This is the health show, a presentation of national productions.
The bombing of the Boston Marathon has a lot of people asking questions, questions like
why, like who was involved, like is the danger over.
We're asking questions too.
Questions about the people injured in the bombing and what their lives will be like going
forward.
On today's health show we'll talk to a doctor who served in Iraq about the traumatic injuries,
treatment and future of the people injured in the attack.
We'll also hear about a soldier who returned from war with injuries and how we dealt with
those and with PTSD.
Plus we'll hear from a public health nurse who works in a rundown urban area but refuses
to give into fear.
I'm Dr. Nina Sack.
I'm Bob Barrett and this is the health show.
From the moment the first bomb exploded at the Boston Marathon, hundreds of lives were
changed forever.
Of course there are the families and loved ones of the people who were killed in the
blasts.
Then there are the people who were injured.
Some who literally had limbs ripped from their bodies.
To find out about the immediate treatment and care of these people, we turned to someone
who worked in similar conditions.
Dr. Jason Cohen is a critical care and emergency physician at Albany Medical Center Hospital
here in Albany, New York.
While he was not in Boston the day of the bombing and has not seen any of those patients,
Dr. Cohen served as a medic during the Iraq war and saw people with the same type of savage
injuries that doctors were dealing with in the aftermath of the bombing.
I asked him about what would be happening in the moments after that attack.
The ones who lost limbs initially would have immediately tried to have their blood loss
stopped by application of turnipets, which is really something relatively new in the
civilian side, but we've been using it in the military for, since it started the war
in Iraq and Afghanistan.
They would have been brought essentially to the emergency department and triaged immediately
to go to the operating room to go have some more definitive control of the bleeding initially.
Oftentimes if it's just the lower limbs that would require emerging amputations and then
subsequent to that would probably have multiple other surgeries to go back and take a second
look and to make sure that no injuries were missed and that any dirt or contamination
had been removed.
And through the course of the subsequent days to weeks coming to a definitive closure
of those wounds.
For something like this such an awful trauma, there's really no saving of those limbs
are there.
Well, it truly depends.
Every patient is different and unfortunately there's a lot of chance and randomness that
goes into how those injury patterns progress.
Once a decision is made to amputate that limb and that's, you know, I'm not a surgeon myself,
but it's, I've been involved in those decisions.
It's a gut-wrenching decision for sure because most of the people that were injured at least
were one on understanding there and based on my experience in the military as well, they're
young people and you know that you're going to make a huge impact on their lives and it's
a hard decision.
So you'll try everything you can to save those limbs, but when you have to do it to save
their lives, you have to do it.
Plus, you're also dealing with a patient who is in severe shock at that time, I'd imagine.
Absolutely.
You're really, that initial surgery coming in from the field is what we call damage control
where you're just trying to stop the bleeding and remove the gross contamination as best
you can and then to bring them back into the ICU or into the floor and resuscitate them,
warm them up, get their blood pressure, they're bleeding under control.
Make sure they've been transfused with they need to be and then once they're a little
bit more stable, that's when you would come back for that second surgery.
Unfortunately, we seem to have learned an awful lot about treating accident victims and
victims like this from our involvement in the in the wars.
Have we come far over the past 10 years because of that?
I think we have, as I mentioned before, I think the tourniquets have, you know, something
that's so simple and really is now getting a lot of attention again, it's it's saved countless
lives in the military and really something 20 years ago back when I was initially at EMT
and all of that, it was kind of frowned on to use those tourniquets as almost a last resort.
Now we're looking at them as a first resort to save lives and that's the experience in
the combat zone, especially with the improvised explosive devices that are soldiers and Marines
are seeing, really we found those tourniquets are saving lives.
So that's changed that initial mentality.
Coming from there also the concept of that damage control that just going and stopping
the bleeding, understanding you're not going to definitively repair on that initial surgery,
but really just saving the life and then recognizing you come back 24 hours later, 36 hours
later and take that second look and do some more definitive surgery.
If it's a choice between life and limb, everybody's going to choose life, yeah.
Clearly.
Obviously you were not at the scene there but you have experience what's going through
the minds of the emergency personnel at that time when so many injuries come in?
So I have a very good friend of mine actually who was in the medical tent at the finish line
at Boston Marathon.
She was volunteering there as a physician.
She called me the subsequent day and was very shaken up and went through her emotional
experience and things that I can relate to her experience having been something kind
of similar.
