Editor’s note: In honor of Veterans Day, November 11, the Bulletin is proud to publish this article about two victims of the 2013 Boston Marathon bombings who received care at Walter Reed National Military Medical Center, Bethesda, MD, and found solidarity among the veterans who were receiving care at the facility.
The prospect of being treated for their blast wounds at Walter Reed National Military Medical Center, Bethesda, MD, gave civilians Jessica Kensky and Patrick Downes a reason for hope—a feeling the newlyweds needed after they both required traumatic amputations from injuries sustained at the Boston Marathon bombing on April 15, 2013. They did have some concerns, however.
“I was nervous about coming to Walter Reed for treatment,” Mr. Downes said. “I was very cautious because this place exists for veterans who have made a purposeful decision to do something for their country. We didn’t make that sacrifice. We just happened to be in the wrong place at the wrong time. I didn’t want anyone to think we were taking advantage of the services that are available for veterans.”
These worries proved unfounded, according to Benjamin Kyle Potter, MD, FACS, orthopaedic surgeon, Walter Reed, and F. Edward Hebert Associate Professor, Uniformed Services University of the Health Sciences, Bethesda, who has provided care and guidance to the young couple since they arrived at the hospital. “I can tell you that they have been welcomed with open arms,” he said. “There is absolutely no resentment that their injuries didn’t come from the battlefield. They have become an important part of our rehab group.” Dr. Potter noted that the couple has joined wounded service members at several events, including bike races.
A veteran reaches out
The couple wound up at Walter Reed thanks in part to the efforts of retired U.S. Army Captain Ferris Butler. Captain Butler, who lost both legs after his vehicle struck a roadside bomb in Iraq, watched televised coverage of the Boston bombing from Walter Reed and wondered how he could help the victims.
“I saw the first reports from Boston, and I knew immediately that this explosion was not an accident,” Captain Butler said. “My first thought was, ‘How can I help?’” He learned through an acquaintance that Jessica’s sister, Sarah, was completing an internship at Walter Reed while studying at Boston University. Through this connection, Captain Butler and Jessica arranged to talk via Skype. Jessica worried that she would have nothing in common with someone who had made a sacrifice on behalf of his country and represented his family’s ninth generation of military service. To her surprise, they spoke openly for three hours. She learned not only that they shared many of the same anxieties, but also that someone who lost both legs was able to lead a full, purposeful life.
“Connecting with Jessica felt full circle to me. I wanted so badly to help someone,” Captain Butler said. “Now I had a specific person with a specific need and injury that was similar to my own.” The Captain was the first to introduce the couple to military programs that grant Secretarial Designee status to civilians, providing them with services through the nation’s military health care system. “I don’t have much to compare with Walter Reed, since I was extremely healthy before my injury,” said Captain Butler. “But the care I received at Walter Reed was second to none. No expenses are spared for veterans, and nothing is left uncovered.”
Thanks to Captain Butler’s persistence, along with support from family, friends, and a number of elected officials, Mr. Downes and Ms. Kensky eventually gained access to the military health care system. On their initial visit to Walter Reed, they were awestruck by the America Building, which houses the Military Advanced Training Center (MATC)—a state-of-the-art facility with a team of physical and occupational therapists who follow service members from their initial evaluations through their discharge. MATC technicians fit and adjust prosthetic devices on site. Cameras and interactive screens are available with special treadmills.
American College of Surgeons (ACS) Executive Director David B. Hoyt, MD, FACS, wrote about MATC in his “Looking forward” column in the March 2014 issue of the Bulletin.* The facility impressed him as the most “patient-centered, accessible, high-quality care available within the military health system.” The MATC’s goal is to help patients move from injury or illness to functional, independent recovery and reintegration through rehabilitation. The on-site prosthetic service, he pointed out, uses three-dimensional printers to produce titanium prosthetic and orthotic components. Once fitted with the device, occupational therapists work to ensure that the patient is able to use the apparatus properly and independently.
For the last two years, Mr. Downes and Ms. Kensky have resided at the Naval Support Activity Bethesda naval base, where they continue to receive comprehensive care from clinicians with experience in treating complex blast-related injuries. At the Navy base, the two patients have access to an integrated system of comprehensive care from specialists of several disciplines, including surgery, rehabilitation, therapy, pain management, prosthetics, and behavioral health. They have benefited not only from the support of the most astute surgical minds focused on blast injuries, but also from the camaraderie with other patients who have injuries similar to their own.
“The kinship we feel with active duty patients as a result of our experience here is eternal,” Mr. Downes said. “Before this happened to us, we had an appreciation for those who served our country, but we tended to have those thoughts as clichés. Now it’s very real for us. We’ve formed such important bonds of friendship here with members of several not-for-profit organizations.”
Their common experiences have forged a lasting friendship between Captain Butler and his wife Laura and Ms. Kensky and Mr. Downes. “I always joke that in another life, we would not have crossed paths, and now we talk to each other every week,” Captain Butler said. All four of them continue to work in support of several not-for-profit groups that serve military veterans and disabled citizens, including Achilles International, which enables people with all types of disabilities to participate in mainstream running events; the Semper Fi Fund, which provides financial assistance to wounded Marines and their families during recovery; and the Vail Veterans Program, which sponsors outdoor recreational programs for individuals injured in the military and their families.
