The Limbs

 

THE LIMBS

A surprising tale of modern prosthetic achievement by strzeka

 

 

European Centre for Neurological Research Conference, Wednesday, October 23rd, 2030

Speaker: Dr Carlton Elliot

 

            – Thank you for your kind introduction. I’m very pleased to be invited to present the latest findings into dissociative neuropathy and I would like to take this unique opportunity to present an individual case. The patient has given permission for his pathology to be made public and he is with us this evening. I shall refer to him as Patient K until I introduce him later.

 

            – We are still researching the causality of RNDS and as you know, environmental factors are now strongly implicated. But whatever the cause, the increasing number of cases in the First World points to something unique in our lifestyles which societies elsewhere have so far managed to avoid. Patient K is one of the first documented victims of the syndrome.

 

            – Five years ago, almost to the day in fact, Patient K sought advice from his doctor on a tingling sensation followed by numbness in his lower extremities. His feet maintained their normal appearance but Patient K insisted that he had lost all sensation in his feet from his ankles down and was finding it difficult to maintain balance.

 

Patient K’s private life, Bayswater, London, five years prior

 

Wesley Stokes arrived home in a taxi just after eleven. The street was dark except for led floodlights illuminating the front entrances of a few neighbouring Georgian houses. Wesley struggled to put his backpack over his shoulders, opened the door of the taxi and set his walking sticks onto the pavement. He swung his legs out of the vehicle and watched as his feet touched the ground. He could feel nothing. It was an extraordinary sensation and Wesley, who had been fascinated by disability and limblessness for years, found it both disturbing and exciting.

 

Kelvin was waiting for him, as always. As soon as he heard the door open, he went to the hallway to meet his handsome lover and kissed him. He took the walking sticks and placed them in a wrought iron umbrella stand by the door.

            – You’re early tonight.

            – I caught a cab.

            – Like a nightcap? The usual?

            – Love one.

Wesley stepped gingerly into their living room, now denuded of its large Afghan carpet. Kelvin had taken it to storage after Wesley tripped on a corner of the mat twice. That had been over two months ago, when he first complained of a lack of feeling. Now Wesley’s feet had not only felt nothing for six weeks, they had also begun to become rigid. His ankles were almost immovable and it was this which excited Wesley. His own feet and calves had suddenly turned into unfeeling rigid lower limbs as immobile as artificial legs. Wesley was getting used to it but walking any distance was a difficult proposition, hence the walking sticks. He kept them hidden as far as possible at work. They hardly suited his public image.

 

European Centre for Neurological Research Conference, Wednesday, October 23rd, 2030

Speaker: Dr Carlton Elliot

 

            – If this syndrome is indeed viral in origin, it will represent the ground zero of new neurological effects. It is not uncommon for viruses to cause readily visible dermatological effects. The RNDS virus, if indeed that is what it is, has the unique ability to affect underlying muscle tissue. Biopsies have demonstrated that viral centres tend to remain concentrated near nerve endings which would logically explain the commonly seen progress of the syndrome. I refrain from calling it a disease. The patient typically remains completely healthy in all other aspects. The syndrome progresses from an initial paralysis of muscle tissue to temporary remission, almost progressing from joint to joint until it meets the body’s long bones. We are currently concentrating on the mechanism which allows the virus or syndrome to behave in such a regularly methodological fashion. As mentioned, an environmental connection is currently being sought. One interesting phenomenon coincidental with the sudden appearance of the syndrome is the concurrent conversion of urban traffic from internal combustion engine vehicles to electric vehicles. We are suddenly exposing ourselves to increasing amounts of cobalt and lithium.

 

Richmond Meteorological Laboratory, London, five years prior

 

Wesley read through his script one last time before checking his appearance in a mirror and on a monitor. He was wearing his trademark outfit—a short-sleeved white shirt and colourful bowtie and a black leather waistcoat. His handsome and hairy muscular arms were on full display. With his perpetual four day dark stubble and clear blue eyes, he was a figure much envied by other men and fantasised over by countless female viewers. He worked his way to stand in front of the green screen and handed his walking sticks to a cameraman.

            – Another bright and breezy day for us tomorrow. The high pressure area bringing us the sunshine is still battling it out with the low pressure area from the Irish Sea and as that dies out, we will see calmer conditions. Let’s look at the national picture…

Wesley’s expressive hands described the motion of air in the atmosphere and he turned to face the camera, fingers linked in front of him to display his arms. He rounded off his forecast with a short quip and a generous smile. The cameraman gave him the thumbs-up signal that he was off camera and brought his walking sticks back.

            – Here you go. Are you feeling any better these days?

            – I feel fine, mate. I wish I could say from my top to my toes but I really can’t feel anything below my knees these days.

            – What does the doctor say?

            – He says ‘Let’s wait’.

            – Do they know what’s wrong?

            – They have absolutely no idea. There are a few cases like me, apparently, across Europe and a few in the US but no-one knows what it is or what’s causing it.

            – But you’re not in any pain?

            – No, nothing like that.

Wesley leaned on his sticks and rocked himself out of the studio back to the tiny dressing room. He sat in front of the mirror and wiped the studio make-up from his face.