What's going through your mind right then?
Initially it's state of shock, the sound, the feeling of the blast, the smell, people
screaming, that's shocked.
So from her perspective, she mainly focused into her training and it comes to that question
just stopping the bleeding and focusing on saving as many lives as you can.
Triage really comes into play there and recognizing when there's somebody who's not going to
be safe no matter what you do and not putting resource on there and spending time on the
patients that you can do the most good for.
But it's that first few minutes that assault of really all of your senses from the blast
and the influx of patients and blood and trauma in front of you.
It takes a minute for you to focus back on what your job is and to take care of who's
in front of you.
But while you're taking care of the patients, you're focused on that and then when the chaos
calms down a little bit, that's when you start to reflect on really what you've just
been through.
We'll talk about gut wrenching decisions, deciding, having to stop working on them because
you could probably save the other one.
And you talked a lot about stopping the blood and we saw so many pictures from the scene
where there's just so much blood on the street.
How much of a problem is infection after the fact?
Because I mean, you have people out there just right out in the open with open wounds.
Sure.
Infection of the patients who are involved with the blast themselves, it can be a major
problem because not only do you have the major, shrapnel pieces that go and cause the injury
but it carries very, it causes microscopic particles and bacteria and that can embed
deep into the tissue.
And you do everything you can, obviously, during the surgery and then the subsequent surgeries
to make sure that you're with any kind of tissue that looks even remotely infected or is
threatened at all.
But as we're seeing with some of our wounded soldiers and Marines, infections are coming
out weeks after that initial surgery that despite the most aggressive wound care and
decontamination, there's deep seating of some of the tissue that's hard to control
for.
But infection is a huge problem and really we'll start to see the complications of that
probably around this time in terms of those patients who are initially injured.
You'll start to start seeing less from the initial trauma than now, the complications
of everything that went along with their resuscitation.
But what's in store for these patients?
He has so much technology now with artificial limbs but I mean you can replace the limb
but that experience is always going to be there.
Oh gosh, yeah.
I, it's hard to tell you what each one of those people are going to go through.
It's a terrifying experience that I can only imagine.
I've taken care of them but I've never been injured in that kind of a situation.
And you expect it in a war zone, you don't expect it at the Boston Marathon.
Exactly, exactly.
It changes a lot and I'm sure that there was some traumatic brain injury associated
with the blast as well which is going to make some recovery hard for some people as
well in terms of concussions and intercrete bleeding.
But the psychological impact of this kind of a trauma, this kind of trauma by itself let
alone losing a limb in somebody who's relatively young and vibrant.
I can't imagine what that will mean for those people.
And it takes a lot of rehab both physical and probably just as importantly emotional
and psychological rehab for people to start to move on from there.
Dr. Jason Cohen is a critical care and emergency physician at Albany Medical Center Hospital
in Albany, New York.
There has been a lot of talk about the possibility of people at the Boston Marathon feeling the
effect of post-traumatic stress disorder in the weeks or months after the attack.
Again, to get perspective on PTSD we go to someone who went to war.
Sergeant Matthew Pennington was injured while serving on combat duty in Iraq.
He showed signs of PTSD but is working towards recovery by promoting self-identification
of these symptoms for other veterans after his appearance in a short fictional film about
in Iraq war vet.
Damian Binneak from the Salt Institute for Documentary Studies has a report.
When Sergeant Matthew Pennington signed up for his third tour of duty in the Army, he
wanted a more active combat role.
He signed up to be a machine gunner.
Writing in Top of Humbay is an escort for military convoys headed up and down the eastern side
of Iraq.
I like being in Mad Max.
You on the open highway, sitting behind a gun, cruising down the road.
As combat increased, he soon found that it wasn't so much like the movie's after all.
In April of 2006, Matthew was asked to drive the lead vehicle of a convoy headed south
towards Palad.
As he prepped his gear for the trip, he tucked his tourniquet into his uniform.
It was just like an eerie feeling.
Something didn't seem right.
Halfway through the drive, the headlights and Matthew's humvee shorted out and he was left
with a single left side lobeam light.
He was driving at about 50 miles per hour when he spotted a small homemade bomb in the
dim light ahead.
But the road was too narrow and there was no way to get around it.
Slurs, you know, and I was scared.
You stepped on the gas, trying to put as much of the engine solid mass over the blast
as possible.
After the explosion, I tried to hit the brakes and I felt that I didn't have anything
down there and stuff.
