Long Mile Home: Boston Under Attack, the City's Courageous Recovery, and the Epic Hunt for Justice (13 page)

He arrived at Mass General around 3:15
P.M.
, a few minutes behind the first patients from the bombing, carrying a banana and wearing surgical scrubs he had hastily pulled on at home. He dove right in, running upstairs to grab the cap and protective glasses he would need in the operating room. Speeding back downstairs and into the ER, he came around the corner and had a clear view of four or five patients lined up in the trauma bays, a series of small exam rooms all in a row. Normally the curtains around the bays were pulled closed, but today, in the chaos and confusion, they were open, giving him an unobstructed panorama of the injuries. That was all it took for him to be sure: A man-made explosive device had blown up at the marathon. He had seen these injuries countless times before, thousands of miles away, as a combat surgeon treating wartime casualties. Most of his work in the army reserve with his forward surgical team was on bombing victims:
75 percent of injuries suffered by American soldiers in Iraq and Afghanistan were caused by explosive devices. Only 20 percent of the wounds came from guns.

King moved toward the most severely injured patient he could see: a blonde woman covered in black soot whose leg had been brutally burned and broken by the bomb. It was Roseann, the woman Shana Cottone had found lying in the street. Shana had helped deliver her to the ER just minutes earlier, in the back of a police transport van. “This lady looks like she’s dying,” King said to another surgeon. “Does she have a chest X-ray?” He reached out a hand to check the tourniquet on her leg, making sure that it was tightened to his satisfaction. He glanced at the unit of blood hanging up over her head and checked that it was flowing at the correct rate. Then he pointed at a young surgical resident standing nearby. “Let’s go,” he said. They moved out of the ER at a brisk clip, pushing Roseann’s gurney down a hallway with white tile walls. Ten seconds later they were in an elevator, ascending from the first floor to the fourth; two more turns of the hallway and they were in the OR, past the big white doors marked
RESTRICTED AREA
. A full team was already there prepping the room: a dozen people, maybe more, dressed in blue scrubs and masks, scrambling now to save Roseann’s life. Saucer-shaped lights glowed bright over the table; cameras at the center of each one would capture the surgeon’s every movement and project it onto big flat-screens mounted high on the wall for his team. “We’ll start with the abdomen,” King told them. “Then the leg.” As he waited for the anesthesiologist to put Roseann under, King pulled out the banana he had been carrying and ate it. No more than five minutes had elapsed since he had walked into the hospital.

Had the blonde woman been the only bombing victim at Mass General that day, her journey to the OR probably would have taken longer, with more stops along the way. A chest X-ray was the bare minimum of information needed for surgery; ideally, she might have had several other X-rays or a CAT scan. But the circumstances of the bombing—with dozens of patients flooding the hospital, and an unknown number yet to come—changed everything. There was no way to calculate the right amount of resources to expend on each, because they did not know when the demand would cease. It was, in a strange way, like the starting line at the marathon: The hospital had to move each wave of patients out of the emergency room and into operating rooms swiftly, to make sure they could keep up with the next wave gathering behind. Trauma teams and specialists worked side by side in a blur, exchanging patients seamlessly, any preexisting disagreements swept aside by the rising sea of need. Normal electronic record-keeping had gone out the window. King was taking notes on index cards stashed in his pockets; when he ran out of cards, he jotted reminders to himself on the leg of his blue scrubs with a black Sharpie marker, lines of scrawled ink creeping up his pant leg from his knee. The overload had driven staffs at other hospitals to similar measures, and would lead, in the case of Krystle Campbell, to that rare and wrenching misidentification.

King’s fundamental approach to surgery on victims of a bombing was the same whether he was in rural Afghanistan or in a top-notch Boston hospital. In either situation, he followed his “medical rules of engagement,” a list of reminders he had posted on the wall in the ER. Chief among them was this: Do not be distracted by the obvious. The most “visually stimulating” injury—that is, the one that looks the most gruesome and dramatic—“is almost never the one that kills them,” he explained. “The leg might be ugly and obvious, but it’s probably not the one that’s fatal.” Problems that were invisible on the outside—perforated organs; uncontrolled internal bleeding; system-wide vascular breakdown—could create an irreversible downward spiral. He had to look further, probe deeper, and consider carefully where to go first when he got into surgery. It could mean the difference between death and survival.