 

European Centre for Neurological Research Conference, Wednesday, October 23rd, 2030

Speaker: Dr Carlton Elliot

 

            – But whatever the cause, for the first few weeks the patient experiences only a certain immobility of their feet. This may be alarming enough and brings many to seek attention of the medical community. Doctors frantically searched their compendiums but were reduced to proscribing muscle relaxants and sedatives. None of which had any effect, needless to say. Then the second, most unwelcome effects began to manifest.

 

Patient K’s private life, Bayswater, London

 

Kelvin woke one morning and wrinkled his nose. There was a bad smell in the bedroom. Not exactly like a fart. More like someone had left the lid off the biowaste. He got up and walked around the apartment looking for a source. Baffled, he returned to the bedroom where the smell was strongest. Wesley slept on. Kelvin looked at his sleeping lover and fell in love with him again. It was almost time for him to start the day. Kelvin pulled the duvet off Wesley and fell across his lover’s belly. The smell intensified immediately. Kelvin looked around in alarm and saw the condition of Wesley’s feet. The toes were almost black, the feet purple and the ankles had an unhealthy green tinge. Kelvin moved closer and cautiously sniffed. He recoiled in disgust. The feet were literally rotting. He shook Wesley.

            – Wake up! Wake up, Wesley. Christ’s sake!

            – What’s up? What’s going on?

            – Look at your feet! They weren’t like that last night, were they?

Wesley sat up, swiping night dust from his eyes, and tried to focus on what Kelvin was pointing at. His feet looked disgusting.

            – Oh God! Oh God! What’s happening to me? Kelvin! Call a doctor.

            – Are you in pain?

            – No. I can’t feel a thing. You know that. We’ve been through this. Ah, fuck! Just look at them!

            – This has gone on too long. We have to get you to a doctor.

            – OK. Order a taxi.

 

European Centre for Neurological Research Conference, Wednesday, October 23rd, 2030

Speaker: Dr Carlton Elliot

 

            – The secondary effect was attrition of the vascular system and quite unlike previous similar prognoses, the effects were sudden and rapid. Overnight a patient could go from outwardly healthy, if paralysed, tissue to necrosis. It was indeed the associated odour which alerted patients and oftentimes their partners to the change. Patients were hurried to hospitals where their situation was evaluated and the traditional surgical remedy for necrosis was applied almost immediately.

 

Patient K’s doctor’s surgery, Pimlico, London

            – Thank you, Mr Webster. Please wait outside. This shouldn’t take long. Now, Wesley. It’s good to see you again but most assuredly not under these circumstances. How long had this been going on?

            – I woke up to this this morning. Three hours ago. The numbness has been present for a couple of months and the stiffness for a couple of weeks. I rely on sticks to walk any distance these days.

            – You’re lucky to be able to walk even with walking sticks, my boy. Can you move your ankles for me? Side to side?

            – No, sorry. Nothing.

            – This doesn’t look good, Wesley. I’m not going to predict anything because I really don’t know what’s going on with you. This is a completely new disease, as far as I’m concerned. But if I were to hazard a guess, I’m afraid to say that you might well end up losing your feet, and in rather short order.

            – You mean amputation?

            – I do. I’m sorry. I’m going to refer you immediately to Roehampton and my colleague Bryant May will take your case over. Deal with him direct in future if you need. And let us hope to God this dreadful business ends here.

 

It did not. Wesley and Kelvin were driven to Roehampton hospital near Richmond on the other side of the park. Dr May looked at his referral and calmly opined that both legs should be removed close to the knees. The patient would make a full recovery and would be walking on prosthetic limbs within three months. Wesley listened to the prognosis with a suitably serious expression, rejoicing in the knowledge that he would soon be granted his lifelong wish of having stumps of his own.

 

European Centre for Neurological Research Conference, Wednesday, October 23rd, 2030

Speaker: Dr Carlton Elliot

 

            – By which I mean, of course, amputation. Many patients have been initially shocked, not to say horrified, by the announcement, coming so soon after the onset of necrosis but no-one has so far declined the procedure. Amputation is a radical solution to be sure but reliably endured with the assistance of modern prosthetic equipment. And because of the unique signature symptom of RNDS, lack of tactile sensation, the amputations have been uniquely pain free for the patients. No amputee patient has reported any sensation of phantom limb or other neurological consequence. The residual limbs heal as expected for a healthy limb but without the typical problems associated with amputation.

 

            – Patient K was admitted to hospital on arrival and two below knee amputations were performed later the same day. The patient was monitored with exceptional attention because (a) he was the first case the hospital had treated and (b) because any sign of necrosis recurring would require immediate additional attention. In Patient K’s case, necrosis did not appear in the residual limbs and after fourteen days, the patient returned home in a wheelchair with an appointment for the hospital’s prosthetics division five weeks after the date of amputation.

 

Patient K’s private life, Bayswater, London, four years prior

 

Wesley was grateful to have avoided publicity so far. He was a familiar face to many but hardly a celebrity. He was often recognised on the street, however, and for this reason he and Kelvin decided to lie low for a few weeks until Wesley was out of the wheelchair and back on two legs, albeit prosthetic.

 

Wesley was completely satisfied with his stumps. They were four inches long, well-shaped by his surgeon and pain free. The scarring was still livid but healing well and Wesley was impatient to get new legs and return to work. It was tedious to rely on a wheelchair and he occasionally knelt and stumped around the apartment.

