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Thursday, May 30, 2013

Ahead of Print: Treat Bomb Victims, Then Yourself by Leana Wen, MD
It was nearly 3 p.m. on Monday, the busiest day of the week, and we were already filled to capacity in the emergency department of Massachusetts General Hospital. I was taking care of critically ill patients in the highest-acuity section. Some relied on respirators to breathe. Others had strokes, heart attacks, and severe infections. All the hallway space was occupied by patients receiving life-saving care.
 
A call came over the loudspeakers that there had been an explosion. First, we heard two people were injured. This, we were ready for. Our ED is a Level I trauma center, which means we can give the highest level of surgical care.
 
Then, a second call: There were two explosions. Many people were injured.
 
For this, too, we were prepared. Doctors, nurses, and transporters disconnected monitors and respirators. We rushed to send every patient to other areas of the hospital to make room for the victims.
 
A third call came in as we cleared the ED. These were bombings. There were dozens, maybe hundreds, of injured. Many were en route to Mass General; how many, nobody knew.
 
Moments later, the doors flew open. There were ambulances as far as I could see.
 
The first patient: pulseless, not breathing, both legs blown to shreds. The second: covered with blood, no blood pressure. The third: covered in soot, one leg gone.
 
Our teams applied tourniquets, inserted breathing tubes, and transfused blood.
 
Medically, we knew what to do. But how could we answer the woman who needed to know whether her husband and children were alive? How could we stop the screaming and the crying when we wanted to scream and cry ourselves?
We were ready for trauma, but not for the volume of tragedy and the overwhelming emotions. I tried to stay calm, but my panic was building: My husband had texted me to say he was leaving work for an hour to watch the marathon. We live just a block from Copley Square, the bombing site, and he was headed there when the explosion occurred.
 
Phone networks were overwhelmed, and I had no idea where he was. I feared the next person I'd be resuscitating would be him, that he would lying on the stretcher injured, bloodied, dead.
 
It was hours before I learned my husband was unharmed. During that time, our ED treated 31 victims. Other Boston hospitals cared for more than 200 people. Atul Gawande, MD, the surgeon and author, wrote about how in Boston, we were ready for such a disaster, and we were. (See FastLinks.) Our first responders, in particular, showed remarkable valor that day.
 
But as technically prepared as we were, nobody can ever be ready emotionally for such an event. Back in the ED the next day, I flinched every time I heard the loudspeaker. Every time sirens sounded, I wondered whether it was a loved one in the ambulance. I felt sorrow, then anger, then guilt: Who am I to have these emotions when so many others were suffering so much?
 
The medical profession fosters a culture of silence. In our training, we learn it's a sign of weakness to show emotion or ask for help. Yet, studies have shown that depression and burnout are prevalent among physicians and that many suffer from untreated post-traumatic stress disorder.
 
After a horrendous event, the first and most critical step for providers is to break the silence. Acknowledge what you went through, no matter how small a role you think you played. Even those who were not physically there can have trauma from worrying about their colleagues and loved ones.
 
Second, talk to others. When I came home from the ED that night, I could not imagine putting into words what I saw or felt to anyone, not even my husband. My supervisor held a mandatory debriefing session the next day, and I did everything I could not to attend. All I wanted was to forget what had happened.
 
As it turned out, the debriefing was the beginning of my healing. I learned that my colleagues had similar experiences. They also had nightmares and were finding it hard to return to work. They also experienced the guilt of worrying about their loved ones while tending to the injured. Hearing their experiences allowed me to share mine, and helped me realize I was part of a community that supported one another.
 
Third, recognize when you should seek additional help. It's normal to be upset, but consider professional counseling if you are not getting better and your distress is interfering with your work or home life. Our hospitals offer free and confidential counseling for employees and their families. For more anonymity, the Boston Mayor's Hotline is staffed with trauma counselors. (See FastLinks.) There are many online resources, including the American Psychological Association. (See FastLinks.)
 
Finally, take care of yourself. Take time off to do the things you enjoy. Spend time with your family. Let others care for you. Bravado and isolation don't just hurt providers; they hurt patients, too. And you can't be present to care for others if you don't care for yourself.
 
Now, after the bombing, I'm doing better. My husband has been amazingly supportive, as have my friends. I am back at work and feel fortunate to have had the opportunity to take care of the victims. As I mourn for the lives lost, I cheer the many who are recovering and rebuilding their lives. In the medical community, we are ready to continue our mission to care for all those in need … including ourselves.
 
Dr. Wen is a senior resident in emergency medicine at Brigham & Women’s Hospital and Massachusetts General Hospital, the president of the American Academy of Emergency Medicine’s Resident and Student Association, and an author of When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests (www.whendoctorsdontlisten.com). She is also a regular contributor to The Huffington Post and to AAEM’s Common Sense, both of which published portions of this article. Follow her on Twitter @drleanawen and on her website, www.drleanawen.com.
 
FastLinks
- Read Dr. Atul Gawande’s article, “Why Boston’s Hospitals Were Ready,” at
http://nyr.kr/12PohJM.
- Find more information from the American Psychological Association at
http://www.apa.org/helpcenter/.
- Comments about this article? Write to EMN at
emn@lww.com.