Life with a new right hand

When Emily Fennell walks into a store or the hair salon, people often ask, "What happened to your hand?" She gets a kick out of their reaction when she casually replies, "I had a hand transplant."

"They say, 'Can they really do that?' " she said, glancing down at the soft brace that covers her right forearm and wrist, slender fingers and neatly trimmed fingernails peeking from the bottom.

Yes, they can. Fennell strolls around Westwood as living proof.

On March 5, Fennell became the first person to undergo a hand transplant in California and the 13th nationwide to have the revolutionary surgery. At the time, the 26-year-old single mother from Yuba City wished to remain anonymous. Now, six weeks after the 14-hour operation at Ronald Reagan UCLA Medical Center, she is talking about her journey.

With long, straight hair and fashionable boots, she could pass for just another UCLA student who fell off her skateboard. But it was a car accident almost five years ago that took her right hand.

"It's crazy how good it looks," she said at her occupational therapy session one morning last week at UCLA, where she spends about eight hours a day working on learning how to move her new hand and fingers. "I knew the match wouldn't be perfect, but if you didn't know what happened, you'd think I just had some kind of orthopedic surgery."

On June 11, 2006, Fennell was a passenger in the front seat of a car that was clipped by another vehicle and rolled over. The sunroof was open. Fennell's hand went through the space and was caught between the car and the road. The mangled hand had to be amputated.

"About a week after the accident, my mom said, 'You can be the kind of person who says 'Woe is me' and gives up, or you can say, 'This sucks, but I'm moving on.' I chose that one," she said.

She learned to use her left hand to write, dress, drive a car and work in an office typing 40 words per minute. When she received a prosthetic arm six months after the accident, she had already mastered many tasks with her left hand and, after months of trying, concluded that the prosthesis wasn't helping.

But she wanted to be able to do more for herself and her daughter, now 6. She heard about hand transplants last year from a friend who was also an amputee, and immediately began researching the surgery.

She was evaluated at UCLA and accepted into its newly formed transplant program to wait for a suitable donor hand to become available.

"I was ecstatic," she said. "I was a little bit nervous, but I don't think I was ever scared."

Doctors told her that the biggest risk from the surgery comes from the side effects of lifelong use of strong immunosuppressant medications, which can cause high blood pressure, kidney or liver damage, elevated cancer risks and lower resistance to infections. These have rendered hand transplants somewhat more controversial than other forms of transplant because, unlike a heart or kidney transplant, receiving a new hand is not a life-and-death matter.

"I decided the benefits were worth those risks," Fennel said. She has adjusted well to the medications.

She was put on the waiting list for a donor hand in February and was told to await a call that could come in weeks or months. Sixteen days later, on March 4, her office phone rang and she was told, "We have a hand for you." It was donated by a family in San Diego.

She hung up, went into a private office, closed the door and cried.

The rehabilitation process has a long way to go, but she has made the ordeal look simple, said Dr. Kodi Azari, surgical director of UCLA's hand transplant program. Doctors, nurses and therapists scrutinize her every move, make copious notes and have only recently began to relax a little, he said -- but Fennell has taken a down-to-earth, even-keeled approach to her adventure.

"She is self-assured," Azari said. "You can see this amazing determination in her. That, to me, is the most important characteristic."

At the therapy session, Azari watches as his patient places cylinder blocks into a pegboard, one of a variety of drills aimed at teaching dexterity to the new hand.

With the brace off, one can see Fennell's scar -- it loops halfway down her forearm, then sweeps back up and around. The donor hand was not attached in a straight line encircling Fennell's wrist like a bracelet. Instead, a circuitous incision was made to prevent a roll of scar tissue from forming at the wrist, which could impair movement.

The therapy continues with ever smaller items that Fennel is challenged to grasp. Therapist Renee Portenier asks her to try to pick up a nickel-sized disk between her thumb and index finger. All the muscles and tendons in her right forearm are weak from years of inactivity and must be strengthened before she can begin to truly take command of her new hand.

Sitting quietly, her left hand in her lap, Fennel tries to grip the piece. She raises and swivels her shoulder to lift and rotate the hand above the disk and bring it straight down to touch it. Her fingers tremble, but she manages to close her forefinger and thumb on the disk and lift it.

She has no sensation yet in the transplanted hand. The nerves grow about one millimeter a day from the connections the surgeons made to her arm, and it will be several more months before sensations develop.

"The hand is connected to me. It's mine," Fennell said. "But until I have feeling in it, it's not going to feel like mine."

She purses her lips with concentration as she loses her grasp of the object and reaches for it again. When she succeeds, she looks triumphantly at Azari.

"The minute you tell me I can't do something, I do it," she said, grinning.

Her therapists encourage her to say "my hand" instead of "the donor hand." It's a psychological adjustment that runs parallel to the physical challenges she deals with.

"I know it's from a donor," she said. To this day, she still has few details about that person. "This is a gift they've given me, and it's such a blessing. But for me to accept it, I have to think of it as mine."

Now, like any 26-year-old, Fennell is eager to get on with her life. On weekends, she sometimes sees friends in Ventura County, where she attended Buena High School. But she fiercely misses her daughter, who is staying with relatives. For now, Fennell lives in UCLA-owned housing and will remain there until May or so.

Once home, she will have regular occupational therapy. Improvements can be expected for several years, and she should eventually obtain about 60% of the function of a normal hand, Azari said. The transplanted hand will always be weaker.

"It's going to be a road of constant rehabilitation, practice, gaining muscle strength, muscle conditioning, nerve growth," said Dr. Sue McDiarmid, medical director of UCLA's hand transplant program, which has begun adding other hand amputees to the waiting list.

"But Emily strikes me as a young adult who loves life. The will to be a whole, functioning mom was a very powerful motivator for her."

Fennell has a mental list of future milestones to celebrate as her hand becomes serviceable. Pull her hair into a ponytail. Cut up meat with a fork and knife. Hug her daughter "with both hands."

"You know," she said. "Little things."

shari.roan@latimes.com

For The Record Los Angeles Times Thursday, April 21, 2011 Home Edition Main News Part A Page 4 News Desk 1 inches; 47 words Type of Material: Correction Hand transplant: In the April 19 LATExtra section, a photo caption with an article about Emily Fennell, who had hand transplant surgery at Ronald Reagan UCLA Medical Center, said she spends eight hours a day in physical therapy. As the article noted, Fennell is receiving occupational therapy.
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