Two weeks after the Boston marathon bombings, the legions of police that swarmed the city have given back the streets, and the news crews that dogged their every move have mostly melted away. Life is returning to normal.
But for the victims who lost one or more limbs to amputation – the only life-saving answer to flesh and bone shredded beyond repair by exploding shrapnel – the long road to recovery has just begun.
For them, normal will never be quite normal again.
Cyndi Desjardins knows what the 15 amputees in Boston are going through – and then some.
Two years ago, she awoke from a month-long medically induced coma to be told that surgeons had had to perform amputations to save her life after necrotizing fasciitis, or flesh-eating disease, had overwhelmed her body.
The lower portions of all four limbs were gone.
Desjardins recalls the moment “clear as day” when her husband gently gave her the news: Doctors had removed both legs below the knee, and both arms below the elbows.
“I remember an incredible feeling of heartbreak,” she says.
“And I know exactly what goes through your head when you’ve had a life-altering situation like this: ‘What kind of life am I going to have?’”
Six months earlier, she’d given birth to her son Liam, a brother for six-year-old Cienna, whom the couple had adopted as an infant.
“My thought was how am I going to hold my children? My son doesn’t know who I am; my daughter misses me terribly. How was I going to make my daughter lunches? How was I going to do her hair? And how was I going to do anything for my children, let alone I was going to have to learn how to brush my teeth, brush my hair and do everything for myself all over again?
“And I knew, too, that the only way I would get through is if I was going to set very specific goals to recapture my independence and reclaim our lives,” says Desjardins, 45, of Holland Landing, Ont., north of Toronto.
“I’ve been raised with faith. And in that moment, thank God I’d been raised with it, because it was going to carry me through.”
As with any loss, amputees typically go through a period of mourning; some will also experience depression as they grapple with their altered physiology and the frustration of adapting to the new reality of their everyday lives.
About 85 per cent lose a limb because of complications from diabetes or peripheral vascular disease, explains Dr. Michael Devlin, a physiatrist at West Park Healthcare Centre in Toronto who specializes in amputee rehabilitation.
“For the most part, they knew the amputation was coming. They’ve had open sores or gangrene, they’ve been house-bound, they’ve been having home-care nurses coming in to do dressing changes,” he says. “Their life had gone down the drain already, and an amputation for that particular population is a step ahead and a step up.”
The other 15 per cent will have suffered a sudden health threat or trauma that led to amputation: bone cancer; a rampaging infection; a traffic or work-related accident; or a blast injury while in a war zone like Afghanistan.
For these patients, the first reaction is shock, says Dr. Sally MacLean, a psychologist at Glenrose Rehabilitation Hospital in Edmonton. “You’re just amazed: ‘How could this happen?’ And the whole notion of how fast things can change and how things can change inevitably for the future.”
Emotions run the gamut from denial to ruminating about such questions as “why me?” – all of which are normal reactions, says MacLean, adding that psycho-behavioural therapy can help a patient work through their grief and fear.
Concerns arise if the person gets stuck and can’t move forward, putting them at risk for depression, anxiety or post-traumatic stress disorder, she says.
The latter, which can manifest itself months down the road as flashbacks or reliving the injury or accident, is more likely to occur when the event was perceived as life-threatening.
Peer support also can be critical for speeding emotional healing, adds Devlin.