(Jim Rogash/Getty Images)

I have a recurring nightmare where I am performing CPR on a patient who turns out to be my husband.

Last Monday, my nightmare nearly came true.

It was 2:50 p.m., and the Massachusetts General Hospital ER was filled to capacity.

In the section where I was working, my patients were critically ill, with strokes, heart attacks and overwhelming infections. Even the hallways were packed with patients receiving emergency treatments.

A call over the loudspeakers announced that there had been two explosions. Many people were injured. That’s all we knew.

As we cleared the emergency room, there was a second call. These were bombings. There were fatalities and dozens, maybe hundreds, of injured. How many were coming to Mass General? Nobody knew.

Three minutes later, the doors flew open. Stretchers came, one after the other. Some victims had no pulse and weren’t breathing. Others had legs blown to shreds. All were covered with blood and soot.

The ER smelled of burnt flesh, and each stretcher left behind a fresh trail of blood.

My first patient was unconscious and bleeding profusely. I knew what to do. Within minutes, he was on a respirator to help him breathe and had two tourniquets to stop bleeding.

My second patient, a young woman my age, was screaming and crying. One of her feet was gone and she had severe burns. She was wailing for her family. Where was her husband? Where were her children? For her, I had no answers.

Screams mixed with ambulance sirens. The loudspeaker sounded again and again, announcing that more patients were on their way.

Amid the chaos, I asked a paramedic where they were coming from. Copley Square, at the marathon’s finish line, he said.

My heart stopped. My husband had texted me to say that he was leaving work for an hour to watch the marathon. We live just a block away from Copley Square, and he was headed there.

Where was he? I frantically dialed his cellphone, only to hear a busy signal. I couldn’t keep calling. I had to focus on the next patient in front of me, an unconscious man who was probably going to lose his legs and needed my help.

In the middle of his resuscitation, a terrible thought occurred to me: Could this patient be my husband?

I looked at the pile of shredded clothing heaped in the corner, half-burned and soaked with blood. I didn’t recognize the brown belt or the tan slacks.

As more patients came in with shattered bones, bloody stumps and bodies riddled with nails and pellets, I sighed with relief when I didn’t recognize their clothing.

I hated myself. What kind of person was I to wish this horrible suffering on someone else’s family instead of mine?

An hour passed. Friends called me to say they were OK, but nothing from my husband. I kept texting: Where are you? I love you.

Two hours later, a cellphone rang. A nurse, a surgeon and I all reached for our pockets, but it wasn’t ours.

The phone was in a pile of clothes in the corner, in the tan slacks of my patient who had gone to the operating room to complete his amputations. I picked it up and saw the messages that had come through: “Where are you? I love you.”

That long day eventually came to an end.

My husband was unharmed. He had misplaced his cellphone, it turned out.

The suspects were identified and one was captured. And Copley Square has mostly reopened.

Life seems back to normal — except it’s not. In the ER, I shudder every time I hear the loudspeaker. Each sound of sirens makes me wonder if it’s my husband in the ambulance.

At work, I feel numb to my patients’ suffering. At home, I break down and cry. Then I feel guilty. Who am I to have these emotions, when so many others suffered so much?

A week after the bombings, I’m not sure what lessons I learned.

I do know that as much anger and sorrow as many may harbor, we need thoughtful reflection to prevent the wrong ideas from taking hold.

The suspects are immigrants, but so are many of the first responders and emergency care providers — like me, an immigrant who came here on political asylum from China.

The suspects were armed and dangerous. But even if every spectator were armed, could guns protect against bombs? The bombings brought on a week of terror, but we cannot live our lives in paranoia and isolation.

For all of us involved, there will be two lives — one before and one after the bombing. I hope that this new life is one that fosters kindness and inclusion, and encourages the collaboration and togetherness that the medical community and all of Boston exemplified last week.

Let these tragic events be a call to action to treat each other as we would our own families.

Wen is an emergency physician at Massachusetts General Hospital and Brigham & Women’s Hospital in Boston, and author of When Doctors Don’t Listen. Follow @DrLeanaWen

Patrick and Jessica Kensky Downes, newlyweds, who each lost their lower left leg in the Boston bombings. (Photo from Jessica’s Facebook page)

A week after the Boston Marathon bombing, only the most seriously injured are still hospitalized. Sacramento native Jessica Kensky Downes and her husband Patrick are among them. As Martha Bebinger of WBUR reports, the couple were at the finish line when the explosions ripped through the crowd. Patrick and Jessica both each lost the lower part of their left legs.

From WBUR:

Friends are having a hard time reconciling this news with memories of the joyful pair who married just last August.  Smiles in photos of Jessica and Patrick jump off the screen.

“But that’s not just a photograph,” says Leslie Kelly, who watched Jessica grow up just outside Sacramento, Calif.  “Those two are the happiest, most optimistic, wonderful people,” continues Kelly, which provides “a real good foundation for both of them going forward.”

Jessica’s right foot was also badly damaged in the blast, but the family has told friends it looks like it can be saved. And Patrick’s third surgery went well. …

“When Patrick came to, he asked if the Red Sox had won,” says Boston College buddy Tom Treacy. “It sounded like they were certainly in good spirits.”

