doesn’t bleed to death on the operating table, and the diseased leg is so
swollen and edematous that dissection is difficult. I have no electrocautery
so every tiny vessel is tied off by hand. I carefully deal with flaps of muscle
so the wound will close well, and after ninety minutes of tedious
exploration, the moment of final amputation occurs. With the hip joint
disarticulated and the limb finally free, I hand off the leg to a nurse. I
loathe this moment. I have amputated arms and legs over the years, and it
always feels like abject failure, even though I know it’s the right thing. In
war, in business, in parenting, we “take our losses,” but amputation
emotionally always feels like comprehensive defeat.
The surgery is accomplished under spinal anesthesia, so that Joseph is
conscious and awake during the operation. He seems to be uttering the
same phrase again and again, and I ask one of the nurses what it is.
Solemnly she responds, “He is saying, ‘Please take me home with you.’”
Blindsided, I’m a jumble of emotions, saddened by Joseph’s plight and
filled with hatred for tuberculosis.
Dr. Charles Neer performed his first shoulder implant arthroplasty on
January 26, 1953, on a fifty-four-year-old housewife who three years
earlier had suffered a severe fracture of her left shoulder. The patient had
initially been treated with simple physical therapy by another orthopedic
surgeon, leaving her with almost no motion of her shoulder. Encumbered
with unrelenting pain and poor function, Mrs. “T.M.” submitted herself to
Dr. Neer’s care, becoming the first person in the world to receive the “Neer
shoulder implant.” Her outcome was excellent—she later told Charlie
Neer that “the old pain is now gone”—with dramatically improved
shoulder motion and function.
Dr. Neer’s first shoulder publication, “Fracture of the neck of the
humerus with dislocation of the head fragment,” which had reported on the
poor results of treating severe shoulder fractures with removal of the
humeral head, was published in the March 1953 issue of the American
Journal of Surgery. Submitted and accepted for publication in 1952, it
merely showed a picture of the shoulder implant, while allowing for the
fact that it had never been used. Therefore, by the time the publication had
been received by librarians and surgeons around the world, patient “T.M.”
had already become the pioneering guinea pig. While it is accurate to call
her the index case of Dr. Neer’s series of shoulder arthroplasties (from