Augmented

♪ ♪ ♪ ♪ ♪ ♪ Today I think it will be probably around four, six or four.

We're local, so we're not flying out... STYLIST: I think you're good...

I can't believe you filmed that.

(indistinct chatter) (indistinct chatter) SPEAKER: About innovation, and really coming into some really innovative... (indistinct) This is a gentleman who really has reinvented bionics.

And we say the Six Million Dollar Man?

I think he's more the 100 Million Dollar Man.

Professor Hugh Herr from MIT.

(cheers and applause) HUGH HERR: Here you can see my legs, 24 sensors, six microprocessors, and muscle tendon-like actuators.

I'm basically a bunch of nuts and bolts from the knee down.

I'm a bionic man, but I'm not yet a cyborg.

When I touch and move my synthetic limbs, I do not experience normal touch and movement sensations.

If I were a cyborg and could feel my legs, it would fundamentally change my relationship to my synthetic body.

♪ ♪ Muscles within the body can be reconfigured for the control of powerful motors and to feel and sense exoskeletal movements, augmenting humans' strength, jumping height, and running speed.

During the twilight years of this century, I believe humans will be unrecognizable in morphology and dynamics from what we are today.

Humanity will take flight and soar.

♪ ♪ (machine whirring) (strikes match) ♪ ♪ I don't use the word disabled.

The word disabled implies that there's a weakness.

Just because a person has an unusual body or mind doesn't mean there's weakness.

Society is obsessed with this idea of a normal human, a normal body, a normal mind.

And that we're so convinced that normalcy is the pinnacle of capability.

That's now collapsing, it's breaking down.

♪ ♪ As a young man, I imagined a future where artificial limbs weren't these passive, inert tools.

MATTHEW CARTY: If we are able to come up with a better way of doing amputation, that fully augments a person's ability to achieve increased levels of function, that is a much different package.

♪ ♪ HERR: I think in 20 years, limb amputation will not be a disability, and there'll be several dimensions that are actual augmentation.

♪ ♪ (birds chirping) (indistinct chatter) (birds twittering) HERR: It's a giant bird's nest.

(sighs) Most of my hardest rock climbs were done in these babies.

INTERVIEWER: Is there a reason to keep them kind of short and stubby?

Yeah, it's an advantage.

You can get your center of mass closer to the wall if your feet are baby-sized.

♪ ♪ (voiceover): I would love to become a cyborg.

I don't have yet that bilateral brain connection between my nervous system and my synthetic powered ankles.

I would love to experience that neurological embodiment that I can architect my own body and it can become me.

It can become part of my own identity.

I would love to experience it.

I'm lucky.

Both of my legs were amputated, and that affords me the ability to adjust my height.

Here, I'm really tall.

(audience laughter) Like, really, really, really tall.

Think Inspector Gadget.

(audience laughter) INTERVIEWER: Do you think back to your accident and say, like, I wish it didn't happen or was it, like, a gift?

HERR: I don't regret the change in my body at all.

Regarding the scratch that I experienced, it's...

I think it's pretty cool.

(chuckles) HERR (voiceover): I sometimes have nightmares where I see myself at the age of 11, 13, 15, up thousands of feet without a rope in a remote region.

It's watching a time bomb about to go off.

And I wake up sweating and terrified.

♪ ♪ I was, I believe, six years old when I first went rock climbing.

And it was near my parents' farm in the foothills of Pennsylvania.

My brothers and I, we saw climbing on the television.

Henry Barber was being filmed climbing a rock in Wales.

And we're like, "What's that?

We want to do that."

And we actually went out and bought a how-to manual from an outdoors shop on how to climb.

And we'd go into the woods of Pennsylvania and be looking up what a piton is, and when a carabiner is... (chuckles) And making our way up this mossy, wet cliff.

It's truly remarkable that we lived through our childhood, actually.

(chuckling) ALISON OSIUS: Hugh just wanted to climb.

He wanted to climb all the time.

It was dark, he wanted to climb, it was freezing cold, and nobody else wants to be out there, and people are breathing in, huge clouds of frost are coming out of their mouths, and Hugh is up there climbing.

HERR: It immediately became an extraordinary passion and it only increased with age.

By the time I was 11, 12, 13, it's all I thought about.

JEFF BATZER: I would say that there was just a, a natural chemistry.

