USA TODAY, April 19, 2013

By Yamiche Alcindor

BOSTON — Jessica Sexton shakes and quietly cries as she describes sitting by a severely injured child’s bedside for hours after Monday’s bombing.

A nurse, she was at the marathon cheering on runners when she heard the explosions, rushed to her nearby home and then biked into work at Boston Children’s Hospital.

Like other doctors, and nurses who described being in packed emergency rooms to USA TODAY, Sexton said she kept calm and focused on caring for injured. Days later, however, she and others are starting to process the experience.

“I was just thinking I had to be there,” Sexton said. “It’s something we’re trained for, so you’re focused on patient needs and what you can do to get them through this.”

Her account and others’ illustrate a medical community that, although shocked by the attacks, endured the immense pressure to provide uncompromised care.

At Children’s Hospital, where 10 people — eight children and two adults — were treated, nurses and doctors quickly sprung into action putting on yellow emergency gowns, large orange name tags, gloves and face masks.

By the time Sexton got there, she was greeted by the smell of something burning, the voices of children describing the bombs, and dozens of people working. She was quickly assigned one patient with whom she remained for several hours.

Citing patient privacy concerns, Sexton would only say that the child was seriously injured; she did not reveal an age, gender, or the nature of the child’s injuries. She did, however, reveal painful moments in the emergency room where patients described the explosion in detail to staff members who struggled but remained calm.

At nearby Beth Israel Deaconess Medical Center, Carl Hauser, the trauma surgeon on call, got a page saying there was an event with possible massive casualties. Hauser, who watched the second World Trade Center tower collapse from a New Jersey roof and treated patients after 9/11, rushed to the emergency room.

His job: Survey each of the 25 patients brought in and assess what kind of care they would need and who should treat them. It meant closely examining wounds filled with debris and shrapnel as well as legs partially or entirely blown to pieces. It also meant prioritizing operations and deciding in one case to send a women with pellet in her eye to an ophthalmologist.

“We had patients with near amputations on one or both legs,” he said. “What’s going through my mind is what is best for this patient. There’s no place for emotion. One of the important things in being a leader under those circumstances is to impart calmness. If you’re not doing that, people tend to lose focus and lives are lost.”

At least six people treated Monday needed amputations or were at risk of losing a leg, Hauser said. Others needed blood transfusions, pain medications and constant support. Houser worked from 6 a.m. Monday until 3 p.m. Tuesday.

For those 33 hours, Hauser worried that things could get worse.

“Even though your patients are cared for, you’re still in the back of your mind recognizing that this may be the beginning of something bigger,” he said. “But you have a job to do and you have to do it.”

Hauser says he relied on his training and experience with other tragedies to keep his head clear. But he admits he sometimes gets emotional when he has to tell families that their loved ones have died. In this case, every patient he treated survived.

Eric Goralnick, an emergency room doctor at Brigham and Women’s Hospital and director of emergency preparedness, also coordinated medical responses. Staff members go through drills for such events and practice treating mass injuries.

Goralnick had been at the Prudential Center, about a block away from the marathon, when he learned about the bombing. When he got to his hospital, things were already in motion. Thirty-one people were treated.

“It was an amazing sight to see all these providers — nurses, physicians technicians working at the speed of light,” he said. “There’s not a lot of processing in the moment.”

Goralnick and the others who spoke with USA TODAY said they are proud of their work and the work of the those who treated people on the scene.

“Now is a time for us to take a step back and ensure that our health care community is healthy,” said Goralnick, who has begun to process his own feelings. “I realized I’m doing the right thing and I chose the right profession. I’m doing what I wanted to do, and that’s help others. Although this is a horrible situation, that was where I found comfort.”

At Children’s Hospital, staff members and patients, surrounded by bright purple, yellow and orange walls, were pushing on Wednesday. Smiles and laughter filled the emergency room despite the ongoing treatment of three children — two of which are in critical condition.

Like at other hospitals, social workers and staff debriefing meetings aim to help providers deal with their emotions. Sexton said her colleagues are checking on one another but know it will be awhile before they fully process what happened.

Meanwhile, Sexton still cries as she talks about her patient. For her, the strong demeanor she kept during hours with her patient dissolved when she got home Monday night. The reality set in that there were some injuries nurses and doctors couldn’t fix.

“You want to do so much more,” she said. “I went home and had a nice therapeutic cry. I was crying so loud one of my neighbors yelled out the window ‘Are you OK?’ I said, ‘I’m good.’ “