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Bittersweet Marathon Anniversary: Lost A Leg, Gained Cherished Friends

Heather Abbott, left, and Roseann Sdoia are both amputees who developed a friendship after last year's bombing. (Jesse Costa/WBUR)

Heather Abbott, left, and Roseann Sdoia are both amputees who developed a lasting bond after last year’s bombing. (Jesse Costa/WBUR)

On the evening before the one-year anniversary of the day that changed their lives, Roseann Sdoia and Heather Abbott met up for dinner. The two women had been acquainted before shrapnel shredded the lower part of Abbott’s left leg and most of Sdoia’s right leg.

Now they’re fast friends who push and inspire each other and offer support and counseling. The close bonds among many of the bombing survivors, first responders and their families are a reminder that Tuesday’s anniversary is mixed.

‘It’s Still Kind Of Surreal’

Abbott was waiting to get into the Forum on Boylston Street last April when the second bomb went off. Sdoia had just stepped out of the restaurant to look for a friend nearing the finish line.

Abbott and Sdoia had come to the Forum with separate groups of mutual friends. The two women didn’t realize they were both amputees until they saw each other at Spaulding Rehabilitation Hospital. They still have a hard time accepting what happened.

“I’m getting a little bit closer, but it’s still kind of surreal to me,” Sdoia said Monday evening.

“Sometimes I’ll wake up in the morning, to get out of bed, and I’ll look down and realize I have to put my leg on,” Abbott said. “And I think, this is never going away.”

Abbott looked down at her left calf and foot. She was wearing a wedge sandal on her dress-up leg. Dress legs come in different heel sizes. There is an adjustable heel, but Abbott said it is not very stable.

“When I inventoried my closet,” Abbott recalled, “four inches was the most popular one, so that’s what I went with.”

Sdoia wore black sandals. The toenails on both feet were a deep purple. Sdoia’s testing a new way to keep the sandal on her carbon fiber foot.

Walking is “not very smooth,” Sdoia said with a laugh. “At any moment, that sandal could come off. I mean it’s velcroed on right now, to the bottom of my foot.”

Sdoia joked about being jealous that Abbott was back into her tight jeans first, wearing heels first and running, again, first. Sdoia, whose amputation is above the knee, has had a more difficult recovery. But each women feels like she’s constantly being fitted for a new socket as her limb shrinks. Abbott has gone through five different-sized sockets and is due for another. Continue reading

Carrying Memories, Marathon Medical Team Prepares For Possible Record Crowd

Medical personnel work outside the medical tent after the Boston Marathon bombing on April 15, 2013. (Elise Amendola/AP)

Medical personnel work outside the medical tent after the Boston Marathon bombing on April 15, 2013. (Elise Amendola/AP)

April 21 could be doubly challenging for the Boston Marathon medical team. Memories of bloodied runners and spectators are still fresh for some doctors and nurses. And now they must get ready to care for 36,000 registered runners, thousands of unofficial “bandits” and an expected spike in crowds along this year’s route.

But as medical tent veterans reconvene for the first time since the bombings, the mood is resolute.

“It’s really good to see all of you,” says Chris Troyanos from behind a podium at the Keefe Technical School in Framingham last Sunday morning. “It’s been a while since we have been together.”

Chris Troyanos, medical coordinator of the Boston Athletic Association, speaks during a training session Sunday at the Joseph P. Keefe Technical School in Framingham. (Martha Bebinger/WBUR)

Chris Troyanos, medical coordinator of the Boston Athletic Association, speaks during a training session Sunday at the Joseph P. Keefe Technical School in Framingham. (Martha Bebinger/WBUR)

Troyanos, medical coordinator for the Boston Athletic Association (BAA), looks out at a sea of faces, many of whom he’s worked with for years. This is the first time Troyanos has spoken publicly about the bombings that tested years of preparation and training.

“We’re obviously facing some new challenges,” he continues. “That’s OK. This team always meets them, and you’ve become, in my opinion and in the opinion of many, the best marathon medical team in the world.”

To respond to a possible record number of runners, there will be 1,900 volunteers, up from 1,400 last year. Troyanos said he had to turn away 600-800 people and only took, for the most part, volunteers with prior Boston Marathon experience.

