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STARTING POINT WITH SOLEDAD O'BRIEN

19 Patients Treated at Boston Medical Center; Update from Boston Medical Center; A Family's Anguish

Aired April 17, 2013 - 08:30   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.


CHIRS CUOMO, CNN CORRESPONDENT: We're also learning more about the third person whose life was taken in the attacks. A Chinese grad student studying at Boston University. We're not releasing her name because we're respecting her family's wishes, they want it kept quiet.

JOHN BERMAN, CNN ANCHOR: Want to bring in Fran Townsend, a CNN national security analyst, former homeland security adviser to President George W. Bush, and assistant to the president. She broke the news just a short while ago of the key finding now from investigators from the crime scene behind us, they found the lid of the pressure cooker used as a bomb nearby on a rooftop.

Good morning, Fran. What more you can tell us?

FRAN TOWNSEND, CNN NATIONAL SECURITY ANALYST: Investigators will go very deliberately over all of the forensic information that they can glean, off these parts. You're showing pictures now, and we've learned that they, in addition to the pictures we're showing of the pressure cooker post explosion, they have also found this lid of the pressure cooker on a nearby roof. That says a lot about the force of this explosion. Look, that's not a surprise I think to us or our viewers when you realize the horrific injuries that these explosions cause. These fragments, regardless of their size, all are clues - clues to who perpetrated this. Was it a group or individual? Were there latent fingerprints or DNA left on any pieces while it was being constructed that can be found by investigators to help identify the perpetrator. Really important for the investigation, for the victims, and for their families.

BERMAN: All right. Fran Townsend, again with this key piece of information, the lid to the pressure cooker, found on one of the buildings nearby. Thank you for the information.

CUOMO: John, and I've been saying - I've been reporting here there are two prongs to the story. The investigation, who did it and why? And those who were affected, lost their lives, hurt, and families trying to rebuild. Some good news. More than half of the 183 people injured in Monday's deadly Boston marathon attack have now been released from area hospitals. It really is amazing when you think about it, how much triage was done. So much terrible injuries and yet, people are starting to go home. Our senior medical correspondent Elizabeth Cohen joins us live from Brigham & Women's hospital where many are still being treated. Elizabeth what is the latest about what you could tell us. ELIZABETH COHEN, CNN SENIOR MEDICAL CORRESPONDENT: What I can tell you is that there is a wide variety of injuries out there. As you said, the least severe have gone home. The most severe are the ones that required amputations. There may be about a dozen people or so who required amputations. Some single leg, just one leg, and others, unfortunately were two legs. We're told by doctors that ,any of these needed to be what is called above the knee amputations because they were so severe.

But there are other people doing much better. I want to tell you about a couple who we heard about. Their names are Nicholas and Lee Ann Yanni (ph). And so, they were ten feet away from the explosion and they managed somehow to get into a nearby store. Nicholas looked at his wife. Saw blood gushing out. Went to the rack on the store, took down shirts, made a tourniquet for his wife. She said I'm okay, go help some other people. He helped other people who had fallen to the ground. And he looked up, and saw that his wife getting into an ambulance. He got on the ambulance with her, they went to Tuft's medical center, and here is what he said when she got out of surgery.

(BEGIN VIDEO CLIP)

NICHOLAS YANNI, BOMBING VICTIM: You know, it was like -- like -- you know, like home, you felt safe, because you know the people you love are there with you and you know they are okay.

(END VIDEO CLIP)

COHEN: Yesterday I interviewed Dr. Burke at the Boston University Medical Center, another hospital treating the injured and right now they are having a press conference. Let's listen in.

(BEGIN LIVE FEED)

DR. PETER BURKE, BOSTON UNIVERSITY MEDICAL CENTER: Caregivers, let's be honest. We do the best we can with this situation.

UNIDENTIFIED MALE: You tell them their life is at risk if you don't take this measure.

BURKE: That's usually the case, certainly in the beginning.

UNIDENTIFIED MALE: Can you describe what you saw when this first happened? I mean you said you had 23 patients that came in?

BURKE: Right.

UNIDENTIFIED MALE: What kind of injuries were you seeing then (ph)?