The couple, who married last August, live in Cambridge, Mass. WBUR reports that Jessica, 32, is a nurse at Massachusetts General Hospital. Patrick is 29 and is completing a graduate degree in psychology.

Kelly has set up an online fund to help raise money to support the couple through their hospitalization and rehab. People have already donated more than $600,000 to a GiveForward campaign. (There are GiveForward campaigns for other victims of the Boston bombings as well.)

The Sacramento Bee printed part of a statement from family members expressing their gratitude: ”Your support in just 24 hours is overwhelming, there are no words to describe what your outpouring of kindness and generosity means to our family as Patrick and Jess start their long road to recovery.”

An update Monday morning on a special Facebook page devoted to the couple says they are both in surgery today. Patrick is already out and doing well.

(Jessica Marcy: KHN)

The Supreme Court’s historic hearings of the Affordable Care Act have wrapped up. The Court addressed four issues over the last three days and held a total of six hours of oral arguments.

Below is complete audio and transcripts from each set of arguments.

First, the court heard arguments about whether it can even consider the case now. Under the new law, the first penalties would be assessed in 2015 for those who do not purchase health insurance. An arcane 1867 law says people can’t sue over a tax until they pay a tax. Must the court wait until 2015 to decide whether the health law is constitutional?

You can listen to the 90 minutes of oral arguments here:

Or read on for the complete transcript as well as audio and transcripts from the other arguments:

The second set of arguments was about the heart of the law–the individual mandate. You can listen to the two hours of oral arguments here:

Or here is the individual mandate hearings transcript:

“Severability” was the third question before the Court. If the individual mandate is struck down, must the entire law be cast aside? You can listen to the oral arguments here:

Or read the complete transcript about “severability”:

Finally, the Court considered whether the health law’s Medicaid expansion is unconstitutional. Listen to one hour of oral arguments here:

And here’s the Medicaid hearings transcript:

(Jessica Marcy: Kaiser Health News)

The Supreme Court signaled Wednesday that it could throw out other key parts of the Affordable Care Act if it first finds the individual insurance requirement unconstitutional.

On the third and last day of arguments, the justices appeared to accept the administration’s argument that at least two important insurance changes are so closely tied to the insurance requirement that they could not survive without it. Those two changes are the popular provisions that both require insurers to offer insurance to applicants with pre-existing conditions and also requires insurers to charge the same rates to people who are roughly the same age, regardless of their health.

Those changes should go, the Obama Administration argued, because without the individual mandate, people might wait until they’re sick before they signed up for coverage. Not enough people would be in the health insurance pool to spread risk. Ruin could come to the insurance market.

In short the Court faces three scenarios if it strikes down the individual mandate:

1. Is the mandate “severable” from the rest of the ACA–can the Court strike down the mandate while upholding the rest of the law?
2. If the mandate is stricken, should the two other changes to health insurers be struck down with it, leaving the rest of the health care law to stand?
3. Is the mandate such an integral part of the overhaul that the entire law should be cast aside?

The Associated Press reported that Paul Clement, the lawyer for the states arguing to overturn the health care law as a whole, said the court would leave a “hollow shell” if it turned aside the individual mandate and the two other insurance provisions. “The rest of the law cannot stand,” he insisted.

Justice Antonin Scalia suggested many members of Congress might not have voted for the bill without the central provisions, and he said the court should not go through each and every page to sort out what stays and what goes.

For those keeping track of the three scenarios outlined above– the Administration argued that if the individual mandate is overturned, that two other provisions must go; attorney Clement argued for some states who say the whole ACA should go and the Supreme Court appointed an attorney, H. Barton Farr III, to argue for severability of the mandate alone (Scenario #1).

As NPR’s Shots blog reports:

And he [Farr] makes the case that even if the mandate is removed, the rest of the law can stand. His brief acknowledged that Congress expected all parts of the law to work together with the mandate.

But even if the mandate goes away, he writes, “it is far from evident that the benefits of extending coverage to those previously excluded from the insurance market cannot still be realized, to a significant degree.”

As the arguments started again Wednesday morning, a smaller group of demonstrators gathered than on Monday and Tuesday. Marching on the sidewalk outside the court, supporters repeated chants they’ve used the past two days including “Ho, ho, hey, hey, Obamacare is here to stay.” Most of the group left not long after arguments began inside.

Opponents of the law, including Susan Clark of Santa Monica also stood outside the court. Clark, who was wearing a three-cornered colonial-style hat, carried a sign that read “Obamacare a disaster in every way!”

“Freedom, yes. Obamacare, no,” other opponents chanted.

The Supreme Court heard two sets of oral arguments today in its final day of considering the health care overhaul. The second arguments were extended and wrapped up about an hour ago. In that session, the Court addressed the question:

Is the Medicaid expansion constitutional?

