Dozens of victims were transferred to area hospitals under a code red, for critical injuries. “We don’t improvise when these kinds of things happen,” said Dr. Ron Walls, chairman of emergency medicine at Brigham and Women’s Hospital. “We’ve drilled this a lot. We know how to do this.” At its peak, Brigham and Women’s was running seven operating rooms simultaneously dealing with the trauma patients. Doctors found ball bearings, metal and carpenter’s nails embedded in victims’ soft tissue. “There’s a lot more missing muscle, missing skin,” Walls said. “The tissue just gets blown off, basically. And the bone in the center shatters, so you have these really horrific injuries. You can train all your life and not get used to seeing that.”
Emergency doctors at Beth Israel, the New York Times reported, borrowed another battlefield tactic, writing patients’ vital signs on their chests in felt marker in the event a chart got misplaced during transfer. At Boston Children’s Hospital, trauma-program director Dr. David Mooney said, he found “this little girl with literally nails sticking out of her flesh. Each of the two critically injured kids had their lives saved by the first responders. Somebody at the scene put a tourniquet on their legs and stopped the bleeding, and I have no doubt they would have bled to death if the first responder hadn’t done that.” The wounds were far worse than the normal injuries they see. “The fact that someone would actually do this to a kid was the kind of thing you don’t want to think about,” Mooney observed. “It’s just hard to imagine.”
(PHOTOS: A Photographer’s View of the Carnage)
The minute the news broke, off-duty nurses and doctors flooded into all the area hospitals. A group of Massachusetts General residents who saw the explosions from a rooftop race-watching party immediately set off for the hospital and set up a makeshift triage center in the lobby, sewing up victims’ wounds and sending those with more-serious injuries through to be admitted. The hospital had brought in a group of Israelis a few years back to consult on upgrading its emergency procedures. So it was now standard procedure that incoming patients were tested with elaborate detectors for hazardous residue, to rule out a chemical or radiological attack. “We have to make sure they don’t bring in to the hospital any materials that injure us or other patients,” said Eric Feins, a 32-year-old surgical resident.
Liz Norden was unloading groceries into her Wakefield home when her phone rang. “Ma, I’m hurt real bad,” she heard her 31-year-old son say; he was in an ambulance, his legs badly burned. He didn’t know what had happened to his brother, who had been standing next to him. It took two frantic hours for her to learn that both her sons lost a leg that day.
Doctors at Massachusetts General Hospital told William and Patty Campbell that their daughter Krystle, 29, a restaurant manager, was injured and in surgery. She had gone to watch the race with her friend Karen; but when the Campbells were finally allowed to see her, 11 hours after the blasts, they learned the truth. “That’s not my daughter, that’s Karen! Where’s my daughter?” William recalled telling the stunned doctors. They had found Krystle’s ID; but now they had to show the Campbells a picture of a young woman who had died. That was when they found Krystle.
Also fatally wounded was Lu Lingzi, a graduate student at Boston University who had come from rust-belt China to work toward her master’s in mathematics and statistics. And finally, there was Martin Richard, 8, whose family had come from Dorchester to watch their friends race. About three hours into the marathon, the family went for ice cream; they had just returned to cheer the runners coming down the final stretch, straining their eyes to spot a friend in the crowd, when they heard the first bomb go off. Panicked, they were looking for a way to climb over the barrier and get into the street—away from the buildings—when the second bomb went off right behind them. Martin died instantly; his sister Jane, 6, lost a leg, and his mother suffered a brain injury.
In the age of Instagram every epic event finds its iconic images in real time; in a matter of hours all around the world, people saw pictures of Martin, including one of him holding a sign from a peace event at his school last year. It read, NO MORE HURTING PEOPLE. PEACE.
By Monday night officials had long since declared the race over; but the marathon clocks along the race route kept on ticking off the time, for runners who would never finish the race.
VIDEO: The Morning After the Boston Attack
This story is part of TIME’s Boston bombing special tablet edition, available on iPad, Nook, Android and Kindle