Artificial limb

Spring, 2017

This letter is about how I went crazy.

I want to tell you about two videos I've seen. Each was only perhaps twenty seconds long, filmed with someone's phone, and they felt as though they could have been recorded at opposite ends of human history.

In 2013 I was struggling at a job I hated. My boss disliked me; I was unsupported, working on a project that would go nowhere. I was withdrawn from friends and I spent too much time on Twitter talking to Syrian guys – mostly my age or younger – living in Az Zarqa or Gaziantep or somewhere they were purposefully vague about. They were lucky that they had found the aperture and resources necessary to flee the charnel house Syria had become, and shockingly unlucky in that they all knew someone who was killed by mortar fire or who became ill in the cold or who was murdered by Shabiha or who just disappeared. They were a lot more like you and I than anyone might sensibly guess, and we mostly talked about pizza and Iron Maiden. I liked almost all of them immediately.

The price I thought I had to pay for friendship with these young Syrians was to quietly act as a disorganized, incomplete, horror stricken witness to the artifacts of violence their country now exports. They retweeted photos and videos their friends and family took at home in Homs or Rif Dimashq. These gory pictures showing the al-Assad regime’s response to the Syrian Revolution were never going to be broadcast in the rest of the world, and I couldn’t convince myself that I wasn’t obligated to look. Videos of the maimed and dead made my ears ring and my face flush – made me feel like I was going to pass out – but if someone captured these images and sent them out to the internet, I believed it was because they wanted someone else, somewhere else, to see them. If the images of these deaths went unseen, would the people whose destroyed bodies they showed be reduced to unexamined data on a server in metro Atlanta? Would they become absences, instead of the dead?

And in early 2013, I saw a video from Douma, a suburb of Damascus, taken in what appeared to be a grimy, ad hoc triage ward. The camera’s view revolved quickly as an unseen photographer moved toward a bed where a baby was screaming because both her legs were blown off at what been her chubby knees. Long tendrils of tissue depended from the wounds, and she screamed in confusion that there could be a pain like this that wouldn’t cease – outraged at the failure of those meant to comfort her. She waved her arms and her leg stumps in agony and anger.

I watched this video only once, sitting in my apartment at dawn on a March morning in Chicago, warm and soft from persistent insomnia, listening to the pinging of the radiators. In the interest of honestly and accurately describing what I saw then, I have gone back to Twitter and YouTube now to look for the footage, but the original post is gone. There’s a video of another little girl from Douma, posted to YouTube by an account called Syrian4all World on February 27, 2013, depicting an eight month old, orphaned infant named Masa, in a hospital. But she still has one of her legs, and more curly black hair than I remember. There is no shortage of dead or dying or grievously wounded children in Syria, and I do not think that I have confused my memory of the baby girl with no legs with this other baby girl with one leg. Another wrong video shows a different baby missing just one leg. His hair is different, his face has worse cuts; he was wounded outside Idlib, in al-Ma’arra (the only geography I know of Syria is a gazetteer of cities that used to not be bombing targets). There are many videos of other children, but they’re older, or the injury is different, or it’s a boy wearing tracksuit pants instead of the fractional baby I still see four years later. I know there was a video of a little girl from Douma with two missing legs, with two bloody, almost chewed stumps. I know there’s a video of filaments dangling grotesquely from a baby’s ruined legs, I know it showed a child furious at an intolerable pain, but I can’t find it, and I don’t know what that absence means (1) .

(1) While this essay was being prepared, a ten-year-old boy identified as Abdel Basit Al-Satouf achieved the worst kind of fame there could be, when a video of him went viral on Twitter. Both his legs were blown off at the knee in an air raid in Idlib. The video shows him firmly but calmly repeating "Baba, carry me, Baba!" Syria is a nation of vivisected children and high explosives.

The other video is from the future. It’s 23 seconds long and shows a young girl with curly blonde hair. She has one arm – her left – that ends where it was amputated above the wrist. Her right arm is a different thing.

