A Day to Forget, A Day to Remember

"Last year, everyone thought it was the toughest Boston Marathon because the temperature was really high – it was almost 90 degrees. By the time a lot of the runners came into the medical tent, we'd started getting more to triage-type of stuff, like people with heat stroke and heat exhaustion. It actually got to the point that we ran out of cots. I thought that first year was my 'trial by fire,' because we essentially went from treating blisters and stuff to triaging people; trying to keep them hydrated."

Karson Mui, DC, CCSP, made the trip from his sports-medicine practice in West Newton, Mass., to downtown Boston again this year, filled with enthusiasm and a desire to do what he loves to do: help others. Little did he know what would await him and so many others that fateful day. In this exclusive interview with Dynamic Chiropractic, Dr. Mui shares his perspective from the main medical tent, a mere 100 yards from the finish line and the first explosion that rocked Boylston Street, turning Monday, April 15, 2013 into a day to forget - and yet, in so many ways, one to always remember.

Why were you in the medical tent this year? I was actually the only credentialed chiropractor in the medical tent. I was with the podiatry team. One of my good friends, John Kaplan, he's a doctor of podiatry and actually practices down the street from me. I met with him two years ago, before the last marathon, and told him I wanted to work the main medical tent. I didn't want to do athlete rehab (which is where the other chiropractors were). Athlete rehab is in the basement of the John Hancock Building, next to the massage area, and they mostly do musculoskeletal stuff. I wanted to be in the middle of everything.

John told me to come hang out with him and the podiatry guys, and if they had any musculoskeletal cases, I could jump in and help out. For the most part, for the past 20 years, it's been pretty slow in the medical tent. But as I mentioned, last year was just crazy (because of the heat) and this year, the whole bombing thing happened.

Because of who I am (my athletic background) and because I'm a sports medicine doc, [last year's experience] really sparked an interest for me. It really got my blood pumping. By the time we're done working on people, they have big smiles, we give them their medal, we give them a pat on the back, a high five, and they walk out. That's probably the biggest high you can experience as a sports-medicine person. That's what keeps me going. So this year, I knew I wanted to be there again.

What types of services were you providing, chiropractic or otherwise, to the runners prior to the explosions? I was doing some triage and helping people with blisters, muscle cramps, shin splints, or just helping them get moving again. It really wasn't anything super serious this year; I mean, the temperature was in the 60's, so we didn't have too many heat-related illnesses. In fact, it was actually pretty slow in there before the whole thing [the explosions] happened.

How many people do you think you saw every 15 minutes or so? The main medical tent is huge. In my area, I may have seen 10 people or so in a 15-minute time frame. It wasn't really that busy. It's kind of hard to gauge because it's not in my memory banks [because of what happened after that].

In general, are the faster runners more or less likely to have an injury that requires care? They usually have less injuries. It's usually people in the four-hour mark who have injuries, so we were beginning to gear up and it was actually starting to pick up a little bit, because usually, the people in the four-hour time frame tend to push themselves a little too much. The faster ones are very well-trained and might come in for blisters.

It was literally at that four-hour window when the bombs went off, and when I looked outside and took that first picture, the first corral of people was packed. So [the bombers] were definitely targeting the time when the most people would be in that area.

Where were you in proximity to the two explosions when they occurred? The medical tent is essentially about 100 yards from where the first bomb exploded. The main medical tent is after the finish line, about 100 yards down. So we were pretty darn close. Boylston Street itself is like a corridor lined by buildings. So when the first bomb went off, [we could] actually feel the shock wave come down the street and open up into Copley Plaza, which is where we were stationed. Everything just shook.

I remember, when the first bomb went off, I was actually finishing up treating a few members of the Massachusetts National Guard, who run the race every year in full gear, with their 40-pound rucks. I was treating one guy for blisters, and we were giving another guy hot broth for some cramps. When the bomb went off, everybody in the med tent looked up at each other. I looked at the Army guys, and you just could tell that they knew what was going on – something just clicked – because they started getting their stuff together. And then 20 seconds later, the second [bomb] went off. That's when I ran outside and took the picture.

When I ran out there, I saw the smoke and everything, but there are some images that are burned in my memory. I saw four yellow balloons floating off to the left, and to the right a big white cloud of smoke. I found out later that the balloons actually belonged to one of my patient's friends, who was standing next to the bomb, holding the balloons for his wife so that when she ran over, she'd know where she was. If you actually watch [video] of that first detonation, you can see the balloons floating off to the left. So that was my first image of everything.

The smell that came afterward was unbelievable. You could smell sulfur floating down the street. I knew then that something had gone off. So I ran back into the main med tent. I remember one of the podiatry students asking me what was going on (there are attending physicians and students in the tent], and I remember telling her, a bomb just went off. I could see the smile melt away from her face. She started crying. I remember telling the whole team, A bomb just went off, we need to get ready.

At that same time, I could hear the announcer / speaker saying that we should stay with our patients, and that there had been an incident outside. We were sequestered there for a minute or two.

