Adele Fifield was just 13 years old when a doctor told her that she had cancer in her knee - and that surgeons would have to amputate her left leg. "My initial reaction was disbelief," recalls Fifield. "For days, my ears seemed to ring from the shock." Eventually, Fifield adjusted and soon was learning to use an artificial leg in the tiny Newfoundland outport of Trinity East where she was raised. In an era of AIDS and soaring cancer rates, the ordeals of amputees rarely find a place in the public spotlight. But the tragedy that engulfed Bloc Québécois Leader Lucien Bouchard, whose left leg was destroyed by a bacterial infection in December, focused attention on the estimated 4,000 Canadians who lose limbs each year. Like Bouchard, who capped his rapid recovery by walking into the House of Commons last month, most amputees adapt to prosthetic devices that at first seem depressingly awkward and painful. "What is amazing," says Dr. Denis Raymond, who supervised Bouchard's recovery at the Montreal Rehabilitation Institute, "is that the vast majority of people will learn to live with an artificial limb. The will to go on with life is very strong."
Still, doctors and other experts in the field say that Bouchard's progress has been remarkable. "He's quick - he's walking very well," says Dr. Michael Devlin, a specialist in rehabilitation medicine at Toronto's Mount Sinai Hospital. "Some people are just naturally good at using an artificial limb - and Bouchard seems to be one of them." It also helps that Bouchard and other amputees today can be equipped with prosthetic devices that are lighter and technologically superior to the clumsy artificial limbs of 30 years ago. They are aided, as well, by the team approach that rehabilitation hospitals have developed to prepare amputees physically and psychologically for a successful re-entry into the world. And they have inspiring examples to follow - most notably cancer victim Terry Fox, whose attempt to run across the country with an artificial leg in 1980 profoundly moved the nation.
Even so, the challenges facing an amputee can be daunting. In most rehabilitation hospitals, teams begin preparing patients for their artificial limbs just a few weeks after their real one has been removed. At that stage, says Shirlene Campbell, a physiotherapist at St. John's Rehabilitation Hospital in Toronto, "most patients are still in the grieving process. It can go on for several years, because you've lost part of yourself." Meanwhile, technicians begin work on designing an artificial limb by making a plaster mould of the patient's stump. The mould is then used as a guide in constructing a strong plastic socket that fits over the stump and connects with the artificial leg below.
Patients and their physicians can choose from a wide variety of artificial limbs, knees and ankles that are manufactured mainly by American, British and German companies. (Bouchard and his doctors declined to release details on the type of prosthesis he is using.) Modern legs feature such technical refinements as pneumatic or hydraulic knees that produce a natural-feeling leg movement. "Compared to a decade ago," says John Mackillop, a prosthetist at St. John's, "the technology has improved tenfold." But artificial limbs can be costly, ranging in price from about $5,000 for a conventional wood-and-fibreglass leg to $12,000 for one made of a lighter, space-age carbon-composite material; provincial health-care plans provide varying amounts of coverage.
Even with a modern prosthesis, considerable effort is required to walk with an artificial leg that can weigh anywhere from four to 10 lb. "For someone with an above-the-knee amputation," says Raymond, "walking with an artificial leg can require between 60 and 75 per cent more energy than before. That's why amputees need to be in top physical condition." To achieve that, rehabilitation teams include physiotherapists who help amputees to build their strength with weights and exercises on parallel bars. In Bouchard's case, notes Shirlene Campbell, "it helps that he's obviously very motivated."
Ultimately, determined amputees can work wonders. Young, sports-minded people using lightweight prosthetics often can hold their own on a basketball court or soccer field - and some even climb mountains. For many amputees, the biggest challenge is to overcome the self-doubts that accompany the loss of a limb - especially in relations with the opposite sex. Fifield, 29, now works as a counsellor for the Ottawa-based War Amputations of Canada and has a steady boyfriend. "There are men," says Fifield, "who have the image of a perfect body - and they'll reject you. You have to look for someone who will love you for what you are. They exist - but you may have to date a few jerks first."
Even amputees who have conquered most of the obvious obstacles to a normal life may have to deal with a phenomenon that afflicts about 80 per cent of them - the conviction that their missing limb is still there causing pain. Known as "phantom pain," the sensations, which can be acute, stem from the fact that neural circuitry for the missing limb still exist in the brain. In severe cases, the pain can be treated with drugs. But, says Devlin, "if a patient can put up with the pain, that is the best bet." That is a choice that Lucien Bouchard may face as he continues his impressive recovery.
Maclean's March 13, 1995