She is an eleven-year-old British girl named Tilly. Meningitis nearly killed her, and she lost both hands to the disease when she was still an infant. Surviving meningitis cost her hands and toes and caused other health problems that she will have to manage, but this video shows her a few minutes after she put on a new 3D printed prosthetic cyborg right arm for the first time. She’s picking up objects from a table she stands behind: a Koosh ball and something that looks like a tube of paint. The actuators in her arm make the small half-buzz, half-hiss sound you’d recognize from every science fiction movie robot you’ve ever seen. Her fingers move delicately. The expression on her face isn’t the one of shock I had when I saw this and started crying at work again. It’s the expression of a child working on a puzzle. The unseen woman filming Tilly tugs on the ball she’s holding, testing the bionic arm’s grip. I do not understand what we see in the face of this child; she lives in the future.

The arm she is using is built by Open Bionics in Bristol, England, a company founded in 2013 that uses 3D printing technology to fabricate low cost prostheses. The firm uses 3D scanners to model the limb of the person for whom a prosthesis is to be fitted, and is working toward providing prosthetics for approximately £2,000 each – about $2,500 at the time of this writing.

This video is the first thing I have seen in my life that makes me believe we actually do – or at least could, if we choose to – live in the future. This is the first time I have seen a technology that isn’t just an incremental improvement on something familiar – I grew up watching space shuttle launches on television; some of my earliest memories are writing HELLO WORLDs in BASIC on the IBM 5155 my father brought home to do something hard-to-care-about with spreadsheets. I remember, five years old, sitting in my parents’ den in Colorado, watching the television news about an accident in Ukraine – I remember thick, scratchy brown curtains, the quiet voices of my parents in the kitchen, and a late April snow (from this long ago epoch I more clearly remember sitting underneath the built-in telephone desk in the breakfast nook, listening to my mom tell Mrs. Takayama next door that we would in fact quite like to take one of the Golden Retriever puppies off their increasingly enervated hands). An iPhone is really just a better VGA monitor and a Dr. Sbaitso smooshed into one, and I guess it can call people (you never use it to call people). I know that automotive engineering has been revolutionized and now I drive to work every day in a car that uses electricity generated by wind power, but it still kind of looks like my mom’s ’89 Honda Accord LX with the flip-up headlights. In kindergarten, happy in a middle class/YMCA soccer/Iowa Tests/grill out all summer long neighborhood in Northern Kentucky, I had a children’s book with beautiful illustrations of a proposed power station that would generate electricity using columnar ammonia-filled heat exchangers that depended from buoys into cold ocean water below the thermocline, and we sure never built any of those. Am I losing the thread? Maybe the point is that I’m losing the thread. In this video I saw something that made me think that now everything was different; I felt like I’d just observed the beam of alpha particles carom backwards off a gold foil in Rutherford’s lab at Manchester, and I had realized that the very matter of the world had changed.

$2,500 per prosthesis. The Syrian American Medical Society estimates that there are some 5,000 amputees in East Ghouta, the neighborhood in Damascus gassed by Bashar al-Assad’s forces on the 21st of August, 2013 – the Sarin attack that we had promised would mean (should it come, if it were to happen, were it to come) dire consequences for the rule of a dictator who believes his country to be something more akin to a farm than a republic: a thing to be owned (it came, it happened, and we did nothing).

I don’t think anyone really knows how many amputees have been made across Syria. One report filed in Newsweek in 2015 suggests a figure of 80,000, but that article puts the death toll at only (only!) 230,000, with 4 million displaced – the right numbers in 2017 are likely closer to 500,000 dead, approximately 6 million displaced within Syria, and another 5 million refugees outside the country. But let us be conservative. Let’s consider a need to provide 100,000 prosthetic limbs. At the $2,500 sticker price – for this back-ofthe-envelope calculation let us ignore both the economies of scale and frictional costs of establishing a new, large medical program – that’s a cost of $250 million.

That’s not nothing, $250 million.