Then we were told we needed to get everyone to the back of the tent, all the runners into the back, and they started dividing up the tent into trauma levels: trauma one in the back for the worst cases, trauma 2 in the middle of the tent, which is not as life-critical, and then trauma 3, where I was. (I was sitting between trauma 2 and 3; the trauma 3 area was non-life-threatening, but still pretty seriously injured). We started getting the tent ready; we started putting foil wraps on the table and trying to clear everyone [the runners who'd already finished and were being treated for running-related injuries] to the back of the tent.

Then the call came out: all available first responders in position; all IV nurses outside. And then I ran outside again.

What were you really feeling at that time, after two explosions and all the chaos around you? I don't know … I really don't remember. I just remember jumping in and having a feeling that I needed to do whatever I needed to. My brother is a police officer and I remember texting him and telling him, A bomb went off ... I'm OK. He sent one back: Get out of there! I remember texting him back and telling him, I can't leave. I need to stay and help. And the next thing I know, he's texting me back about a secondary device going off, targeted at first responders.

And I didn't care. People outside needed me. And I just ran out into it. I didn't make it all the way to the finish line, and I'm kinda glad I didn't, but I made it probably 50 yards and by then, because we'd been sequestered, they'd already cleared a lot of people and were shuffling them toward us. I think the final stat is they evacuated 97 people within 27 minutes from the main bomb site into the main medical tent.

I saw the first person being ushered toward us and I grabbed her and I escorted her back into the tent itself. It went from a tent where we were working on minor things to a war zone. I remember assessing vitals on a couple of girls. One woman, I had to cut her pant legs off because they were essentially riddled with shrapnel. I remember seeing flesh on the pant leg – someone else's flesh, not her flesh. I remember flicking it off and just continuing cutting, cutting off her entire pant leg. And once I exposed the skin, it looked like she'd been hit with a shotgun. And we didn't have stuff for that; we didn't have trauma dressings. We had gauze pads we were using for blisters.

Everybody jumped to action; nobody really spoke. I was doing a lot of the trauma work on this one lady and I remember reaching up and people were handing me things – gauze, sterile bandages, Bacitracin just to smudge [into the wounds]. I was trying to stop blood with these little 3x3-inch gauze pads – I don't even know if they were 3x3, but they were small; and I just had a handful of them, and I remember squeezing them [into the wounds] as hard as I could to try and stop the bleeding.

There was blood all over the place. There was blood all over my gloves, there was blood all over the floor. I remember looking over and the lady next to me had lost her ear; at the table next to me, a group of doctors were trying to stabilize this one guy and blood was shooting straight out of him, I think from a severed artery. It was just insanity.

The cases you're seeing at that point, those are still not the worst, correct? But it's all under one roof, obviously, so you can see everything. The med tent is fairly large; you can probably put about 100 cots in there, so it's a decent-sized bed tent. The level 1 cases were people who'd had their legs and feet blown off, and they were being taken to the back, so they had to go right past me.

I remember looking up because the announcer was telling everyone to clear the center aisle. At that moment, the double amputee you've seen on the news [Jeff Bauman] was being shot down that aisle, maybe 50 feet from me. I remember looking over and seeing two tibias hanging and the flesh just dangling off him. They were flying down the aisle. I remember him vividly as he went through.

I remember seeing a lot of people with tourniquets. I remember looking over at one of them and [the tourniquet] was a big brown belt with big circles for the belt loops. I can still see that distinctly. I remember the guy who had his leg patched up essentially with a big cardboard box; he was coming through at that time, too. People were being carted through by wheelchair, one after the other, and they were being manned by nursing students. It wasn't even physicians.

Were people freaking out; for example, any of the nursing students? Everybody was doing their jobs, but some people were definitely freaking out. I remember pulling one of the students aside because she was crying uncontrollably. I remember grabbing her and pulling her aside and saying, I need you. I need you here. If you're not here with me, I need you to sit down and not look. I remember sitting her on the side, grabbing one of her classmates and having her sit with her. Then I ran back over [to my section of the tent] and started working again.

Did you have to remind yourself in that situation, OK, stay here. Don't freak out. Make it happen? At that time, because of my [sports physician] training, which included emergency-response training, it just kicked in. I didn't even think. It wasn't until afterward, after I'd patched people up – looking at their faces … I definitely have some PTSD [right now], I admit it. The blood and gore was definitely horrible, but it's just blood and gore. But the thing that really haunts me are the faces of the victims. Just looking into the faces and smelling the sulfur coming off them, and the smell of burning flesh, is something I will always live with. I get a little emotional at this part [voice starts to crack, pauses several times].

How long do you end up treating people in the medical tent? When did you actually leave the site? They let us out at about 4:30, so I was there for about two hours after the initial blast at 2:50. They let us out because they wanted us to get out of there. They didn't know if there was going to be another attack.