BURKE: Well, we're seeing, and this is the trauma service, I was not here in the initial event. I was out of the state and came back. We saw the -- these are the injuries that we see, but never quite as -- not this many all at the same time. And they -- the injuries are related to the -- to the device and the form of trauma from fragments and the blast.

UNIDENTIFIED MALE: Shrapnel?

BURKE: Fragments, that's what we call -- fragments, shrapnel. They're really just fragments of the bomb itself perhaps and things around where the bomb went off.

UNIDENTIFIED MALE: Have you been able to identify anything (INAUDIBLE)?

BURKE: We have taken off large quantities of pieces of things. Hard to really tell exactly what they are. We sent them to the pathologist and they are available to the police.

UNIDENTIFIED MALE: Surgeons over at (INAUDIBLE) describe some of the shrapnel. The shrapnel over there. (INAUDIBLE) Some was directly involved with the nails or the bearings. The rest was debris. Is that the same conclusion here?

BURKE: We were not really making any judgments about where these fragments come from. Some of them are metal, some are plastic, some are wood, some are concrete, it's really difficult to know. So it doesn't really matter to us. We're just trying to deal with the consequences of those fragments.

UNIDENTIFIED MALE: Dr. Burke, can you talk about the first responders and the critical role they played in getting patients to you (INAUDIBLE)?

BURKE: I cannot sing the praises higher than for the EMS services. They were there, they triaged patients, they brought them to several different hospitals across the city that allowed those hospitals to step up and take care of patients. If they brought them all one place, that place would be overwhelmed. That didn't happen, because Boston EMS thinks about this, they are organized, they cannot be praised higher.

UNIDENTIFIED MALE: Do you think Boston is unique in its ability to handle such a large-scale tragedy like this?

BURKE: No, I don't think so. I think most cities have systems for this and, you know, nothing is perfect, but most places try to anticipate things like this. Boston is unique in certain respects that we have a lot of places that are level one trauma centers and close to each other, and that works well in a situation like this that can be helpful. And I think it was in this case.

UNIDENTIFIED MALE: Can you explain -- I don't know -- you can explain how it works when something like this happens? All calls go through Boston EMS and they're the ones that --

BURKE: Right, there's a central system for dispatching this and they work together.

UNIDENTIFIEDF MALE: So, that's how the 20 or 25 people at each hospital, and you didn't have 75 at one?

BURKE: Right. Right. I'm sure if you ask them, they can tell you all about it. Being organized is really important. Being organized in the beginning helps patients do well.

UNIDENTIFIED MALE: Can you talk a little bit medically about the medical challenges you all faced in the early hours and now going forward what surgeons and other kinds of specialists will be doing (INAUDIBLE)?

BURKE: Initially we're worried about life-saving maneuvers, stopping the bleeding, things like that. Stabilizing patients so that we can deal with their injuries over time. But it's really important for people to realize that this is something that they get injured really quickly, but it takes a long time for people to get better and lots of steps in that process. So now what we're doing with these patients is evaluating their wounds to see -- making sure that there is not any other processes going on, trying to prevent infections, and allowing them to be -- for these wounds to heal and eventually for the patients to have the wounds closed and then start the rehabilitation process. So it's a continuum and it begins in the beginning and it's continuous.

UNIDENTIFIED MALE: When does -- I'm sorry, when does care for particular (ph) PTSD kick in? I know there's work done on (ph) beta blockers early on in treatment --

BURKE: Right. This is a subject that is very important and we start from the beginning, we try to get -- be sensitive and to work with these patients and their families as well. PTSD is not just about the patients, it's about their families as well. We work from them from the beginning. There is no -- as for as I know, any magic bullets to prevent this, but we need -- again, it's a process. And it evolves over time and it's something, again, that people need to not forget about, it's something that can be with these patients forever and we can actually help them.

UNIDENTIFIED FEMALE: What was the majority of injuries that you saw? We talked about EMS assessing who goes where. Is that something you specialize in?

BURKE: No, we're a level one trauma center, see all kinds of injuries, so we saw the kins of injuries that were from this kind of incident. So blast injuries, fragment injuries, this particular event was very much focused on the lower extremities it seems and that was true for all of the other hospitals, we also saw the same kind of stuff and the EMS people take these patients, depending on how sick they are, to the highest level of care, which in this case would be a level one trauma center like Boston Medical Center.

