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Life, After

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My cosmetic hand: Beautifully made, but whom, exactly, is it for?  

In my job as a science and technology correspondent, I have covered some of the advances in prosthetic technology in recent years. They are remarkable. But now that I am looking as a customer, I see shortcomings. The devices rely on actuators, which in turn rely on batteries. That makes these arms very heavy, less reliable, and not weatherproof. To make some of them work well, doctors need to move nerves to better connect them with sensors inside the robo-arms. Replicating what the human hand does is a very difficult problem for engineers, much harder than making an artificial leg. I have learned, though, that one hand—with all its dexterity, sensitivity, and opposable-thumb efficiency, along with something much more crude that has the simple ability to grasp—is all you need. For now, the split hook I wear is working well. I’m pretty sure that it’ll allow me, eventually, to return to the cockpit.

My prosthetist assumed I would like to have a cosmetic hand, one that has no real function but looks like the real thing, and so he made a mold of my remaining hand. An artist who produces fake wounds in Hollywood created a clear silicone mirror image. Then she sat with me for six hours, painting it, even embedding bits of hair snipped from my right arm. The result is haunting, and I don’t like looking at it. I’m not sure whom I would be wearing it for. I don’t feel the need to pretend or to make my presence easier on others.

The biggest problem I cope with is phantom pain. My arm has become a ghost, immobilized as if it were in a sling—which is where it was the last time I saw it. If I concentrate, I can move my imaginary fingers. The arm feels as if it’s been asleep and the circulation has just begun once again. First thing in the morning, it’s actually a pleasant, painless feeling. My arm is suspended, almost as if it is weightless. But as the day goes on, it feels as if it is progressively bound tighter and tighter, to the point of excruciating pain. In addition, my fingers often feel as if they’ve been jolted with surges of electricity.

Doctors don’t really know how to treat pain in a part of the body that no longer exists. I’m taking a fairly heavy dose of Neurontin, which is also used to treat epilepsy, restless-leg syndrome, and insomnia. I’m not supposed to stop taking it abruptly, so there’s no way for me to test exactly how well it’s working. Acupuncture, massage, and exercise help. So does marijuana. I’ve also tried mirror therapy, first pioneered by the UCSD neuroscientist V. S. Ramachandran. I place a mirror on a table perpendicular to my chest and sit up close, so it looks as if I have my missing left hand back. If I concentrate on moving my phantom left hand and matching its movements with my right hand, my brain is tricked into thinking that its old internal map is still complete. The movements alleviate a lot of my phantom pain.

How this works is mysterious. It’s not psychosomatic, as was once thought. Recent research suggests that our brains map out our bodies, like a neural schematic of switches, channels, and routers in a complex communications network. When there are suddenly no circuits feeding areas of the brain that control a newly missing limb, the nerves in another part of the body will attempt to fill in the gaps. So now when I scratch the back of my cheek near my ear, or the bottom of my heel, or my chest near the sternum, I feel a sensation in the fingers of my missing hand. And even odder than that, when I take a drink of something cold or hot, it feels as if it is flowing directly into my phantom arm. I also get a tingling feeling there when I’m having sex.

Besides the pain, the biggest inconvenience about being one-armed isn’t any individual task, but in the aggregate. I had a very busy, overbooked life before I lost my arm. Now each thing I do takes longer—sometimes much longer. 
Consider what it takes for me to get ready in the morning: In the shower, I wear a wash glove and put bottles between my thighs to squeeze out body wash and shampoo. To wrap a towel around my waist, I must grab a corner with my teeth and hula-dance a little so that I can grab the other end with my arm, bring it back around, and tuck it in. I use my big toe to move the lever on a fingernail clipper. I button the right cuff of my shirt before I put it on so that I can slide my hand through. The other buttons can be managed with one hand, but each takes more time (especially the top one). I learned how to tie a tie from a one-armed guy who’s made a great YouTube video.


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