BALTIMORE — Perched on a therapy table at Johns Hopkins Hospital, one of the few quadruple amputees from the Iraq War reached up over his head with both hands and launched a pink ball to the Marine Corps commandant.
Five months ago, Army Sgt. Brendan Marrocco’s arms belonged to someone else.
Marrocco, who was blown up in 2009, is the first soldier to receive a double arm transplant — and just the seventh successful recipient in the United States.
Marrocco didn’t have any physical sensation of the plastic ball in his hands, but he managed a pretty good zip as he played catch with Gen. James Amos on Wednesday.
“Mentally, they’re all mine,” Marrocco said about his new limbs. “Physically, I can’t feel them.”
Doctors estimate it could be two years before he gets feeling all the way down to his finger tips, as nerve tissue regenerates about an inch a month.
In December, a 16-surgeon team at Hopkins attached two cadaver arms to Marrocco in a 13-hour operation that started at 1 a.m. His remaining nerves, muscles, bones, blood vessels and tendons in his upper arms were intricately connected to the donor arms, and eventually, as the nerves come to life down the arm, the limbs will move like they were his own — albeit less than 100 percent functional.
The rehabilitation process is long and grueling, but doctors said Marrocco has so far beaten every time line expectation. The lead surgeon, W.P. Andrew Lee of Hopkins’ plastics and reconstruction department, said the amount of determination a patient has is one of the most important factors for a transplant like this to be successful, and the wise-cracking, hard-headed soldier has pushed from Day 1.
Marrocco started therapy three days after the surgery, doing four hours every day, including the weekends at first. He is building strength in his upper body with resistance training by lifting a mallet or a three-pound weight wrapped to his hand, and he is also working on being able to grip objects. Recently he was able to grab and hold a tennis ball — a feat that elated his occupational therapist, Molly Ferris, even though she said Marrocco was “a cool cucumber” about it. He rarely shows excitement about his progress, she said.
Marrocco said trading in his prosthetics for the transplanted arms meant taking a step back in what he is able to do. Last year, for example, he shot a gun with his prosthetic hands on his annual hunting trip.
Of the successful bilateral arm transplants done in the U.S., the hospital reported that Marrocco’s surgery was the most complicated and extensive. Because of the remaining elbow on his left side, doctors had to overlay the donor arm muscles on top of his, giving him two sets of muscles and a bulky forearm.
When Amos greeted Marrocco, one of the first things he said was, “I expected your Popeye arm to be bigger.”
He also teased the soldier about his longish — by Marine standards — hair and scroungy goatee.
The two first met at Walter Reed not long after Marrocco was hurt, and the commandant was asked during a visit to the hospital to help “jack him up.” The general often talks about what Marrocco said as they wrapped up their conversation that day: “If I could just have one arm my life would be changed forever.”
On Wednesday, Amos marveled, “now you have two.”
Amos is committed to raising awareness of the procedure among the military’s amputees. Last week he said he met a Marine who had lost an arm and asked him if he knew about arm transplants.
“What are you talking about?” Amos recalled the confused Marine asking.
Lee said the hospital is forging partnerships across the military to educate both patients and doctors about the chance for amputees to get non-prosthetic limbs. About a month and half ago, Department of Veterans Affairs Secretary Eric Shinseki visited the hospital and expressed interest in covering the costs of rehabilitation for vets who undergo the procedure, Lee said.
The surgery isn’t covered by the military insurance Tricare, so Hopkins and the Armed Forces Institute of Regenerative Medicine footed the bill for Marrocco’s surgery. The doctors donated their time.
Marrocco, who will move to Walter Reed for the rest of his rehab, said his new arms give him hope for the future. While he was waiting for a donor, he said he didn’t make any plans. Now he’s starting to plot out the next few years of his life.
On tap for this year: pulling the trigger with his new hands during his hunting trip in November.