A tale of two physicians: reflections on the Boston Marathon bombing

On 15 April, I found myself thinking for the first time, “I wish I was a surgeon.” As a second year internal medicine resident, I am training to be a diagnostician. If a patient’s leg is red and swollen, I can differentiate between a clot and an infection. If a patient has abdominal pain, I can identify the culprit organ and determine if he needs medical or surgical intervention. If a patient has chest pain, I can decide if he is having a heart attack. But when disaster struck Boston on Monday afternoon and I saw a trauma victim point to a leg that had been ripped open, there was no diagnostic dilemma that needed my expertise. When the woman on the stretcher buckled over with pain lifted her hands for me to examine her, the third degree burns were explanation enough for her excruciating pain. And when the man with chest pain had a piece of shrapnel protruding from his chest, you didn’t need me to tell you why he was in pain. As our emergency department was inundated with victims, I started to think these patients needed a trauma physician and not an internal medicine doctor.

As a third year medicine pediatrics resident, I spent the night before the marathon reviewing the basics of treating hyponatremia. I was working in the emergency department and anticipated an influx of patients requiring careful sodium repletion after drinking too much water during the race. When the announcement that two bombs had exploded in Copley crackled over the emergency radios, there was a brief moment of stunned …