Family photo via Facebook
Paul and JP Norden each lost a leg in Monday's bombings at the Boston Marathon. At least 11 people lost limbs in the attack, and perhaps several more, according to hospital reports.
By JoNel Aleccia, Senior Writer, NBC News
The most severely injured patients from Monday?s bomb blasts in Boston showed up at Massachusetts General Hospital with their lower legs ?completely mangled? -- torn limbs hanging by skin and tissue, said Dr. George Velmahos, chief of trauma.
Faced with massive blood loss and imminent death, there was no time to discuss the only option that could save patients? lives -- amputation.
?We just completed the ugly job the bomb did,? Velmahos told reporters at a briefing. ?This was not the time for talking. This was the time for doing.?
Four patients at that hospital lost their legs, plus five more at Boston Medical Center, said Dr. Peter Burke, chief of trauma surgery. The toll reportedly included two grown brothers who each lost a leg, plus the 6-year-old sister of Martin Richard, 8, who died.
All told, there have been 11 confirmations of amputations after the blasts, plus reports of several more lost or threatened limbs, hospital officials said. Overall, three people died and at least 176 were hurt in the blasts.
That makes Monday?s tragedy one of the worst sites for limb loss on U.S. soil since the terror attacks in 2001, said Ian Weston, executive director of the American Trauma Society.
?To be honest, shy of 9/11, that?s where we?ve seen this level and similar types of injury,? he said, adding that it was more like a battlefield than a civilian setting. Even emergency doctors accustomed to horrific casualties weren?t used to this, Burke told NBC News.
?We see traumatic amputations, or the need for amputation after trauma, but not generally five patients in the same day,? he said.
The Boston victims will join about 185,000 Americans who undergo amputations each year, and the nearly 2 million who live with existing loss, according to the Amputee Coalition, an advocacy group. Most lose limbs to car crashes or lawnmower accidents, or to complications of vascular problems, such as diabetes.
The new patients are very early in the process of grappling with amputation, but some are starting to heal, Velmahos said.
?They?re amazing people. Some of them woke up today with no leg; they told me they were happy to be alive,? he said.
How well they recover -- both physically and emotionally -- depends on the care they receive now and in the weeks to come, experts said.
?Those folks are a little lucky in that they are in Boston, which has some of the best health care facilities in the country,? said George Gondo, director of research and grants for the Amputee Coalition.
The city has multiple Level 1 trauma centers and some of the nation?s most experienced disaster management experts.
Even so, the road ahead is hard. Patients with traumatic amputations ? arms, legs or feet severed by the blasts ? needed immediate surgery to treat the initial wound, but they?ll probably need more surgery to prevent infections and ensure good closure, Burke said.
After that, they?ll need weeks of management to compress the limb and control swelling in preparation for an artificial limb, said Jay Tew, an expert with Hanger Inc., one of the nation?s leading makers of prosthetics and orthotics.
?They can?t be fit if the bottom of the limb is bigger than the top,? said Tew, who started a clinic for amputees in Haiti after that country?s devastating earthquake in 2010.
In addition, the patients will need therapy to desensitize their residual limbs to touch. ?When you have the surgery, your body is very sensitive,? he said. ?Light touch can feel like an ice pick.?
At the same time, many new amputees will need psychological support, particularly from those who?ve also lost limbs. Several programs offer ?peer-to-peer? support, in which a recovered amputee will show up in the hospital room of a new patient.
?There?s something to be said about working with someone who?s been through the process,? said Weston, of the trauma society. ?To see someone who?s lost a foot doing the things you want to do, it provides comfort.?
Peter Thomas, 49, is a Washington, D.C., lawyer who lost both his legs below the knee in 1974, when he was 10.? He was in a car carrying seven members of his family when a snow plow with its blade up struck the vehicle, cutting through the car ? and severing the boy?s legs. Thomas? 8-year-old brother, Eric, died.
A few days later, a double-amputee drove 300 miles to surprise the devastated child in the hospital ? and changed Thomas? views about what he could and could not do. Now, as an adult, Thomas has visited more than two dozen amputees to share his story.
?If it?s something that you?ve been through, and you?ve made it through it, you want to help someone who?s in despair,? said Thomas, a husband and father of three sons who is an avid golfer.
Several local amputee groups say they?ve already reached out to the Boston patients. It?s hard to say how the new amputees will respond, said Thomas, who chairs the Trauma Survivors Network.
Some immediately welcome the support, but for others, it?s too soon.
?Some people are hit so hard by this that they have significant psychological issues, just to get back on track,? he added.
Thomas said he tries to reassure new amputees that they?ll adjust to their new reality. Advances in prosthetics mean that artificial limbs are lighter, more flexible and more adaptable than ever before. Patients who were runners will likely run again, said Tew.
?When I started out, there were just one or two running feet. Now, you have almost a catalog,? he said.
It may not seem like it now, but both Thomas and Tew said their years of experience have shown them that the Boston amputees will come through the tragedy.
?I just know with our spirit in America and our people, in getting through these situations, I know we?re going to see people coming back and running in this event with their new arm or leg,? Tew said. ?You can?t stop them.?
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