After an amputation, most patients have a sensation that the limb is still attached and functional. It's known as phantom limb, and it's just one sign that the psychological adjustment to losing a limb can be as challenging as the physical adjustment.
In addition to phantom limb, those who lost legs in Monday's Boston Marathon attack may face post-traumatic stress disorder and grief as they adjust to a new normal.
"I always tell my patients that as hard as it is, it's a new reality, and the choices are to go into a dark room and close the door or confront the world in that new reality," said Dr. Alberto Esquenazi, chairman of Einstein Healthcare Network's Department of Physical Medicine and Rehabilitation and chief medical officer for MossRehab Medical Center in Pennsylvania, who is himself an amputee.
Often, doctors will hear new amputees say their lives are over. When Dr. Terrence Sheehan, Chief Medical Officer at Adventist Rehabilitation Hospital of Maryland and medical director of the Amputee Coalition hears that, he says, "Nope. It's changed, and we're going to help."
The rehab process involves a team of social workers, psychiatrists, physical therapists, occupational therapists, case managers and nurses. Often one of the most powerful visits in that early stage, Sheehan said, is from a new peer: a fellow amputee.
"When someone who has also lost a limb comes in and says, let me show you how to get back to life, that's when they can see what life's going to be," said Sheehan, referring specifically to the Amputee Coalition's peer visitation program.
And while runners may be able to handle the physical challenge of rehab and therapy, sometimes the emotional toll is hardest on people who perceive themselves as strong.
"It can take much longer for them to realize their new reality," Esquenazi said. "You can imagine that for someone who was running the race or had the ability to be there watching, in an instant their life changed. When you're confronted with that kind of life-changing event, it can be very challenging psychologically." Like those injured in war zones, many people who witnessed the scene at the Boston Marathon may face PTSD.
"The shock is wearing off," Dr. Joseph Shrand of Harvard Medical School said on New England Cable News. "Now the reality is setting in." Symptoms may include anger, fear, sadness, a sense of confusion -- at any time, in any order, he said. That's in addition to the steps of the grieving process that most new amputees go through, Esquenazi said: denial, why me?, blaming others ... and, finally, acceptance.