UNIDENTIFIED MALE: You mentioned ongoing surgeries, you can explain to us initially things like amputations. What more surgeries --

BURKE: Initially we do the life- saving things which sometimes require and amputation to control the bleeding. The next step is to re- evaluate wounds. Because of the capricious nature of trauma you can't tell exactly all of the damage that may have happened and you need to look at things over time. So time is a really important concept here in terms of the wounds and what happens to them. And you don't want to close a wound definitively. You bring the skin back together over the damaged tissues until you know the tissues underneath are viable and not infected and the foreign bodies as much as possible are removed. If you close them too early, then those wounds will become infected and you are starting over again. So, it's very much a process.

UNIDENTIFIED MALE: And the operations to clean out wounds or something?

BURKE: Exactly. Right. Cleaning those wounds out. Making sure that the debris is gone, making sure the tissues that remain are viable.

UNIDENTIFIED MALE: Is it too early for a physical therapist to be --?

BURKE: In general we start with getting physical therapists involved. You know, there's lot going on for these patients. You don't want to overwhelm them. And it's a balancing act, but generally speaking, we like to think we're starting the process of rehabilitation from the moment these patients hit the door.

UNIDENTIFIED MALE: I believe yesterday you said that some of the life- threatening injuries. Today are things looking better?

BURKE: Right, so initially, we had 10 or 11 that were considered critical. Now we have two. They are still critically ill. Most patients are making good progress moving through the process.

UNIDENTIFIED MALE: Do you expect the patients will survive?

BURKE: Yes, I do. But until they are home, I won't be satisfied.

UNIDENTIFIED MALE: How are you able to go from 10 or 12 to (INAUDIBLE) two?

BURKE: Well, they get better, and we re-operate on them, and we stabilize them, and they no longer need as much critical care. Sort of how we judge these things. So they are getting better. Less critically ill.

UNIDENTIFIED MALE: Sorry, two critical --

BURKE: So we have two critical, 10 serious, and seven fair. And that's, again, a continuum as you start critical usually and then you move through the process and then they get to go home, which is the goal.

UNIDENTIFIED FEMALE: There was a five-year-old? Is that patient -- ?

BURKE: He's still critically ill, yes.

UNIDENTIFIED MALE: What was the age range again?

BURKE: From five to 78. For the patients that we say.

UNIDENTIFIED MALE: And these are all specters or some runners? BURKE: They are both. And it's hard for us to judge. We haven't -- we have some runners. I cannot -- I cannot give you the breakdown of who is what. It seems to be a lot of observers. Spectators.

UNIDENTIFIE MALE: Break down the gender?

BURKE: I could, but I can't. Not off the top of my head. Reflects the general population.

UNIDENTIFIED MALE: The two critically ill patients, are you able to assess, leg injuries or --

(CROSSTALK)

BURKE: They are both. They are both. Some are pulmonary, many are extremity, and the consequences of what -- when a person gets critically injured it may just be to extremities, but it has systemic affects, makes them sick all over, makes their lungs not work, hearts not work, and depending on what you bring to the table at the time of the trauma it can be different.

UNIDENTIFIED MALE: Has the hospital turned over any forensic evidence yet to investigators?

BURKE: Not that I'm aware of. I'm sure it's available. You know, the general process where we -- when we remove things from people that we send to the pathologist, that's our process, and so they would be available I would assume.

UNIDENTIFIED MALE: What type of --

BURKE: We're talking about fragments taken out of victims in this case.

UNIDENTIFIED MALE: You said the 5-year-old was one of them?

BURKE: He's still critically ill, yes.

UNIDENTIFIED MALE: Is it a boy?

BURKE: Yes.

UNIDENTIFIED MALE: There's been a lot of interest now in how because so many of these people had family and young children in the family, how is that dealt with when they are brought into their hotel rooms -- hospital rooms. How do you care for the family members when the patient is so critically injured in that way?

