BALTIMORE (AP) — After weeks of round-the-clock medical care, Brendan Marrocco insisted on wheeling himself into the room, using an elbow from one of his newly transplanted arms to turn the wheels of his wheelchair.
Then the former soldier pushed his hair aside, using his new left thumb.
Such simple acts might go unnoticed in other patients. But for Marrocco, 26, who lost all four limbs during combat in Iraq, they show how far he's come in the six weeks since he received a rare double-arm transplant.
After being wounded in 2009, Marrocco said, he could get by without legs but hated living without arms.
“Not having arms takes so much away from you. Even your personality, you know. You talk with your hands. You do everything with your hands. And when you don't have that, you're kind of lost for a while,” the New Yorker said in a press conference Tuesday at Johns Hopkins Hospital here.
Doctors don't want him using his new arms too much yet. But his gritty determination to regain independence was one of the main reasons he was chosen for the surgery, which has been performed in the U.S. only seven times.
It's also the message Marrocco said he has for other wounded soldiers.
“Just not to give up hope. You know, life always gets better, and you're still alive. And to be stubborn. There's a lot of people who will say you can't do something. Just be stubborn and do it anyway. Work your ass off and do it.”
Dr. W.P. Andrew Lee, head of the team that conducted the surgery, said the new arms eventually could provide much of the function of Marrocco's originals. Another double-arm transplant patient can now use chopsticks and tie his shoes.
Marrocco's recovery, the doctor said, has been remarkable, and the transplant is helping to “restore physical and psychological well-being.”
The press conference marked a milestone in the veteran's recovery: his discharge from the hospital. Next comes several years of rehabilitation, including physical therapy that will become more difficult as feeling returns to the arms.
Before the surgery, Marrocco had been living with his older brother in a specially equipped home on New York's Staten Island, built with the help of several charities. Then last fall, the home was heavily damaged by superstorm Sandy.
“We'll get it back together,” said his father, Alex Marrocco. “We've been through a lot worse than that.”
For the next few months, Marrocco plans to live with his brother in an apartment near the hospital.
The former infantryman said he can already bend the elbow on his left arm and rotate it a bit, but there hasn't been much movement yet for his right arm, which was transplanted higher up.
His mother, Michelle Marrocco, said her son can't hug her yet so he just brushes his left arm against her face.
He said the first time he moved that arm was a shock, an involuntary motion while friends were visiting him in the hospital.
“I had no idea what was going through my mind. I was with my friends, and it happened by accident,” he recalled. “One of my friends said 'Did you do that on purpose?' And I didn't know I did it.”
Marrocco's operation also involved a technical feat not tried in previous cases, Lee said.
A small part of Marrocco's left forearm remained just below his elbow. Doctors transplanted a whole new forearm around and on top of it, then rewired nerves to serve the old and new muscles.
“We wanted to save his joint,” Lee said. “In the unlucky event we would lose the transplant, we still wanted him to have the elbow joint.”
Leg transplants are “not very practical” yet, he said, because nerves regrow at best about an inch a month, so it would be many years before a transplanted leg was useful.
Even if movement returned, a patient might lack sensation on the soles of the feet, which would be unsafe if the person stepped on sharp objects and couldn't feel pain, he said.
Moreover, unlike prosthetic arms and hands, which many patients find frustrating, the ones for legs are good. That makes the risks of a transplant not worth taking, the doctor said.
Now Marrocco, who was the first soldier to survive losing all four limbs in the Iraq War, is looking forward to getting behind the wheel of his black 2006 Dodge Charger. And hand-cycling a marathon.
Will he be able to throw a football someday? Yes, said Dr. Jaimie Shores, but maybe not like Baltimore Ravens quarterback Joe Flacco.
“Thanks for having faith in me,” Marrocco chimed in, drawing laughs.
Marrocco, his mother said, has always been “a tough cookie.”
“He's not changed that, and he's just taken it and made it an art form. He's never going to stop. He's going to be that boy I knew was going to be a pain in my butt forever. And he's going to show people how to live their lives.”
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