The array of other injuries was dizzying. Patient admission logs kept at Tufts Medical Center showed the relentlessness and range of the damage:
3:33 P.M. Female with third-degree burns and shrapnel wounds
3:35 P.M. Male with shrapnel and ruptured eardrums
3:35 P.M. Male with a complex penetrating wound
Soft tissue injuries, nerve injuries, bone fractures, abrasions, and embedded foreign bodies—nails and ball bearings—followed. In the midst of the onslaught, Tufts officials were forced to evacuate their ER because of a bomb scare; bomb-sniffing dogs brought in to check out a suspicious package appeared to confirm that it contained explosives, forcing all emergency patients into the hospital lobby for thirty minutes. Another bomb scare disrupted at Mass General, where the hospital was briefly placed on lockdown because of a suspicious package in a parking garage. Meanwhile, well into Monday night, patients were still showing up at the hospitals—at Tufts, a runner suffering from exposure checked in at 6:14 P.M.; a spectator with hearing loss arrived at 7:01; more burns and abrasions followed at 7:23. The following day, new patients with hearing loss and head injuries arrived—along with the first wave of those seeking help for invisible wounds, like the “witness with anxiety and depression” noted in the Tufts log at 3:30 P.M. Tuesday. In all, 275 people would be treated at hospitals.
In the midst of so much pressing need, there were inevitable inconsistencies, and patients who experienced gaps in the level of care. Allison Byrne, who had just run the marathon and had a large piece of shrapnel lodged in her left leg, sat in the ER holding her own tourniquet for hours after being brought in a police car to Boston Medical Center. She had just run twenty-six miles, but she wasn’t given much water, couldn’t get to the bathroom, and had to beg for Tylenol. In the case of some of the doctors and nurses, she found their bedside manner and communication wanting.
As the hours crept by Monday night, and as dawn approached on Tuesday, the tally of the wounded mounted. City officials and shaken, sleepless residents waited for the death toll to creep upward, too. It seemed inevitable, given the power of the explosions and the witness reports from the scene, the videos and photographs and bloodstains on the sidewalks. Yet the number of fatalities remained at three. The first identified was Martin Richard, whose name had begun circulating in the city, and on social media, before 9:00 P.M. Monday; at 1:00 A.M. Tuesday, the Boston Globe confirmed it via Twitter. The world learned Krystle Campbell’s name later Tuesday. Boston University said Tuesday the third victim was a student, though it took until Wednesday for Lingzi Lu’s name to be made public. It was hard to believe there would be no further fatalities, but hopes grew with each passing day. Every injured person who had been transported alive from the scene to a hospital—even a few who had lost all or nearly all of their blood, who may have come within minutes of death, like Marc Fucarile—had survived. It only seemed more stunning the longer it stayed true, a tribute to the frenzied medical response at the bombing scene and the skill and readiness of Boston hospitals.
It was a strange truth that many would acknowledge in the days and weeks that followed: If there had to be a terrorist attack somewhere in the US, the finish line on Boylston Street, with the medical tent already in place and six of the top hospitals anywhere within a mile or two, was about the best place it could happen. Such a concentration of skilled surgeons, nursing staffs, and operating rooms was extremely rare. The underpinnings of Boston’s medical infrastructure had been established early, in the eighteenth century, giving the city a huge head start on its evolution into a health-care mecca. Harvard Medical School had been founded in 1782. Massachusetts General Hospital, one of the first hospitals in the country, opened its doors in 1811. In 1846, the first demonstration of ether anesthesia took place in the so-called ether dome at Mass General. During the famous surgery, the patient on the table suffered no pain—an internationally heralded breakthrough. Its success was further confirmed a month later when MGH doctors amputated an anesthetized patient’s leg. The use of ether would transform the practice of surgery and profoundly improve public health, cementing Boston’s place as a center of innovation. After Harvard’s medical school relocated, in 1906, to five marble-fronted buildings on Longwood Avenue in Boston, a medical building boom followed. The new campus was surrounded by marsh and farmland, open space filled by new centers for treatment and research. The growth led to more medical milestones, including the first fertilization of an ovum in a test tube and the first successful human organ transplant.