BURKE: Well, it's very difficult. Important thing is to remember that there is more than just the patient and the family needs to be involved. I think at least our process is to be very up front and honest with the people and let them know as much information as we have. Let them know that this is a continuum, it changes over time. Families are different. People really want to know everything, some people really have it, some would rather have information more slowly. And I think in general, people want to know what's going on and we're very forthcoming about that, and as honest as possible in the situation that changes over time. But it's very important to have a process where we are involved in that. Because these patients don't get better unless these families are whole and able to take care of them. That's another important concept. We need to treat the family as much as the patients, because otherwise the patient won't do as well. That's the goal.

UNIDENTIFIED MALE: Can you go in and explain pulmonary injuries? What was the worst --

BURKE: We had a few injuries where the lungs seem to have been damaged from perhaps the blast or being thrown. It's hard to tell sometimes and that -- the lungs become bruised and then they don't function as well. And generally the treatment for those kinds of injuries are supportive and that's what we're doing and we expect that these -- the patients in question are going to get better.

But, you know, again, I will not be happy until they are home. I will not be satisfied.

UNIDENTIFIED FEMALE: Any other questions?

UNIDENTIFIED MALE: Doctor, I don't know if you have any military experience or anything, but have you seen wounds like this in your career?

BURKE: Well we see wounds like this, not so much from blast injuries and not -- never in this volume. I don't personally I have military experience, but many of my colleagues do, and they have made ourselves, they have made themselves available and there is -- you know, we're not going to reinvent the wheel. When people have experience, we are going to use it because that improves patient care.

UNIDENTIFIED FEMALE: From what you have heard from other hospitals, they (inaudible) the patients coming in and that they were very alert and they knew what was going on to describe their pain.

BURKE: Right that was our case as well. That many of these patients were -- were alert enough to know what was going on. Some of them weren't because they were so critically ill. And the ones who got really taken quickly to the operating room generally were the latter, so -- but, yes, in patients, we involve them in their care as much as we can. Because again they get better when they are -- when they are involved. They get better, better.

UNIDENTIFIED MALE: What was the most dire injuries you saw?

BURKE: It's hard to classify them. But the major ones that were life-threatening involved large amounts of soft tissue injuries and also vascular injuries so the blood vessels to the extremities were compromised and needed to be repaired. And also the ones that if we don't get to them quickly and the EMS is not on top of things that we can -- they can bleed to death and that was some of the issues that were going on so.

UNIDENTIFIED MALE: Is it critically (inaudible) anymore about what specific injuries are?

BURKE: Some of them have pulmonary injuries and other are just extremity injuries. Yes.

UNIDENTIFIED FEMALE: Can you tell us the ages and sex of patients?

BURKE: Well there's one who is five. And another in his 60s I think. I think so, yes. 60 and I got the breakdown of six males and 13 females, so not quite the general population.

UNIDENTIFIED MALE: And the 5-year-old person.

BURKE: He's a male.

UNIDENTIFIED MALE: And the 60-year-old.

BURKE: The 60-year-old, male.

UNIDENTIFIED FEMALE: You didn't say that.

BURKE: Yes.

UNIDENTIFIED MALE: You mentioned a couple of times about preventing infections.

BURKE: Yes.

UNIDENTIFIED MALE: Given the surgeries they had, is that because of the fragments that might have been embedded?

BURKE: It's both. And it has to do with the size of the fragments and being able to remove them. Some of them are tiny and you can't really find them. And it has to do with how much damage is done to the local tissues around. The only way we ever get people to prevent infection and to keep from getting infected is because the body is good at fighting infection. And you need to allow the body to do that.

And we've learned that to do that, we need to make sure the tissues are -- are viable, i.e., the blood supply is adequate and that the foreign bodies are removed as much as possible and then the body can -- can prevent its own, prevent infection and/or treat infection that may have started. Antibiotics help, but they do not -- it takes more than that.

UNIDENTIFIED FEMALE: What is in the risk of the patients going forward in terms of operations, treatment, things that you're worried about that are keeping your staff up at night?

BURKE: Well we worry about a lot of different things. There are a lot of problems that patients who are critically ill can get into. They -- infection is a big issue. We worry about when anybody is significantly traumatized. They have more a higher incidence of making clots in some of their veins. So they can get clots in their veins that then can travel up to their lungs and that can be a deadly scenario. And you know we worry about all the complications of pneumonia, if they are intubated and things like that. So there are a lot of consequences of that reflect out from being this critically ill and we worry about them all. And -- and try to prevent as many as possible.