They all knew Monday night’s work was just the beginning. The first operations aimed just to stop the bleeding, remove the shrapnel, and limit the risk of infection. They would let the patients rest before heading back to the OR to continue their work on wounds that had been left open for that purpose. The goal was to minimize the stress on the sickest patients, breaking up the complicated repairs they needed into a series of smaller, discrete tasks. There would be days of follow-up surgeries ahead, patients who might require three, four, a dozen or more operations. King and a handful of his colleagues sat down together in a conference room late Monday night and reviewed a list of all the patients and their injuries. It was the first chance he had had to consider how he felt, and the first thing he realized was that he was wild with thirst. He had finished the marathon nine or ten hours earlier, and all he had eaten since was a banana. A medical student, dispatched to the ICU pantry to find him something to drink, came back with packages of Saltines and graham crackers, a can of Coke, and a carton of milk. Chewing on the crackers, King felt awful. He would finally go home and to sleep at around 2:00
A.M.
; before the sun rose Tuesday, he was headed back to work. There wasn’t any time to watch the news or read the paper. He knew, at once, less than most people about what had happened and far more than most would ever want to know.

 • • • 

W
ith the eyes of the world still fixed on Boston Tuesday morning, the names of the wounded were beginning to leak out. Already, friends and family members of the most severely injured were setting up fund-raising pages on the Internet, drafting paragraphs describing their loved ones, and their injuries, and uploading photographs taken in happier times. It was a big step to go public, to give up a victim’s cloak of anonymity even before the prognosis was clear, but a sense of urgency crept in as the national media descended. With millions watching, the public’s shock had quickly turned to sympathy. It had become clear that many of the victims would be facing long and costly rehabilitations. There was tremendous potential to tap the mass impulse to help, but the impulse wouldn’t last forever.

An online campaign for Jeff Bauman, the man who lost both legs, raised $745,000 in nineteen days, attracting gifts from more than sixteen thousand people. By Wednesday, the world would know the names and faces of Patrick Downes and Jessica Kensky, attractive young newlyweds who’d each lost a leg in the bombing. By Thursday night, as they lay in two different hospitals just three days after the bombing, donations to their fund-raising site would reach $300,000. Over the next four months, the total would nearly triple, to $875,000. Donors who clicked on the site for Patrick and Jessica lingered over a photo of the pair taken on a carefree stroll before the tragedy; in it, they walk together holding hands through Harvard Square in Cambridge, Jessica smiling as she looks back at Patrick, the skirt of her red dress flaring as she strides ahead. The poignant image seemed to capture all the innocence and freedom they had lost.

No photograph would more perfectly distill Boston’s lost innocence than one of Martin Richard that ricocheted around the globe the day after the bombing. On Monday night, the news that an eight-year-old was among those killed had made the unimaginable day feel unbearable. Martin and his family—his parents, Bill and Denise, and his brother and sister, Henry and Jane—were well known and much loved in their corner of Boston. Bill had spent years volunteering his time to improve their neighborhood and was one of the people most often credited with its renaissance in recent years, its new businesses and brightly refurbished subway station and swelling civic pride. His efforts had deeply endeared him in Dorchester, a working-class haven with a long Irish heritage, and now the most diverse corner of the city, with Vietnamese pho shops scattered between the traditional Irish bars like The Blarney Stone and The Banshee. In the midst of change, violence had persisted on some streets, gangs and guns that changed how people looked at Dorchester. Some who had the means had left for good, fleeing to the safer suburbs south of Boston. Others, like the Richards, chose to stay, digging in and deepening their commitment.

As the awful news spread through the neighborhood, many residents were mute with grief, shaking their heads and waving away the reporters who had descended. They had just begun to absorb the overwhelming facts: Bill and Denise and their three young children had been standing next to the second bomb when it exploded. Both parents had been injured, Denise suffering a serious eye injury, and Bill enduring shrapnel wounds, burns, and hearing loss. Their oldest child, Henry, had escaped serious injury. But their youngest, seven-year-old Jane, who loved Irish step dancing, had lost her left leg below the knee. And Martin—the baseball-loving boy with the big brown eyes—was gone forever. It seemed more than any family could bear. At the beautifully restored Victorian home where the family lived, Martin’s classmates filed up the steps one by one to leave flowers and notes and balloons by the door. Meanwhile, on the Internet, a photograph of the freckled child holding up a handmade sign had gone viral.
NO MORE HURTING PEOPLE. PEACE
, the boy had written with colored markers.