The hospitals had a rich history, but their preparedness for mass casualties on Marathon Day was largely due to recent training. In the decade since 9/11—since the nation had been forced to accept that terrorist acts could happen in America—hospital leaders and public health agencies had incorporated that reality into their planning for emergencies. They reviewed the latest literature on mass casualty events and hosted conferences on how to respond. They updated their communications systems. When reports of the bombing began to spread via Twitter and text messages, the hospitals had some idea what to expect. They sprang into action, emptying their ERs of less serious patients, preparing operating rooms for vascular and orthopedic procedures, and ordering additional blood supplies from outside the city. When the day nursing shift at the hospitals ended at 3:00 P.M., those nurses were asked to stay, doubling the size of the staffs on hand when victims began showing up. Many off-duty staff members showed up to help even though they weren’t scheduled to work. In part because of the grim legacy of 9/11, it was understood from the first reports that this event would be unprecedented and all-consuming.
• • •
Three miles away from the hospital room at Brigham and Women’s where Heather had awoken on Tuesday, David King was facing families’ urgent questions at Mass General: Will my daughter live? Will she need more surgeries? Will they have to take more of my son’s leg? Will he walk again? When? They craved certainty, but with so much still unknown, that was more than King could give. There would come a time when answers would be clearer, but with some of the victims facing more surgery or sedated, the time for such projections was still days or weeks away. The families needed someone to sit down with them now, to hold their hands and explain what was happening. King didn’t have time for that. He was moving too quickly, consulting with colleagues, evaluating patients, assessing which ones should head back to surgery and which ones needed to rest. He relied on the ICU nurses to engage with the distraught family members. As distracted as he was by the work, he registered how compassionate they were, the pains they took to make terrified parents and spouses and friends feel calmer and more comfortable.
It had been a long night for the trauma surgeon. His work had begun the previous day, just as he was heading home after the marathon. He had run twenty-six miles in three hours and twelve minutes and he was ready to rest, to sit down and drink some Gatorade. After finding his family at the finish line, he had lifted his six-year-old daughter onto his shoulders, while his wife, Anne, pushed the two-year-old in her stroller. They had planned to take the subway, but the lines were long, so they piled in a cab and headed home to Cambridge. The ride across the river took less than ten minutes, but by the time they got there, King had received a swarm of text messages. He always got supportive notes from friends when he had a big race—he liked to save them to read when he got home, after he had showered and swallowed some ibuprofen—but this looked like an unprecedented influx. While his wife went around the corner to pick up a pizza, King brought the kids upstairs and scrolled through his messages. Are you okay? one of the texts asked. Another mentioned an explosion. King tapped the screen to call up some breaking news from Fox or CNN. The websites wouldn’t open—another bad sign. Something had happened. He had to get to the hospital. Anne had seen the news on the TV at the pizza place; she arrived home ready to drive him to work.
He arrived at Mass General around 3:15 P.M., a few minutes behind the
first patients from the bombing, carrying a banana and wearing surgical scrubs he had hastily pulled on at home. He dove right in, running upstairs to grab the cap and protective glasses he would need in the operating room. Speeding back downstairs and into the ER, he came around the corner and had a clear view of four or five patients lined up in the trauma bays, a series of small exam rooms all in a row. Normally the curtains around the bays were pulled closed, but today, in the chaos and confusion, they were open, giving him an unobstructed panorama of the injuries. That was all it took for him to be sure: A man-made explosive device had blown up at the marathon. He had seen these injuries countless times before, thousands of miles away, as a combat surgeon treating wartime casualties. Most of his work in the army reserve with his forward surgical team was on bombing victims: 75 percent of injuries suffered by American soldiers in Iraq and Afghanistan were caused by explosive devices. Only 20 percent of the wounds came from guns.