Many tents along the route will double in size. There will also be more cots and medical staff. Both of the two white, glistening tents at the finish line will be bigger, with one as long as a football field.

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Marathon Bombing Victim Anticipates Return To Boston

Marathon bombing victim Erika Brannock, left, and her mother, Carol Downing (Carol Downing)

Marathon bombing victim Erika Brannock, left, and her mother, Carol Downing (Courtesy Carol Downing)

LAUREL, Md. — Erika Brannock, a 30-year-old preschool teacher from Baltimore, holds a record she never sought in the history of the Boston Marathon: Brannock spent 50 days at Beth Israel Deaconess Medical Center and was the last patient to leave an acute care hospital after last year’s bombing.

Brannock had come to Boston with her sister and brother-in-law to watch her mother, Carol Downing, cross the marathon finish line.

The first bomb blast ripped off most of Brannock’s left leg. Shrapnel tore through bone, muscle and tissue in Brannock’s lower right leg, leaving what she calls a big divot. Doctors have been rebuilding the leg and Brannock had started walking on it and her prosthetic left leg when an infection set in.

Recovery And Retraining

In February, Brannock had her 18th surgery since leaving Boston. Speaking last month from her aunt and uncle’s home here, she said she’s confident now that she will keep her right leg.

“It’s looking good,” Brannock said, patting the leg propped on a velvet pillow in front of her. “My surgeon’s really happy with how it’s healed and I can start getting back up and walking again.”
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Why Some Bostonians Refuse Shelter In The Dead Of Winter, And How They Survive

Nelson Bennett stocks the Pine Street Inn's outreach van with food and supplies. (Courtesy Rick Friedman)

Nelson Bennett stocks the Pine Street Inn’s outreach van with food and supplies. (Courtesy Rick Friedman)

A van crawls through the streets of downtown Boston, pausing at the intricate iron entrance to a city landmark or a doorway carved in stone. By day, these openings are passages to power and wealth. At night, they are coveted shelters from wind, sleet or snow. People inside the van know this. Their carefully trained eyes scan the shadows of every building, stairway or bench, watching for hints of life.

On Winter Street, at the end of a brick alley, there’s a flicker of movement. The van pulls over and a figure in a light coat emerges.

“Is that you James?” asks a man with a reassuring, deep voice who has stepped out of the van. “You going in tonight?”

What Happens To The Body Of A Person Who Sleeps Outside In Extreme Cold?

Dr. Jim O’Connell, with Boston Health Care for the Homeless Program, explains:

When a person gets cold, their body shuts down blood going to the skin to preserve warmth near the heart. When hands and feet don’t have enough blood they may develop frostbite.

With frostbite, hands, feet, ears and noses can swell and blister. The skin turns black and necrotic. In cases of severe frostbite, dead tissue will fall off or autoamputate. Some patients are left with a disfigured toe or finger, some lose the tip or whole digit.

In the last two weeks in Boston, a homeless man who sleeps on the street lost one leg below the knee as well as part of the other foot to frostbite. Another man will need to have one of his legs amputated below the knee.

O’Connell explains the body’s reaction to cold in depth here.

Nelson Bennett knows James. He sees this young man often as Bennett circles downtown Boston in Pine Street Inn’s outreach van. It’s packed with blankets, hats, gloves, underwear, socks and sandwiches. Large insulated containers keep hot water handy for instant soup, oatmeal and hot chocolate.

“It always helps, especially in these conditions, to get some warm liquid into your body,” Bennett says.

Bennett and his crew are also out every night trying to persuade people who plan to sleep on the street to spend the night in a shelter instead.

Now, with the temperature at 15 degrees and dropping, Bennett wants to know, will James come in?

No, James says. His girlfriend was assaulted at one of the shelters and won’t go back, so he’s staying out with her. James stands next to a pile of ripped boxes from which he’s pulling pieces to build their bed. It will be three layers of cardboard pushed up against a glass office front with a short wall around the sides.

“I kind of go a little overboard,” James says, laughing. “I don’t want any of the rodents and whatnot getting in.”

