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Dzhokhar Tsarnaev shortly before being taken to Beth Israel Deaconess Medical Center.

Tending to Tsarnaev

A trauma surgeon on the moment the accused Boston Marathon bomber became his patient.

On the evening of April 19, 2013, Dzhokhar Tsarnaev was rushed by ambulance to Boston’s Beth Israel Deaconess Medical Center after a gun battle with the FBI. Dr. Stephen Odom was the attending trauma surgeon on call. Boston and its surrounding towns had been on lockdown all day as police hunted Tsarnaev, and it was a tense time throughout the city — not least of all at the hospital, where several marathon bombing victims were recuperating from surgeries and amputations.

Tsarnaev arrived with multiple gunshot wounds, “the most severe of which appears to have entered through the left side inside of his mouth and exited the left…lower face,” Odom told a judge in a hospital bedside court hearing on April 22. “This was a high-powered injury that has resulted in skull-base fracture, with injuries to the middle ear, the skull base, the lateral portion of his C1 vertebrae, with a significant soft-tissue injury, as well as injury to the pharynx, the mouth, and a small vascular injury that's been treated,” Odom explained to the judge.

Last year, Tsarnaev’s lawyers filed a motion to strike from the record statements that Tsarnaev made from his Deaconess hospital bed in the days before that interview — statements he made involuntarily, they argue, while on heavy painkillers. Questioned by the FBI’s “high value interrogation group,” he had to write his answers in a notebook because a tracheotomy made him unable to talk. In the notes, Tsarnaev wrote things like, “I’m hurt,” “I’m exhausted,” “Can we do this later?,” and “You said you were gonna let me sleep.” One note reads, “I need to throw up.” At one point, his lawyers write, “his pen or pencil then trails off the page, suggesting that he either fell asleep, lost motor control, or passed out.”

On the day Tsarnaev arrived and in the week that followed, Odom performed Tsarnaev’s emergency surgery, then led the team that coordinated Tsarnaev’s care before he was transferred to the Federal Medical Center in Devens. Odom recounts to The Marshall Project how he weighed the FBI’s pressure to interrogate Tsarnaev against his own obligation to protect his patient, recuperating from life-threatening injuries in the intensive care unit.

Dr. Stephen Odom

Dr. Stephen Odom

When did you get the heads-up that Tsarnaev was going to come here?

Me and the residents, the on-call team, you got the sense that something was happening. On the news — you see snippets of the news — he’s been surrounded, things like that. There’s five Level I trauma centers in Boston, so you kind of never know when something goes down which center it’s going to go to. But we heard the patch on the radio from the Watertown EMS saying that he was coming here.

What were you thinking when you heard it on the patch?

I would say my preeminent feeling at that time was anxiety. Then crowd control became an issue. It was a madhouse, between the people who belong there and the people who are there to see the show. There were tons of people: security, administrative people. A number of surgeons — all the muckety-mucks in the surgery department were here to offer their assistance. It was a crowded situation, so I was concerned about how to lead a team in the midst of all that chaos. Then there was the concern, raised by the security here, of him being armed or wired in some way. So there was a potential threat to the staff as well. We only had moments — it was probably 5 or 10 minutes before he arrived that we knew he was coming.

You’d treated patients under armed guard before, but this sounds like it was a whole other scale.

Oh yeah, this was out of control. We often take care of “the bad guy.” But I’ve never seen anything like this. There were hundreds of police officers and FBI. There was a pretty heavy presence of armed people with visible weapons. That’s not something you usually see in a hospital or an operating room.

Did they get in the way of you doing your job?

No, I don’t think so. They were very respectful of what we had to do. They were pretty clear that they wanted us to do everything we could to get him to talk. To do a good job so that he could tell them why and where and when and all that stuff. The FBI officer in charge told me, ‘anything you need from us, we can help.’

Dzhokhar Tsarnaev, surrounded by police, on April 19, 2013.

Dzhokhar Tsarnaev, surrounded by police, on April 19, 2013.

What did he think you might need from him?

I guess he was just indicating that they were not there to impede the process or to direct it in any way. I think it was just a general way to say, ‘despite the fact that I am wearing an FBI jacket and have a machine gun, I’m here to protect you and protect the suspect.’ I think he was trying to take down some of the tension that was pretty obvious.

And there were some decisions that we had to make, later on, in the operating room, that wouldn’t necessarily be compatible with a quick interview. And they were like, ‘whatever you need to do to be safe and do the right thing.’

Did you actually run it by them in the moment, in the OR?

They were there. I was thinking out loud with the team, and they indicated that they were not going to be involved in those kinds of decisions and didn’t want to be.

You said you often take care of the “bad guys.” Can you talk more about that?

Trauma is not always the innocent person crossing the street who gets hit by a car. A lot of times, I would say, trauma is influenced by drugs or alcohol — someone’s doing something they’re not supposed to do. Sometimes you’ll have the drunk driver in one room, and two rooms down you’ll have the lady that he ran over.