King moved toward the most severely injured patient he could see: a blonde woman covered in black soot whose leg had been brutally burned and broken by the bomb. It was Roseann, the woman Shana Cottone had found lying in the street. Shana had helped deliver her to the ER just minutes earlier, in the back of a police transport van. “This lady looks like she’s dying,” King said to another surgeon. “Does she have a chest X-ray?” He reached out a hand to check the tourniquet on her leg, making sure that it was tightened to his satisfaction. He glanced at the unit of blood hanging up over her head and checked that it was flowing at the correct rate. Then he pointed at a young surgical resident standing nearby. “Let’s go,” he said. They moved out of the ER at a brisk clip, pushing Roseann’s gurney down a hallway with white tile walls. Ten seconds later they were in an elevator, ascending from the first floor to the fourth; two more turns of the hallway and they were in the OR, past the big white doors marked RESTRICTED AREA. A full team was already there prepping the room: a dozen people, maybe more, dressed in blue scrubs and masks, scrambling now to save Roseann’s life. Saucer-shaped lights glowed bright over the table; cameras at the center of each one would capture the surgeon’s every movement and project it onto big flat-screens mounted high on the wall for his team. “We’ll start with the abdomen,” King told them. “Then the leg.” As he waited for the anesthesiologist to put Roseann under, King pulled out the banana he had been carrying and ate it. No more than five minutes had elapsed since he had walked into the hospital.
Had the blonde woman been the only bombing victim at Mass General that day, her journey to the OR probably would have taken longer, with more stops along the way. A chest X-ray was the bare minimum of information needed for surgery; ideally, she might have had several other X-rays or a CAT scan. But the circumstances of the bombing—with dozens of patients flooding the hospital, and an unknown number yet to come—changed everything. There was no way to calculate the right amount of resources to expend on each, because they did not know when the demand would cease. It was, in a strange way, like the starting line at the marathon: The hospital had to move each wave of patients out of the emergency room and into operating rooms swiftly, to make sure they could keep up with the next wave gathering behind. Trauma teams and specialists worked side by side in a blur, exchanging patients seamlessly, any preexisting disagreements swept aside by the rising sea of need. Normal electronic record-keeping had gone out the window. King was taking notes on index cards stashed in his pockets; when he ran out of cards, he jotted reminders to himself on the leg of his blue scrubs with a black Sharpie marker, lines of scrawled ink creeping up his pant leg from his knee. The overload had driven staffs at other hospitals to similar measures, and would lead, in the case of Krystle Campbell, to that rare and wrenching misidentification.
King’s fundamental approach to surgery on victims of a bombing was the same whether he was in rural Afghanistan or in a top-notch Boston hospital. In either situation, he followed his “medical rules of engagement,” a list of reminders he had posted on the wall in the ER. Chief among them was this: Do not be distracted by the obvious. The most “visually stimulating” injury—that is, the one that looks the most gruesome and dramatic—“is almost never the one that kills them,” he explained. “The leg might be ugly and obvious, but it’s probably not the one that’s fatal.” Problems that were invisible on the outside—perforated organs; uncontrolled internal bleeding; system-wide vascular breakdown—could create an irreversible downward spiral. He had to look further, probe deeper, and consider carefully where to go first when he got into surgery. It could mean the difference between death and survival.
They all knew Monday night’s work was just the beginning. The first operations aimed just to stop the bleeding, remove the shrapnel, and limit the risk of infection. They would let the patients rest before heading back to the OR to continue their work on wounds that had been left open for that purpose. The goal was to minimize the stress on the sickest patients, breaking up the complicated repairs they needed into a series of smaller, discrete tasks. There would be days of follow-up surgeries ahead, patients who might require three, four, a dozen or more operations. King and a handful of his colleagues sat down together in a conference room late Monday night and reviewed a list of all the patients and their injuries. It was the first chance he had had to consider how he felt, and the first thing he realized was that he was wild with thirst. He had finished the marathon nine or ten hours earlier, and all he had eaten since was a banana. A medical student, dispatched to the ICU pantry to find him something to drink, came back with packages of Saltines and graham crackers, a can of Coke, and a carton of milk. Chewing on the crackers, King felt awful. He would finally go home and to sleep at around 2:00 A.M.; before the sun rose Tuesday, he was headed back to work. There wasn’t any time to watch the news or read the paper. He knew, at once, less than most people about what had happened and far more than most would ever want to know.