And what do you do then? Did you go home right away? Typically after the marathon, I would just jump on the T, the train, and take it back to my car, which was in Wellesley. That was the plan, but because of the bombing incident, they'd shut all public transportation down; everything was shut down, so I had nowhere to go. I didn't know where to go.

The second I was released from the medical tent, I ran over to the John Hancock Building, because I knew my DC buddies, Eric and Mike, were in there [in the rehab area]. I wanted to make sure they were OK. But they had been escorted out way before I was.

Everyone had been texting me to make sure I was OK, so my phone was dead. Plus they shut off cell service. I remember [before my phone died] texting one of my PT friends in the city, and she told me to come over. So I did. I went over to her clinic. Thank God for Facebook, because I was able to get on her computer, get on Facebook and contact one of my buddies. He drove all the way from Needham, Mass., into the city and picked me up at Northeastern University.

From my PT friend's clinic to Northeastern was probably a 2-mile walk. I remember leaving her clinic, walking down the street; it was still a beautiful day outside, as we'd anticipated. Looking down the street, I saw cherry trees, white and blooming, and the petals were coming down. People were laughing, walking back and forth, and I even passed by a couple of runners with their medals on. And then there was me [voice breaking again] in my jacket … just walking.

The crazy part is, [when the explosions happened] I was tracking two of my patients. They were at the 40 K mark right before the bombs went off; about a mile out. And just because of my credentials and because I can access the chute [the finish line area], I was actually going to walk out there and meet them. If I hadn't been doing something else at the time, I would have been walking straight into it. And that kind of got me afterward. I thought, My God, I was that close to being right there.

How have you dealt with the events of that day? How are you doing? The worst part was the coping process afterward. I didn't know how to handle it. I literally cried myself to bed that night. Then I went to work the next morning, feeling very angry. I remember the first patient I had; ironically, she's a psychiatrist. Her appointment was at 8:00; I'd been there since probably 7:00 because I just didn't sleep. I didn't want to stay home and I didn't want to be by myself. My office manager knew I needed help, so he'd come in early; my new intern, Dr. Josh Harpel, who just graduated a few weeks ago [and is now my associate]; he came in for the first day ever, and I didn't even say hi to him.

I remember just staring at the floor and when my first patient walked in, she looked at me and immediately said, Are you OK? I remember looking at her and saying, no, then she asked me what happened. And I told her: I was at the finish line. And you could see – I wish I had a camera for every time I told somebody that, because you see their jaw just drop.

The sad part is, I'd treated her for the first time the week before (she's a runner), and I was so excited. I'm really excited when I'm at work. But that morning, she told me it looked like the innocence had been taken away from me. And she was right. The day after the marathon last year, I was so excited about what I'd experienced and how many people I helped, and [this year], that was taken away from me...

Hopefully you can appreciate, although it still may be too fresh right now, that you did help people, albeit not in the way you would ever have imagined. You know, the thing that keeps me going is I know I helped people. I regret not making it to the finish line to be part of [those efforts], but I know I helped. I really know I helped. You always wish you could have done more, and sometimes I wish I could have done more.

Anything else you want to say to your fellow chiropractors about this experience, getting involved in athletic events in general, providing care to athletes, etc.? I know you are involved with the New England Sports Medicine Council. I'm actually the founder of the New England Sports Medicine Council, the purpose of which is to essentially network and work with other like-minded sports-medicine people. We cover events all the time. The things I want to really express are:

1) Chiropractors are sometimes a little shy about working events because they think, Oh, we're chiros, we don't really deal with acute care, we don't deal with this, but with the right training, you can do a lot of stuff. Chiropractors can make a difference. I know I've made a difference, so I'm a prime example of that.

2) Another thing is to really know your colleagues. The days after the marathon, I had so many calls from doctors in New Jersey – Greg Dorr, Matt Kowalski, Richard Vincent – they all called me. They were like, how are you doing? All sports-medicine chiropractors, asking me how I was doing, how I was holding up. If it weren't for them, my patients and my family, I would not be where I am right now. I would probably still be in a corner, sucking my thumb and crying.

They made me strong. They told me, You're going to live with these images, but [the experience] is going to make you stronger as a doctor. It's a part of you now. And that's the thing: when I talk to my [chiropractic] colleagues, I tell them, you can do all this stuff. The reason I didn't want to work in the athlete rehab area is because I didn't want to be the chiropractor that was sequestered in the bottom / basement floor of the John Hancock Building. I knew because of my skill set that I could do a lot more than that.

Definitely go do the CCSP program and do the [sports] diplomate program. Become involved. Join a sports council; team up with them and learn from them. They're the ones who are going to make you better. That's what I did, learning from all the mentors I mentioned. They're my idols. They're the ones who contacted me [voice breaking]…

This might be a tough last question, but do you think you are more or less likely to participate in next year's Boston Marathon or similar events following your experience this year? More likely – I'm there, 100 percent. I need that closure. And I'm already going to the Dew Tour this year in Ocean City, Maryland. I'm more ready for it than ever.