Finding a new normal after the Boston bombings

PAUL NORDEN NEEDS a break. He is winded, sweating heavily after a stint on a stationary bicycle and the slow walk to a padded treatment table. It is hard work for Norden, who lost his right leg that Monday afternoon in April.

"I used to say, 'I'll never go to a gym,'" he says with a weary smile. "Now I'm stuck here."

He is in Spaulding Rehabilitation Hospital's large state-of-the-art gym for his afternoon physical therapy session. Just a few short weeks ago — a lifetime ago — Norden, 31, was clambering on the very roof above his head, a "tin knocker" who helped attach sheet metal to the new $225 million facility.

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Now, Norden and 21 other survivors of the Boston Marathon bombing, including two of Norden's boyhood friends, are among its first inpatients.

As Norden rests, Adam Soiref, a physical therapy intern, takes advantage of the break to show him how to properly wrap his stump. Norden soon will be doing this on his own, and it's important that he knows how to maintain its conical shape as the tissue shrinks, to ensure a good fit with the prosthesis he will receive in coming months.

They remove an Ace bandage, revealing the angry, jagged suture line. With Soiref's guidance, Norden rewraps what remains of his leg, which ends above his knee.

Rehab at Spaulding is the second phase of the attack victims' recovery, a grueling, at times painful, step in their transition to an uncertain future. The immediate physical and psychological impacts of the blasts have slowly begun to subside. Ahead is the difficult period of learning to function outside the cocoon of support that has been spun around them. For Norden, that will mean negotiating the 14 steps up to the second-floor home in Wakefield where he will live with his mother. It will mean learning to reach for something high in a kitchen cabinet while balancing on one leg and a crutch. It will mean adjusting the way he bathes, grappling with medical expenses, and finding new ways to simply get around. His family also must care for his older brother, J.P., who lost his right leg in the bombing as well.

For now, though, Paul Norden and the others are in the care of a small army of doctors, psychologists, physical therapists, occupational therapists, family, and friends at Spaulding, as they learn those new skills and regain others.

"They are getting through this," says Spaulding psychologist Christopher Carter. Many victims have moved on from the need to rehash the attack itself. Some have begun to startle less easily and calm down more quickly when they do. Burned skin is healing. Damaged hearing is returning.

In the gym, Norden says: "I'm just focusing on learning how to walk. I don't know what the future holds. I'm not giving up, I know that."

THE FIVE BUDDIES from Stoneham, a mostly working-class bedroom community of 21,000 north of Boston, have known each other since elementary and middle school. Some have become closer as time has passed. They have worked, fished, and played poker and basketball together for years. Most also have been coming down to the marathon every Patriots' Day since they were able to drink legally.

This year, they were there to cheer for Mike Jefferson, another friend who was running the race and was headed up the final stretch on Boylston Street. They gathered outside Forum, a bar near the finish line. The Norden brothers were there, along with Jacqui Webb, Paul Norden's girlfriend of eight years; James "Bim" Costello; Marc Fucarile; and Jarrod Clowery, who was making his first trip to the marathon. Three older women who knew the gang were nearby.

The first blast went off near the finish line, a short distance down Boylston Street from where the group stood.

"Right away, I knew it was a bomb," Costello says as a physical therapist helps him stretch his badly burned legs in the Spaulding gym. It didn't make sense that race officials would fire a cannon to celebrate people finishing long after the winners had crossed the line. "I said, 'That's a bomb' three times," he remembers.

At 35, Clowery had given up his dream of making a living as a professional pool player. Now he was sleeping on J.P. Norden's couch, doing residential construction work with the brothers when he could get it. He was with them and their family for Easter dinner.

Something told Clowery the group would be safer in the middle of Boylston Street than behind the waist-high spectator barricade outside the bar. He put one hand on the barricade and began to vault it. When the second bomb went off at ground level just a few feet away, Clowery's legs were atop the metal fence. That's why he still has them.

"Before I could finish saying, 'Get your ass in the street,' boom!" Clowery recalls.

He was blown into Boylston Street by the blast and opened his eyes to a scene of unspeakable carnage. A few feet away, a small boy lay dead. The street was awash in blood, littered with body parts. Costello was tangled in a barricade, his shirt and pants partially burned away.

"I actually thought to myself, 'Are these my last breaths?'" Costello recalls. "From head to toe, I was like on fire." He got up and started to make his way down Boylston Street, his shirt smoldering, asking for help. No one came to his aid in those first few moments. He sat on the curb and pulled two nails from his abdomen.

