Athletic trainers just did their jobs

Medical workers help U.S. runner Shalane Flanagan after crossing the finish line during the 2014 Boston Marathon. Greg M. Cooper/USA TODAY Sports

BOSTON -- What they wanted Monday wasn't all that different from what the 36,000 people running toward them wanted. The 230 athletic trainers and their students working at the Boston Marathon yearned to finish the race and to do their best.

They were still helping to save lives. It just wasn't as obvious.

Inside a small, partitioned area of Medical Tent A in front of the Boston Public Library, the stone surface was slick with water that had sloshed out of ice tubs. Heat, not terrorism, was the chief thought on the minds of the volunteers working there as runner after runner was brought in with core temperatures exceeding 104 degrees. Some were delirious. One howled in agony for several minutes after he was immersed in the tub. Others struggled with heaving chests or looked hollow-eyed into empty space.

Shortly after 1 p.m., Ray Castle, Louisiana State University's athletic training program director, moved from tub to tub, helping scoop chilled water over the runners' torsos, wrapping damp towels around calves rigid with cramps, supporting one man's head and neck as another volunteer gave him sips of a power drink. "There you go, buddy, you're doing good," Castle said.

Castle was wistful when he first learned he wasn't reassigned to the finish line, where he'd been stationed in 2013. When the first explosion ripped through the spectator area last April, Castle used his medical shears to cut through fencing and waded into a sea of casualties. The experience traumatized him, then galvanized him to return. As soon as the runners began arriving in the hyperthermia area, Castle forgot everything except the patient in front of him.

"We're making a difference in here," he said.

The first responders of last year were everywhere, including nearly every athletic trainer who helped treat the wounded or manage the chaos. Many, like Marisa Love, an occupational therapist and athletic trainer from Connecticut, are veterans of past marathons whose anger and sorrow turned to determination.

"I didn't believe that should define me and my experience over the last eight years," Love said in a recent interview. Monday, she stopped to talk after helping a woman with blurred vision into the medical tent, one of numerous trips she made back and forth from the finish line.

Love found herself fixating on the backpacks some spectators brought to Boylston Street despite the pleas of public safety officials. She and a few fellow volunteers talked about it and then let it go. "It's nice to be here with someone who gets it and doesn't think you're crazy," she said.

Barbara Hemphill, who helped tend to several gravely injured spectators last year, also worked the finish line again "because I have to ... If we choose not to go back, then [the bombers] have accomplished their goal," she said before the marathon.

She admitted to some anxiety Monday as midafternoon approached, but then a runner needed her help back to the medical tent, distracting her from a time of day she'd been dreading.

Tim Cuddeback, an athletic trainer doing graduate work at the University of Hawaii, traveled across six time zones to be back in Boston despite scenes that are still "terrifying, vivid" to him. "It's how we apply our knowledge, not where," he said in an interview last month. "It can be turf burn or a shrapnel wound. I want to be that first responder. It's made me a lot more motivated and passionate about my profession."

Cuddeback has been personally touched by violence before -- his brother Zachary was murdered in an airport shooting in Germany while serving in the Air Force.

Monday, in Medical Tent B, Tim said the trip was well worth it for the fulfillment he felt. "This is very high-pace," he said, keeping one eye on the patients on cots in front of him. "It's what I like to do."

The athletic trainers started their long day with an 8 a.m. meeting, joining nurses, physical therapists, emergency room doctors, podiatrists, cardiologists and 60 psychologists in a downtown auditorium where marathon medical coordinator Chris Troyanos addressed them.

Many in the room have done Boston Marathon duty for years. They are used to staying until the last runners finish and are cared for, and then getting to say goodbye to one another. Those rituals were aborted by the bombing, and Troyanos said he understood the need for healing and closure at this race.

"My suggestion to everyone in the room is to embrace those emotions,'' he said. "Don't run from your feelings ... If you're nervous and anxious about today, draw on the collective strength of this team.''

Troyanos wanted Monday to be as routine as possible. Apart from adding 500 people to the team because of the larger field, he made only one visible concession to the previous year. Blue and gold memorial patchwork quilts donated from all over the world hung inside the tents, giving a splash of color to the drab interiors.

The medical volunteers trooped over to Copley Square, ate bag lunches and dispersed to the two large medical tents and multiple wheelchair zones in a several-block-square area. With no amateur runners expected for a couple of hours, many gathered around the flat-screen televisions mounted in Medical Tent A as the elite men's race unfolded, and erupted in cheers when Meb Keflezighi became the first U.S. runner of either gender to win in Boston since 1985. Keflezighi later walked into the tent still wearing his gold laurel and navigated through ranks of enthusiastic medical volunteers, giving and accepting high-fives.

Athletic trainer coordinator Brian FitzGerald, in his 36th year at the race, said Keflezighi's victory was the only time he thought about the bombings. "Is that an exclamation point on the whole thing, or what?" FitzGerald asked rhetorically. "On this occasion? Phenomenal."

As the amateur runners approached, public address announcer John Anderson, who received a standing ovation at the prerace meeting for his coolness under fire last year, stepped in front of his standing microphone.

"This space may be empty now, but just wait," he said, pausing for dramatic effect. "They'rrrre coming ..."

And they began to arrive, transported by many of the same volunteers who rose to the occasion last year.

One of them was Thomas Doucette, a Marine Corps veteran who served in Africa and Iraq. Last year, he witnessed more injuries at one time than he ever did in the military. His anger coalesced into a vow to return for those who were defying lingering fear to run. "We're not going to give up on them," he said before the marathon. "We still owe them a race."

Devin Wang, the Boston University student athletic trainer who helped rush double amputee Jeff Bauman to the medical tent last year, ferried weakened runners Monday to the same destination and loaded her wheelchair with cases of bottled water to take back.

In the afternoon sun beating down on the finish line, Jack Foley's face was reddening despite a liberal application of high-SPF lotion. The Lehigh University director of sports medicine, who was in the thick of the first response last year, stood just behind the blue-and-gold finish line, clapping and exhorting the legions flowing and staggering past him.

The cheering had a purpose. Runners had to be kept in motion to avoid bottlenecks at the finish, which would have prevented Foley and others from seeing those who needed help.

A few finishers cartwheeled through the last few feet, seemingly fresh as the new daffodils blooming from planters on Boylston Street. Others wobbled as soon as they crossed the painted line, clearly having expended their last kilojoule. Foley and his fellow athletic trainers rushed to keep anyone from "stopping and dropping," as they call it, taking one arm, asking gently for a name, a hometown, a race time to judge their condition.

Many runners paused to thank anyone in those white medical windbreakers that were so easy to spot last year amid the gruesome footage of the bombings' aftermath. "I told them, 'It's not about us. It's about what you did,' finishing what they couldn't finish last year," Foley said. "I'm just happy to be working from 2:49 on."

As that time approached, the finish line announcer asked the spectators to quiet in recognition of the moment when the bombs exploded nearly 12 seconds apart. It seemed incongruous amid the festive atmosphere, something already observed in almost a full week of tributes, but the spectators mostly obeyed. Several runners raised their arms silently as they finished. For a short, suspended few instants, the soft sound of sneakers kissing asphalt was all that was audible.

Foley glanced at FitzGerald and two other athletic trainers who'd been with him a year ago. They were already looking at him. When the announcer coached the crowd to let out a cheer "the world can hear." Foley crossed the street, taking care to avoid the foot traffic, and hugged his colleagues one by one.