BOSTON -- Chris Sale was the first to go down, on June 1, with a stress reaction in his left shoulder. Then it was Tanner Houck, who was struck by a batted ball against the Yankees on June 16, leaving him with a facial fracture and a subsequent surgery in which a metal plate was inserted. 

And in the most recent act of attrition for the starting rotation, Garrett Whitlock was limited to just one inning in his Sunday start in Toronto due to right elbow inflammation, and was placed on the 15-day injured list prior to Tuesday’s game.

The Red Sox are down to three healthy starting pitchers in Brayan Bello, Kutter Crawford and James Paxton, the American League Pitcher of the Month for June.

As the Sox (43-43) experienced first-hand in Tuesday’s 6-2 defeat to Texas at Fenway, it is going to be hard to piece it together at times, particularly against a top-hitting team like the Rangers.

But that’s exactly what Boston has to do until some reinforcements come back.

“No, I don’t think we’re threading the needle by any means,” said Red Sox catcher Connor Wong. “We trust our guys. They all have good stuff. So I think they're all fully capable of getting the job done.”

In a perfect world, the Sox could call up a Triple-A starter or two on the cusp of being ready to pitch in a Major League rotation.

But the world is imperfect and quality starting depth is the current weakness of Boston’s farm system.

Of late, the Sox have been going with openers rather than starters to fill the void in the rotation. Brennan Bernardino got the nod on Tuesday and did reasonably well, retiring four of the five batters he faced.

The problem is that there were still 23 outs to go and Kaleb Ort allowed a three-run homer on just the second batter he faced in relief of Bernardino. 

“It’s hard for everybody,” said Red Sox manager Alex Cora. “If you lose [multiple] starters at this level, it’s hard to do, but I think we’ve done an outstanding job piecing it together. It’s not easy, but this is where we’re at right now. With the guys that we have, we should be able to do it.”

These games are easier for the Sox to get through when Nick Pivetta is available. But it was Pivetta who made Sunday’s 5-4 win in Toronto possible when he fired four tremendous innings (two hits, one run) on the day Whitlock was injured. Pivetta likely won’t be in play until Thursday at the earliest.

One solution would be to move Pivetta back to the rotation. But Cora has been steadfast in his belief that Pivetta is too important to the bullpen at this point, while also noting it’s tough to stretch a pitcher out on the fly.

There are also these splits: In eight starts this season, Pivetta has a 6.30 ERA and an opponents’ OPS of .885. In 13 outings since moving to the bullpen, Pivetta has a 2.63 ERA while holding opponents to a .478 OPS.

On days the Sox have a tough time scoring -- such as Tuesday -- the high-wire act with the pitching staff is even more difficult for Cora.

There is good news on the immediate horizon. The Sox have their three healthy starters set to go the next three days in Bello, Crawford and Paxton. But there is no clarity on how the club will patch the staff together for the final two games heading into the All-Star break against Oakland on Saturday and Sunday. 

What does the path back to normalcy in the rotation look like for the Red Sox?

Whitlock’s injury could be short-term, and he’s eligible to come off the injured list on July 18, which is the fifth game coming out of the All-Star break. There’s no guarantee the righty will be back that soon, but there’s at least a chance.

Houck’s status is less certain, but the team should have a better gauge on his recovery time at some point this week.

As for Sale, he is on the 60-day injured list and isn’t eligible to pitch for the Red Sox again until Aug. 1. The good news is that Sale was cleared to resume throwing last week and there’s reason to believe he might not be out as long as originally feared.

“You don't want to ever lose anyone, especially those guys,” said Wong. “But I think we have a good next man up mentality and we're gonna keep grinding it out.”

There’s also the chance that chief baseball officer Chaim Bloom could upgrade the rotation via trade, with the Aug. 1 Trade Deadline looming.