 

He received his first pair of prosthetic legs two weeks after being measured. The sockets were printed according to laser scans of his stumps and completed with steel pylons and basic feet. They were suspended using liners with locking pins. Looking at himself in the mirror at the end of the parallel bar where he practised finding his balance, Wesley was fascinated to see his legs transformed into mechanical facsimiles with not an inch of skin visible. Walking on the artificial feet was so similar to walking with his natural but unfeeling rigid feet that he surprised his prosthetist with his prowess and was allowed to walk out wearing his new legs. He notified his employer that he was ready to return to work and would be back on the following Monday morning. In the mean time, he practised walking in his home, with and without walking sticks. He determined that one was enough and sported a cane in public from then on..

 

Wesley’s colleagues were pleased to see him back again, outwardly unchanged. They were interested to see the feet and pylons when Wesley lifted his trouser cuffs for inspection. After an unremarkable absence of two months, Wesley was again presenting weather reports for broadcast with no-one the wiser. The handsome ladies’ man was now a bilateral below knee amputee and it was kept a well guarded secret.

 

European Centre for Neurological Research Conference, Wednesday, October 23rd, 2030

Speaker: Dr Carlton Elliot

 

Unfortunately, RNDS is insidious and in almost all cases, the syndrome renews on a time scale varying from several weeks to several months. Also, in most cases, the most recently amputated limb or limbs are the next in line to be affected. There are three cases worldwide where RNDS has switched from the lower to the upper limbs before returning to destroy more tissue in the legs. The mechanism for this alternating pattern is completely unknown and the subject of intense research both here at the ECNR and at Johns Hopkins in the United States. Patient K was able to enjoy a productive return to employment for seven months before becoming aware that all was not well.

 

Patient K’s private life, Bayswater, London

 

Wesley sat on the edge of his bed and plucked his liners from the artificial legs standing nearby. For the first time, he noticed that his knees felt numb. He flexed them several times but sensation did not return, nor would it. He thought it odd but paid it no more attention. He did not suspect that his RNDS was recurring. The slight loss of motion caused by his tight liners concealed the progress of the syndrome and it took several weeks before Wesley became alarmed by having lost voluntary movement in his knees. He could still bend his stumps by forcing them with his hands but that was all. He mentioned it to Kelvin one morning.

            – How long has this been going on? Why didn’t you say anything?

            – I first noticed it last month. I didn’t think anything of it, to be honest, but this is exactly what happened before I lost my feet.

            – I think you ought to give that doctor a call. What was his name, the one at Roehampton?

            – Bryant May. I’ll text him.

            – Do that. Are your legs painful?

            – Nope. Can’t feel a thing.

 

Wesley made an appointment with Dr May and attended a consultation. May was proud to see the well-healed uniform stumps which he had created.

            – Wesley, if you are sure that these symptoms feel identical to those you experienced last time, I’m sure you can guess what the next stage is going to be.

            – You mean gangrene again?

            – ‘Fraid so. Further necrosis. Now, we can either wait for it to present itself and act or we could be proactive and amputate now.

            – And those are the choices?

            – Can you think of anything else we might do? We already tried antivirals and antibacterials and you know yourself the results we had with those. Can you organise a month off work again? I’m afraid to say that you’ll probably be returning to work in a wheelchair next time rather than on prostheses.

            – How much are you thinking of amputating?

            – Bilateral disarticulations from the pelvis.

            – Leaving me completely legless? No stumps? Isn’t that just a bit exaggerated?

            – What do you suggest?

            – Well, I was thinking that since we’ve caught it early this time, it might be enough to amputate, say, mid-thigh. I want to be able to use artificial legs again after the new amputations. I really don’t want to be in a wheelchair.

            – I’m sure we could also manufacture a torso socket for you which you could wear to let you remain mobile on crutches. You do realise that your body will not be able to support you in a sitting position without some prosthetic aid after disarticulations?

            – Yes, I realise that. That’s why I want some stump.

            – Well, it is highly irregular but I do agree in your case that there may be a chance that mid-thigh stumps may suffice to arrest the syndrome’s progress. Shall we make arrangements?

 

Wesley discussed the matter with his employer who rearranged the schedules for the next six weeks and wished Wesley luck. Once again, one of his colleagues would present the weather forecasts during Wesley’s recovery. His stumps were amputated four days after his conversation with May, leaving him with six inch stumps which were the minimum practical length for the successful use of above knee prosthetic legs. Wesley recuperated at home and was fitted for new prostheses five weeks after the amputations. This time he felt disabled and the sensation excited him. Leglessness, with short thigh stumps, had always been his ideal which he enjoyed seeing on other men who exhibited themselves and their prostheses online. He would shortly be returning to work and wondered if he would be scheduled to present the forecasts again. He was wary of doing so from a wheelchair but it would be a couple of months before he was standing on two feet again.

 

European Centre for Neurological Research Conference, Wednesday, October 23rd, 2030

Speaker: Dr Carlton Elliot

 

            – It was recognised that RNDS recurs at longer intervals the higher up the affected limbs are amputated. Patient K underwent his second bilateral amputations eight months after his first. Due to his public exposure, he wished to remain as outwardly normal as possible and enthusiastically learned to operate a pair of above knee prosthetic legs, although for much of the time he relied on two walking sticks again for general mobility. At home, he used a wheelchair and toward the end of the second phase, he paid for a pair of short prostheses or stubbies, which enabled him to walk around at home on his stumps.

