BOSTON - Bombing Victims Face Difficult Path

"Victims in Boston Face a Difficult Path to Recovery" by ABBY GOODNOUGH and JESS BIDGOOD, New York Times 4/25/2013

Excerpt

Almost two weeks after the Boston Marathon bombings, which killed three and injured more than 260, the medical toll is becoming clearer, with many of the victims suffering complex wounds that are causing intense pain and that will require several more operations.

Thirty-one victims remained hospitalized at the city’s trauma centers on Thursday, including some who lost legs or feet.  Sixteen people had limbs blown off in the blasts or amputated afterward, ranging in age from 7 to 71.  But in a way, their cases are the simpler ones, said Dr. David King, a trauma surgeon at Massachusetts General Hospital.

For some whose limbs were preserved, Dr. King said, the wounds were so littered with debris that five or six operations have been needed to decontaminate them.

“The idea is to spread out the physiological stress over multiple operations,” he said.

Some of the wounded also still need surgery to repair bones, veins and nerves.  Many will need physical therapy as well.  About 10 patients have already arrived at Spaulding Rehabilitation Hospital in Boston, said Timothy Sullivan, a spokesman, and that number could soon double.

For many of the wounded, managing pain is a constant challenge.  Dr. Alok Gupta, a trauma surgeon at Beth Israel Deaconess Medical Center, said the hospital was giving patients oral and intravenous narcotics and, where possible, regional nerve blocks using catheters.

Dr. King said that for those who lost limbs, so-called phantom pain — which feels as if it is coming from the body part that is no longer there — can be excruciating and particularly hard to treat.

“You have to balance between taking the pain away,” he said, “and them being interactive and able to participate in their own rehabilitation.”

The ailments are not just physical.  Some patients are upbeat, doctors said, but others are angry, anxious and depressed.

Joan Smith, the manager of social work services at Tufts Medical Center, said that virtually all of the 14 victims who came through the hospital were experiencing post-traumatic stress disorder that may continue indefinitely.