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 Monday. About half remain at the center, including one in critical condition, said Peter Burke, chief of trauma services.
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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 the 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."
The military veterans are part of the Semper Fi Fund organization. The critically ill patient 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.
Doctors also have been treating internal bleeding, injuries sustained when falling or thrown to the ground from the bomb's shock wave and embedded debris.
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 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 ER, "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." Stress Reactions 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, Mass., 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, Mass., after an almost 24-hour manhunt that shut down Boston and surrounding cities. Dzhokhar Tsarnaev, 19, was in serious condition at the time of his capture and is being treated at Beth Israel Deaconess Medical Center. 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.