 

Patient K’s private life, Bayswater, London

 

Wesley regretted losing his stumps. He loved his new body image with the truncated legs and loved handling the steel and plastic prostheses each morning. He walked as well as any other bilateral amputee and was frequently complimented on his prowess by the few friends and colleagues who knew of his illness, if such it was. Now his body ended with two fairly short stumps, a compromise between residual limbs which could physically cope with operating prosthetic legs and the complete leglessness which May had suggested. Wesley spent much of the time at home on his rump, hand-swinging from one room to the next. The two men refurbished their kitchen and bathroom in preparation for both Wesley’s current disability and future possible revisions. After receiving his stubbies, Wesley’s mood improved. His old joie de vivre returned, much appreciated by both Kelvin and his colleagues at work. Wesley presented the forecasts less frequently, which was explained to disappointed enquirers by his continuing education and study. In front of the camera, Wesley wore his long prosthetic legs but leant against a wooden tripod painted green which was invisible on camera. He left his legs at work in his locker and wore them only in the video studio. His colleagues became used to seeing the short figure with his remarkable short steel legs and shorts whose hems swept the floor. Kelvin transported Wesley to work each day in the small electric car they had bought and collected him each evening. The public never realised and the gutter press was kept in ignorance.

 

European Centre for Neurological Research Conference, Wednesday, October 23rd, 2030

Speaker: Dr Carlton Elliot

 

            – Shortly after Patient K’s return to work, his companion began to notice an increasing lack of dexterity in his hands. His fingers felt stiff at first and then lost feeling. It was impossible to deny the effects of RNDS and the question arose—is the disease transmissible? If so, it would cast doubt on the prevailing theory that it was due solely to a CPRS variant and some as yet unknown environmental factor. Patient K contacted his surgeon at Roehampton and explained the situation. Patient K and his companion were invited for interviews at their earliest possible convenience. It would be redundant to repeat the progress of the young man’s syndrome. Suffice it to say that his gangrenous hands and forearms were shortly amputated leaving two inch stumps below his elbows. Over the following weeks, the patient made a good recovery, encouraged by Patient K, and in ten weeks was able to function with bilateral prosthetic arms. They lived as bilateral amputees assisting each other until the imperceptible effects recurred in Patient K. Possibly because of the lack of a joint in his residual limbs, the syndrome progressed much further than had previously been the case and manifested only when the patient noticed a discolouring of his stumps. He kept an eye on the situation for three weeks and alerted his surgeon when the tell-tale stench recurred. Within hours, he underwent the complete removal of his femurs. He was returned to his home encased in a torso socket with a broad flat base which allowed him to remain upright without putting pressure on his stump.

 

Patient K’s private life, Bayswater, London, three years prior

 

Kelvin struggled to open the door with a hook and stood aside as an ambulance man wheeled his lover inside. Wesley gave a wan grin. He was strapped into a wheelchair by a broad Velcro strap, his torso stump resting on a soft cushion.

            – Thank you very much. I can manage from here.

The man left and Kelvin kicked the door shut.

            – I could manage weeks ago. Goddamn this derogatory attitude. Damn them! Come here! Give me a hug. I want to feel your arms around me.

            – Sorry they aren’t the one you loved.

            – Those are fine. You look great. Have you been learning to use them while I’ve been away?

            –I suppose so. I can dress myself and cook.

            – Good. I like the way you are, Kelvin. I have always thought that a man with hooks looked hot. I never expected my own lover would have a pair. They look good on you. I hope you never change.

            – So do I but I don’t hold out much hope.

            – I know. Let’s make hay when the sun shines. How about going out tonight? I want to see some life again after being in Roehampton for two months. Are you up for a trip into town?

            – I don’t know. I suppose so. What’s on? Have you got something in mind?

            – Let’s go for a meal. You can drive the car, can’t you?

            – More or less. I tried it twice without crashing.

            – Great!

            – And I’m pretty certain we can fit the wheelchair in the back.

 

Wesley selected a restaurant in Bermondsey which had been getting good reviews. He booked a table after making sure the place was accessible. Kelvin fetched the car and, with considerable effort, the two bilateral amputees enjoyed a good meal in comfortably non-pretentious surroundings. Wesley sat opposite Kelvin and had fun feeding his lover across the table. They bought a bottle of red wine and took it home to continue la dolce vita, their small celebration of living life as they wanted despite adversity.

 

European Centre for Neurological Research Conference, Wednesday, October 23rd, 2030

Speaker: Dr Carlton Elliot

 

            – At this stage, two years after the first cases began appearing, it was obvious that RNDS had a seventy percent risk of affecting all four limbs. Many patients had undergone disarticulations of their legs and were living in fear of having the syndrome repeat in their arms. The majority were to lose their hands and arms. For a few, it has been sufficient to remove forearms, for others, they are living with above elbow amputations and able to use prosthetic arms. A few have suffered bilateral disarticulations of their arms and as a result are now completely limbless. Prosthetic research is currently working on relatively inexpensive bionic solutions to allow such people to operate artificial arms and hooks with shoulder movements rather than imbedded sensors which are difficult to learn and unreliable in use. Worldwide, there are two such cases who have maintained their careers with various prosthetic applications. In the United Kingdom, Patient K is the first victim of the syndrome to find himself limbless.

