Plane Speak


I was returning from a trip out to the Veterans Affairs (VA) hospital in Tampa, Fla. I had just finished speaking to my wife back in California as she gave me the incredible news that we were going to have a son, due in January. I was ecstatic as our 2-year-old daughter, Naya was going to have a baby brother to pick on.

I was elated as I approached a gaggle of morose, impatient travelers lined up in front of me in an impossibly long, serpentine line that snaked its way amid the turnstiles. As I settled in at the tail end of the procession I almost missed it. Sure enough there it was: the BAHA. While it may be a common thing for manufacturers who have been in the business to see their products on someone, for me, a clinician who has merely dabbled in research and product development, to see something that I had a hand in creating really filled me, not so much with pride, but rather contentment, even happiness. For those of you unaware of what the BAHA is, the acronym stands for Biomechanically-Aligned Harness Actuator. It replaces the harness ring and functions to increase harness efficiency and axilla comfort. This experience brought home a lesson of the meaning of life.

Common ground

Whenever I see a person with an involved limb, more often than not I leave them alone, hoping they are receiving adequate prosthetic care, or they have — for one reason or another — chosen to live their life without prosthetic intervention or assistance. In this case, however, I really wanted to know what he thought of the BAHA and if there was any information I could glean that would allow us to improve it for future wearers. I approached him, introduced myself and asked him what he thought.

As it turned out, it was the first prosthesis he had ever received and as such had no real opinion other than “okay I guess.” After that swing and a miss we got to talking about his life and what happened. He attempted to get by with his involved arm “just hanging there” as he put it. He told me the pain was unbearable and that he was on medication because of it. I told him I knew how it felt. I had also been in a motorcycle accident and had injured my brachial plexus nerve, yet it had merely stretched and not severed. I told him I understood the meaning of unbearable pain and that I had not slept for a week when it had happened to me. When I related to him that my accident occurred my senior year at UCLA, and the mental anguish I went through having just been invited to national rugby trials, which I had to forego, and being forced to watch my teammates play the entire season with my spot taken by someone else, he nodded patiently until I was done. He then proceeded to tell me his story, which made mine look like a walk in the park.

Different reality

He was living with his son at the time and the discomfort from his injury was so severe that he was forced to send his son away to live with a relative while he learned to deal with the pain. I can only imagine the mental anguish he must have felt as a father, to be so helpless and in such bad shape that he felt he was at risk of destroying his relationship with his son. I asked him where his son was now and he said he was picking him up at the airport because he was coming home to live with him again. I was amazed at how much joy I felt, having only known this gentleman for a few moments. Perhaps finally becoming a father had made me realize what it must have meant to lose and then gain your child back, or maybe it was the fact my wife had just told me I had a son on the way, or perhaps because the guy was so excited and filled with anticipation of his son’s return. I don’t know, maybe it was all three.


I bid the gentleman farewell and told him good luck, having finally reached the ticket counter. I then headed up to the security check ready for another endless line and ran into him again just as I was getting ready to show my license and boarding pass. Our lines were split into two and he was across from me, facing a small boy in front of him who appeared terrified of his prosthetic hook as my new friend was attempting to show the kid how it worked. It was obvious the boy was uncomfortable and his mom, who you’d think would know how to turn the situation into an educational win-win, wrapped her arms around her child and with a fearful glare, pulled the boy away without so much as a “hello” or a “thank you” or an apology.

Having just heard what this guy had gone through, the scene broke my heart. I was about to tell the child’s mother that the monster she just saved her child from was actually a human being who had just gone through a living hell, when my friend just looked at me with a gleam in his eye that told me his son was coming home, and nothing was going to ruin his day.

And then it hit me: as prosthetists we go about our daily routine taking care of these folks and of course we appreciate their circumstances and of course we want the best for them, but will we ever truly understand the battles they live through day after day? When we ask our patients to strap on a hook, do we think enough about every encounter they’ll experience from that moment on? In their own way, these civilians are warriors; they just fight a different enemy, an enemy that can shatter more than their self-esteem. And while my hat is always off to those military personnel who physically fight to save our freedoms, I cannot take away from those other soldiers who do battle on our own soil against demons out to destroy them and their loved ones.

Other factors

When we offer prosthetic solutions to them, we must focus far beyond function as the sole metric we consider and regard the impact of those solutions on our patients’ mindset. While functional independence plays a tremendous role in self-esteem, an individual’s social and psychosocial interactions may rest on a host of other critical factors that equal – and often surpass – functional independence. A common misconception is that functional independence is the only endgame.

My friend fought his personal battle, engaged the enemy head-on and emerged victorious. I wish him and his son the very best, wherever he is at this moment. And I thank him for teaching me how to better appreciate the personal war that often has little to do about working a door latch or combing one’s hair, but is rather against mental and physical anguish being fought by all of our patients at one time or another, as well as those who surround them throughout their lives. So please remember this when you sit down to evaluate someone based solely on physical factors. Think about how many times this person will run into people that don’t know how to handle seeing a prosthesis, and the inner turmoil your patient might feel each day with every person they encounter. Some may not care, but your patient will never know who those people are on the street until they run into them. Every morning our typical patients get up, they don their prosthesis and prepare to do battle. While we can not join them in battle, we can cheer them on.

Randall Alley, BSc, CP, FAAOP, CFT

Randall Alley, BSc, CP, FAAOP, CFT is chief executive officer of biodesigns inc. He is chair of the CAD/CAM Society of the American Academy of Orthotists and Prosthetists, an international consultant and lecturer, and a member of the O&P Business News Practitioner Advisory Council. Alley can be e-mailed at

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