Among Boston's first responders

Running a marathon isn't just physically grueling. It can also pose psychological challenges, which is why the medical tent at the Boston Marathon always includes psychologists as well as physicians, nurses and physical therapists. Runners may need help with pain management or may be anxious or angry about finding themselves injured and in the medical tent. While the medical team sees to a runner's physical needs, a psychologist may be explaining what's going to happen next or using cognitive-behavioral therapy (CBT) techniques like deep breathing, relaxation or imagery to calm the patient down. The medical team typically treats about 1,000 runners on race day.

This year, of course, there was an added challenge: bombs at the finish line.

The Monitor talked to the two psychologists who volunteered at the marathon this year. Jeffrey L. Brown, PsyD, a private practitioner in Arlington, Mass., and assistant clinical professor in the department of psychiatry at Harvard Medical School, has been part of the marathon's medical team since 2002. Beth S. Meister, EdD, a private practitioner in Belmont, Mass., clinical instructor in the department of psychiatry at Harvard Medical School and mental health director at Brimmer and May School in Chestnut Hill, has volunteered since 2006. Brown and Meister are also clinical associates in psychology at McLean Hospital in Belmont, Mass.

What was your experience this year?

Brown: I was in Medical Tent A, about 100 yards beyond the finish line, when the first blast occurred. I was working with a runner who was having painful muscle cramping. I knew the sound of the blast didn't fit any typical category of sounds we hear in the city. The second blast confirmed my initial gut feeling that the beautiful day we had was going to change dramatically.

I ran to the finish line to help in whatever way I could. Boston Emergency Medical Services provided an amazingly rapid response. I left the finish line and returned to the medical tent as victims started filling the tent. I tried to identify those in psychological distress and offer support. Of course, none of us had all of the answers to the questions about why this happened and who was responsible. Helping victims do quick problem-solving, helping them be grounded in the midst of injury, reducing their visual exposure to unpleasant sights and helping them remain focused on an immediate plan all quickly came into play. There was fear and angst, but other victims experienced intense anger. Others tried some failed attempts at humor as a way of trying to cope.

Meister: When we felt the blasts, I was kneeling at the cot of a young runner, guiding her to concentrate her attention on warming her frigid body to a normal temperature under three blankets. Someone saw my surprised expression after the first blast and said that perhaps a transformer had blown. The second blast sent a number of volunteers running out of the tent toward the site, and I knew that a disaster must have occurred. This time a passing colleague said "two IEDs [improvised explosive devices]." The young runner began to cry and panic. I held her head toward me to reduce her exposure to others' injuries.

Eventually, our medical team was focusing only on those injured by the bombs. The most severely injured were carried immediately out to waiting ambulances, leaving many in the tent to be treated by marathon volunteers. I helped calm and reassure several patients as their wounds were bound, talking about what the medical folks were doing to help them.

What have you done since the bombings?

Brown: I've seen many individuals in my clinical practice who have been affected by the bombings and manhunt: runners who finished, runners who didn't, people who work or live in that area of the city or in Watertown, where the suspects were. The event has touched most of the lives in the city and has taught me about the different hats we wear as psychologists.

Meister: As the director of mental health in a school, I talked with many students dealing with their experience. I spoke at a school assembly of the first responders' bravery and skill and wore my white race jacket, "PSY" cap and marathon identification. This worked well to shift the focus, if momentarily, from the event's horror to images of the heroic and caring first responders.

What kind of self-care have you done, given your own exposure to the events?

Brown: I've been practicing what I preach to others, focusing on healthy eating, regular exercise and a routine that includes ample sleep. While I've processed the event many times with patients who've brought their own experiences into therapy, I've also participated in a team support session and other meetings focused on shared experiences and support for medical team members directly exposed. Dr. Meister and I have kept in close contact with each other as the days move on. Key to my own mental health is the fact that I walked home that afternoon with a good friend of mine who is a physician on the medical team, Dr. David Nazemi. David and I had both responded to the finish line together before returning to the tent. After the blasts, the subway was shut down. We walked home — a five-mile distance — talking about our experience, processing emotion and supporting each other. Outpourings of support from family, friends and colleagues, as well as my own faith, have been invaluable.

Meister: I attended a support session for race volunteers two weeks after the event, which was helpful. Although I felt no prominent after-effects, I tried to talk to family and friends about the experience when they asked and when I felt it would be helpful for me to talk. Fortunately, people were receptive to listening. I watched for signs of post-traumatic stress disorder, but saw none that needed special treatment beyond my own management. I returned to my usual schedule as soon as possible. My initial anger at the loss of life, injury, destruction and disruption of a sense of security has been replaced by a feeling of sadness when my mind goes to that day. I have found cognitive strategies helpful in dealing with the memories, just as I teach them to my patients.

Rebecca A. Clay is a writer in Washington, D.C.