The staff at Boston Medical Center is steeling itself for remembrances.
This month will be filled, as it should be, with events to mark the Boston Marathon bombing: tributes to resiliency and lives rebuilt, to the actions of first responders and the generosity of strangers. BMC, like other local hospitals, shares in the history and the emotion.
But another idea has been percolating in the hospital hallways, tempering the pride, dampening the celebrations. It’s hard to come to terms, as one doctor says, with the fact that, on a typical day, “there is no outpouring like this.”
This happens, without intention or ill will, whenever there’s a newsworthy disaster. A plane crash is an international event; a car crash is a private tragedy. An act of terrorism, ghastly and unexpected, overshadows the horror of day-to-day violence.
But the contrast is especially acute in a place like BMC, New England’s largest trauma center, where many patients aren’t strangers to what Dr. Andrew Ulrich, vice chair of emergency medicine, calls “intended violence.” About 1,000 patients with gunshot and stab wounds are treated in the Emergency Department every year. The day after the Marathon bombing, four people were brought to BMC with gunshot wounds.
I sat down recently with Ulrich and other hospital workers — a surgical intensive care nurse, a social worker, the head of patient advocacy — to talk about what happened on the week of April 15, 2013, when 19 bombing victims were admitted, 10 of them critical.
They remembered the day with pride: how their crisis-response training paid off; how everyone on staff contributed, down to the crew that worked at breakneck speed to clean medical equipment. Patients rallied, too; people who had come for rehab and detox offered to give up their beds for bombing victims.
Still, it was hard not to notice the attention and support that was showered on Marathon victims and their families, the accolades that poured in for the medical staff, at a volume and intensity that BMC usually doesn’t see. People donated wheelchairs and private planes so that loved ones could fly to and from Boston. Pizzas arrived from a hospital in Texas. Edible fruit arrangements appeared, followed by more of them. Celebrities roamed the halls: Actors, singers, Red Sox, Patriots, and Bruins players. At one point, Elizabeth Warren’s entourage bumped into Bradley Cooper’s entourage.
And so, in those days, the staff had dual goals: Helping people heal, and making every patient feel equally important. Sheryl Katzanek, director of the hospital’s Office of Patient Advocacy, said hospital workers made a point of visiting patients who weren’t connected to the Marathon, telling them, “We want you to know that this must be difficult for you.”
And Carol McCarthy, a nurse in the surgical intensive care unit, said the staff’s unofficial motto became, “We did this for the Marathon patients, we can do this for the SICU cases every day.”
That has turned out to be the silver lining, staff say, for BMC’s everyday patients. Lessons drawn from the Marathon experience are changing how the hospital treats everyone.
Some of those changes have to do with medicine. Dr. Jeffrey Kalish, a vascular surgeon, said the volume of amputation patients forced the hospital to better coordinate its care, bringing doctors, nurses, psychologists, and social workers together to visit with patients as teams. This turned out to work better for patients, so it’s becoming official practice.
Some of the changes have to do with healing. When Marathon victims’ relatives stayed at the hospital overnight, the patients seemed to recover more quickly. So staff members resolved to make those visits happen more often.
Those new practices will supplement the many things that BMC already does to serve its client base. The hospital keeps a food pantry, so patients don’t go home hungry. It hosts a clothing bank, to replace clothes torn off in emergency-room chaos. Hospital staff have been known to send relatives, in ambulances, to attend the funerals of loved ones. They’ve dispatched volunteers to sit with dying patients, so that nobody dies alone.
These things happen without fanfare every day. But this year, it seemed right to make special note of the struggles many patients face. When BMC holds its own Boston Marathon commemoration later this month, the event will be dedicated, explicitly, to all victims of violence.