A Life Regained
Overcoming the odds for her critically wounded patient came naturally
The Boston Marathon bombings, on Monday, April 15, last year were just the start of our local mayhem and bloodshed. Four days later, in the immediate aftermath of the killing of Sean Collier, a young MIT police officer who was shot while sitting in his cruiser at the edge of the campus in Cambridge, Mass., 33-year-old MBTA officer Richard (“Dic”) Donohue got caught up in a wild nighttime shootout between police and the bombing suspects on the streets of nearby Watertown that left him critically wounded.
Donohue was rushed to Mt. Auburn Hospital, where Heather Coffin Studley, ’06, an ER physician on duty, awaited his arrival. She would be instrumental in saving his life. Studley says she was drawn to emergency medicine initially because of how the field contains “a little bit of everything,” but nothing could have prepared her for this.
Studley is the daughter of John Coffin, the American Cancer Society Research Professor of molecular biology at the medical school, and sister of Erica Coffin,’99, an anesthesiologist in Pittsburgh. The vascular surgeon who was called in that night to operate on Donohue was Frank Vittimberga, ’62, chief of vascular surgery at Mt. Auburn. (A further Tufts connection to this story involves Donohue’s mother, Consuelo Donohue, who has worked as a nursing supervisor at Tufts Medical Center for many years.) Studley lives in her hometown of Scituate, Mass., with her husband, Ralph, who works in financial services, and their two children, Madeline, 4, and Benjamin, 18 months.
Studley talked with Tufts Medicine about the night “Dic” Donohue died—and then didn’t.
Tell us about that night.
It started out like a typical overnight shift. The way we do it is there’s a doctor who’s there in the ER from 6 p.m. to 2 a.m., and there’s another who’s there from 10 p.m. to 7 a.m. That was me. I was the overnight doctor that day.
We heard from a security guard at the hospital that there had been a shooting over at MIT. We heard it was a robbery, and didn’t think too much more about it. We knew they would be taking him to MGH, which is the nearest hospital. Then, about 30 minutes later, someone told us, “There’s a shootout going on in Watertown.” I looked at the doc I was working with and said, “Oh, no.”
Mt. Auburn was not a designated trauma center, but Watertown, where the shooting happened, is maybe a half mile from us, and so I knew there might be someone coming to us if they were seriously wounded. Soon after that we got a call from the dispatcher saying, “We have a police officer coming to you; we have no details.” Two or three minutes later the ambulance pulled in and we heard, “He’s been hit in the leg.” At first we thought, “Oh, that’s not so bad.” But then pretty soon, looking through the window at the front of the hospital, I could see that the emergency guys were doing CPR on him, and I knew it was more serious.
When Dic first came into the ER, he was dead. He had basically bled to death at the scene of the shooting. He was in full cardiac arrest. He had sustained a single gunshot to the right groin, which had hit his femoral artery and vein. Under those conditions, it would only take two or three minutes before you bled out.
We followed our standard protocol. We put a breathing tube in, and we continued CPR. How much sense did this make? Not a lot. CPR is primarily meant to push blood around, but he had no blood volume, so what good was the CPR? It’s hard to know. It must have done something for him, but when we first looked at the groin wound, he wasn’t bleeding. He had no blood left.
Had he flatlined?
Yes. He had no cardiac activity.
Had you seen this condition before?
I have. The difference is that in those other cases the patient didn’t live. We knew that the only way Donohue had a chance of living was if he got blood, and quickly. We were able to get a large central line into him and start pumping blood into his system. After three units of blood, we put an ultrasound on his heart—there was still no cardiac activity.
How long had you been working on him at this point?
Fifteen or 20 minutes, maybe. There was me, an ER resident and another doctor there, together with about five nurses. And remember, he had been on the ground in Watertown and getting him to the hospital had taken at least five or 10 minutes. So his heart had probably been stopped for half an hour at this point.
What were his likely odds of survival?
Well, it’s fair to say that everyone in the room was feeling we would be done with the case soon. If he has sufficient blood volume, and we still can’t get his heart back, we’re done. But then we put three units of blood into him and gave him a dose of epinephrine and, amazingly, his heart started beating again.
How would you describe the mood in the room when that happened?
Cautious optimism. Just because we got the heart beating again, the patient still has suffered neurological damage. When he started hemorrhaging from his groin wound, we took that to be a good sign.
The trauma surgeon, Dr. Russell Nauta, arrived about then and said, “He needs to go to the OR.”
Meanwhile, we’re trying everything to stop the bleeding. I put my hand on the wound to apply pressure, but that didn’t stop it. I ended up getting up on the stretcher as it was wheeled to the OR and putting my knee right on the wound. It was all I could think of that would get enough localized force to stop the bleeding. Even after we reached the OR, I climbed back up on the table and kept my knee on the wound. The surgeon was able to clamp the artery from inside Dic’s body.
Once we were in the OR and everybody else was there, I stepped back and let them take over. Then came the hardest part. I had to be the one to speak to Dic’s wife and mother. They had arrived at the hospital and were of course distraught. They were concerned about Dic’s brain function and wanting lots of answers that we couldn’t always give right away. I went back and forth between them and the OR and updated them through the night.
It’s always the hardest job, talking to families. You try to be as positive as possible but also realistic. You want to give people hope, but not false hope.
Based on your experience, what were Dic’s chances?
For a patient to survive cardiac arrest from trauma, maybe 5 percent, with 5 percent being very generous. Given the nature of Dic’s wound, he was probably in the 1-to-2 percent range for recovery.
Have you stayed in touch with Dic and his family since that night?
I’ve seen them a bunch of times. It’s nice to see him up and walking and talking. Plus, he and his wife have a baby who’s just a little bit younger than mine.
Do you see ER medicine any differently now?
Not really—this is what we’re trained to do. The job is humbling every day.