For the first time in too many days, Marc Fucarile has shaved. He’s wisecracking with his doctor. His fiancee sits next to him in the reclining chair that doubles as her hospital sleeping quarters. The rest of his family crowds around, leaning close to his damaged ears so he can hear better, but taking care not to brush against what they call his “good leg.”
The “good leg” is good in this way: It’s not the right leg. The Marathon bombing sheared off that leg in a millisecond. It spared the left, but not by much. The blasts broke his foot in too many places to count. Second- and third-degree burns burrowed deeply into the leg. Dozens of BBs peppered his flesh. The force of the blast turned muscle to mush and obliterated blood vessels.
Doctors have made no promises that the good leg can be saved.
Propped delicately on three fluffed pillows, the good leg is what Fucarile and his family are counting on to speed his transfer to Spaulding Rehabilitation Hospital, where, not so long ago, the 34-year-old warehouse worker for Marshall Roofing delivered materials for the new building’s roof.
On this day, with glimmers emerging of the old Marc — the confident charmer, the energetic father of a 5-year-old son he shares with his fiancee — hopes run high.
‘Unless he has some infection, we continue to go down this route and see how he does. Given the fact that we saw improvement in the last three days, I’m optimistic.’ - Dr. Jeremy Goverman
“We just gotta get him up on that good leg,” says Eddie Fucarile, his older brother.
There are 10 Marathon bombing victims scattered in hospitals across Boston. Marc Fucarile is the lone patient still at Massachusetts General Hospital. He suffered just about every injury in the array of explosion damage: amputation, burns, blown eardrums, arms and legs that daily take on new contours as shrapnel migrates out of muscle and pokes at the skin’s surface. One BB pellet, vitally, has stayed put: the one lodged in his heart.
He’s had seven operations. Pain medication is constant — both an antidote and an isolating chamber of sleep and fog. Spring has been denied, its apple blossoms and days melting away.
“What’s today? Is it May 1? Give me my computer,” Fucarile says on Thursday of last week, pointing at his laptop sitting atop jars of cookies, gifts of friends and strangers, banked on the hospital window sill. “I gotta pay my bills.”
“Bills — who cares?” his brother says.
His family — a large and loyal clan from Stoneham — is at the hospital more than not, away from young children and their jobs, his brother as a Stoneham cop, his sister as a controller for a Boston business, his fiancee as a nurse. Five of Fucarile’s Stoneham friends are grappling with their own injuries. They were standing with him at the Marathon. Two of them also lost legs.
His family spends days handing out blue and yellow wristbands that read “marcfucarile.com,” his fund-raising website, and tending to him with small comforts — running out to J.P. Licks for chocolate frappes that remind him of ones his Grandma Mabel made when he was a boy.
At times they are drill sergeants. “Don’t you want more of your chicken-broccoli ziti?” his sister Stephanie Baron insists, in the hope he’ll eat more protein that he needs for rebuilding tissue. “Marc Anthony!” his mother gently rebukes when he picks at his skin grafts.
But more than not, they are simply present, sleeping by his side, stroking his forehead, and watching over the good leg.
‘Healing is up to the body’
There is waiting, too, on the medical side.
In trauma recovery, doctors in the specialty say, medicine can provide the most favorable setting for a patient to heal — with skin grafts, antibiotics to battle infections, wound cleaning — but ultimately, a patient’s strength helps to determine the course of his or her recovery.
“Any surgeon worth his salt will say that the best we can do is optimally treat the wound,” said Dr. Michael Yaffe, a trauma surgeon at Beth Israel Deaconess Medical Center. “The healing is up to the body.”
The idea is not a new one. One of Yaffe’s favorite sayings comes from the 16th-century surgeon to French kings and wounded warriors, Ambroise Paré: “I dressed the wound. God healed it.”
For weeks now, doctors have been waiting on Fucarile’s good leg.
Early on, they placed wires to hold together the splintered foot and cleared out dead tissue. They covered his ankle’s exposed bone with artificial skin.
But major issues remained.
“The blood vessels running down to the foot were disrupted so blood flow was not what it should have been,” said Dr. Jeremy Goverman, a burn surgeon at Mass. General who is treating Fucarile.
More alarmingly, he said, “The tissue was pulverized. The muscles were really injured, though you wouldn’t see it from the surface.”
There are techniques that help spur tissue growth. But doctors weren’t sure Fucarile was a good candidate for them. Not yet.
It was best to wait.
Eager for some good news
On Friday, a day after Fucarile’s good day, the family gathers in a sunlit corridor to await the results of his sixth operation. When Goverman appears, they gather round him expectantly.
“Let’s not do this in public,” Goverman suggests, leading the family to a windowless conference room.
There is good news, Goverman tells them. Skin grafts are taking.
“But,” he says, “we’re not out of the woods yet.”
They had found more dead tissue in Fucarile’s foot. The plan remains: Pursue “limb salvation,” but with no assurances.
The family bows heads and cups foreheads.
What are the odds for his good leg? Marc’s father, Ed Fucarile, asks.
Seventy-five percent, Goverman says.
His sister presses further: Is that 75 percent chance he’ll keep the good leg, or 75 percent chance he’ll be able to use the good leg?
Goverman pushes his chair away from the table. I don’t know, he says.
That night, once again, Fucarile’s room is a crush of people. His family. The family of his fiancee, Jen Regan. Nurses from the intensive care unit pay a visit to their former patient.
“You look amazing,” one tells him. A chocolate frappe sits on his bedside table and the pillows under his foot are rearranged so the area of the ankle with exposed bone dangles freely without rubbing against fabric.
“It’s like a six-star hotel here,” Fucarile quips. “Frappes, the pillows are always fluffed.”
The family forces laughs.
Now it is Fucarile’s turn to comfort them. The good leg, he says, may not be such a good leg.
“I remember seeing my leg open. I was surprised I had it,” he says of the moments after the bombing.
The crowd nods. His brother Eddie sighs. To no one in particular, he says, “Once you take it off, you can’t put it back on.”
In some ways, what’s most complicated in Fucarile’s case is that no path is straightforward.
Saving his good leg will require a delicate marriage of tissue regrowth and improved blood flow. If that doesn’t work, amputation poses other challenges because it would be to a leg with skin grafts, which can be vulnerable to the constant pressure from a prosthesis.
Goverman went to medical school in Israel. He’s treated bombing victims before. And the thing of it is, he says, Fucarile will do well either way. “He’s so positive. Whatever happens, he’s going to have a good outcome.”
Improvement and optimism
Another day, another surgery. Fucarile’s seventh. This time, the news in the conference room is better. The ankle showed only trace amounts of dead tissue.
“Unless he has some infection, we continue to go down this route and see how he does,” Goverman says. “Given the fact that we saw improvement in the last three days, I’m optimistic.”
The family’s reaction is muted. They are learning what Goverman learned long ago: Trauma is a roller coaster. The only thing to do is press forward.
And so, practically in unison, they ask: When can he come home?