To say Steven Lloyd was good with his hands would be an understatement. He refurbished the run-down ranch house he and his wife, Jodi, bought when they were engaged, installing walls and plumbing, and built a wrap-around deck and stone walls along the property's edge. He repaired friends' cars and restored a 25-year-old Jeep for off-roading.
But Lloyd was unexpectedly stricken by a massive brain hemorrhage in October, on the day before his 44th birthday. As he lay dying in the hospital, the New England Organ Bank called his wife at their New Hampshire home with a special request: Did she want to donate her husband's hands?
Jodi Lloyd hung up and turned the question over in her mind for several hours. "Why let these hands go to waste?'' thought Lloyd, recalling her decision in an interview this week. "Steven's talents were in his hands. It just made sense to me.''
Within days, doctors at Brigham and Women's Hospital in Boston transplanted Steven Lloyd's hands and lower arms onto Richard Mangino, who had lost his forearms, as well as his lower legs, to a bloodstream infection.
Now, four months later, Mangino, 65, has made tremendous progress in learning how to use his new hands. He picks up and stacks one-inch-square wooden cubes as part of his rehabilitation routine, and he opens the refrigerator door and wraps the fingers of both hands around the milk carton to lift it out. The hair and fingernails on his new hands are growing. And Mangino, an artist, is playing piano already and looks forward to painting.
Jodi Lloyd, who met Mangino at the Brigham in October, said if she could have chosen the person to give her husband's hands to, it would have been him. "It's sad what happened to Steven, but there is some comfort,'' she said.
The Lloyds had no clues that tragedy was about to befall their family. Steven Lloyd was healthy and energetic. He loved to ride dirt bikes, all-terrain vehicles, and snowmobiles with his family on the unpaved roads that weave in and around Troy, the town where they live. He worked as a supervisor at Teleflex Medical OEM, which manufactures medical devices, in Jaffrey, N.H. - his employer for 25 years.
But on the morning of Oct. 1, he told his wife that he had a terrible headache. He sat down on the edge of the bathtub and held his head. "Something is not right,'' he said. They were the last words he spoke to her.
An ambulance took Lloyd to a nearby the community hospital, which transferred him to UMass Memorial Medical Center in Worcester for advanced care. Later, doctors told Jodi Lloyd that they believe he was born with a malformation in the blood vessels in his brain, and eventually they burst. But he had no symptoms, so no one knew.
At the hospital, Cindy Clark, a family services coordinator for the organ bank, approached Lloyd about donating her husband's organs, to which Lloyd readily agreed. "Steven helped everybody in his life, from people on the side of the road in a snow storm to people who needed help moving or starting their car,'' she said. "He would drop everything.''
The next day, when Lloyd was home comforting her two boys, Cullen, 11, and Carson, 5, Clark called. This time she asked Lloyd about donating her husband's hands. Clark "told me she was a little apprehensive about asking me because [his death] was so sudden. But she kept thinking about all the things I told her about Steven,'' Lloyd recalled.
Lloyd said she initially was taken aback because she didn't realize doctors were doing the operation in the United States. She told Clark that she wanted to have an open casket at her husband's funeral; Clark assured her that her husband's arms could be fit with prostheses.
Lloyd wanted to make the decision on her own, without seeking the opinions of family and friends. Once she made up her mind, she said, she called her father-in-law, who thankfully gave his blessing.
Her one request to the doctors was that they try to retrieve her husband's wedding ring in one piece, which they did. She wears it every day.
Lloyd watched the Brigham's televised press conference after the transplant, during which Mangino thanked the donor and his family, and only then did the magnitude of her decision register. Several days later, Clark called and asked if she wanted to come to the Brigham and meet Mangino and his wife.
Lloyd said she was "very nervous'' and didn't look at his hands at first. But Mangino spoke to her about grief and put her at ease. He asked if she wanted to touch his hands, and she did.
"They definitely felt like my husband's hands, and I knew they were my husband's hands because I recognized them,'' she said. "It was bittersweet. We had been together 23 years. When he was in the hospital, all I did was hold his hands.''
During the meeting, Lloyd was impressed by Mangino's tenacity - he had led a full life without lower legs or forearms after they were amputated in 2002. "I felt honored to be able to give him my husband's hands,'' she said.
"It's really hard to lose a loved one,'' Mangino said in an interview last week at his East Boston home. "I explained to her that if I died, I wouldn't want my family to sit around and mourn.''
Mangino is upbeat about his progress, explaining his rehabilitation regimen, which includes stacking blocks and small plastic cones and squeezing clay to build strength while he watches sports shows.
When his son pointed out that he was walking with his forearms pointed straight out, Mangino studied people walking at the mall, swinging their arms at their sides. "You forget these things,'' he said. "If someone gave you wings, you'd say 'what do you do with these?' ''
Scars encircle his forearms and the skin of his new hands and lower arms is slightly lighter in color than his own. He often wears braces to keep his fingers from curling.
After his infection, Mangino became a prolific artist, holding a brush in a prosthesis he attached to his left arm. He said he has not started painting again because he wants to focus on his rehabilitation. But he plays the piano, including his own arrangement of music from the old Dustin Hoffman movie "The Graduate,'' though he cannot separate his fingers well enough yet to play most chords.
Dr. Bohdan Pomahac, director of plastic surgery transplantation at the Brigham, said while Mangino can feel pressure on his hands and fingers, it will probably take another year until he can feel sensations such as heat, cold, and pain. But, he said, his rehabilitation is progressing faster than doctors expected.
Mangino has not had any complications or episodes of his immune system rejecting the new tissue, Pomahac said. "He is doing great.''
Liz Kowalczyk can be reached at firstname.lastname@example.org.