• • •
With the eyes of the world still fixed on Boston Tuesday morning, the names of the wounded were beginning to leak out. Already, friends and family members of the most severely injured were setting up fund-raising pages on the Internet, drafting paragraphs describing their loved ones, and their injuries, and uploading photographs taken in happier times. It was a big step to go public, to give up a victim’s cloak of anonymity even before the prognosis was clear, but a sense of urgency crept in as the national media descended. With millions watching, the public’s shock had quickly turned to sympathy. It had become clear that many of the victims would be facing long and costly rehabilitations. There was tremendous potential to tap the mass impulse to help, but the impulse wouldn’t last forever.
An online campaign for Jeff Bauman, the man who lost both legs, raised $745,000 in nineteen days, attracting gifts from more than sixteen thousand people. By Wednesday, the world would know the names and faces of Patrick Downes and Jessica Kensky, attractive young newlyweds who’d each lost a leg in the bombing. By Thursday night, as they lay in two different hospitals just three days after the bombing, donations to their fund-raising site would reach $300,000. Over the next four months, the total would nearly triple, to $875,000. Donors who clicked on the site for Patrick and Jessica lingered over a photo of the pair taken on a carefree stroll before the tragedy; in it, they walk together holding hands through Harvard Square in Cambridge, Jessica smiling as she looks back at Patrick, the skirt of her red dress flaring as she strides ahead. The poignant image seemed to capture all the innocence and freedom they had lost.
No photograph would more perfectly distill Boston’s lost innocence than one of Martin Richard that ricocheted around the globe the day after the bombing. On Monday night, the news that an eight-year-old was among those killed had made the unimaginable day feel unbearable. Martin and his family—his parents, Bill and Denise, and his brother and sister, Henry and Jane—were well known and much loved in their corner of Boston. Bill had spent years volunteering his time to improve their neighborhood an
d was one of the people most often credited with its renaissance in recent years, its new businesses and brightly refurbished subway station and swelling civic pride. His efforts had deeply endeared him in Dorchester, a working-class haven with a long Irish heritage, and now the most diverse corner of the city, with Vietnamese pho shops scattered between the traditional Irish bars like The Blarney Stone and The Banshee. In the midst of change, violence had persisted on some streets, gangs and guns that changed how people looked at Dorchester. Some who had the means had left for good, fleeing to the safer suburbs south of Boston. Others, like the Richards, chose to stay, digging in and deepening their commitment.
As the awful news spread through the neighborhood, many residents were mute with grief, shaking their heads and waving away the reporters who had descended. They had just begun to absorb the overwhelming facts: Bill and Denise and their three young children had been standing next to the second bomb when it exploded. Both parents had been injured, Denise suffering a serious eye injury, and Bill enduring shrapnel wounds, burns, and hearing loss. Their oldest child, Henry, had escaped serious injury. But their youngest, seven-year-old Jane, who loved Irish step dancing, had lost her left leg below the knee. And Martin—the baseball-loving boy with the big brown eyes—was gone forever. It seemed more than any family could bear. At the beautifully restored Victorian home where the family lived, Martin’s classmates filed up the steps one by one to leave flowers and notes and balloons by the door. Meanwhile, on the Internet, a photograph of the freckled child holding up a handmade sign had gone viral. NO MORE HURTING PEOPLE. PEACE, the boy had written with colored markers.
The Richards were among the families who met with Governor Deval Patrick as he visited six of the city’s hospitals Tuesday and Wednesday. Patrick spent time with Bill, Denise, and Henry. The governor didn’t see Jane; she was in surgery. Bill told Patrick of a photograph he had of Martin, as a toddler, holding one of the governor’s campaign signs. They talked about how the family could go about rebuilding their lives without the whole world watching. They wanted to maintain their privacy. Denise had the impossible task of simultaneously mourning her son and staying strong, to aid her own recovery and that of her family. Patrick wasn’t sure, in these visits, what to say. All he knew was that he didn’t want to say much. He figured the bombing victims and their families probably didn’t want to hear it. What he could offer, he felt, was a dose of emotional support, a warm hug, a quiet reminder that he cared.
Long Mile Home: Boston Under Attack, the City's Courageous Recovery, and the Epic Hunt for Justice Page 12
