Wednesday, Jul 9, 2008
Why are we hearing about a successful hand transplant two years after the fact? Maybe because the field's first poster child turned out to be a criminal who couldn't afford his meds.
Aug 24, 2000 | Two years ago, a New Zealand businessman made medical history when physicians in Lyon, France, replaced his amputated right hand and forearm with replacements salvaged from the corpse of a Frenchman whose brain had just been crushed in a motorcycle crash. The successful operation on Clint Hallam, 48, was a coup for the French-led team. They beat out University of Louisville transplant specialists who had been promised by Hallam that they could operate on him.
But if the French team seemed to have gotten the jump in the research race, the Americans have gotten the lead back.
This week, the New England Journal of Medicine announced the successful results of a similar operation on Matthew Scott, the 38-year-old New Jersey paramedic whom the University of Louisville team operated on four months after the Hallam operation. They reported that Scott can now write and turn the pages of a newspaper, tie his shoes and pick up his two sons. In the subsequent media fanfare, a thoughtful Scott appeared on ABC's "Good Morning America" on Friday talking about how he'd resigned himself to a life of disability since age 24 when he had a stupid accident with a firecracker.
So why was Scott's operation worthy of such media attention? Why aren't we reading about the successful results of Hallam's hand surgery instead?
Maybe it's because Hallam turned out to be a crook and con man who lied his way into the operating room and hasn't stopped lying since. Maybe it's because Scott was much readier for prime time. Although Scott has had more complications than Hallam, the relative success of his operation -- and his appealing appearances on TV -- have breathed new life into this fledging field.
In an era of media-driven medical science, patient personality has become increasingly important. Think spunky hemophiliac Ryan White and AIDS, think Christopher "Superman-brought-low-but-still-fighting" Reeve and stem cell research. In the case of Hallam and Scott's hand surgeries, personality was even more important than getting there first. Poster child patients become more than the "first try" at a new technique or drug: They become symbolic of the illness or treatment as a whole. A noncompliant patient makes follow-up care difficult, and can end up giving the research or treatment a bad name.
In this case, the messy life of Hallam not only complicated his recovery, it added fuel to the arguments of physicians and medical ethicists who regard limb transplants as unnecessary elective surgeries requiring toxic immunosuppressant drugs.
Still, much as they might like to, the surgeons who gave Hallam a hand can't ignore him. As Hallam travels the globe, one step ahead of police, his doctors are forced to ignore his trespasses as they struggle to keep him and his hand alive.
"I've told him time and time again that he has to take his medication if he doesn't want to die, but with Clint it's not only a medical problem, we have to sort out social problems as well," says Dr. Nadey Hakim, a British transplant surgeon. "He's not the ideal patient, but at this point we've no choice in the matter."
Hallam lost his hand in a circular saw accident at a woodshop in a New Zealand prison in 1984 where he was serving a sentence for fraud. The hand was sewn back on but didn't take and was removed in 1989. From that time on Hallam began haunting the offices of physicians around the world who were investigating the possibility of limb transplantation.
Hallam eventually made contact with both the French team and the Louisville team, offering himself as a subject for surgery. He lied about his past, saying he'd lost his arm in a construction accident.
The day after his surgery, Hallam simply didn't show for the breakfast appointment he'd made with the Louisville doctors. When Dr. Warren Breidenbach, the leader of the Louisville team, called Hallam's wife back in Australia, she told him: "He doesn't need you anymore. He already has his arm."
Hallam's criminal record surfaced shortly after the operation, leading the French-led team, all men at the tops of their fields, to shake their heads at the confidence job he'd performed on them.
"He's an absolutely charming chap, clever enough to have fooled a great many people in his many careers," says Australian microsurgeon Earl Owen.
Owen, Hakim and six other top physicians from around the world had donated their time and money for the operation. At the hospital, Hallam befriended a French liver transplant patient, then ran up a $32,000 bill on the Frenchman's borrowed American Express card. Fleeing fraud charges in France, Hallam turned up at Hakim's flat in Britain and stayed for 10 days, working late into the nights on the computer trying to arrange the sale of his story.
Get Salon in your mailbox!