A year later, shattered bones have knitted back together, burned skin has regrown, and the survivors who lost legs are walking on prosthetic limbs. What remains for many are the relentless injuries nobody sees.
While there have been remarkable stories of recovery and perseverance among the 275 wounded in the twin explosions on Marathon Day 2013, many still battle hearing loss, ringing ears, anxiety, depression, and post-traumatic stress.
One shakes so badly from anxiety that he has a hard time working as a carpenter. Another, college freshman Sydney Corcoran of Lowell, has developed an eating disorder. Corcoran has endured leg surgeries, complications, and more surgeries, but her emotional scars run deeper. She is often on edge, startles easily, and has trouble sleeping, symptoms of PTSD.
Her mother, Celeste Corcoran, was seriously injured in the blast, too, with legs so mangled both had to be amputated. “My legs were blown off and that’s huge,” she said. “But so many more people suffer in silence because everybody looks at them and sees this whole person.”
On a day for gauging how far they have come, many of the survivors are thankful for the progress they have made in the hands of skilled and caring doctors, nurses, and therapists. Still, some have nerve damage in their legs that has not healed, and the 16 people who lost legs have had to get their prosthetics adjusted repeatedly as their residual limbs shrink.
Four survivors initially treated at Beth Israel Deaconess Medical Center have required more surgery since January, one to have additional bone removed from an amputated leg, another to have perforated ear drums repaired. At Boston Medical Center, two patients have undergone skin grafts this year, and many others, the hospital said, continue with rigorous outpatient rehabilitation sessions.
One of the most lasting and widespread challenges, say caregivers, is hearing problems, with about 40 survivors continuing to receive treatment at Massachusetts Eye and Ear .
David Yepez is among those still grappling with ear damage. He is back playing football and wrestling, a rebound his Andover family finds hopeful. Second-degree burns on his left arm have healed, as has the wound from a 3-inch piece of shrapnel embedded deep in his left leg.
As his father, Luis Yepez, puts it, “There’s some beauty to being 15 and how the body recovers.”
But both of the teenager’s ear drums were perforated, and Yepez, now 16, has some hearing loss and ringing in his left ear, a nearly constant, high-pitched tone, “the sound you hear after going to a concert,” he said. It bothers him when he is trying to sleep or study.
“It’s pretty much going to be there forever,” he said his doctor told him, “and it may get gradually worse as I age.”
Dr. Alicia Quesnel, an ear specialist at Mass. Eye and Ear and Harvard Medical School, is leading a study following 93 patients who suffered ear injuries in the Marathon blasts. It is one of the few studies to track hearing-related problems in such a large group that was not exposed to military explosions.
“Unfortunately for many of them, even if the hearing has improved, the tinnitus [ringing in the ears] seems to be a persistent problem,” she said.
The sensation — in which a patient hears ringing, hissing, roaring, whistling, chirping, or clicking when no sound is present — is created by the brain in response to ear damage. There is no cure.
Other caregivers continue to treat survivors for a range of mental health issues, most commonly post-traumatic stress and anxiety. At Boston Medical Center, Jennifer Lawrence, a social worker who specializes in trauma-related counseling, said she regularly sees several of the survivors and their family members, who are still grappling with nightmares and flashbacks.
“People are more able now to function, more able to be productive again at work or at home and use coping skills they have developed,” Lawrence said, “But I have three or four people who are still debilitated . . . and are not able to go back to work.”
A couple of those patients, she said, have become extremely fearful of leaving their homes, a condition known as agoraphobia.
Some of the injured were so overwhelmed by dealing with immediate issues, including undergoing repeated surgeries and sorting out whether they would be able to work again, that they put their emotional needs on hold, said Donna Ruscavage, interim director of the family assistance center at the Boston Public Health Commission. The agency has coordinated mental health services for many survivors.
“We held a special Christmas gathering [for survivors] and noticed at that time more people were coming to us wanting assistance addressing mental health needs,” Ruscavage said. “Some people were for the first time addressing their PTSD and flashbacks.”
Sydney Corcoran was one of the survivors who started in counseling late last year. Now 18, she had almost bled to death after shrapnel shredded the major artery in her right thigh. But sessions for the rest of the family — her father, Kevin, and brother, Tyler, who battles guilt for not being at the Marathon with his family — were put on hold when Celeste, her mother, needed surgery in February to repair her ruptured right ear drum.
Half of the patients in the Mass. Eye and Ear study suffered perforated ear drums, the thin tissue that separates the ear canal from the middle ear. The ear has “an amazing ability to repair itself,” particularly for small holes in the ear drum, Quesnel said. But Celeste Corcoran and some of the other survivors had operations to repair larger tears.
“There is so much emotional healing to be done,” said Celeste, “and we are just at the very beginning.”
Counseling has helped ease Jarrod Clowery’s bouts of anxiety. Still, Clowery, who suffered burns, shrapnel wounds, and hearing loss, now fights such debilitating ringing in his ears and shaking when he feels anxious that he is often unable to work.
“Before [the bombings], when people talked about anxiety and panic attacks, I thought it was a cop-out,” said the 36-year-old carpenter, who lives in Millville, near the Rhode Island border. “I feel foolish about being so block-headed about it all those years.”
His boyhood friend from Stoneham, Marc Fucarile, lost his right leg in the explosions and still suffers pain from a broken knee and shattered foot on his left.
Fucarile has had three leg surgeries since January, including one to amputate more of his right leg after the bone got infected. It took two months for the swelling to subside.
With each new operation, the socket that attaches the prosthetic to the limb must be remolded to fit the new shape.
“My leg is a battle I will have for the rest of my life,” he said.
Another battle Fucarile wages is far less visible. He lives with the uncertainty that a shard of shrapnel lodged in his heart may be lethal if it starts to move. Heart scans are part of the routine now to gauge whether it has shifted.
For those who did not lose legs, but suffered severe nerve, bone, and blood vessel damage, the journey toward recovery is also far from over.
“People who kept their legs, that doesn’t guarantee that they will keep their legs forever,” said Dr. Jeffrey Kalish, Boston Medical Center’s director of endovascular surgery.
Kalish operated on three of the amputees and a fourth survivor with such significant leg injuries that pain and uncertainty are familiar companions.
“Some of these people have no feeling in their feet or legs and they have to be constantly aware [so] they don’t injure their legs,” he said.
Even an injury considered not terribly serious for others could lead to an amputation for these patients.
“They have to live with this life-long vigilance,” he said.
Bella English contributed to this report. Kay Lazar can be reached at Kay.Lazar@
globe.com. Follow her on Twitter @GlobeKayLazar.