Dr. William D. Tobler, Jr., remembers this about his dad: He coached all of his baseball teams and made a concerted effort to attend all of his games. The senior William D. Tobler, MD, may have been late – he was almost always late – but he got there.
“It’s not until now that I realize what he did,” Dr. Tobler, Jr., says. “I don’t know how he did it. My mom says he probably went back to work after we went to sleep.”
That special father-son bond extended to The Christ Hospital, where young “Tobes,” as he was known, rounded with his father on weekends and quickly developed an interest in surgery.
Now a general surgery resident at Boston Medical Center, the primary teaching affiliate of the Boston University School of Medicine, Dr. Tobler, Jr., did his parents and mentors proud last week as he helped anchor one of several operating rooms where lives hung in the balance following the bomb explosions that killed three people and wounded more than 170 near the Boston Marathon’s finish line.“He worked so hard to save these lives,” said his mother, Terri Tobler.
Dr. Tobler, Jr., a 2008 graduate of the University of Cincinnati College of Medicine, had just finished an elective case when he received two text messages from one of his sisters, the first asking whether he was OK, the second alerting him to an explosion at the marathon. “I went down to check, and as I opened the doors to the trauma bay, that was the moment when patients started coming out of the ambulances and into the medical center,” Dr. Tobler said.
Twenty-three of the patients injured in the blasts were brought to Boston Medical Center.
Over the next six and a half hours, Dr. Tobler performed multiple duties. He triaged patients, performed life-saving maneuvers, reapplied tourniquets, and helped with blood and IV fluid transfusions. He also was summoned to one of several operating rooms on the surgical floor, where he and an attending operated on two patients, removing shrapnel and tissue.
Dr. William Tobler, Jr., at Boston Medical Center
The experience was at once routine and unprecedented. “We actually see injuries like this all the time,” Dr. Tobler said. “What we do not see is a large number all at the same time. I had never seen a terrorist attack like this. So although we have constant exposure to patients who have suffered trauma, the hard thing for us in this situation is seeing young patients with traumatic injuries from an event in which someone purposefully tried to injure people.”
At that point in the day, however, Dr. Tobler did not have time to reflect on the magnitude and horror of what had happened.
“You train in trauma surgery and you kind of develop an unconscious competence where you just go into work mode,” he said. “You don’t think; it’s more reflexive. You do what you need to do. At that moment, I didn’t stop to think about what was going on. I was focused on doing what was necessary to get the patients into a safe environment and to take care of life-threatening injuries.”
In cases where traumatic amputation is inevitable, Dr. Tobler said, “our primary objective is to remove tissue that will not survive and leave as much as we can so that the patient has as much function as possible. If you can keep the amputation to a level below the knees, the patients tend to do better. During trauma surgery, you also want to be in the operating room for as short a period of time as possible: we do damage control operations to take care of the life-threatening injuries in critically ill patients and then move them as quickly and safely as possible to an intensive care unit, where they can be resuscitated as appropriate. Often, they will have to go back to the OR multiple times.”
Three days later, Dr. Tobler was one of three surgical residents from Boston Medical Center to receive an invitation to attend the Presidential interfaith service at the Cathedral of the Holy Cross in Boston.
“It was one of the first times I’d had a chance to sit down and reflect on what had happened,” Dr. Tobler said. “People from Boston are very resilient, and we are not going to let something like this take control of our lives. We are going to come back and be better than ever.”
Dr. Tobler praised the first responders for saving lives with their rapid, selfless efforts. “There was a quick and heroic effort by people who ran towards the explosions rather than away,” he said. “On top of that, Boston Medical Center ran smoothly in all facets of responding to trauma. There was great coordination between the emergency room staff and the trauma surgeons as well as the nurses. It was a coordinated effort that involved a lot of people, and the people directing it who are my superiors did a great job.”
After texting his parents Monday night, Dr. Tobler also texted one of his most important mentors, Jeffrey T. Keller, PhD, Research Professor of Neurosurgery & Anatomy and Cell Biology at UC and the Mayfield Clinic. As a medical student at UC, Dr. Tobler had been involved with UC’s Department of Neurosurgery and the Mayfield Clinic and had performed research with Dr. Keller in the Goodyear Microsurgical Laboratory.
“Tragedies so often bring out the worst but, fortunately, also the best in people,” Dr. Keller said. “I was proud to learn that William D. Tobler, Jr., MD, aka “Tobes,” was able to assist some of those injured by terrorist bombs at the Boston Marathon. As one of his mentors, I say with a tincture of pride that I participated in his training — training that enabled him to assist those so gravely wounded by a senseless act of terror. Tobes’s arduous educational pathway for the last nine years has afforded him the talent and skill to practice his craft as a surgeon and to render care and comfort to those most in need of such expertise.”
As Dr. Tobler, Jr., eyes the end of his residency in general surgery, his future remains uncertain. He has been interested in plastic surgery since working with Operation SMILE while in college, and he has applied for fellowships in that sub-specialty.
“Plastic surgery is a diverse field that is complex and challenging, and the creativity sparked an interest for me,” he said. “I am inspired by the potential to restore function to patients, to enable them to live a normal life following trauma or cancer surgery. I have long thought that plastic surgeons were the most skilled surgeons in the hospital, and I have wanted to emulate that.”
— Cindy Starr