James explains he collects new pieces of cardboard every night and throws them away in the morning.

“Once you get in this situation, it’s like impossible” to get a job and get back into housing, James explains. “I have my own issues up here,” he adds, tapping his head. “I’ve had a lot happen, but I don’t want to deal with it so…”

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Newton Parents, Community Leaders Seek Answers After Teen Suicides

The first was last October: a promising senior who was fighting an eating disorder. The second suicide within two weeks was another young woman, a sophomore who struggled with depression. Then two days ago, the city of Newton buried its third teen, a boy, a junior who killed himself without any warning to his family, friends or teachers.

Nearly 400 parents attended Tuesday nights community forum on teen suicide at Newton South High School. (Martha Bebinger/WBUR)

Nearly 400 parents attended Tuesday nights community forum on teen suicide at Newton South High School. (Martha Bebinger/WBUR)

“Who could ever imagine that we’d be back here again under similar circumstances?” asked Newton Public Schools Superintendent David Fleishman Tuesday night as he welcomed nearly 400 parents to another community forum on teen suicide.

Outside the auditorium at Newton South High School, two moms stopped to share stories about Roee Grutman, 17, who was buried Monday. The suicide of this outgoing student seems to have stunned everyone who knew him.

“We’re all worried about our kids, every parent I’ve spoken to tonight is worried about their kid,” said Barbara Pittel, whose children knew Grutman.

Faith Paul’s son had three classes with him.

“When my son transferred in middle school, Roee was the first person who made friends with him,” Paul recalled. “He was just awesome.”

Parents are worried, because “if [suicide] happened to Roee, it could happen to our kids,” Paul said.

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Mass. Approves 20 Medical Marijuana Dispensaries

CLICK TO ENLARGE: Dispensary locations across Massachusetts (Mass. DPH)

CLICK TO ENLARGE: Dispensary locations across Massachusetts (Mass. DPH)

A small grocery store and a former warehouse are among the buildings that may soon be redesigned to open for a very different purpose: selling marijuana to qualifying patients.

The Massachusetts Department of Public Health on Friday approved 20 medical marijuana dispensary licenses in 19 communities.

Voters approved the use of marijuana for medical purposes in 2012. The law said the state could OK up to 35 dispensaries, with at least one, but not more than five, in each county.

Boston, in Suffolk County, has two licenses. Four licenses were awarded in Middlesex County, with two licenses each in Barnstable, Bristol, Essex, Norfolk, Plymouth and Worcester counties. Hampden and Hampshire counties each got one license.

The dispensaries are in the following cities and towns: Ayer, Boston (2), Brockton, Brookline, Cambridge, Dennis, Fairhaven, Haverhill, Holyoke, Lowell, Mashpee, Milford, Newton, Northampton, Plymouth, Quincy, Salem, Taunton and Worcester.

Four counties do not yet have a dispensary. Six qualifying dispensary applicants were invited to seek an alternate location, in order to serve the remaining counties. State officials said they may issue additional licenses in June.

Owners who were notified they cleared state approval will now have to begin the local approval process, which includes zoning, inspection and public health rules in some communities.
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Uncertainty Surrounds Medical Treatments For Transgender Youth

Last of a three-part series.

BOSTON — Jackie cocks her head to one side, trying to recall the first clue that her daughter Natalie wanted to try life as a boy.

“I found something on my Amazon account,” Jackie says. “She had used my Amazon account to buy a binder, so I thought it was a binder for school.”

Jackie giggles as she remembers mentioning the bill to Nate.

Nate Piracini at his home in Boston. (Jesse Costa/WBUR)

Nate at his home in Boston. (Jesse Costa/WBUR)

“‘Oh, you should tell me,’ ” Jackie says she told Nate. “‘I go to Staples all the time. I’ll get you some binders.’ ”

Nate muttered something about it being a different kind of binder.

Then Jackie noticed the charge: $39.95. The product link opened to a picture of a female wearing a thick elastic band that made her chest nearly flat. Breast binders are a common early step for females transitioning to male, but they come with health risks.