 

Patient K’s private life, Bayswater, London, twelve months prior

 

Wesley returned to work in his wheelchair. Kelvin, who was unable to work at his profession and now received a pension, drove Wesley to Richmond every morning and collected him in the afternoon. He was easily able to manage his job of meteorological analysis and, by popular demand, made a return to the screen as a weather forecaster. The studio constructed a revolving platform, about a meter high, on which a studio hand placed Wesley in his torso socket. Wesley continued to wear his trademark clothes and was shot featuring only his face and upper body. The studio hand crouched down and turned the platform at the appropriate time to suggest that Wesley was turning toward the weather map. Management was not satisfied with such a close view of their favourite weatherman and apologetically demanded that Wesley’s career as a presenter should end.

 

Two months after he was relegated to office work, Wesley became aware of familiar and unwelcome sensations in his hands.

            – Did yours start with pins and needles in your fingers?

            – Yeah. Why do you ask? I’ve told you this before.

            – I know. It’s just that I’ve had itchy fingers for a couple of days and it’s driving me nuts.

Kelvin manoeuvred his prostheses so he could place a leather bookmark in the book he was reading and set it to one side.

            – Is it only in one place or all over your hands?

            – All over. I’ve tried scratching but it doesn’t help.

Kelvin looked at his lover silently. They both understood the situation perfectly. Kelvin had avoided a repetition of the syndrome in his feet but it had now spread to Wesley’s hands and it was only a matter of days before the inevitable amputations would take his hands. And shortly his arms. Kelvin stood and walked across to his rigid lover, erect in his wheelchair. He positioned his prosthetic arms around Wesley’s neck and the men wept together.

 

Wesley arranged for a disability pension to be granted on receipt of confirmation of his newest bilateral amputations. It might be possible to operate the meteorological centre’s IT equipment with artificial hands or hooks but coupled with the difficulty with mobility, Wesley decided to retire at the unlikely age of thirty‑four. Dr Bryant May was sympathetic but assured Wesley that he had enjoyed more years of mobility and dexterity than was the case for the vast majority of patients.

 

Within weeks, Wesley’s arms were amputated halfway between his shoulders and his elbows. He was in a similar situation as his lover but his prostheses also featured artificial elbows. Wesley received them seven weeks after his amputations and returned home in a wheelchair, propelled by his handless lover who had been lucky to retain his natural and healthy legs. Wesley found his new arms to be challenging but his sense of aesthetics was gratified by the glossy black carbon arms and their steel hooks. The arms were however completely incapable of gripping the wheelchair’s push ring and Wesley started researching motorised chairs. They were either impractical for use in their apartment or formidably expensive, especially the two wheeled gyroscopic model which would have suited Wesley’s needs. Instead, he purchased a conversion kit for his manual chair which would convert its method of propulsion to that of levers. He should be able to operate his wheelchair by pumping his prosthetic arms back and forth. He believed his stumps could produce enough torque to move himself, all thirty-two kilos of him.

 

The auxiliary levers were a successful solution. The two amputees were mobile and Kelvin had become adept at using his hooks. The threat of further amputation receded from their minds. Wesley continued his study of meteorology and climate chaos from home and was in frequent contact with his former colleagues. Once a month the two men invited a few friends to their home for dinner and drinks. It was a welcome social event which helped them maintain some kind of contact with the outside world.

 

European Centre for Neurological Research Conference, Wednesday, October 23rd, 2030

Speaker: Dr Carlton Elliot

 

            – Almost inevitably, a year after his previous amputations, Patient K sensed the return of the discomfort in his arm stumps. As with his thighs, the syndrome had advanced much further before making itself obvious. Patient K underwent a fifth procedure to remove his rotting stumps. He was totally limbless and fiercely determined not to be helpless.

 

Instead of moving back home, it was decided that Patient K should move into small but comfortable accommodation in a separate wing of Roehampton hospital. It was commonly used for patients whose prosthetic treatment and rehabilitation required constant and frequent visits to the hospital and staff were on hand around the clock to give assistance. Patient K required assistance with everything. He was assigned a pair of personal assistants one of whom was present from seven in the morning to ten in the evenings, with a two hour break around midday. His accommodation was heavily subsidised in return for ‘hands on’ assistance with the technical production of readily printable electronic prostheses, specifically artificial arms and functional terminal devices.

 

The base of his torso socket was adapted to accept an auxiliary base to which were attached two reciprocating stubbie legs, about twenty centimetres in length. The legs could be easily removed by depressing a lock and his companion, a bilateral below elbow amputee, was able to do so. Patient K learned to walk again by rocking his body from side to side. The opposing short leg swung forwards automatically a few centimetres each time and the patient was again mobile on any flat unimpeded surface. To sit on a chair or in his wheelchair, the auxiliary base was detached allowing the flat base of the socket to support the legless user.