UNIDENTIFIED FEMALE: And so far they doing great (ph).

BURKE: So far so good.

UNIDENTIFIED MALE: That's what we heard about the pulmonary impact on some of these patients. Any neurological trauma that you are concerned with?

BURKE: We -- in our population, we had one or two head injuries, not any very severe head injury which is very lucky. So we haven't had to deal with lots of mechanical head injuries. The other injuries that we always worry about in blasts and we've seen some of these are injuries to the eardrums and some -- some of that. And we're -- we had all of our patients basically assessed by the ear, nose and throat specialist so that we can catch that over time and -- and deal with that.

UNIDENTIFIED MALE: What is the largest fragment?

BURKE: I think there were some fragments that are four or five centimeters, some big pieces of stuff.

UNIDENTIFIED MALE: You said there weren't too many severe head injuries. Does that indicate anything about where the bomb was placed or --

(CROSSTALK)

BURKE: I suppose it does to people who are experts at that. I think as you -- as you can tell that we have a lot of lower extremity injuries, so I think the damage was lower to the ground and it wasn't up. But now the patients who do have head injuries were blown into things probably or hit by fragments that went up. So it's hard to know.

UNIDENTIFIED FEMALE: So the patients that have to undergo multiple surgeries, (inaudible) I mean do you feel confident you will be able to release them. But will it be from one hospital to rehab?

BURKE: Yes generally and this is true for all -- for trauma patients in general. We -- we do the acute care part of their -- their needs. We deal with their -- their wounds and their orthopedic in all various injuries and then at some point when we are -- when those things are stabilized, the next very important thing is to get them to rehab because that's part of getting better. So we try to move that process as quickly as possible, to get them to the rehab that they need for whatever their injuries are. And they are varied so.

UNIDENTIFIED MALE: Is there a blood supply problems?

BURKE: No. We've had no issues with blood supply. And people are looking for things to do that can help, donating blood is always good. And you won't find a trauma surgeon that won't advocate for that.

UNIDENTIFIED FEMALE: Ok. Thanks, everyone.

UNIDENTIFIED MALE: Thank you.

(END LIVE FEED)

ELIZABETH COHEN, CNN SENIOR MEDICAL CORRESPONDENT: We just heard from Dr. Peter Burke, who is the chief trauma surgeon at Boston Medical Center. I talked to him yesterday and he was telling me that on Monday afternoon, he was actually at a convention, a meeting in Nevada, looked up while he was walking into his hotel and saw CNN, saw the news on CNN and said, "Oh, my God, I've to get back to my team." Flew back, led his team, they treated 20, they've treated 23 patients, five of whom required amputations, two of whom needed a double amputation.

Ten of the patients were in critical condition yesterday. Today only two are. So recovery is happening. One of the two in critical condition is a 5-year-old boy. Chris, John.

JOHN BERMAN, CNN ANCHOR: All right, Elizabeth Cohen, our thanks to you. And that doctor said he will not be satisfied until all of the patients are home. Thanks so much.

CHRIS CUOMO, CNN ANCHOR: As terrible as the injuries are, those are the lucky ones. Three people lost their lives. We don't want them to be known just for how they died, it's about who they were.

And yesterday of course we've all been captivated by the eight-year- old boy who lost his life but now we hear about 29-year-old Krystle Campbell who is also something special. She worked hard, she was loved by her friends, she did the right thing by her family and we sat down with her grandma, Grandma Wilma. And she told us as much as it hurts, she knows that her favorite grandchild is now an angel.

Take a look and listen.

(BEGIN VIDEO CLIP)

CUOMO: What do you think when you see this photo.

WILMA CAMPBELL, KRYSTLE CAMPBELL'S GRANDMOTHER: Beauty.

CUOMO: What was she like in high school?

Campbell: : Smiling all the time. All the time she smiled. No matter what happened, she's come out with a smile. I used to dress her up. I used to love to dress her up. Put her hair in long curls, and bows in her hair. She loved it. She'd go out prancing, proud as anything to school.