Dr. Ralph Vetters, who treats transgender teens at the Sidney Borum Jr. Health Center in Boston, says binders make breathing more difficult, increase the risk for lung infections and, “by compressing the breasts, they can cause a sort of fibrosis. Scars may be a word for it. It hurts.”

The alternative for transgender men — females transitioning to male — is surgery that pulls tissue out of the breast. The procedure costs $5,000 to $10,000 and is only covered by a handful of employers in Massachusetts. (Harvard University, where both of Nate’s parents work, covers transgender medical procedures.)

Teenagers need a parent’s permission for surgery and any other transgender medical treatment before the age of 18. Some doctors refuse to help patients of any age make such a fundamental change. Leonard Glantz, who teaches bioethics at the Boston University School of Public Health, says the main concern is surgery that removes a healthy penis, ovaries or breasts.

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Nate's Transgender Story: Battling Perceptions And Pronouns

Nate, who was born Natalie, shares a laugh with his dad, Tom. (Jesse Costa/WBUR)

Nate, who was born Natalie, shares a laugh with his dad, Tom. (Jesse Costa/WBUR)

First in a three-part series.

BOSTON — Nate leans in, his broad shoulders hunched, his brown bangs almost touching the sewing machine bulb.

“Yes,” says the 16-year-old, with an “s” that lingers. “OK, I’m gonna keep going, it’s not stuck.”

Nate’s fingers push the seam of a sky-blue fleece stocking cap past the pounding silver needle.

“I’m going to do the hood and worry about the cowl later,” he says without looking up.

The hood is part of a costume Nate plans to wear to the next meeting of his cosplay, or costume role-play, group. There are cosplay chapters all over the world. Nate’s is based on a Web comic called “Homestuck.” His transformation from Natalie to Nate began two years ago, when he put on a blue men’s suit and boots, and gelled his hair into thick loops.

“That’s where I started it,” he says. “And then it just kind of took off from there. It was just like, no, I’m a boy.”

As far back as he can remember, Nate, of Boston, was uncomfortable as a girl.

“I felt so wrong as a female, it was just so wrong, and there was so much I didn’t like about myself,” he says in a soft, steady voice.

Nate had never heard the word “transgender” before he got to high school. But once he did, and figured out what it meant, “I was just like, ‘Oh my God, that’s exactly how I’m feeling.’ When you’re trans you just know. It’s not something like…” Nate pauses. “I don’t want to be like this. Who would choose this?”

Nate Becoming Nate, And Heavy Conversations

Nate at his home in Boston. (Jesse Costa/WBUR)

Nate at his home in Boston. (Jesse Costa/WBUR)

Nate’s parents, who are divorced, and his stepfather are trying to understand and accept Nate’s decision, but they are worried and scared.

Nate’s future is hard to imagine, says Tom, Nate’s dad.

“This is a big challenge to a lot of people,” Tom says. “And that’s where it gets scary. When people don’t understand things, that’s when they get the most uncomfortable and we don’t know what they’re capable of. So I want to follow Nate around everywhere and just say, ‘Wait a minute, don’t even try that.’ But of course that’s not possible.”

Nate and his family agreed to do this story in the hopes that it will help people understand transgender issues, but they are also concerned that it will leave Nate exposed and vulnerable. WBUR has agreed not to publish the family’s last name.

“I was just like, ‘Oh my God, that’s exactly how I’m feeling.’ When you’re trans, you just know.”
– Nate, on figuring out what 'transgender' means

Last year, Nate cut his straight brown hair short, started wearing a thick elastic binder to compress his breasts, and gave away his “girl” clothes. Even as Natalie, he’d been wearing a lot of flannel shirts and jeans. Nate has not had surgery to flatten his chest, nor has he started hormones that would produce new facial and body hair, more muscle and a deeper voice.

He still loves the high notes his female vocal cords can hit, but when speaking, Nate very consciously drops his voice into its lowest range to try to sound male.

“My vocal tone, the way it’s deep right now, this isn’t natural,” he says. “My natural voice is — no, we don’t talk about that.”

