He invited Miranda and me into his office. Settling weakly into the swiveling leather armchair behind the desk, he said, “Please,” and nodded to the two wing chairs that faced it. We sat. “Would you like something to drink? Perhaps coffee or tea?” We both declined quickly — too quickly, apparently, because he smiled sadly and said, “Please don’t stop using your hands just because you’re with me.” His forearms had been resting on the arms of his chair, slightly below the level of the desktop, but now he shifted them to the desktop and stared at their ravaged ends. “I can say this to you only because you are my friends. It makes me feel more conspicuous if you act incapable of picking up a coffee cup or pushing a button. That makes me feel almost as if I’m contagious — as if I’ve infected and destroyed your hands, too.”
“I’m sorry, Eddie,” Miranda said. Leaning forward, she reached across the desk and gently squeezed his left elbow. “Thank you for telling us.” He smiled again, not as sadly. “Is there anything else we can do that would be helpful,” she asked, “besides, you know, not acting weird?”
“As a matter of fact, there is.” With the two fingers that remained on his right hand, he gestured at the computer occupying a table to one side of the desk. “If one of you wouldn’t mind navigating the Web, I’d like to show you some sites I’ve been looking at. I’d show you myself, but I’m very slow on the keys, pecking with just one finger.”
“That would be Miranda’s department,” I said. “I’d be as slow as you.” As soon as I heard the words, I wished I could reel them back in, but when Miranda snorted and Garcia laughed softly, I relaxed.
Miranda moved to a rolling stool parked in front of the computer. As she swiveled into position in front of the keyboard, she made a big show of interlacing her fingers and cracking her knuckles. Then she rubbed her hands briskly together and wiggled her fingers rapidly. “At your service. What’s your wish?”
“Let’s start with toe-to-thumb transplants,” he answered. Miranda’s fingers clattered rapidly over the keyboard.
“Wow, look at that,” she said. “Over a hundred thousand hits. Who knew that was such a hot topic?”
“This one.” He pointed with his pinkie to one of the search results. “Click on that, please.”
Miranda used the mouse to highlight the link. As it loaded, she remarked, “You know, Eddie, if you replaced this clunky desktop computer with a laptop, you might get pretty good with the touch pad.”
Before he had time to respond, the page finished loading and a television news story began to play. The footage showed a teenage boy — a New Jersey fourteen-year-old — who’d lost his thumb and first two fingers in a fireworks accident. A close-up showed the damage to the boy’s right hand, which looked almost exactly like Garcia’s right hand. Five months after the injury, a Philadelphia hand surgeon removed the second toe from the boy’s right foot — the toe Miranda liked to call the “index toe”—and fashioned a new thumb from it. “The structures line up very well,” explained the surgeon on camera. “You have two major nerves, you have a major blood vessel, you have similar tendons. The circumference is very similar.” In the story’s “after” images, the gap created by the missing index finger and middle finger remained quite prominent, but the reconstructed right thumb was a virtual mirror image of the boy’s undamaged left thumb.
“Cool,” Miranda commented. “Very cool. That would give you back an opposable grip on your right hand.”
Garcia pointed her through a quick series of articles about toe-to-thumb transplants. The procedure might not qualify as “routine”—complex microsurgery was required to stitch together the network of delicate blood vessels and nerves — but it had been performed hundreds of times during the past few decades, with a success rate of well over 90 percent.
“Let’s change the search,” he said. “See what you find using ‘myoelectric prosthesis’ and ‘bionic hand’ as search terms.” The technical term — a reference to the use of electrical impulses from muscles in the arm to trigger electric switches and motors in an artificial hand — produced about a hundred thousand hits. The much catchier “bionic hand” yielded over three hundred thousand, including thumbnail-size photos and sketches. Miranda clicked on one of the images, a robotic-looking prosthesis called the i-Hand.
Miranda leaned closer to the monitor. “Ooh, that’s kinda sexy,” she remarked, studying the photo. The i-Hand’s fingers were formed of pale white plastic, translucent enough to reveal bonelike metal rods in the fingers, as well as hinges and tiny motors. According to several articles, the i-Hand was the first prosthetic hand to faithfully mirror the structures and movements of the human hand. One video clip showed a young woman with an i-Hand lifting bags of groceries, picking up a set of car keys, and typing on a computer keyboard. Her bionic hand was covered with a flesh-toned “skin” of rubber. “I like it better without the skin.” Miranda frowned. “Much more futuristic-looking.”
“Yes,” Garcia agreed, “very Luke Skywalker. But I suspect that the rubber provides a better grip than the hard plastic. It probably also protects the mechanism from things that could damage it. Dirt. Sharp edges. Coca-Cola.”
“Embalming fluid,” I added, thinking of the body we’d just examined. “Blood.”
“Oh, fine,” Miranda retorted with mock indignation. “Go ahead, rain on my style parade, see if I care.” She wiggled the fingers of one hand, then folded all of them except her middle finger. “I assume the i-Hand is capable of making this gesture, with or without the skin.” Garcia asked her to bookmark several of the i-Hand links, then asked if she’d search one more topic. “Sure,” she replied. “What?”
“Total hand transplantation.” He said it quietly, but I heard an edge of hope and anxiety in his voice that I hadn’t heard earlier, when he’d asked for the other searches.
Miranda’s fingers clattered. “Wow,” she breathed, “almost a million hits.” Garcia had her call up only a few of the million, but those were enough to confirm my prior impressions. Hand-transplant surgery was relatively new; the first total transplant had been attempted in Ecuador in 1964, but it didn’t work, and the procedure had been attempted only a few more times until the late 1990s. Even now it remained incredibly rare — so far, fewer than fifty hand transplants had been performed in the entire world. The surgery was extraordinarily complex, requiring surgeons to connect dozens of nerves, tendons, veins, arteries, and muscles. The operation was both an intricately choreographed ballet and a brutal test of endurance, requiring delicate, nonstop work for twelve to sixteen hours. Even if the surgery itself went perfectly, the long-term outcome was far from certain. To keep their immune systems from rejecting the transplants, recipients had to take immunosuppressants — drugs to weaken their immune systems — for the rest of their lives, and the immunosuppressants increased their vulnerability to diseases.
Total hand transplantation looked like a medical miracle, no doubt about it. But I couldn’t help thinking how much riskier it looked than either the toe-to-thumb reconstruction or the prosthesis.
“It’s a big risk,” Garcia said, as if hearing my thoughts. “But it would be worth taking a big risk to have real hands again.”
His words stayed with me long after I drove back to the stadium and Miranda had wheeled him back upstairs to become the hand-trauma case in 718 once more.
CHAPTER 7
I gritted my teeth as I pulled into the parking lot in Farragut, the suburb to the west of Knoxville. I was headed for my spring dental cleaning, and like most people, I tended to be nervous about it. I would much rather be using my lunch hour to eat lunch than to have my teeth probed and scoured. “Sorry I’m late,” I said to Barbara, the dentist’s silver-haired office manager. “I just came from an autopsy. I figured y’all would appreciate it if I took the time to wash my hands afterwards.”