And then in school, the teachers would say, oh, Krystle, you look so beautiful who did your hair? My nana did my hair.

CUOMO: You had a special bond from what you're -- CAMPBELL: Oh, gosh yes.

CUOMO: How did Krystle make you feel?

CAMPBELL: Oh, full. My whole heart and soul. She was it. And she made me feel that way. She made me happy. I used to look forward to her coming over to see me.

CUOMO: As she grew up, she didn't change.

CAMPBELL: No.

CUOMO: She still came. She still is with you.

CAMPBELL: She still came. And she still made me feel the same way, happy.

CUOMO: What kind of young woman did she become?

CAMPBELL: Smart, ambitious and loving.

She wanted -- she never complained on what she wanted or talked about it that much. She just used to say I'll just take one day at a time, Nana. See what happens.

CUOMO: She just took life as it came.

CAMPBELL: She loved life.

CUOMO: Lots of friends?

CAMPBELL: Oh, lots of friends. Lots of friends. Her disposition, her attitude. And her bubbliness -- she was so bubbly all the time and laughing.

CUOMO: When she got a little older, there was a time when you got a little sick. And she was there for you.

CAMPBELL: Yes, definitely.

CUOMO: Tell me about it.

CAMPBELL: When I come home from the hospital, she came over one day and she said, "Nana, I think maybe I want to move in with you." And I said why? She said, "Well, I just figure you should have somebody here with you to stay with you, make sure you are ok." I said "You really want to do that, Krystle? Your whole life is ahead of you." She says, "Well, I can -- I'll make it. I'll arrange it so that I'll be here with you."

CUOMO: What did that mean to you?

CAMPBELL: Oh, everything. Everything. It did me so well because I felt good, and I felt comfortable and safe with her in the house with me.

CUOMO: Solidified her as number one too, right? That was it after that? Everybody else was in a race for second.

CAMPBELL: Exactly.

CUOMO: What do you think when you see her on the TV?

CAMPBELL: Huh?

CUOMO: What do you think when you see her there?

CAMPBELL: I wish I could go up and grab her and kiss her and hug her. I can still feel her.

CUOMO: How do you make sense of this?

CAMPBELL: I don't. I don't make any sense of it at all. I can't believe it's happened. I can't believe it. I won't even accept it now, and I'm sitting here now with you. I'm having a hard time. When I see her on the TV, it's killing me inside.

CUOMO: It's not real.

CAMPBELL: Huh?

CUOMO: You can't believe that something like this would happen to somebody you love so much.

CAMPBELL: No. That's the farthest thing from my mind.

CUOMO: How are you going to remember Krystle? How do you want to remember her? What do you want to remember?

CAMPBELL: With love. All my love will be there forever. My heart, she's in my heart. Always is, all of them. That's my Krystle. And she'll always be my Krystle. I love her. I love her so much. I love all of them, but she's -- she's my special one.

(END VIDEO CLIP)

CUOMO: It so was important to put some detail and the life to go with the face and the name of Krystle, and also, you know, I think grandma Wilma was instructive of Boston strong. She's hurting, but she loves. And she knows she has to move on. The combination of emotions I think a lot of people are doing that now.

BERMAN: You know it's so clear that Krystle's love lives on through Grandma Wilma. As you said, so strong, so remarkable. So amazing that (inaudible).

STARTING POINT back live in just a moment from Boston. Stay with us.

(COMMERCIAL BREAK)

BERMAN: That's all from STARTING POINT this morning. I'm John Berman.

CUOMO: And I'm Chris Cuomo. Please, stay with CNN for continuing coverage of the aftermath of the Boston terror attack.

BERMAN: NEWSROOM begins right now.

CAROL COSTELLO, CNN ANCHOR: Happening now in the "NEWSROOM", who did it? Breaking overnight: new pictures of bits and pieces of the pressure cooker bomb and a plea form investigators.

(BEGIN VIDEO CLIP)

RICK DESLAURIERS, FBI SPECIAL AGENT IN CHARGE: The person who did this is someone's friend, neighbor, co-worker or relative.

(END VIDEO CLIP)

COSTELLO: Plus, Boston unites as the city --