I think technology has evolved enough to let us be earnest about the fact that a consumer of a prosthetic is the same consumer buying an iPod or glasses or a couch for their house. You want options.
Obviously, the role of a prosthetic is one far more intimate than that of a couch, and being fitted for a prosthetic is much more labor intensive than just picking out eyeglasses, and but the ideas aren't so dissimilar. From the 1930s to as late as the 1970s, the UK National Health Service mandated only one "choice" for their eyeglasses—considered solely as "medical appliances"—and the standard was a plastic frame formed in a rather horrid pinkish color, an attempt at "flesh tone," already problematic in that description: Whose flesh tone, exactly?
The NHS believed that people would want discretion in their vision correction—the social humiliation generally thought to be incurred by wearing glasses meant that no one would want their glasses to stand out. So there was one form of glasses made for everyone. Today, that sounds ludicrous.
Meanwhile, no one has yet to build a leg that does it all—I have to change legs when I want to wear high heels; I have to change legs when I want to wear different height high heels; I have to change legs when I want to swim, take a boxing class at the gym, or sprint on the track. I have 12 pair in all (though many are housed in museums).
Until that functionality is matched with one single prosthetic, you want to be able to have the fullest quality of life as deemed by you. For some people, it will never be important to swim, or wear a pair of high heels, or to have a prosthetic limb with a cosmesis that really replicates humanness. But for others, those things could be very important. For some people, like me, some of those things are important only some of the time.
In my functional daily arsenal, I have a general rotation between what I call the "Robocop" legs (Re-Flex VSP Legs made by Ossur) and my cosmetic, very life-like legs (by Dorset Orthopaedic).
As if we weren't already aware of the dire state of the American healthcare system, the lack of prosthetic opportunity and choice for most people is due to very limited coverage by insurance companies. To be frank, since my teenage years, I have pursued each and every opportunity to be a guinea pig, trading the use of my body as a testing ground for new technologies for the privilege of using them. Not one pair of my legs is covered by insurance; not one pair of my legs is considered "medically necessary."
What is considered medically necessary for the American insurance standard is whatever gets you from the bed to the toilet. I am not kidding. No other aspect of daily living other than using the bathroom is considered "necessary," which means your basic prosthetic given to most amputees—a stick with a rubber foot as a leg, or a stick with a hook on the end as an arm, has fundamentally not changed since WWII.
My Ossur legs are constructed of woven carbon fiber. They've got a shock absorber, springs, and a split-toe foot so I can navigate uneven terrain with a bit better balance-and basically there's nothing human-looking about that leg. I don't mind this aspect. I'm quite happy with this amazing construction looking like what it is: a good prosthetic that enables me to move around very well. I've embraced the sci-fi aesthetic of the sleek black carbon fiber, the WD-40 glistening on the shock absorber, and I feel rather cool wearing them. They're the prosthetic leg version of a motorcycle jacket. However, I am very aware that there are some vets—mostly female, but some male as well—currently coming back from Iraq and Afghanistan who aren't exactly thrilled about looking like the Terminator, and their consumer desire for choice should be respected.
My Dorset legs are designed more for style than utility. Far lighter than the VSPs, the skeleton or internal frame is made from a hollow carbon fiber custom made tube, and like my sports legs, the sockets are shaped to match my residual limbs exactly so I am able to wear the prostheses all day without discomfort. The carbon is used because it has tremendous strength and weighs very little, approx 300gms. The frame is then covered with a polyurethane foam that is then sculpted both to my specific requests and the aesthetic imagination of the prosthetist Bob Watts, who will ask me how I want them to look. (My last pair got a super flexed calf muscle; it serves as a reminder to get the rest of my body to the gym.) Finally, the prosthesis is sheathed in a 2mm custom-made silicone cosmesis. The cosmesis is a truly astounding work of art: a Kevlar-backed and vulcanized silicone sleeve is built up of many thin layers of differently colored silicones that matches my exact skin tone by combing through nearly 500 color swatches of silicone. You won't find any standardized pinky-beige hues here. Dorset will even map hairs or just hair follicles (I prefer mine smooth, thank you), capillaries, veins, moles, and yes… tattoos. The Cosmesis takes a technician 2 weeks to build and sculpt. The result, incredible.
When traveling, I try to always wear my Robocop legs mainly because the shock absorber makes traversing the airport halls more comfortable. I can also easily lift the legs of my yoga pants and pop them off easily on a plane, making air travel much more tolerable when sitting trapped in a confined space for a few hours. An additional travel hazard I face is with airport security metal detectors: wearing legs that look so perfectly human, like the cosmetic pair I have, is not ideal because generally people in airports hear the word "prosthetic" without registering what it means. Being laced with bits of metal, I set off the bells and whistles and it isn't obvious why, and it leads to a more complicated, lengthier interrogation and inspection for me. Anyone who has ever raced to make a connection in Charles de Gaulle airport knows that every minute counts!
I once wore my cosmetic legs while transiting in Portugal and (predictably) set off the metal detector. They waived me aside—this was right after 9/11—and in a pathetically muddled hybrid of Spanish and Italian, I was like "no, no, yo tengo…" and "ho due…," struggling to complete the sentence with the Latin root word of "prosthetic." I said what I thought sounded like a good approximation, and I immediately got hauled off to one of those strip search rooms replete with search dogs, because the whole time I was actually saying "leave me alone, I'm with two prostitutes."
Not eager to revisit my lost-in-translation experience, I've learned to keep the cosmetic legs in the suitcase. I wear the Robocop legs, and when I set the metal detectors off, I just show my carbon fiber limbs at the ankle, and it's automatic: we commence with the wanding, the bomb swab, the pat down—if at JFK they have an additional X-ray box with a battery of 10 scans I have to pass—they actually know me by name now.
So I guess that means when traveling, I do anything but try to look like everyone else—which is a bit different from what the UK National Health Service would have ever predicted in 1950. [Image by Nick Knight]