But in 2016 the Washington Post reported the loss of $125 billion to wasteful Department of Defense administrative spending over a five-year time scale. We’ve stopped asking frequent questions about Iraq and Afghanistan, but Reuters reported in 2013 that something like $2 trillion has been spent on the Iraq War, depending on how you count the costs, and the price of that conflict may hit $6 trillion by the time we stop thinking of it as a catastrophe we own. A 2015 article in Time suggests that Afghanistan cost the United States something approaching $700 billion. The U.S. Government Accountability Office has warned that mothballing the A-10 fleet, destined to be phased out by the USAF partly to justify the buildup of the F-35 force – is likely to save far less than the $4.2 billion that the Air Force suggested, as other military aircraft will be needed to fill the vacancies left by the A-10. These are big numbers. There are smaller ones, closer to the $250 million price tag.

Where else might we look for savings to fund this notional plan to try to undo some small amount of the damage that occurred while we studiously looked elsewhere(2) ? Consider that in 2013, New York City spent approximately $168,000 per inmate per year of incarceration. The city had reduced its prison population from a peak of 23,000 in the early 1990s to something like 12,000 prisoners by 2013. Further reducing the number of prisoners in New York City by slightly under 1,500 for just one year would provide sufficient savings to pay for 100,000 prosthetic bionic limbs – for the sake of completeness, I admit that this is another over-simplification, as there are fixed costs in the correctional system that cannot be reduced by marginally reducing the number of prisoners. That counterargument is true, but it is also missing what logicians call the goddamn point. The point is that $250,000,000 – observe all its terminal zeroes, signifying enormity – is a staggering sum of money. It is also the kind of staggering sum that we can easily afford to spend, and this would be a very fine way to spend it.

(2)Recall that 2013, when this kid from Douma got her legs blown off, was a moment the internet’s commentariat spent ferociously arguing about Is Game of Thrones Too Sexist? and doing absolutely anything to avoid mentioning Syria.

But some will doubtlessly maintain that $250 million is an absurd amount for Americans to spend building limbs for Syrian refugees who had their bodies blown apart. I would like to know what amount would be reasonable. $50 million? Enough for 20,000 prostheses that would radically change lives. $1 million? Still enough to buy 400 3D printed bionic limbs. You could put a sticker on these 400 robotic arms from the future: A GIFT FROM THE AMERICAN PEOPLE WHO ARE HOPELESS AND TERRIFIED BY THEIR TOLERANCE FOR WHAT HAS BEEN DONE TO YOU.

But what I suspect is that $1 is likely to be too expensive to satisfy many people who raise this complaint. I do not know how viewing a video of a screaming baby in Douma, weakly thrashing the stumps of her legs, would affect their commitment to thrift.

Q.: Is this argument unfair – is it an emotional attack? Yes, yes it is. What of it?

I live in Maine now, an empty place with aureolin sunsets that needs people. Our governor sometimes interrupts his incoherent growling about the need for an authoritarian president in America to insist that the state will never accept Syrian refugees. I think most of us have given up hope that we as a nation will do something to help the displaced. But at a quiet, intimate New Year’s Eve party, friends still spoke earnestly about what such a moonshot effort might look like – we’ve seen pictures of Syrian refugees trapped at the tank berm on the Jordanian border. What if 100,000 came to Maine, what if we brought a million refugees to America? I wrote out Emma Lazarus’s ‘New Colossus’ in longhand, I keep it tucked into my wallet now. We’re not going to do it; we’re too afraid of these guys who like pizza and Iron Maiden.

There's a great chance I'll never really be wholly sane again, not if I keep seeing the ragged stumps of a baby's legs behind my eyelids half a dozen times a day. I’ve caught myself occasionally interjecting a description of some recent horror I’ve seen third-hand into a conversation that has nothing to do with war, because the conversation I’m having in my mind is mostly about watching a Hashd fighter in Iraq carving pieces off a charred body, or a father in Aleppo screaming in a sunny, smoky street for his third dead child. But my preoccupation with this violence is not very important.

There is something the United States can do to help Syrians who have lost so much – who have lost parts of themselves to this conflict we have insistently kept as far from us as possible. We have the resources. And for the very first time in history, we have a technology that can change the lives of people who have suffered grievous injuries. We can spend money to try to undo the damage that occurred during a moral vacuum.

But we’re not going to do that, are we?