Boston Trauma

After working through the night at Boston Medical Center, Dr. Tracey Dechert was finally home and thinking about a nap. Then the trauma surgeon started hearing the wail of sirens and the thumping of helicopters circling nearby.
She didn’t immediately connect it with the April 15 Boston Marathon going on not too far from her house.

“One of our residents was on vacation back in New York. She sent me an email saying ‘Is everything OK in Boston?’
and I’m thinking ‘What is she talking about?’ ” the 1988 Bloomsburg University graduate recalls. “Then I turned on the TV. I thought ‘Oh, my God’ and started to get dressed.”

All Dechert could think about was Sept. 11, 2001. The rush to set up emergency medical facilities to treat the wounded. But the collapsing World Trade Center towers left hardly anyone alive to treat. She prayed that whatever just happened in Boston would be different.

“By the time I got to the hospital about a half hour after the explosions, we had already gotten patients. They were doing triage, separating out the ones who needed to be treated right away. The call had gone out and we had surgeons from all over. We were running 11 operating rooms in three different buildings on the campus at the same time,” Dechert says. “I had never seen anything of this size where so many patients come in so quickly with such severe injuries.”

All around was controlled chaos. Doctors and staff from the hospital’s other departments flowed into the trauma center to help. In the rush to get the wounded to treatment, families were scattered and no one was sure how many had been injured or whether more attacks were yet to come.

Dechert looked for a patient to treat and immediately found one: A woman in her 40s who had been watching the race near the finish line.

“She was close enough to the bomb that her lower extremities below the knees were hit; one leg was traumatically amputated and the other one was severely mangled, almost amputated,” Dechert says. “She was awake and talking, so she could tell us she didn’t feel pain in her belly [indicating possible internal damage] and didn’t seem to have other life-threatening injuries.”

In trauma cases, speed is the surgeon’s byword. Fix the main problems; stabilize the patient. Procedures to address non-life threatening problems can wait for another day.

“Your goal is to do what you need to do because, after taking a hit like that, if you keep them in the O.R. a long time, they don’t do as well,” Dechert says. “So we just took off both legs and put her in the recovery room. You do what you have to do that first day and then you can plan other operations.”

Boston Medical Center saw 23 patients that first day; 21 were admitted, 17 were operated on immediately and two others had their initial surgeries later.

With more than 130,000 emergency visits and more than 2,000 trauma admissions a year, Boston Medical Center is the busiest in New England. But the victims from the bombing were more than any one facility could handle. In all, 26 hospitals in the Boston area treated more than 260 victims from the pair of closely timed bombings, which left three dead.

The woman Dechert worked on for more than two hours was her only operation that first day, but there was plenty of work to be done. Her team of seven other trauma surgeons met with the rest of the care team and began reviewing their patients and the operations and treatment yet to come.

Catching five hours of sleep between stints if she was lucky, Dechert caught the news from quick snatches on a trauma center TV: Authorities were looking for Chechen brother Dzhokhar and Tamerlan Tsarnaev in connection with the attack. A resulting gun battle left older brother Dzhokhar dead. Younger brother Tamerlan was captured after he was found hiding in a trailered boat next to a Watertown, Mass., house.

“For the next two weeks, it was pretty up-tempo,” Dechert says. All amputations were done that first day, but most patients required additional surgeries. “It was removing shrapnel from the wounds and the orthopedic and vascular surgeons began doing follow-up operations and treatment on the amputation patients. As a trauma team, we were managing all of the patients the entire time.”

Bottling the horror
When emergency cases are brought through the door, there’s no time to dwell on the sorrow and tragedy. Training kicks in. The focus is on saving lives.

“I don’t know what they were thinking,” Dechert says of the victims that first day. And she didn’t say much to the woman she operated on. “All I said to her is ‘We’re going to take good care of you.’ I don’t know if she realized how bad her injuries were and I didn’t ask.

“It’s not usually like it is on TV; sadly, the only people who ask if they’re going to die are the ones who die. They are in shock and seem to know.”