You must have developed methods over the years of compartmentalizing your role as a caregiver versus your human reaction towards a “bad guy.”

In general, surgery, you have to emotionally divorce yourself. You wouldn’t normally cut somebody open. You have to have some distance anyway and focus as much as you can on the job. I would say that this was harder, not because of who it was, so much as, this was on the news. There was constant stress from the administration and news agencies and law enforcement — from all the stakeholders. Each party had something they wanted.

Remember, the hospital was suddenly home to hundreds of law enforcement. A lot of that was on the hospital’s dime. So the administration was kind of anxious to move things along. Also, steering clear of media was a challenge. So you’ve got to sneak out through the loading dock, or go out through the back door of the office on the side.

The patient, too. How do you make sure you’re doing the right thing for the patient when you’ve got a lot of pressure from law enforcement to interrogate? We had to, in a friendly manner, negotiate the best way to do that so that it was safe. So that I wasn’t necessarily abandoning him to the authorities, but they could get the information they wanted to get. I was unsure about the ethics of that at the time. I was unclear about what the right thing to do was. I think we did a pretty good job of finding the balance. We set up a way so that we could monitor things from an adjacent room so that it was safe. Any time we wanted access to him, we just had to let them know. They didn’t want us present for the interrogation, but if we saw something on the monitor, say, that we didn’t like, we could just knock on the door and they would let us in.

Police medics attend to Dzhokhar Tsarnaev at the scene of his arrest.

Police medics attend to Dzhokhar Tsarnaev at the scene of his arrest.

How did the media get in?

There was some woman, she was a journalist, but she had a leg amputation, and she had a prosthetic. And she came in with a short skirt on. The prosthetic was prominently on display. She came in here, and said, I want to talk to some of the victims, give them some encouragement. Turns out, she was working for some outlet, and was really trying to finagle her way in. So slimy. There was a whole bunch of that kind of shenanigans going on.

We were all under very clear instructions not to take any photographs at any time. That next morning [after Tsarnaev’s surgery], there was a photo from the OR on some website. The FBI photographer had come in and was taking identification photos. So the FBI leaked this photo. But, that morning, everybody who was in the OR got called to talk to the FBI, and they were like, “One of your staff leaked this photo, and we want to know who it is.” I was like, “Listen, I was there, I saw who took the photo, and it was your guy who took the photo.” That was the first day.

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What was the water-cooler conversation? What did nurses talk about at the nurses’ station?

There was a very select set of nurses that worked with him. We all talked to each other and spent a lot of time together — not letting off steam — but, we were together a lot. We could kind of tell when somebody was getting stressed out. These nurses were working, two of them at a time, 12-hour shifts, over and over and over, under incredible stress. There were so many consultants involved, and there was such pressure to get everything exactly right. They did an awesome job, but it really was stressful for them.

What made it so much more stressful than usual?

You’re under observation. Nothing was routine. There were a number of security checkpoints to move through the hospital, just to get to his room. When there’s complex decision-making, you always wonder, Oh gosh, is this the right thing to do? So we were always second-guessing everything. Then also, I was like, Am I doing this because of who it is? Or am I doing this because it’s the right thing to do? So there was a lot of that questioning going back and forth. We were all pretty stressed out, and we talked to each other a lot about that — how to try and make good decisions, not bow down to anybody’s pressure.

When you wondered, Am I doing this because of who it is? Or am I doing this because it’s the right thing to do? was the impulse to do more than you would normally do?

I don’t know if you’ve ever heard about VIP medicine. The more famous a patient is, the more consultants get involved. The care is, on some level, not routine. That’s one of the symptoms: That you always want to make sure that everything goes well, so you want the absolute best resource that you have for this. You don’t necessarily always do that. I don’t want to make it sound like we give people different levels of care. It’s just that, in this case, we knew that everybody’s eyes were on it.

There’s an irony in the government spending all these resources to make this man well in order to possibly execute him. Was that on your mind?

I don’t remember thinking, at the time, that he was going to be executed. I didn’t understand, really. If you committed a crime in Massachusetts, I didn’t know you could be executed. That became clear at the indictment. The judge said, you realize that the possible punishments for this are imprisonment or death. That was a heavy moment. The judge was in her robe, and they brought in a court reporter. There were officers of court. It was very official, but it was in a hospital room, which I’ve never seen. When the charges were read to him, suddenly it was outside of my medical comfort zone. It definitely made me question my part in it — part of this societal institution that has this weird authority. I was part of the people on this side of the bar.

Did you have a personal opinion about the death penalty before all of this?

I’ve never been a fan of the death penalty. It’s not necessarily something I agree with politically or ethically. But, that being said, I grew up in Texas. So I’m not unsympathetic to people wanting the death penalty. I get it. I understand that people want it. I just don’t necessarily think that they should be able to get it.

What do you say to someone who says this guy doesn’t deserve the world-class care that he got?

I think everybody deserves world-class care. What would the alternative be? I think people who say that would never actually have to turn somebody down. That’s what I think. Even people who are incarcerated for terrible stuff still get care. It’s just what we do.