By Shannon Pettypiece & Drew Armstrong | Bloomberg | bloomberg.com | April 22, 2013
Patients who lost limbs in the Boston Marathon bombings started using walkers to move around Boston Medical Center, met with amputee veterans and began to prepare for prosthetic legs.
The hospital treated 23 patients following the explosions, five of whom have undergone amputations involving multiple surgeries, said Jeffrey Kalish, Boston Medical's director of endovascular surgery at a press conference today. About half remain at the center, including one in critical condition, said Peter Burke, chief of trauma services.
Boston Medical was one of five trauma centers that handled the worst cases following the blasts, which killed three people and injured more than 175 as nails, pellets, wood and other debris exploded from two bombs. The physical and emotional recovery may take many more months though doctors said they are encouraged by the early progress.
"We have definitely seen every range of emotion this past week," Kalish said. "For us, we have seen amazing improvements, really great attitudes. We've had veterans come in with amputations that have walked through the halls and shown these patients their life isn't over."
A week after the attack, 48 people are still hospitalized, according to figures from six Boston hospitals that dealt with most of the seriously injured. At least 13 survivors lost a limb, including some who had multiple amputations, said the hospitals, which include Brigham & Women’s Hospital, Beth Israel Deaconess Medical Center, Tufts Medical Center, and Massachusetts General Hospital.
Soldiers from the Semper Fi Fund, a veterans group for injured military personnel, came to Boston to meet with about a dozen patients and their families at four different hospitals. They told them about the importance of getting active as soon as possible and setting goals to aim for. The group said they plan to be back at the end of the week.
The Semper Fi Fund has raised $74 million over the last decade, and has now set up a Boston Marathon fund for those hurt in the blast. The group helps modify the environment of the injured to help them stay mobile and active, as well as providing support in getting prosthetics and services. They also have a team of athletes, including B.J. Ganem, 36, a Marine veteran who lost one of his legs in Iraq in 2004.
"It's a small club, not a lot of people know what it's like," said Ganem in an interview. He competes in adventure races and trains using the fitness program Crossfit, known for its emphasis on difficult bodyweight exercises.
Critically Ill Patient
The critically ill patient at Boston Medical is in the intensive care unit and on a ventilator, Burke said.
"Do I think he's going to survive? Yes. Do I worry about him? Yes," Burke said in an interview.
Boston Children's Hospital is caring for two patients, a 7-year-old in critical condition and an 11-year-old who recently left the intensive care unit and is now in fair condition. The hospital initially treated 10 patients.
Doctors have been treating internal bleeding, injuries sustained when falling or thrown to the ground from the bomb's shock wave and embedded debris.
The bombs that were packed with shrapnel had let loose a lethal array of projectiles that created multiple wounds. Some victims had 40 or more fragments of pellet and nail-like objects embedded in their bodies, George Velhamos, chief of trauma surgery at Massachusetts General Hospital, said at a briefing last week.
Patients with amputations have been put into rehabilitation as soon as possible, to help them use walkers, learn basic exercises, and do tasks around their hospital rooms, Kalish said. Two of the Boston Medical patients had more than one amputation.
The next phase will be temporary prostheses, which can be fitted two to three months after the injury followed by permanent ones about a year later, said Simona Manasian, a rehabilitation doctor at Boston Medical.
There are emotional scars that also must be addressed, said Tracey Dechert, a member of the trauma surgery and critical care team at Boston Medical.
When patients are released from the emergency room, "this may initially seem like they're being discharged and everything is going fine," Dechert said in a telephone interview last week. "But the emotional scars can last for quite a long time, if not forever."
Victims may undergo stress reactions including intrusive memories, nightmares, flashbacks or feelings of hyper-vigilance, said Michael Leslie, a psychiatrist in the Dissociative and Trauma Disorders Program at McLean Hospital in Belmont, Massachusetts, a Boston suburb.
The long-term concern is the type of post-traumatic stress disorder seen in military veterans, Leslie said in a telephone interview last week. PTSD symptoms don't always start right at the time of trauma.
"An event like this disrupts a person's sense of safety in a fundamental way," Leslie said. "People need to take care of themselves in the aftermath of such an event." That includes "basic self-care," like making sure to get eight hours of sleep each night, eating three healthy meals a day, and "sticking with their regular routine as much as they can," Leslie said.
Police captured the second suspect in the Boston Marathon bombing April 19 hiding in a boat behind a house in Watertown, Massachusetts, after an almost 24-hour manhunt that shut down Boston and surrounding cities. Dzhokar Tsarnaev, 19, was in serious condition at the time of his capture and is being treated at Beth Israel Deaconess Medical Center. He was accused of using and conspiring to use a weapon of mass destruction resulting in death, according to a filing in Boston federal court. He was also charged with malicious destruction of property by means of an explosive device resulting in death.
His brother, Tamerlan Tsarnaev, 26, the other suspect, was killed.
The brothers, immigrants of Chechen descent, are accused of planting two bombs that exploded about 10 seconds apart near the finish line of the Boston Marathon on April 15.
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