Shock and Awe

When conflicts erupt and trauma and injury result, physicians who serve in hospital emergency departments must assess and address the damage inflicted on the people involved. As a vascular surgeon at Boston Medical Center, Alik Farber, MD ’91, is one such physician.

Farber, who is chief of the Division of Vascular and Endovascular Surgery at Boston Medical, the associate chair for clinical operations in its Department of Surgery, and a professor of surgery and radiology at Boston University School of Medicine, says that helping patients survive is deeply gratifying. But, he adds, there can also be a tug of sadness, even frustration, when violence occurs to the innocent or is repeated so frequently that victims, and society, become numb.

“We see a lot of patients who are victims of penetrating trauma, says Farber. “In other words, trauma by knife or gun. We certainly see patients with blunt trauma sustained in a car accident or a fall, but because of the role that Boston Medical Center serves in this community, we see a lot of patients with gunshot wounds or stab wounds. I’d say once a week at least we’re dealing with situations involving penetrating trauma that has damaged blood vessels.”

The number of cases Farber and his colleagues at Boston Medical and elsewhere see may be on the rise as a result of increasing rates of interpersonal violence in cities, according to a 2017 paper in Frontiers in Surgery.

Perhaps more sobering, the authors point out that data gathered in the late 1980s indicated that the majority of vascular trauma within city populations was carried by young men, 90 percent of whom had themselves been injured by firearms or knives.

This was the reality confronting Farber when he began his career, and it continues to trouble him.

“I remember one of my first cases,” says Farber. “The person had been shot in the arm and had an injury to the brachial artery. I fixed the artery. When I went to see the patient the next day, I remember being shocked. He was sitting on his bed, surrounded by three or four young men his own age, smiling and laughing. This guy seemed to act like the shooting and his injury were nothing.

“I remember thinking to myself, if this had happened to me, I would be like, ‘Oh my god. What happened? How am I here? What's going to happen now?’

“You know, when the patient comes to me, I don’t say to myself, ‘Is this a good guy or a bad guy?’ I say to myself, ‘This is a patient. He or she has a problem. I’m going to help them.’

“But as a young surgeon, it was difficult for me to realize that a lot of people who are involved in these sorts of traumatic events may have a different approach to life than I have. It’s a bit emotionally disturbing.”

Farber’s reaction came despite years of surgical training, “socialization” as he refers to it, that emphasized the importance of disengaging the emotional being from the professional being.

“You have to do that in order to remain whole,” says Farber. “If a surgeon can’t do that, they can’t be a surgeon.”

Yet being a physician means caring about people, so it can be difficult to remain removed to, as Farber says, “disengage our emotional being from our professional being.”

Farber’s efforts during the Boston Marathon bombing in 2013 highlight this tension. In this edited excerpt from an interview he gave to researchers from the Francis A. Countway Library for their project Strong Medicine: The healing response to the 2013 Marathon bombing, Farber discussed that day and the young patient he first saw in one of Boston Medical’s trauma rooms.

“It was clear to me that she had a significant injury to her right leg, and to her left leg as well,” recalls Farber. “There was significant bleeding, so clearly she had a massive vascular injury. One of my assistants held pressure on the bleeding to control it, and I dissected out the artery above the bleeding, the common femoral artery and the superficial femoral artery, and proceeded to dissect out to the area of the injury.

“She also had multiple pellets in her skin. Another area on her left leg looked like it was an open fracture, but in fact, it was someone else’s bone that had become ingrained in her skin. It wasn’t actually her bone. Somebody else’s.

“There was a concern that she had a fracture, so we took an X-ray. It showed a big piece of metal in her thigh, the size of an iPhone. It was sort of remarkable; we’re not used to treating patients with shrapnel injuries.

“We must have been there for three to four hours, but when we finished, I went to talk to the patient’s family. I found out that her sister had been running the marathon, and the family had been watching. One of the orthopedic surgeons had amputated both of her mother’s legs while I was in the operating room working on the woman’s daughter.

“It was a surreal experience.”

Working on patients who come into the emergency department following trauma can mean interacting with first responders such as EMTs and police officers. Farber notes several instances when patients and police arrived simultaneously—and one time, during his years as an attending vascular surgeon at Cedars-Sinai Medical Center in Los Angeles, when the patient was a member of the Los Angeles Police Department.

“I was on call. They brought in this patient, and there were like ten policemen with him. I was told that he too was a policeman, who was basically undercover. He had been shot in his left arm and right shoulder and an artery had been hit. He’d required six pints of blood before being transported to the hospital. We got him into the operating room and fixed his artery. He survived. I felt very good about that; when the emotions rushed in, I was actually really happy that I could help.”

So were members of the Los Angeles police.

In a February 2003 letter of thanks to Farber, Rick Caruso, who was then the president of the Los Angeles Board of Police Commissioners, wrote, “…Your expertise literally saved this young officer’s life. … We realize that you give your complete and devoted attention to all of your patients, but we would like to express our sincere appreciation to you for your dedication to the health of one of our officers.”

This letter, framed and hanging in Farber’s office, brings him joy and renews his pride in his work.

“It was nice to receive this. I’m very proud of it,” he says.

The young officer Farber helped that day has remained on the LAPD, and has risen to the rank of detective. In 2011, eight years after Farber mended his wound, the officer received a Purple Heart from his colleagues, acknowledging the severe wounds he had received in the line of duty.

Image: John Soares