It's just the crumb of a muffin, but Martha Galvis must pick it up. Lips clenched, eyes narrowed, she goes after the morsel, pushing it back and forth, then in circles, across a slick tabletop.
"I struggle and struggle until," Galvis pauses, concentrating all her attention on the thumb and middle finger of her left hand. She can't get them to close. Oh well.
"I try as much as I can. And if I do it I’m so happy, so happy," she says, giggling.
Galvis, 62, has just finished a session of physical therapy at Boston's Brigham and Women's Faulkner Hospital, where she goes twice a week. She's learning to use a hand doctors are still reconstructing. It's been two years to the day since she almost lost it.
On April 15, 2013, Martha and her husband Alvaro Galvis headed for Cleveland Circle — mile 22 on the Boston Marathon route. This would be the first of three spots from which they’d enjoy the race and the boisterous crowd. Their last stop would be at or near the finish line in Boston.
Watching the marathon was a ritual that began in the mid 1970s when the Galvises, who are both from Columbia, met in Boston. Their three children grew up with the marathon as a family holiday. The Galvises planned to continue the annual event after retirement.
"But not anymore," Martha says, waving both hands in front of her face. "I don't feel secure to do this."
The former preschool teacher tries not to think about the moment when a pressure cooker bomb placed on the ground exploded, hurling nails and BBs into her left leg and the hand Galvis had lowered to reach her bag.
"I don’t know if you can still see, the surgery was all around here," Galvis says, outlining the scars of skin and bone grafts. "My hand was destroyed, destroyed, it was so bad."
"I don’t want to be too graphic about it but it was really blown off," says Dr. George Dyer, a surgeon who specializes in hands at Brigham and Women’s Hospital. He began rebuilding Galvis’ hand about 30 minutes after the bombs went off. Dyer decided he would try to save everything - except Galvis’ ring finger.
"She had a very beautiful wedding ring that was two fine bands kind of wrapped around each other," Dyer says. "The force of a bomb going off right next to your hand, it’s kind of like a miniature hurricane. It unwrapped these fine gold bands and then wrapped them together very tightly around her finger and just cut it off in place."
Dyer picked pieces of the wedding ring out of bone and tissue and saved them for Galvis. He salvaged parts of the ring finger to replace joints and tissue missing from its companions. In surgery No. 16, Dyer took bone from Galvis' hip, where the marrow has the best potential to stimulate healing, and grafted it to a joint in her pinky. Doctor and patient are waiting to see if she'll need further operations. Galvis calls Dyer a magician.
Alvaro Galvis, 64, who was next to his wife with the bombs exploded, took pictures of her hand at every stage of rebuilding. He and Martha put the pictures in a scrapbook for Dyer.
"It's incredible that they would realize how much this means to me," Dyer says. "We really have become partners in the reconstruction of her hand. It's a unique and wonderful relationship."
Seventeen marathon bombing patients lost parts of one or both legs. There were just a few serious hand injuries because the deadly spray went out, not up into the zone where survivors clapped, cheered or held drinks.
Martha Galvis also severed nerves in her left leg. She was in Spaulding Rehabilitation Hospital for two months learning to walk again and to regain limited use of her hand. She goes on and on, praising the Spaulding staff and her current therapist at the Faulkner, Kerstin Palm. But two years of surgery and rehab, and more surgery and rehab, are wearing Galvis down.
"Then I’m thinking about when I was going to the marathon and I was cheering the people and I say, 'Come on, keep going, keep going, one more mile,' " Galvis says. "So I look at my hand and I say, 'Come on, keep going, you can do it, this is like a marathon.' And I can feel people in Boston say, 'Yes, you can do it, come on keep going, keep going.' "
Many marathon survivors say the emotional and financial support they've received, from friends and strangers, has been critical to their recovery.
"If you think of a traumatic event as a rock dropping in water, you'll have a ripple effect," says Kevin Becker, program director at the Massachusetts Resiliency Center. The trauma will be intense for those at the center, but the ripples spread far and wide. "It's really important for the people at those outer edges of the ripples to help contain the impact and hold the people at the center," Becker says.
The jeweler in Downtown Crossing who made Galvis’ original wedding ring took the shattered, twisted pieces and molded a new band. But Martha Galvis, who is devoted to her husband, says that for a long time, she was afraid to put it on.
"It’s silly maybe," Galvis says with a sheepish shrug, but she couldn't shake the worry that "something might happen and I could lose my hand again, the other hand."
For some bombing survivors, the emotional and psychological scars are healing more slowly than the physical ones. Martha pauses and reaches over to stroke the back of her husband.
"People tell me time heals, but it’s a very slowly turning clock to me," says Alvaro, a former Harvard Pilgrim health insurance salesman. He had two surgeries to repair his leg. He says a one-inch-by-two-and-a-half-inch piece of pressure cooker removed from his right leg was introduced as evidence in the trial of now-convicted bomber Dzhokhar Tsarnaev.
"How can someone do so much damage that you, at moments, have no control over your reactions?" Alvaro asks. "I don’t know if we are wired as human beings to be able to deal with tragedies like this. I don’t know if we will ever be able to. We’re trying, we keep trying."
Alvaro struggles with flashbacks; he’s jittery and anxious. He says he can’t get used to the feeling that he has no control over his surroundings.
"You think about a lot of things, you know, in two years of trying to understand," he says. "That’s part of the healing."
Neither Alvaro nor Martha has been able to return to work since the bombing, and they aren’t sure if they ever will. They say they were getting better, before the trial. Martha was at the dentist’s office for a checkup last week when someone told her the jury had reached a verdict. She had to get up and leave.
"I’m so happy that..." Martha pauses. She tries to finish the sentence twice, but she's breathing rapidly and shifting in her chair. After she calms down, she continues: "Justice is done. But there is no closure for us. There is never going to be closure, because we have a big scar in our hearts."
So Martha prays.
"I ask God, please," she begins, "in my heart, I don’t want to hate him. I don’t want to hate him, because it's no good for me to feel I hate him. And I ask God for him. But he has to be punished, because he did horrible things and he has to be punished."
Martha and Alvaro stop the interview. It's too much for them. They leave the hospital arm in arm, supporting and protecting each other as they enter a world they've learned they can not control.