Rebecca Murphy, a social worker at Massachusetts General Hospital, has not been interested in talking with many friends about all that has happened since the Boston Marathon bombings, about holding patients’ hands as they grapple with profoundly changed lives, or helping them apply for disability assistance.
She confides her anguish to close work colleagues. “The people outside, your other friends — they don’t really understand.”
Murphy, who works in the surgical intensive care unit, has felt weary. In the weeks since the attack, caregivers have reported persistent anxiety, sleeplessness, or trouble shaking images of the bombings’ aftermath. People who work in Boston’s world-class hospitals are trained to deal with trauma, but most are unaccustomed to dealing with mass casualties caused by an attack in their own neighborhood, or working under lock-down.
Now, with many of the Marathon patients discharged or moved to rehabilitation facilities, hospitals are helping their staff members process what they have been through, with counseling sessions and interfaith services.
Mass. General provided free yoga, meditation, and massage to staff members last week. The chaplaincy program at Brigham and Women’s Hospital has been making the rounds with tea and cookies. In the two weeks following the attack, Boston Medical Center’s employee assistance program handled five times the typical number of requests for individual counseling.
About 60 employees sought one-on-one help in those weeks from Partners HealthCare’s assistance program, nearly all from Mass. General and the Brigham.
Many people who work at the Brigham are “used to trauma,” but more often in the context of an automobile accident in which one or two people may be critically injured, said Sister Kathleen Gallivan, the chaplaincy director. “One thing was the magnitude of this.”
In the hours following the bombings, emergency department staff at Boston Medical Center received nearly two dozen victims; 10 were later listed in critical condition. Pediatric social worker Katie Collins worked that afternoon assisting family members searching for loved ones or waiting for information about those being treated. That night, she made a plan.
Trained to lead small group sessions for caregivers who lose a patient or after a particularly difficult case, Collins knew that the emergency staff would need to talk through all they had seen.
Sixty people showed up for a debriefing the day after the attack. As people started talking about the horrors of the aftermath — and the pride they felt in the hospital’s response — “there really wasn’t any quiet,” she said. “This is a group that has seen a lot in their professions, but they were definitely affected.”
Several more emergency department sessions have been smaller, but necessary, Collins said. Some people are dealing with exhaustion, others with “intrusive thoughts.”
“The adrenaline has worn off, and things are starting to settle in,” she said.
Nurses in the Mass. General surgical intensive care unit have been gentler with each other, knowing that everyone is short on patience, resource nurse Brenda Whelan said.
Whelan knows from experience that the effects could show for months to come. She has worked in disaster medicine all over the world, including following the massive 2010 earthquake in Haiti, and she understands what it is like to deal with nightmares or anxiety for weeks after witnessing major trauma.
With the Marathon bombings, there is “absolutely a different element in my mind from what I’ve witnessed [previously] . . . a sense of a loss of innocence,” she said. “Things have always happened elsewhere.”
Caregivers tend to separate themselves from emotion, said Dr. Beth Lown, medical director of the Schwartz Center for Compassionate Healthcare.
“It’s not just a habit,” she said. “It’s a highly valued way of life. How brave can you be? How courageous can you be in ignoring your own needs?”
That is harder to do in a major public event like this one, when the feelings that clinicians might typically bottle up are overflowing within their own families and the broader community, Lown said.
One goal is to let caregivers know that what they are feeling, including sleeplessness, anxiety, or muscle aches, is a normal response to trauma. For most people, those symptoms will dissipate.
Spending time with family and friends and a return to normal routines can help, said Dr. John Herman, medical director of the Partners employee assistance program.
For a small number of people, symptoms will persist. In those cases, he said, therapy can be very effective.
Murphy, the Mass. General social worker, has found relief in her 1-year-old granddaughter, someone to “just hug and love.”
Soon after hearing that two bombs had rocked Boylston Street, Murphy stepped into the Blum Center. Normally a quiet reading room just off the hospital’s main lobby, it was full of staff members taking calls from people looking for loved ones who may have been injured in the attack.
The scene brought her back to the February 2003 day that she spent trying to comfort people desperately searching for loved ones who had been caught in the ferocious fire at The Station nightclub in West Warwick, R.I. In the weeks that followed, Murphy worked closely with several families, including that of 33-year-old Pam Gruttadauria, who would become the 100th person to die from the fire.
Working with Marathon victims has been different. For one thing, Murphy said, there was fear to contend with.
On the Friday when the entire city was told to stay inside while one bombing suspect remained on the loose, Murphy’s son walked her from her Boston condominium to the hospital, where anxiety weighed heavily on staff and patients.
Murphy never got to know the fire victims, so badly injured that they were unconscious during much of their monthslong stays in the intensive care unit. But she has worked directly with Marathon victims and has watched as they begin the healing process following severe injuries, some of which led to amputations.
Just as in 2003, Murphy said, she sits with the victims and listens to whatever it is they and their families need to say.
When they leave the hospital, she said, their story “doesn’t leave you.”