Nate’s parents say they weren’t shocked when Natalie yelled, during an argument, “I’m a boy,” but they didn’t exactly see it coming either. Continue reading

Mass. Launches A Grand Experiment: Pricing Health Care

There’s a grand experiment underway in Massachusetts and we are all, in theory, part of it.

Here’s the question: Can we actually list prices for childbirth, MRIs, stress tests and other medical procedures, and will patients, armed with health care prices, begin to shop around for where (and when) they “buy” care?

One of the first steps in this experiment is a new requirement that hospitals and doctors tell patients who ask how much things cost. It took effect Jan. 1 as part of the state’s health care cost control law and we set out to run a test.

Our sample shopper is Caroline Collins, a 32-year-old pregnant real estate agent from Fitchburg who is trying to find out the price of a vaginal delivery. Her first call is to the main number at Health Alliance Hospital in Leominster. From there, she is transferred to the hospital’s obstetrics department. A receptionist there tells Collins to call the billing office at UMass Memorial Medical Center in Worcester, Continue reading

Why Boston-Area Hospitals Have A Big Range In C-Section Rates

Though only performed on women, Cesarean sections — the incision in a woman’s abdomen and uterus through which doctors deliver a baby — have become the most common surgery in the U.S.

Many health care experts grimace at this news. Research shows a C-section can have negative consequences for both the mom and the baby. And though childbirth experts have been pushing to reduce C-sections, their sense of urgency has not spread to many doctors or moms, who say C-sections are an important option in the process of delivering a healthy baby.

So are C-sections really that bad? Lots of women have one. It’s generally considered low-risk surgery. You can barely see the scars these days. And there’s some dispute about whether they really cost a lot more than a normal vaginal delivery.

So if you’re wondering why some people get worked up about rising C-section rates, listen to Dr. Catherine Spong, with the National Institute of Child Health and Human Development. She says birth is a natural process that prepares a baby to enter the world.

“If you have a Cesarean delivery without any labor, without going through any of those processes, sometimes [babies] have problems with that transition because they haven’t undergone all of those physiologic changes,” Spong says.

There’s a growing body of evidence that children born by C-section are more at risk for asthma, type 1 diabetes and obesity. And there are risks for the mom, so preventing first-time births by C-section is particularly important.

“Once you’ve had a Cesarean and you have an incision in the uterus, that incision could open, called uterine rupture,” Spong says. “That can be catastrophic for both mom and that subsequent baby.”

The odds of that rupture and other bleeding problems are not high, but go up with each birth.

The federal government had hoped to cap Cesarean sections at 15 percent of all births by 2010, but the country blew right past number. In Massachusetts, 23 percent of first-time moms have C-sections. But within the state there’s a big range.

In the Boston area, Cambridge Hospital has the lowest rate of C-sections, at 15 percent, according to data collected by the state Department of Public Health. Tufts Medical Center has the highest rate, with 30 percent, but that’s only slightly more than other prestigious teaching hospitals, such as Brigham and Women’s and Beth Israel Deaconess.

Nurse manager Jessica Buinicki, left, and Dr. Kate Harney sit in the birth center at Cambridge Hospital. (Martha Bebinger/WBUR)

Nurse manager Jessica Buinicki, left, and Dr. Kate Harney sit in the birth center at Cambridge Hospital. (Martha Bebinger/WBUR)

The gap in rates may have something to do with the culture of these hospitals.

At Cambridge, Tufts Hospitals

The culture of childbirth at Cambridge Hospital begins in a Victorian house, across a driveway from the main hospital lobby. It’s the Cambridge Birth Center. Both the hospital and birth center are part of Cambridge Health Alliance.

The center is as close to a homebirth as you can get without staying home. Dr. Kate Harney, the hospital’s chief of obstetrics and gynecology, walks up a winding staircase into a room with big windows, painted a soft blue. She sits down on a four-poster bed covered with a diamond-pattern quilt.

The room “has all the emergency equipment,” Harney says, but it’s “nicely hidden away.”

Only about 10 percent of pregnant women who come to Cambridge Hospital give birth in this house. Most women choose a more traditional experience in the main hospital. But Harney says the natural birth focus of the center sets the tone for all hospital deliveries. Continue reading