DAY THREE of a 3-day series
WHEN YOU ARRIVE
Published July 16, 2002
When Jim returned to Paris for treatment in the fall of 2001, he discovered that the joy of living in the city he loved had been replaced by the task of just trying to get around.
It was late July of 2001, Lance Armstrong had won the Tour de France two days before, and Jim Miller was on his way to a prosthetics clinic in a corner of the Paris suburbs. The clinic came highly recommended by an expatriate friend living in Paris.
As the car pulled up to the sloping driveway of the Centre de Reeducation et d'Appareillage, Jim thought back on the 18 months since the accident, frustrated that after so much time he still wasn't walking. Though he had made progress with Bill Copeland, the Tampa prosthetist who had worked with him for a year, Jim considered their relationship a failure. Jim had concluded Bill's practice was too small to handle a case as unique and difficult as his. What Jim had learned from his friend in Paris led him to believe that this clinic might be the answer.
The Centre de Réeducation et dAppareillage is one of the largest clinics for amputees in France. The array of prosthetic legs shows the different levels of patients being treated.
A doctor in a three-quarter-length white coat guided Jim through the pleasantly lit corridors, past the gymnasium and the room where patients practiced walking between parallel bars. Jim began to appreciate the advantages of a larger operation. Everything was under one roof. He would be fitted for legs in one room, and across the hall an expert in gait training would monitor his every step.
At the end of the tour, the doctor, who was the chief of the medical staff, asked Jim to climb on the examining table so he could look at his stumps. Jim wasn't an athlete and he wasn't 17, the doctor noted, but his stumps were in good shape thanks to the reconstructive surgery he'd had in California. If Jim had the determination to handle the treatment, the doctor said, he'd probably do well.
Then they came to the inevitable subject of cost.
You're not a French citizen, the doctor said, so you'd have to pay the full amount.
How much would that be? Jim said.
About 84,000 French francs. A little less than $12,000.
"That's a quarter what I would have to pay in the U.S.," he told the doctor. "I can't afford not to come."
He decided then he would begin treatment in France as soon as possible.
Jim came home with a proselytizing fervor. He had not taken the first step in a pair of French-made legs (it would be two months before he could begin the program), but he was convinced the French system was not only less expensive, but also less obsessed with technology (the clinic in Valenton still carved about 40 percent of its sockets out of wood) and, therefore, more humane.
He did not hesitate to share his discoveries with Bill Copeland.
"They told me that people who learn on stubbies take longer to walk," Jim said.
"I don't agree with that," Bill said. "It depends on age. Young people can go straight to knees, but older people might get freaked out."
Bill might have pointed out to Jim that he had reacted exactly that way several months earlier, but he chose not to. Generally, I noted during these appointments, Bill said nothing during Jim's critique of the American way of making prostheses, which, after all, was Bill's life's work.
Bill, for example, did not remind Jim that the French doctors were recommending the same kind of knee that Bill had first given him, the ones Jim had rejected. Nor did he mention that French prosthetists can ignore profit margins because they are subsidized by the government. Bill never said that his price of $14,000 (roughly $2,000 more than Jim was prepared to pay in France) was too low for him to make a profit.
Bill shared these concerns with me, but he knew arguing with Jim was pointless. Jim had too many complaints about Bill's work: the fit of the sockets, how to put the legs on, and that Bill had no one on staff to teach him how to walk in them.
While it was clear that Jim was headed to Paris for treatment, he and Bill had yet to find a satisfactory end to their foundering relationship. Bill wanted out. Jim wanted his money's worth. Until they came to some agreement, Bill had to listen to Jim use French words like les cuisses instead of thighs.
"They're too painful, too cumbersome," Jim said of the legs Bill had made. "The window of time in which you can use them is too narrow."
"It's going to be tough," Bill said, suggesting as he had before that there was more to the process than just the equipment.
"Then it's time to quit right now," Jim said, bristling. "I can deal with phantom pain, but I can't deal with real pain."
"I've never stopped trying to make them comfortable for you," Bill said.
"I've never doubted your sincerity," Jim said.
Bill proposed returning to a donning method he had first tried before Jim's surgery in Sacramento. This method used roll-on liners with pinky-sized metal pins on the end that locked into the sockets. The pin system was not as stable as the suction method, but it might be much easier for Jim to put the legs on.
He told Jim he would recast a set of sockets by the following week.
"Polycarbonate sockets?" Jim said.
"We can do that," Bill said. He paused to judge Jim's reaction.
"We're okay with that?" Bill said.
"I've fired off all my cannons," Jim said. "I'm ready to move on."
But for a few cursory follow-up appointments, that was the end of slightly more than a year's work.