Day of the bombing
Mr. Downes’ and Ms. Kensky’s lives were, indeed, very different before April 15, 2013. There was no hint of impending tragedy that spring day of the famed Boston Marathon. The young couple, who had been married a little more than seven months, walked hand-in-hand enjoying the sunny Patriots’ Day celebration, a state holiday and a rite of spring in Boston. The couple was planning a move to San Francisco, CA, where Mr. Downes would begin a doctoral internship in clinical psychology. Although both were runners, they were enjoying this event as spectators. They stopped at the finish line to cheer on the runners completing the 26.2 mile course.
Two bombs, which contained BB-like pellets and nails that exploded 12 seconds apart near the finish line on Boylston Street, abruptly changed their lives. According to the U.S. Federal Bureau of Investigation, the bombs exploded from pressure cookers hidden inside backpacks. The blasts killed three spectators and left an estimated 264 injured, with 17 people, including Ms. Kensky and Mr. Downes, requiring traumatic amputations.
Mr. Downes has no recollection of the blasts. “I was in and out of consciousness. I have snapshots of what happened that day, but everything I know is from Jess retelling it,” he said. Mr. Downes and his wife, an oncology nurse at Massachusetts General Hospital, Boston, each sustained grievous injuries that, in both cases, resulted in the amputation of their left leg below the knee. They suffered a number of other serious but less visible injuries, including ruptured eardrums, shrapnel wounds, impaired vision, depression, anxiety, mild traumatic brain injury, and post-traumatic stress disorder.
In the chaos that followed the blasts, the two were transported to different hospitals. An ambulance carried Mr. Downes to Beth Israel Deaconess Medical Center. Ms. Kensky went to Boston Medical Center for her injuries, and for one day, neither patient knew the condition of the other. “Jess and I first saw each other two weeks after the bombing,” he said. “Her team transported her to see me at Beth Israel.”
Mr. Downes’ injuries were less extensive than his wife’s, and he has recovered more quickly. He is able to move around with a prosthetic leg. Ms. Kensky’s right leg, however, sustained considerable damage. “Her Achilles heel was blown off, and her foot was missing so many essential pieces,” her husband explained. Walking was excruciating. Her right ankle was so out of alignment that with each step, she splintered cartilage and bone. In addition, a painful knot of bone at the end of her amputated left leg—a heterotopic ossification—made wearing the prosthetic almost unbearable. This excess bone growth in soft tissue is common among Iraq and Afghanistan war amputees. Two years after the bombing, Ms. Kensky, who her husband said has endured “so many operations we’ve lost count,” had her right leg amputated below the knee.
Both Mr. Downes and Ms. Kensky wish they had a timetable that would allow them to map out their recovery, but they have been forced to be patient. “We wish we knew that it will take X number of days, and then we can move to the next step, but the body has its own time frame,” Mr. Downes said.
The young couple has stayed in close contact with other Boston bombing victims who underwent amputations. “The feeling that we all have, I think, can only be understood by those who have experienced it,” Mr. Downes said. “We get to see them whenever we go home to Boston. We will forever share a bond with them.”
The couple will always feel profoundly grateful to the Boston first responders and the medical personnel who took care of them immediately after the bombing. “Boston is the mecca of medicine,” Mr. Downes said. “The doctors and nurses were incredibly helpful. They took care of us. They took care of our families. They ran errands for our families. We remain very close to the Boston clinicians.”
Likewise, they will always be grateful to the clinicians and veterans who continue to provide their support at Walter Reed. “We feel so blessed that here at Walter Reed, we are accepted and understood,” Mr. Downes said.
Running the marathon
In the spring of 2015, Mr. Downes put on his running shoes again and began to train. In April 2016, wearing a running blade, he ran the Boston marathon alongside friends and family members. As he passed through the neighborhoods of his hometown, he ran with the initials on his chest of the three bystanders killed in the 2013 blast and the Massachusetts Institute of Technology police officer murdered by the bombers a few days later. As the runner passed Boston College (BC), his alma mater, he heard cheers and saw BC supporters holding up signs of the team’s mascot, the Eagles. He ran on behalf of a generous scholarship endowment, Boston College Strong, created by the Class of 2005, to honor the young couple. The perpetual fund will provide scholarships to disabled students.
Mr. Downes and Ms. Kensky continue to advocate for a strengthened national trauma system that would merge care in the military and civilian populations and ultimately result in “zero preventable deaths.” This type of military-civilian collaboration is exactly what is being advocated in the newly released report from the National Academies of Sciences, Engineering and Medicine (NASEM), and sponsored in part by the ACS. The NASEM report, A National Trauma Care System: Integrating Military-Civilian Trauma Systems to Achieve Zero Preventable Deaths after Injury, seeks to enhance the care of civilian trauma patients while preserving the military trauma system during interwar periods. (For details, see the October 2016 Bulletin, pages 23–28.) Merging of the two systems also facilitates adoption of the advances made in Iraq and Afghanistan into civilian trauma care and serves to enhance research endeavors. The ACS Committee on Trauma and the ACS partnership with the Military Health System initiated in 2014 support these efforts.
*Hoyt DB. Looking forward. Bull Am Coll Surg. 2014;99(3):8-9. Available at: bulletin.facs.org/2014/03/looking-forward-march-2014/. Accessed September 14, 2016.