 

The upper extremity specialists at Roehampton were keen to develop a rigid carbon fibre harness fitted with standard prosthetic arm components driven by miniature electric motors activated by shoulder movement. Sensors inside the shoulder socket would respond to motion and after some practice, the patient was expected to be able to move the upper arms through thirty degrees and the forearms through one hundred and twenty. The terminal devices, commonly expected to be electrically operated hooks, would be fixed to the forearms precluding any possibility of rotation or pronation. It was hoped that development would progress further with active input from an intelligent user. Patient K was the ideal candidate and soon found himself a welcome member of the development team. He was rewarded for his efforts with a gyroscopically controlled two wheel wheelchair.

 

Patient K’s private life, Bayswater, London, four months prior

 

Kelvin collected Wesley from Roehampton every Friday afternoon and drove him back for a nine o’clock start the following Monday. Kelvin missed his lover during the week but was relieved and encouraged by the improvement in Wesley’s mood after losing his remaining stumps. Wesley was allowed to keep his reciprocating stubbies and actually found it erotically fulfilling to rock himself from side to side. His genitals were suspended inside his socket but with an erection, his penis touched it and he could use the friction to masturbate. He made many circuits of their apartment, an armless torso covered in black carbon fibre with a smile on his handsome face. Kelvin knew soon enough what he was doing after finding a quantity of drying ejaculate inside Wesley’s codpiece, as they called the detachable cover in his groin.

 

Wesley was content to be fed and watered by Kelvin over the weekends. He was encouraged by the progress being made at Roehampton and fully expected to have a new set of functioning hooks soon. Until then, he relaxed into the ecstasy of being utterly limbless and indulged physically and sexually by his handless lover. Wesley’s torso stump was very sensitive, one broad erogenous zone. His leglessness had the unexpected advantage of enabling almost endless erections through minor stimulation. Even having his body stump dried after a shower, where Kelvin held him in his lap to wash him, was an erotic experience. Kelvin was not deterred by Wesley’s limblessness and allowed himself to be explored anally by the torso with the insistent cock laying on his back, supported by his own handless arm stumps.

 

Wesley’s first pair of arms was ready in a surprisingly short time. It was more time-consuming to hone the micromotors to react reliably to the shoulder motions which the armless man had available. To their great credit, the technicians worked with what Wesley could do, rather than insisting that he learn to move his upper body in unfamiliar and awkward ways. Wesley would never be able to don his prosthetic arms himself, nor secure himself in his torso socket, but with an assistant’s help he was soon strapped into his wheelchair wielding a pair of hooks. Their movement was improved almost imperceptibly over a period of two months and Wesley gradually felt himself capable of leading a semi-independent life.

 

European Centre for Neurological Research Conference, Wednesday, October 23rd, 2030

Speaker: Dr Carlton Elliot

 

            – Thanks to the efforts of the prosthetic department at Roehampton, Patient K was able to return home and achieve some kind of normality within a few weeks. He had functioning prosthetic arms and the Roehampton team continued work to make the miniature stepper motors more responsive and stronger. Patient K was satisfied, able once again to feed himself and to operate electronic equipment with remote controls. And now, ladies and gentlemen, it gives me much pride to introduce Patient K who will answer your questions for the remaining forty minutes we have available. Please welcome Wesley Stokes!

 

The audience burst into applause along with gasps and shouts as they recognised the familiar and popular tv weatherman. Everyone had noticed his absences which had been explained as further study. They were shocked to see him in his current situation. Wesley was wearing his trademark outfit—short-sleeved white shirt with a gaudy bow tie and his leather waistcoat. His body ended at his pelvis. He was seated in his rigid carbon torso socket and balanced on the gyrochair. He shrugged a shoulder and his prosthetic right arm rose in greeting. He waved the hook at the audience.

            – Good afternoon, everyone. The outlook for this evening is unsettled with intermittent showers.

The audience laughed. Many people stood and applauded.

            – Thank you. I’m very pleased to be back, some of me anyway. As you can see, I am what the medical profession describes as a quadruple amputee. I have undergone disarticulations of all four limbs, which simply means that I don’t even have stumps. I doubt that I shall ever walk again but thanks to the brilliance of the technicians at Roehampton Hospital, I have a functioning pair of artificial arms and find myself able to do more and more for myself each day. I want to reassure you all that I feel positive about my future and I don’t want pity. A little common consideration is quite enough.

More laughter.

            – Doctor Elliot has already described the medical side of the syndrome we now call RNDS. I suspect that there are other people here who it has affected, either personally or through a loved one. I believe there is still too little practical information publicly available, so I invite your questions, no matter how trivial or personal and I hope I can rely on Doctor Elliot for support with the medical side. Please, who will be first?

            – Are you going to make a return to our screens?

            – You mean as a weather forecaster? No, probably not, at least not in the near future. I have officially retired with a nice disability pension. After I lost my legs completely, I presented reports a few times but it was awkward to televise both my gestures in half frame in front of the map graphics. So we stopped trying. Prior to that, I had been on artificial legs for three years or so, which apparently never became known to the general public.

            – Did you realise at the outset that you might lose all four limbs?

            – Absolutely not. That’s what has been the most shocking and dreadful aspect of RNDS. It seems to go away but just lays in wait for a few months. It is very challenging to come to terms with amputations at the best of times. Learning to use artificial limbs calls for a lot of determination and physical strength. It is a very frustrating experience to start learning to use short fake legs only to undergo another amputation six months later and have to start over again with a completely different set of legs. Or arms, of course. Several victims lost the limbs in the reverse order compared with myself. Hands and arms first, then feet and legs. In my own case, I lost my feet first, which I did not find disabling but I was extremely baffled when RNDS recurred. I had assumed it was a disease like CRPS which is often cured with one amputation.