Some trappin'le had torn through the floorboards of the humvee, shattering his right leg and amputating
his left leg just above the foot.
Not wanting to look at the wound, he reached for his tourniquet and tied off his left leg.
Matthew received emergency care and was eventually transported to Walter Reed Army Medical
Hospital in Washington, D.C.
Not only did they treat his battle wounds, but they also diagnosed him with post-traumatic
stress disorder.
Before I got hurt, we'd already been through three or four bombs.
We'd been shot at by snipers, you know.
We'd been in a firefight, so it was by that point it was just kind of like, you start
really thinking about how many times you know, you came near close to death and you know,
it's like it'll really weigh on your mind.
When he returned home to the state of Maine, Matthew found it difficult to settle back into
civilian life.
As he drove the roads around his home, he was looking for roadside bombs and tripwires
along the road.
He couldn't go to the grocery store or crowded places without feeling anxious.
He also found himself to be easily irritated and untrusting of strangers.
He was constantly on edge.
You have things that'll trigger you or mind you, you know, it's all sudden a car commercial
comes on and he's flying through the desert and then you're like, oh, desert, oh, wait,
crack, oh man, now I'm thinking about it and it's like, okay, wait, and it's just so
you're constantly stressing about things and that's a lot of the disorder is.
Matthew had a lot of social interaction, a Walter Reed, taking marketing classes and
going to many things they put together for the soldiers being treated there.
At home in Maine, however, he was far removed from the local Veterans Affairs Office.
They were frequently behind on his paperwork, which complicated getting full coverage for
his benefits and attentive treatment.
I understand how they expect somebody going through that to be proactive in taking care
of their own self when clearly they're got PTSD and they're not doing that.
Even when his paperwork was sorted out, the care they were giving him wasn't helping
him.
He was still depressed and stressed out.
Matthew needed to find another way.
In 2009, he learned about a casting call for a short film about an Iraq war vet.
Peter Nicholas Brennan had interviewed other war veterans and wrote a short fictional
account of a marine returning home to a small main town and coming to terms with his own
PTSD.
I spoke to him by phone.
We had to find a young male who was an epitee who was a veteran who was ideally from New
England or, you know, should be great if he's from Maine.
You know who can act.
Although Matthew had never acted before, the director knew he was a good fit.
He was pretty clear as soon as we really started going, but there was a lot there with Matthew
in that.
He was sort of looking for an outlet for himself.
In this scene from a marine's guide to fishing, Matthew's character has a PTSD episode while
he's attempting to fix a boat engine.
He's approached by an imaginary superior officer.
Damn it, Liam's cardboard!
What the hell are you trying to pull?
I'll do respect, sir.
I'll do respect it.
I'll do respect it.
I'll do respect it.
I'll do respect it.
I'll do the like film.
I'll never expect it to really care for the arts or even really think about a love
drawn growing up.
I'll play music.
But, you know, that was really about where it went to.
So I figured, you know, well, like, PTSD and this is a horrible place for me to go.
You know, so let's go do it.
Let's get through this.
The experience was better than therapy.
In playing the part of the fictional Connor Sullivan, Matthew saw parallels with his own
life and came to his own realizations about his PTSD.
The part I most identified with was when he was fishing and he was having intrusive thoughts
because that was a problem I'd have a lot as I would be going about my normal day and
then all of a sudden I'm thinking about this thing in Iraq.
Matthew has since begun touring with the film, presenting lectures for other veterans
who have had a chance to watch the project.
He wants to bring it to other former soldiers suffering from trauma and PTSD as a way of
communicating with them.
He hopes that vets in a similar situation can self identify some internal issues they
may not have otherwise seen within themselves, like he did.
That's kind of I think one of the best approaches to take is kind of why we do it.
You know, it's better than confronting them or, you know, trying to shove it down their
throat if they can see it, realize it within themselves, you know, they're much more
likely to succeed.
Matthew found a way to move forward through this film project, but for him the camera wasn't
the cure.
It was what was in front of the lens that could really fix him.
By accepting how he had changed, he was able to move forward in healing his issues with
PTSD.
For Salt Radio, I'm Damien Bignac.
Still to come, a public health nurse in an inner city neighborhood deals with a day-to-day
fears of her job.
That's next on The Health Show.
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This is The Health Show.
I'm Bob Barrett.
When I'm Dr. Nina Sachs, Amy Gastelom is a public health nurse making daily home visits
to areas of Brooklyn where crime is common.
