The Red Sox also have several key players on the disabled list, including Jason Varitek, Trot Nixon, Tim Wakefield, Alex Gonzalez and Jon Lester. The mass departures of so many key players left a strange and somewhat empty feeling in the clubhouse.
"It's very unique," said Red Sox second baseman Mark Loretta. "In all my years, you've seen injuries and you talk about how every team goes through injuries. I think we're a little bit beyond that stage of having way more than our share, whether it's injuries or illness, things like that. The guys that are able to play are professional players, and we're going to give it our best and try hard and try to win games. That's all you can do."
Ramirez was in the lineup for just two of the first seven games on this West Coast trip, and his knee didn't seem to be making any progress. Manager Terry Francona cited an instance in which Ramirez was tagged out at third base on Saturday night because he wasn't healthy enough to slide.
"I kind of had a long conversation with him. He's hurting," Francona said. "He couldn't play here. Let him go back and get further evaluated. He was going to slide the other night into third. It was bothering him. He got scared. So we're going to try to protect him. We need to protect him. He's too good. He deserves it for us to protect him. So we're going to have him evaluated, too. So we just put the guys on the plane and sent them all back."
Francona had said Monday that he didn't think Ramirez would be sent home for more tests. But that was before his conversation with the left fielder.
"In Manny's case, he needs to be looked at again," said general manager Theo Epstein. "This is a legitimate injury. We've rested it. That hasn't worked. So we're going to have it looked at it again. He may need further rest. We'll see. He certainly wasn't going to be able to play the next two days. So it made sense to get him, rather than get looked at on Thursday afternoon, maybe he can get looked at Tuesday night. Every day counts."
Pena had to be taken out in mid-game on Friday after feeling pain in his left wrist. The outfielder had the hamate bone removed from that wrist in a procedure in late May. In this case, a cortisone shot might serve as a remedy.
"In Wily Mo's case, if a shot is called for, he can get that shot by the guy who did the hamate surgery in the first place," said Epstein.
The decimated state the Red Sox are in left them with just four Opening Day starters in Tuesday's lineup. Third baseman Mike Lowell and center fielder Coco Crisp were the only two to be playing in their normal positions. Mark Loretta served as the DH and batted third, with Kevin Youkilis hitting cleanup and playing left field.
"I can't be David Ortiz; Youk can't be Manny," said Loretta. "We've got to stay with our strengths and try to get on base, get guys over. It's a different style, but we have to stay with it."
Because rosters can be expanded on Friday, Epstein decided not to add any position players to fill the void left by Ramirez, Pena and Ortiz.
"It's not often that you have a lot of these gray-area injuries at the same time," said Epstein. "It could be one or two days or it could be 10 to 12. We just have to make rational decisions based on that. Once we get to Sept. 1, it won't be an issue anymore."
The Red Sox entered Tuesday's game trailing the Yankees by seven games in the American League East and the Twins by six games in the Wild Card standings.
Boston has 31 games left in the season. Epstein and Francona were hopeful that all the injuries would not create bad morale.
"I think Tito said it best the other day. Nobody wants to hear this woe-is-us stuff," Epstein said. "I'm not going to get too much into it. I think we'll just focus on the fact that this adversity represents a challenge for us and a good opportunity to show some character and leadership and get through it.
"It's easy to be a good pro and a good leader when things are going good. This goes from everyone in the clubhouse and us. It's more challenging during the difficult times. This is a good opportunity to show what we're made out of, and it will make us better in the end."
Francona said that the focus, at least when the game starts, cannot waver.
"When the game starts, it doesn't matter who is here or not here," Francona said. "The losses hurt just as much and we feel an obligation to win that game. It never changes. That's what we'll do. Our responsibility is to try to win. We haven't done a good enough job lately of that. We can either put our tail between our legs, which we're not going to do, or we can get through this."