Dechert readily admits trauma surgery carries the danger of burnout. You see a lot. That’s why it’s important to make sure you get away, take your vacation time, don’t dwell. “You have to focus on the surgery and taking care of the patients. If you get emotional, that doesn’t work,” she says. “There were medical students on their first day of rotation. You could see the horror on their faces but, with us, this is what you do, you don’t let the emotion in.

“It affected some who weren’t as used to seeing these kinds of injuries. This was hard. The patients were young … and it’s a marathon … and that’s not supposed to happen. It’s terrible to see young people lose their legs and the stories that come out are tragic. But we in the trauma group were not quite as affected, or at least not outwardly.”

Dechert says she just tries to concentrate on the medicine. “A lot of times in trauma someone will come in with a gunshot wound and my husband may ask me later how they got shot,” Dechert says. “I don’t know any of the stories, and I think we do that on purpose because it’s better not to know. Once you start hearing the story, it’s too hard to stay detached.”

Still, over the days and weeks following the bombings, Dechert learned about her patients as she continued to treat them. “There was a woman from Minnesota who I took shrapnel out of. I did think that there were a lot of people who were in a strange city and now needed surgery. There were also family members who were in different hospitals – there was no time to try and get family members to the same hospital. That also makes it harder when they are going through a lot and can’t be together.”

Ironically, the fact that so many victims survived is owed to lessons from the battlefield. America’s wars in the Middle East – and the traumatic injuries caused by booby traps and roadside bombs – have expanded the knowledge of first responders and trauma teams. “There is a close relationship between trauma and military surgery,” Dechert says. “Military surgeons often hang out in trauma centers to keep their skills up and, when they are here, we are learning from them.”

Dechert says she remains focused on the lives saved. “It’s a horrible thing that happened, but all the patients that came here lived,” she says. “Yes, they lost limbs, but everything worked well as a system and a hospital.”

A surprising choice
The first in her family to go to college, the 47-year-old Pottsville native says she didn’t consider a career in medicine. She earned an undergraduate degree in communications and took a marketing position with a medical publishing house. But as she interacted with doctors, medicine put the hook in her.

She hadn’t taken any pre-med courses, but found a program at the University of Pennsylvania for people like her who wanted to prepare for medical school. “I figured if I pass chemistry, I’ll keep going; if I don’t pass, I’ll stop.”
Dechert didn’t stop and was accepted to attend Temple University School of Medicine. During her third year, when students rotate through various specialties, she fell in love with trauma care. “You make quick decisions. I like the feeling that you could do something right away to fix them in an operation. I like the immediacy of surgery and the fast pace.”

She completed her residency in general surgery at the Medical College of Virginia in Richmond, with her fellowship in the Department of Traumatology and Surgical Critical Care at the Hospital of the University of Pennsylvania. Dechert joined the trauma team at Boston Medical Center three years ago, attracted to BMC because it is a “safety net” hospital, meaning that, like Temple, it treats the neediest of patients.

In the days following the bombings, Dechert was among a group of doctors and staff who answered questions from the media. “We just thought it would be nice for one person not to have to do it all,” she says. “The other hospitals were showing all of these old white men. We wanted to show there are women involved, as well.”

It was challenging to talk about the treatment being provided and, at the same time, ensure patient confidentiality. They would say, for example, they had patients ranging in age from 7 to 60-something, but were intentionally vague in their answers to follow-up questions to safeguard patients’ identities.

“The hardest part is that we always talk like doctors,” she says. “You realize people aren’t understanding some of the things you’re saying, that you’re using too much jargon.”

Dechert says Boston has mostly returned to normal. Following the bombings, the city’s residents took pride in being “Boston Strong.” Now, Dechert says, a quiet pride reigns.

When she thinks about the bombings and the aftermath, Dechert remembers how everyone worked for the common good. “When something like this happens, you look for the good and how the human spirit cannot be defeated. On that day, what really pulled us through was how everyone came together in the hospital. You see that in the midst of all this terribleness, there are good people. I can’t say I ever felt anything quite at that magnitude.” •

Jack Sherzer is a professional writer and principal partner with Message Prose LLC,, a communications and public relations firm in Harrisburg.

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