 

            – What’s it like to have RNDS? How do you know you have it?

            – I found out when my feet started rotting. There had been some odd sensations before that too, skin irritation and stiffness, but I tried to ignore it and battle through regardless.

            – Typical male reaction.

            – Yes! We put off going to see a doctor until you start falling apart. Literally, in my case. The unfortunate thing is that once RNDS is diagnosed, it’s almost impossible to prevent it recurring later. And no-one can say whether it will spread from your legs to your arms. I guess I was one of the unlucky ones. My partner also lost his hands to RNDS about five years ago but so far has remained free of further problems. But we are both very conscious that the disease may take his arms at any time. That is one of the reasons why I want to help with research at Roehampton.

            – How are you able to operate your artificial arms without stumps? My brother has an artificial arm as a LAE amputee and finds it aggravating to use even with a fairly healthy stump.

            – I’m wearing an experimental set-up which the team worked on. The idea was to produce prosthetics which don’t rely on implanted sensors in the patient’s chest because no-one naturally uses their chest muscles to move their forearms, for example. This is an example of the end user advising engineers to adapt to his capabilities instead of engineers expecting the patient to adapt to their own capabilities, or lack of.

A smattering of applause.

            – So I’m wearing a yoke across my shoulders which has built-in gyroscopic sensors. They have a drop of mercury in them so they know which way I’m tilting them. When they sense a rapid change of position, they activate a server motor in my shoulders or elbows and that part of the arm raises or lowers. To use the hooks, I remain still for half a second and tilt my body slightly. The hook on that arm opens and another tilt closes it.

            – So it all works like a toggle switch?

            – Yes, that’s a good description.

            – It must be very difficult to use.

            – It’s not easy or intuitive but bear in mind that it has been made for me according to ideas which I provided myself. You can probably appreciate that for a man with no arms, having any kind of movable extensions from his shoulders is going to be useful. I am in the position now of having a pair of functioning hooks like my partner and we manage quite well together.

            – Is that prosthetic design going to be made available to other users?

            – I certainly hope so. We are still refining certain aspects of it. This pair sometimes has trouble distinguishing shoulder movement from elbow movement which is a little inconvenient but considering that I am doing things which no amputee with disarticulations has been able to do before, I’m not complaining.

 

            – I hope this isn’t too intrusive a question. If so, I apologise but how are you able to sit without legs? I don’t understand how you can balance upright.

            – I’m wearing a kind of corset which encompasses my lower body and which has a flat base. So I’m held secure by it and it is resting on my wheelchair’s seat. I can show you. Let me open this Velcro strap first.

Wesley sat upright and tilted his right shoulder. His right arm rose and he waited a moment. The forearm moved to a suitable angle and he made himself sit more erect. The hook opened and Wesley manoeuvred it to his shirt tail. He shrugged slightly, the hook closed and Wesley tilted his shoulders. The forearm rose and lifted his shirt to reveal the black carbon shell which enveloped him.

            – I know this looks shocking to you but I can assure you that it feels extremely comfortable and after it warms up in the mornings, it is very comfortable to wear. It replaces my legs and I am quite satisfied with it, strange as that may sound.

He released the hook and his shirt dropped down to the seat of the wheelchair.

            – This is the most important piece of prosthetic equipment which I own. It allows me to be upright, which is a much better position to view the world. Naturally, I cannot get into it myself. I will always rely on an assistant’s help to fit it onto my body and to raise me to a sitting position.

Wesley rapped on his shell with his hook. The sound was picked up by his microphone and reverberated around the auditorium.

            – If I may be permitted, I would like to introduce my life companion, my fellow RNDS amputee  victim Kelvin Webster.

 

Kelvin marched out onto the stage and waved a hook at the crowd. It was a surprise to some of the female members of the audience who had not dreamed that such a masculine man as Wesley Stokes might have a male partner.

            – Kelvin and I have been together for almost ten years and we’ve been through purgatory together. I can’t think of anyone else who might have stood by me as I lost myself bit by bit. I am eternally grateful to Kelvin, who has also learned what it means to lose a limb. In his case, two.

            – Did he catch it from you?

            – We don’t know. At this stage, it doesn’t seem likely. The syndrome is not believed to be contagious. There are many other nuclear families where one member suffers from RNDS but the other family members are fine. It seems more likely that in our case Kelvin is merely very unlucky, although it must be said that Kelvin is also a subject for study because RNDS has not recurred in his arms after four years or so.

            – Kelvin, what do you think? Do you blame Wesley for losing your hands?

            – Well, it’s not Wesley’s fault in any way but I know what you mean. Aah, I’m not sure. At first I thought it had to be contagious but over time I’ve come to realise that it probably isn’t. That whatever virus it is what’s causing it is probably what I caught too, but not from Wesley. Because of the other families. It wasn’t contagious for them. As for losing my hands, I do just fine with hooks and I have to admit that I feel rather proud of myself for coming to terms and managing everything with hooks instead of hands. So if there is anyone in the audience who dreads losing their hands, let me reassure them that it’s not as bad as it might seem.

