More than a year and a half after the Boston Marathon attack, a 27-year-old Texas woman who was severely injured in the first blast underwent surgery Monday to amputate her left leg below the knee.
Rebekah DiMartino’s decision to amputate came after more than 15 previous operations in Boston and Houston aimed at saving the limb. It made her at least the 17th person to lose a leg as a result of the April 2013 attack, but the first apparently since the life-saving surgeries that immediately followed the traumatic bombing.
Doctors said DiMartino’s choice reflects the continued struggle some of the critically injured survivors have faced in trying to regain mobility and minimize pain over the past 19 months.
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With what has become her trademark optimism and humor, DiMartino held a “Left Leg Last Hurrah” dinner over the weekend and posted a break-up note to her leg on her public
Facebook page, along with a photo in which she had written “It’s Not You It’s Me” across her heavily scarred foot, ankle, and shin — above one final pedicure.
“Today is the day I say goodbye to what is holding me back, and I reclaim my life,” she wrote hours before heading into surgery, thanking friends, family, and the public for support.
On Monday night, her orthopedic surgeon, Dr. William McGarvey, said the hourlong surgery at Memorial Hermann Katy Hospital west of Houston was successful.
“There were no hiccups,” McGarvey said, in a phone interview immediately after the surgery. “Having spoken with Rebekah for the last several months, I think she’s going to do well. She’s got a great attitude, and I think for her, this is sort of a reconstructive procedure as opposed to an elimination procedure.”
McGarvey said DiMartino’s decision was driven by the acute, persistent pain that has forced her to rely on a wheelchair, crutches, and leg brace and limited her ability to live a normal life with her 7-year-old son, Noah, and husband Pete, both of whom were also wounded in the attack.
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He said she should gain smooth movement with a below-the-knee prosthesis and hoped her pain would ultimately vanish, but it may persist. “As a result of the blast injury, she clearly had skeletal trauma, she clearly had muscular trauma, but she also had neurological injury, and that’s probably the thing we have the least control over,” McGarvey said.
Dr. Edward Rodriguez, the trauma surgeon who initially treated DiMartino at Beth Israel Deaconess Medical Center, said “limb salvage” patients — those who elect with their care teams to try to save damaged limbs — can sometimes have a more complex, painful trajectory than those who lose limbs immediately from trauma.
“It’s very sad that it took this long to reach this point, but I think it’s important that you don’t see this as a failure,” Rodriguez said. “It’s not that she failed to keep her leg. She had a leg that wasn’t working for her, so it could be a success.”
DiMartino — then Rebekah Gregory — was a divorced single mother when she met Pete DiMartino, a construction worker and bartender, on a business trip in upstate New York in 2012 while traveling for her job as membership sales manager for a private-clubs association. They were dating long distance when she joined DiMartino and his family in Boston to watch his mother run the 2013 Marathon. They gathered to cheer her at the 17-mile mark before jumping on the MBTA to root her on again on Boylston Street, site of the bombings.
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Pete DiMartino lost the majority of his right Achilles tendon and suffered multiple broken bones, burns, and cuts, while Noah, then 5, emerged with a bad leg cut and shrapnel in the back of his head, according to previous reports. Noah left the hospital in five days, and by late May Pete was well enough to throw out the first pitch at a Red Sox game. But Rebekah spent five-plus weeks at Beth Israel before transferring to Spaulding Rehab, where it became clear that she needed more surgery.
Even in those two days at Spaulding, she made a strong impression on the staff with her positive outlook and close connection to her young son, said Dr. David Crandell, medical director for the Spaulding Rehabilitation Network’s amputee program. She transferred from Spaulding to Houston for further surgery and rehabilitation, and to be with her son and parents.
Gregory and DiMartino married last spring in Asheville, N.C., after winning wedding website TheKnot.com’s 2014 Dream Wedding contest.
Crandell said he has treated patients who have ultimately elected amputation after even a decade of trying to save a damaged limb.
“People mourn the loss of a limb just like a loved one, but if you’re truly focusing on function, the reality may become, with quality care and rehabilitation, that they may do better” with amputation, said Crandell, who advised One Fund Boston’s second round of distributed aid last summer.
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The One Fund’s initial distribution of $61 million in 2013 gave $1.2 million to each survivor who lost one limb, and less — $125,000 to nearly $950,000 — to 69 others who were hospitalized for at least one night, based exclusively on how long they were hospitalized. DiMartino’s extended hospitalization would have put her at the top of that range. But the second round of One Fund awards, totaling nearly $19 million this summer, took into account the potential for future amputation as well as lifelong need and other factors.
DiMartino had planned just a brief visit to Boston in 2013 when her life was altered at the Marathon. She formed close relationships with her Beth Israel team; some of her nurses attended her wedding, and at least one planned to fly to Texas Tuesday to see her.
That nurse, Tracy Kiss, was photographed holding DiMartino’s hand as the survivor crossed the finish line of the Marathon last April in a wheelchair. DiMartino has set a goal to run the next Marathon on a new prosthesis. McGarvey, the surgeon, said it may be possible. “Based on what I’ve seen and the amount of commitment she’s put into everything she’s done to this point, and the attitude she has, I wouldn’t doubt it for a minute,” he said.
More coverage:
• A look at the Boston Marathon wounded
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• Caregivers, Marathon bombing victims have special bond
• Final Marathon victim leaves the hospital
• Globe photographer meets woman in Marathon photo
Eric Moskowitz can be reached at emoskowitz@globe.com.