Remember that Medicaid is the health care plan for the poor and disabled that is run by individual states with both state and federal dollars. The Affordable Care Act expands those eligible for Medicaid to adults earning 133 percent of the federal poverty level. But in order for states to continue receiving any federal money for Medicaid, the ACA requires them to comply with this expansion. Twenty-six states have challenged this requirement saying that withholding all monies for Medicaid is coercive and therefore unconstitutional. Those states which support the expansion–including California–say that Congress can constitutionally attach such conditions under what’s known as the “Spending Clause.”

You can listen to the complete oral arguments about Medicaid expansion here:

Or read on for the complete transcript … and for audio/transcripts of all the Court’s earlier sessions:

Original post 9:45am PT:

In the first set of arguments earlier today, the Court addressed the question:

If the Individual Mandate is Unconstitutional, Can the Rest of the ACA Go Forward?

On Tuesday, the Supreme Court heard arguments about the constitutionality of the individual mandate. What about the rest of the ACA? If the individual mandate is struck down, can the rest of the ACA go forward? Earlier this morning the Court heard arguments to determine if the mandate can be “severed” from the Affordable Care Act, allowing the remainder of the ACA to stand.

You can listen to the complete oral arguments here:

Or read the complete transcript:

The audio and transcript of Tuesday’s oral arguments at the Supreme Court can be found here.

The audio and transcript of Monday’s oral arguments can be found here.

(Image: Kaiser Health News)

WASHINGTON (AP) — The heart of the Obama administration’s health care overhaul hanging in the balance, the Supreme Court is turning to whether the rest of the law can survive if the crucial individual insurance requirement is struck down.

The justices also will spend part of Wednesday, the last of three days of arguments over the health law, considering a challenge by 26 states to the expansion of the Medicaid program for low-income Americans, an important feature toward the overall goal of extending health insurance to an additional 30 million people.

The first two days of fast-paced and extended arguments have shown that the conservative justices have serious questions about Congress’ authority to require virtually every American to carry insurance or pay a penalty.

The outcome of the case will affect nearly all Americans and the ruling, expected in June, also could play a role in the presidential election campaign. Obama and congressional Democrats pushed for the law’s passage two years ago, while Republicans, including all the GOP presidential candidates, are strongly opposed.

But the topic the justices take up first on Wednesday only comes into play if they first find that the insurance mandate violates the Constitution. If they do, then they will have to decide if the rest of the law stands or falls.

The states and the small business group opposing the law say the insurance requirement is central to the whole undertaking and should take the rest of the law down with it.

The administration argues that the only other provisions the court should kill in the event the mandate is stricken are insurance revisions that require insurers to cover people regardless of existing medical problems and limit how much they can charge in premiums based on a person’s age or health.

The federal appeals court in Atlanta that struck down the insurance requirement said the rest of the law can remain in place, a position that will be argued by a private lawyer appointed by the justices, H. Bartow Farr III.

On Tuesday, the conservative justices sharply and repeatedly questioned the validity of the insurance mandate.

If the government can force people to buy health insurance, justices wanted to know, can it require people to buy burial insurance? Cellphones? Broccoli?

Audio and transcripts for Tuesday’s court argument can be found here.

The court focused on whether the mandate for Americans to have insurance “is a step beyond what our cases allow,” in the words of Justice Anthony Kennedy.

“Purchase insurance in this case, something else in the next case,” Chief Justice John Roberts said.

But Kennedy, who is often the swing vote on cases that divide the justices along ideological lines, also said he recognized the magnitude of the nation’s health care problems and seemed to suggest they would require a comprehensive solution.

And Roberts also spoke about the uniqueness of health care, which almost everyone uses at some point.

“Everybody is in this market, so that makes it very different than the market for cars or the other hypotheticals that you came up with, and all they’re regulating is how you pay for it,” Roberts said, paraphrasing the government’s argument.

Kennedy and Roberts emerged as the apparent pivotal votes in the court’s decision.

The law envisions that insurers will be able to accommodate older and sicker people without facing financial ruin because the insurance requirement will provide insurance companies with more premiums from healthy people to cover the increased costs of care.

“If the government can do this, what else can it not do?” Justice Antonin Scalia asked. He and Justice Samuel Alito appeared likely to join with Justice Clarence Thomas, the only justice to ask no questions, to vote to strike down the key provision of the overhaul. The four Democratic appointees seemed ready to vote to uphold it.

Kennedy at one point said that allowing the government mandate would “change the relationship” between the government and U.S. citizens.

“Do you not have a heavy burden of justification to show authorization under the Constitution” for the individual mandate? asked Kennedy.

At another point, however, he also acknowledged the complexity of resolving the issue of paying for America’s health care needs.

“I think it is true that if most questions in life are matters of degree … the young person who is uninsured is uniquely proximately very close to affecting the rates of insurance and the costs of providing medical care in a way that is not true in other industries. That’s my concern in the case,” Kennedy said.

Justice Ruth Bader Ginsburg said she found the debate over health care similar to an earlier era’s argument about the Social Security retirement system. How could Congress be able to compel younger workers to contribute to Social Security but be limited in its ability to address health care? she wondered.

“There’s something very odd about that, that the government can take over the whole thing and we all say, Oh, yes, that’s fine, but if the government wants to preserve private insurers, it can’t do that,” she said.