to the forefront. Though I was not ordered to “stay safe at home,” I did and found it hard to concentrate on anything other than news of the Boston Marathon bombings and related manhunt. In the outpouring of information, Boston’s medical community and related media outlets provided some of the best reporting, with news and reflection of lasting value.
Immediately following the bombings, much of the news was medical, focused on the nature of injuries sustained by spectators and others near the race’s finish line and the response of volunteers, emergency services, and Boston hospitals. Local physicians and medical reporters provided commentary that was informative and educational. I drew comfort and strength from their reports. I’d like to share some of the best of these bright spots from a dark and scary week.
Physician Reports
The first two links below are to press conferences held by physicians who were actively engaged in caring for the injured. These physicians, and others who reported throughout the week, were articulate and sensitive. They were, of course, informative about the medical details in a way that we can’t expect from local news reporters. I also found their reports to be surprisingly reassuring given the severe injuries they described. They and other medical professionals provided good “bedside manner” for a region in need of honesty and caring in equal measure.
Peter Burke, MD, chief of trauma services at Boston Medical Center (BMC), which has the largest emergency department in New England, answered reporters’ questions for an extended period following a brief update about victims of the bombing who were brought to BMC.
In a different press conference or perhaps at a point from this one that wasn’t preserved online, Dr. Burke made two comments that caught my attention for their applicability to patient safety. When asked if military medical experience was relevant or an advantage in treating those injured by the bombing, Burke responded that BMC defers to expertise over authority. This, of course, is an accepted principle for high reliability organizations. Physicians who have treated patients with similar injuries caused by explosive devices in Iraq and Afghanistan may have had especially relevant skills; regardless, every patient deserves to be treated by the most skilled caregivers, no matter their rank or seniority.
In numerous press conferences, reporters asked physicians about the emotional effect of treating patients with grievous injuries, particularly the amputations that characterized this attack. Dr. Burke indicated that BMC recognizes the importance of emotional support for physicians, nurses, and staff members, which is gradually becoming recognized as important for all adverse events, including those caused by medical error.
Peter Fagenholz, MD, trauma surgeon at the Massachusetts General Hospital, patiently offered a long press briefing on Monday evening, roughly seven hours after the attack. In this case, good bedside manner was actually good sidewalk manner, as it appears this briefing was held outdoors, near the entrance to the hospital.
In an article published toward the end of the week, Liz Kowalczyk, medical reporter for The Boston Globe, captured the ethos of offering emergency medical services to all—including the alleged terrorists—and the immediacy of the attack for local residents. Kowalczyk describes the actions of an emergency physician who heard a gunfight and explosions near his home in Watertown early Fri. morning. Anticipating an influx of emergency patients, he raced to Beth Israel Deaconess Medical Center, getting there in time to help treat one of the attackers, who was also involved in the gunfight, and who died from his injuries.
Disaster Preparation
The value of disaster preparation was a recurring theme in media reports through the week. Boston is full of great hospitals and Level-1 Trauma Centers, which were put to good use especially on Mon following the bombings. Every story I read attributed the hospitals’ rapid, effective response to good training.
In a mid-week blog post for The New Yorker, Boston-based author, surgeon, and patient-safety expert Atul Gawande, MD, interviewed physicians and administrators to learn more about Why Boston’s Hospitals Were Ready. The answer, it turns out, is both reassuring and depressing. Gawande found that training in itself was no more important than teamwork, relevant experience (wars and disasters), willingness to improvise, and an attitude of acceptance or at least resignation that we live in a world where these events happen. All of us can now imagine the unimaginable, and our medical community has learned from observation, experience, and practice how to save and treat many of the victims. Gawande reports,
Talking to people about that day, I was struck by how ready and almost rehearsed they were for this event. A decade earlier, nothing approaching their level of collaboration and efficiency would have occurred. We have, as one colleague put it to me, replaced our pre-9/11 naïveté with post-9/11 sobriety. Where before we’d have been struck dumb with shock about such events, now we are almost calculating about them. When ball bearings and nails were found in the wounds of the victims, everyone understood the bombs had been packed with them as projectiles. At every hospital, clinicians considered the possibility of chemical or radiation contamination, a second wave of attacks, or a direct attack on a hospital. Even nonmedical friends e-mailed and texted me to warn people about secondary and tertiary explosive devices aimed at responders. Everyone’s imaginations have come to encompass these once unimaginable events.