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, 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.
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.