The Richards were among the families who met with Governor Deval Patrick as he visited six of the city’s hospitals Tuesday and Wednesday.
Patrick spent time with Bill, Denise, and Henry. The governor didn’t see Jane; she was in surgery. Bill told Patrick of a photograph he had of Martin, as a toddler, holding one of the governor’s campaign signs. They talked about how the family could go about rebuilding their lives without the whole world watching. They wanted to maintain their privacy. Denise had the impossible task of simultaneously mourning her son and staying strong, to aid her own recovery and that of her family. Patrick wasn’t sure, in these visits, what to say. All he knew was that he didn’t want to say much. He figured the bombing victims and their families probably didn’t want to hear it. What he could offer, he felt, was a dose of emotional support, a warm hug, a quiet reminder that he cared.

That held true for the caregivers, too. Just before 8:30
A.M.
on Wednesday morning,
Patrick arrived at the emergency department of Brigham and Women’s Hospital. The plan was for him to slip into the hospital quietly, without the media knowing, greet employees in a small staff lounge, and maybe make some remarks. Patrick began walking around the emergency room, chatting quietly with secretaries, nurses, housekeepers, anyone he came upon. He shook hands, he gave hugs, he asked how they were doing. They were simple, unremarkable gestures, but something about his solicitousness gave license to people to open up and confront their own emotions. Many broke down in his presence. “People who had been saying, ‘No, no, I’m fine’ up until that moment with him seemed to say, ‘It was really hard. It was really awful,’” said Erin McDonough, the hospital’s senior vice president of communication and public affairs, who was there. “It started to feel okay to say you’re not okay.” Patrick approached one nurse who had been working on Monday. She’d seen the carnage wrought by the bombs. Her husband, a paramedic with Boston EMS, had been one of the responders who tried to help Martin Richard on Boylston Street. Patrick walked over and embraced her. He thanked her and her family, but didn’t say much more. He didn’t need to. They stood, arms locked, for several moments.

Patrick figured that the adrenaline that had been propelling the medical teams since Monday afternoon would soon begin to ebb, that the enormity of it all would soon sink in. His message, when he finally made it to the ER lounge, was simple. “I told them I wanted them to know that they were appreciated, that I was proud of them, but that they also needed to look after themselves,” he said. The Brigham, like the city’s other top hospitals, boasted some of the most accomplished doctors and nurses and technicians in the world, wizards of medicine whose skill and experience would save lives that week they had no business saving. Underneath, though, they were still people. Their own emotional wounds, which they’d tried, out of necessity, to ignore since the bombs had gone off, would also need tending.

 • • • 

A
s dusk fell on Tuesday outside her hospital room, Heather Abbott was feeling reassured: The terrible thing that had happened to her could have been worse. She had learned the answer to her question—the question she had hardly dared to ask—and to her surprise, she still had her foot. It was there, underneath the sheet that covered her leg. She was one of the lucky ones. She could hardly believe it. But she wasn’t out of the woods yet—the doctors had made that clear. In the hours after the bombing, surgeons had removed blood vessels from her undamaged right leg and grafted them into the left in the hope they would take over the work of circulating blood through the devastated foot. But it was too soon to tell if the transplant would take. If it failed, much more painful options might await her.

Heather’s close friend Jason Geremia had been with her at the bar by the finish line. Now he was beside her in the hospital. A home builder from Newport who was nearly ten years her senior, he had always been protective, like an older brother. Late into Monday night, after the bombing, he had waited downstairs with their other friends, in a room filled with the families of other victims. Every group of loved ones he saw was different—five people here, a couple there, a girl by herself in the corner—but almost every one of them was crying. There was food and water in the room, and at some point as the hours crawled by, a priest appeared. Jason found himself talking to the man, asking him why God would let something like this happen.