            – I can confirm that. Being completely limbless, I am completely reliant on Kelvin to get me assembled every morning and he does so with good humour and his steel hooks. Kevin was always a handsome man and his hooks do not detract from that, as I think you will agree.

 

            – I have a personal question for you. I hope you don’t mind.

            – No. go ahead.

            – Well, I was wondering about how you adapt to your new body image. For some of us, it’s difficult enough to appear in public with a new haircut or new spectacles. There’s an uncomfortable feeling that everybody is looking and judging.

            – Yes, I know what you mean. I was conscious of it when I lost my legs for the first time. Sorry, that sounds ridiculous. My first amputations were below my knees and I quickly learned to walk with two artificial legs. And I dare say that very few people who didn’t already know me would have noticed anything amiss. I did weather forecasts for seven or eight months like that and none of my fan mail mentioned anything about my legs. Of course, that changed when I lost my legs for the second time. I was in a wheelchair then for much of the time and the question of body image was much more evident. But the thing is, sitting legless in a wheelchair is less confusing for other people who see someone with two legs using a wheelchair. There is less reason to wonder why. Personally, I was glad to be able to use the chair. I didn’t mind it, providing there were no thoughtless obstacles to negotiate. And after the third amputations, when my stumps were amputated completely, there was little difference as far as my outward body image was concerned, although of course it felt very different to be held upright by a kind of stiff corset rather than sitting on my own buttocks.

 

            – Can I add something here? I was initially embarrassed about being seen without my hands. I felt that everyone was looking and turning away in disgust but I soon noticed that most people are very considerate and look away after they notice my empty sleeves. Children stare and ask questions sometimes but my amputations didn’t lead to any great crisis in self-image. I was content with these stumps, which I’ve had now for about four years, because for what they are, they’re well-shaped and are not criss-crossed with scars like some stumps. As far as the hooks are concerned, I was a little wary at first but now I actually like the way they look. I’m not at all embarrassed to be seen wearing my artificial arms and I usually wear just a T-shirt in summer like everyone else.

            – Thank you, Mr Webster.

 

            – I have a question for Mr Stokes. You’re a well-educated man with a career cut short. What plans do you have for the future?

            – First of all, I want to continue working with the prosthetics team at Roehampton on developing a new type of artificial arm for other people as severely handicapped as I am. And then, probably concurrently, I’m sketching out ideas for a book about how to mitigate climate chaos in your daily life. The things you can do to make your life more secure. I’m not talking about sorting your garbage or turning vegetarian, I’m talking about how to behave if you are threatened by a rain bomb or how to sleep during a mega heatwave. There are so many aspects now of the threats we face but really no-one has any idea how to confront them.

            – It sounds like a necessary book. Thank you, Mr Stokes. I look forward to reading it.

 

            – If no-one else has any questions for Mr Stokes or Mr Webster, I’ll call an end to the meeting. Thank you all for your kind attention and many thanks to our two eminent guests.

The auditorium burst into applause. Wesley leaned forward slightly and coaxed his wheelchair closer to the front of the platform accompanied by Kelvin who spread his arms in acknowledgment. After twenty seconds, the lights were dimmed and the two men retreated backstage where they were invited to indulge in an opulent supper. For the first time in public, Wesley demonstrated his skill with his prosthetic arms and, slowly but surely, tasted a selection of sushi, nipping the food into his mouth with a hook. Conversation with his hosts continued for another couple of hours until they returned home in a taxi. Wesley had interesting new topics to think about for his book.

 

TWO YEARS LATER

 

Wesley continued his co-operation with the Roehampton team and was rewarded with a lightweight set of upper limb prostheses. Its joints were spherical and the upper and lower limbs were mere two centimetre thick connection rods. The wrists terminated in standard split hooks. It was shocking to see, almost insectile, but Wesley was now as independent as it was possible for a limbless torso to be. He also continued his research into likely climatic changes and how they would affect daily life in the nation. With the assistance of voice input and artificial intelligence, he was able to submit a first draft to a publisher who forwarded a fifty thousand pound advance. Over the following three months, he honed the book to his satisfaction with an editor. Never Too Late was published at the end of the year in time for the Christmas market and sales grew steadily throughout the next year as the book’s value was appreciated more widely.

 

Wesley had thoroughly enjoyed the writing process and wanted to continue. An autobiography seemed the obvious theme. He would describe his involuntary transition to limblessness, describing the disease itself and the prosthetic solutions he had worked on. The title was It Never Rains. Before the book went for final edit, Wesley received his third generation arms. They were mechanically similar to version two but were covered in life-like cosmeses complete with hair. The rounded wrists looked odd, terminating again in split hooks rather than hands but the arms looked realistic, coloured with a healthy tanned shade and providing a huge psychological boost to the man who had not looked down on a pair of natural arms for four years.

 

The personal relationship with Kelvin continued as before. Kelvin was grateful for being spared further amputations and gave every assistance to his limbless lover. He had become accustomed to his own hooks and paid them little attention. Disregarding a few minor adjustments he had been forced to make, his life as a retiree was enriched by helping with Wesley’s projects, full of admiration for his resilient handsome lover.

 

THE  LIMBS