Clowery could be any guy in long, dark sweatpants and a light sweatshirt, until he rolls up his sleeve to show what looks like a small field of blackheads on the underside of his left wrist. It is actually debris — wood, plastic, dirt, and other detritus blasted into his arm by the bomb. The nastiest wound is from a hot nail that entered his skin lengthwise. Sometimes Clowery uses tweezers to pull out tiny bits. Surgeons have removed denim from his thigh.

In his right leg are three nails, 20 BBs, and a metal spring. He faces more surgery to remove some of the objects, but others will be left to work their way to the surface or remain in his body forever. His left hand, contracted and burned by the blast, has been massaged back to health by occupational therapists. Sometimes it shakes uncontrollably.

EVERYONE IN THE Stoneham group survived. But both Norden brothers lost their right legs. Fucarile lost his right leg and suffered severe damage to his left. Costello was badly burned. Webb suffered shrapnel wounds in both legs, but, like Clowery, has gone home.

Costello and Paul Norden are still at Spaulding, and J.P. Norden may be there soon.

Costello cannot stand still, because the blood pools in his leg, causing intense pain despite the medication he takes. Therapists have worked basketballs into the regimen for him and Paul Norden, hoops fans who played regularly in pickup games and rec leagues. Costello dribbles, cuts, passes, and pretends to jump shoot under the watchful eye of his physical therapist, each drill designed to improve his balance, strength, and movement.

At the end of his Thursday afternoon session, he gazes across the gym at Norden, who is beginning to make his way across the floor on crutches. "That's my inspiration right there," he says.

Norden admits he did not work out much before the attack. He weighed 246 pounds. He is 206 now, but an apples-to-apples calculation is difficult. "I don't know how much my leg weighed," he says. He looks drawn and pale, his head newly shaved. Burned skin is a fiery red below the bandages on his remaining leg.

The luxury of being out of shape is one of many things Norden has lost to the bomb. If he is to walk again normally when he is ready for his prosthesis, he must regain his balance, strengthen his core, and develop his remaining leg. He will need more upper body strength in coming months as he moves around on crutches or with a walker. He has to improve his stamina and agility.

Soiref and his supervisor, Kristen Vito, put Norden through a tough 90-minute set of exercises Wednesday. He practices going up and down stairs on crutches, negotiates an obstacle course with his walker. He sits on an exercise ball and plays catch with a basketball. At times he is nervous about falling over.

"If I give out, I don't have another leg to catch me," he says.

The therapists are relentlessly positive and by Thursday's session, Norden's spirits have rebounded. "I just want to be prepared, and they're going to get me prepared," he says about leaving Spaulding sometime soon. "So I think I'll be confident."

IN THE GYM on Wednesday are half a dozen soldiers from Walter Reed National Military Medical Center, all with amputations or leg injuries. One man in a wheelchair is missing the lower half of his body. Another, Staff Sgt. Travis Mills, 26, lost all four limbs to an improvised explosive device in Afghanistan. Mills, who wears three different kinds of prostheses, including a myoelectric left arm that works via muscle contractions, shows amputees how to get up after falling to the floor.

The soldiers walk among the injured, on hand to answer a question or deliver an "attaboy" but careful not to intrude.

"We kind of came up here to show them there's life after amputation," Mills says. "You gotta get stronger and keep going. You can't sit and dwell on the past.

"You're not a bad person," he adds. "It's not because of anything you did with your life. Things just happen."

There has been an outpouring of physical, emotional, and financial support for the survivors. They are celebrities, feted at pro sports events, visited by everyone from President Obama to New England Patriots owner Robert Kraft. When Clowery, at a news conference, said the choreography of the medical response surpassed any drive that Patriots quarterback Tom Brady had orchestrated on a football field, Brady signed a jersey and had it delivered to Clowery, who keeps the prized possession in a cabinet in his room.

The nearly $30 million donated to the One Fund for victims, and the money pouring into smaller and individual funds, seems staggering until costs are closely considered. For an above-the-knee amputee such as Norden, a prosthesis will cost $30,000 to $60,000 and will need replacement about every three years. During each three-year period, adjustments and component and socket replacements can add another $10,000 to the cost. Insurance coverage varies widely, he said.

"You're [31] years old and you're missing a leg and you're not working," Clowery says of Norden. "It's going to take five years to get well."

But all that is for the future. The Stoneham victims share a determined focus on the here and now. They spend less time each day on the past, little yet on what is to come.

"I know we'll be normal," Norden says. "It's just a different normal."

By Lenny Bernstein. ©2013 by The Washington Post. Reprinted with permission.