Some of Amy's friends and family worry about her safety as she uses public transportation
and shoe leather to travel between clients.
But Amy has discovered that there is a price to pay for fear.
Every day I leave my apartment in a part of Queens or nobody worries about me getting
hurt.
Hi, good morning.
A lot of people who take the G train south to Brooklyn get off at stops that connect
to Manhattan.
There aren't a lot of people who get off the train at my stop.
There are no connections to the city here.
It's Bedstuy, the heart of Brooklyn.
This is where some people worry about me.
I make visits to people's homes in this neighborhood.
I'm a public health nurse for law and comfort time moms.
I go to places that a lot of my friends and family will never go ever.
For some of them that means certain blocks of Bedstuy.
For others it means stepping into a tiny stainless steel elevator, wet with urine and
a public housing complex.
I just can't see my father in law there and he can't either.
So when we talk about my job he fixates on safety.
Pat has encouraged me to carry a taser and my mother-in-law wants me to carry bear spray
which is mace, enough for a bear.
A few people want me in self-defense classes.
I'm told to keep my face up and look around.
Don't look down and distract it.
Don't stand next to vans.
Someone could open the door and snatch me.
Don't wear overalls because someone could cut the straps with a knife.
Don't wear my hair in a ponytail.
Someone could grab it and control me that way.
But my favorite advice is this.
If I need to get on an elevator and there's a creepy person there too, fake a conversation
on my flip phone.
Oh, hi.
Yeah, this is Amy.
Okay, then hold up a finger and tell the creepy person.
Oh, come on up.
It's my boss on the phone.
Like they care who it is.
A lot of the other nurses do this.
But I think if I tried it, I would laugh at myself and they would think I was creepy
making fake phone calls and laughing.
To be fair, all the advice I'm given is not completely baseless.
They have been attacks on visiting nurses.
In 2010, Carolyn Johnson was caring for her patient in Detroit and someone entered the house
shot her and her patient and set the house on fire.
Then there was the home visiting nurse in New Orleans who was kidnapped and raped by
five men last year while working.
One nurse at my job was walking on the street and got punched in the face for her iPhone.
She always finishes the story saying she shouldn't have brought it out.
She has to say that or someone else will.
I know that if I embrace fear and I'm attacked, people will say it wasn't her fault.
She was very cautious.
But if I don't show the right amount of fear and I'm attacked, people will say I was careless
and I will have to take some of the blame.
It's not that I'm fearless.
I'm not from this city and I'm pretty small.
I have my own fear I carry but the consensus seems to be that it's not enough.
I jokingly told a friend that my plan for the guys who started to follow me one day was
to tell them I'm an undercover cop.
I laughed at myself.
She didn't smile.
She said Amy, you may think you have a plan but those guys did their all day thinking
of a plan for you.
I feel powerless and exhausted when people remind me to be afraid.
You know walking into a patient's life saying I'm going to take care of you without being
100% sure if you're safe is something that nurses have always done.
Usually the risk is infection.
The nurses that took care of HIV positive patients in the 1980s must have been afraid.
And maybe their friends and family couldn't understand where they would want to keep doing
that work.
But their friends and families never got to see their human patients being human beings.
I can't stop someone from hurting me if they really want to.
But fear makes me give up on friendliness with the people who also walk in the neighborhood.
Fear messes up my ability to see my client as a unique individual if I'm scared of her
environment or her family.
I give up on ponytails and overalls.
I give up on daydreams like gifts that wander in while I walk between visits.
Fear requires my whole brain.
Amy Gastellum is a public health nurse in New York City.
She also produced this segment which she called, rather take the blame.
That's all the time we have for this week's health show.
If you'd like to listen again, join us online at healthshow.org.
You can explore the archive for any programs you might have missed or would like to hear
again.
You can also subscribe to our podcast that's healthshow.org.
Want more?
Then follow us on Facebook.
Just go to facebook.com slash the health show.
And if you have any questions or comments about the program, send them in.
Our email address is letters at healthshow.org.
I'm Bob Barrett.
And I'm Dr. Nina Sack.
Stay healthy and be sure to join us next time for another edition of the health show.
Dr. Nina Sack is a practicing member of the American College of Gastroenterology.
Bob Barrett is producer of the health show.
Dr. Alan Chartock is executive producer.
The health show is a presentation of national productions which is solely responsible for
its content.
