Doctors Remove Nail Fragments, Pellets From Boston Victims

Many injured patients remain in intensive care and in critical condition, which means their condition could still tip toward recovery or death.

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In Boston hospitals today, many injured patients remain in intensive care and in critical condition. That means their condition could tip toward recovery or toward death. But so far there have been no more deaths beyond the three that occurred on Monday. Some patients have even gone home. And as NPR's Richard Knox reports, doctors are beginning to grapple with everything they've seen in the past 24 hours.

RICHARD KNOX, BYLINE: Boston Medical Center is used to trauma. Its emergency room treats more than its share of gunshot and stab wounds and multiply-injured crash victims. But Dr. Andrew Ulrich says the 23 patients delivered to the hospital's emergency room on Monday represented something different.

DR. ANDREW ULRICH: What we don't commonly see is so many of them at the same time, and I think the really - the kicker that makes this incredibly difficult is that it was intentional.

KNOX: Ulrich, an emergency medical specialist, says that reality is beginning to sink in along with the recognition of the long road ahead.

ULRICH: But then some of it, the recovery part is difficult, and I think that's what we're dealing with today going forward. I think the patients have a lot of recovering to do. The families certainly have a lot to deal with, but also the people who took care of them have a lot of recovering to do too.

KNOX: Part of that recovery is dealing with anger at the unknown person or persons who wreaked all the havoc. Nicholas Yanni was injured yesterday along with his wife, Lee Ann.

NICHOLAS YANNI: I don't have a face to go with who caused all this, so it's hard for me to be mad at something that's not tangible, but the fact that somebody did this, yeah, you're mad.

KNOX: Among the medical people who are caring for victims, there's a particular source of anger as they compare notes about what seems to have been in the two bombs that exploded on Monday afternoon. Dr. George Velmahos is a trauma surgeon at Massachusetts General Hospital.

DR. GEORGE VELMAHOS: Probably, this bomb had multiple metallic fragments in them, and we've removed pellets and nails.

KNOX: The MGH saw a number of patients with so-called traumatic amputations, legs blown off by the explosion or so maimed there was no choice but to amputate. Velmahos says these limbs were riddled with pellets and nail-like fragments.

VELMAHOS: They are numerous, numerous. There are people who have 10, 20, 30, 40 of them in their body or more.

KNOX: To him, it didn't look like what would happen if the fragments had come from nearby objects blown up by the bombs.

VELMAHOS: So I think it's unlikely that they would be so consistent if they were pulled out from the environment.

KNOX: Over at the Beth Israel Deaconess Medical Center, which got 17 bomb victims, emergency medicine doctor Stephen Epstein saw the same thing.

DR. STEPHEN EPSTEIN: One of my colleagues showed me an X-ray that had a number of objects that, you know, could have been and, you know, I don't think we're certain what they are, but had the appearance at least of BBs.

KNOX: To him and to a number of doctors, it looks as if the perpetrator was intent on doing the maximum amount of harm.

EPSTEIN: And that's, I think, you know, the question that everybody's wondering about.

KNOX: But the aftermath also contains some positive reflections too. One involves the way Boston's emergency system successfully and efficiently distributed the bomb victims across hospital.

EPSTEIN: We have five level-one trauma centers in Boston. Any one of those trauma centers could've been overwhelmed had they received all of the patients who were critically injured.

KNOX: That's what happened 71 years ago when victims of an infamous nightclub fire mostly ended up at two hospitals. That lesson has been learned.

EPSTEIN: By distributing them throughout the city, we gave each one of those patients the maximum chance of survival because we were able to match the available resources in the city to all the victims. And I'm certain that that, you know, contributed greatly to minimizing loss of life and limb.

KNOX: In other words, as horrific as Monday's terrorist attack was, it could've been a lot worse. Richard Knox, NPR News.

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