You know, Hugh and I liked each other.

The rock climbing definitely brought us together.

We shared a remarkable passion for climbing.

That led to, you know, Jeff being my full-time climbing partner.

BATZER: And so we would just get together and climb a good bit, and ended up going on all these New York Shawangunks climbing trips.

That was the east coast Mecca for rock climbing.

And he would rope up and he may take a fall or two, and in some cases not fall on a really hard climb, and he'd pull it off.

And that word, in the climbing world, gets around really quickly, and so he became known as Hot Hugh.

HERR: By ten, 11 years old, I was a, considered a child prodigy.

I had national recognition for my climbing prowess.

I studied Zen and meditation.

I would often sit alone, and kind of rock back and forth and meditate for...

I mean, my poor parents thought I was mad.

♪ ♪ BATZER: I always said that Hugh was known in the United States as being in the top handful of the best climbers, even though he's only, you know, 15, 16 years old, and when we were on Mount Washington he was 17.

♪ ♪ ANNOUNCER: At 6,288 feet, the view is the beauty and the weather, the beast.

OSIUS: This is like so many of these events where it's never just one thing, it's an accrual.

It's a whole series, and if you could change any one of those things, it wouldn't happen.

BATZER: I wanted to go to Mount Washington.

I said to Hugh, I said, "I'd really like to do "one of the ice gullies, "but go to the top of the mountain "because I want to train more for doing peaks and things like that," and Hugh said, "Sure, you know, glad to do that."

We knew it was going to be a little more dangerous than the other things we had done.

♪ ♪ OSIUS: Hugh and Jeff drove up to New Hampshire.

BATZER: I probably dominated things with the music there, but it was probably mostly The Police on the way up.

And I can remember just remember listening to this one song that says, "You'll be sorry when I'm dead."

(laughs) STING: ♪ You'll be sorry when I'm dead ♪ ♪ And all this guilt will be on your head ♪ ♪ I guess you'd call it suicide ♪ (song echoes and ends) (footsteps crunching) BATZER: The first night when we got there was just to get up to stay overnight on the mountain at Harvard Hut.

You know, there was very much that warning to the Appalachian Mountain Club folks, that were very careful, I think, to warn people like, "Hey, do you know what you're doing here?

You know, you're going to go up into a really rough realm."

And so there would have been a bit of that, too.

That next morning is where we wanted to choose a route going up through Huntington Ravine, where there are a number of different ice climbs.

So, we decided, really, I think it was that morning, to do O'Dell's Gully.

Hugh led it, and did a number of pitches on up through.

And at one point I had these heavy Gore-Tex mittens, and I had slings that were Velcroed on, and so I could let them hang down, so I could work on the tools and take screws in and out.

So, the one time I did that, the sling came open and I looked and the mitten was gone.

So that would come in later on as far as being a major problem with, you know, trying to keep my hands from becoming frostbitten.

(wind gusting) So, we're at the top of O'Dell's Gully, which is 800 feet from the ground.

We decided we would drive on, and actually try to get to the summit, and just try to knock that all off.

Maybe about 20, 25 minutes or so, and these little wispy wind gusts and snow that was coming down turned into just hurricane force winds.

HERR: Above Huntington's, we probably walked five minutes at the most.

That was the critical decision that led to the accident.

You know, among the mistakes that they made was that they didn't have a compass, they didn't have a map and compass.

And they were using the wind.

And so when they turned around to walk down, they did not realize that the wind had changed and so they walked in the wrong direction.

(wind blowing) Instead of going down where they had come from, they went down the wrong side, and they went into the Great Gulf, which is an immense wilderness.

♪ ♪ BATZER: So the day goes on, you know, half an hour after half an hour starts going by and we're like, "Man, what is going on here?"

At some point we've got to break through to something that looks familiar here.

We still thought we were in Huntington Ravine.

We thought if we go out, we hook to this one side we're going to hit the Harvard Hut eventually, we'd at least be able to get there, no big deal.

OSIUS: At a certain point, they realized they were lost.

But at that point, it was better just to keep going then try to go all the way back up.

BATZER: We'd gone for hours now, and going in toward evening, and we're thinking, "Okay, "this is starting to get a little more serious.

"We don't have anything to eat.

"We don't even have water with us.

Just some awful events happened that night.

There was a river over in that Great Gulf area.

Well, let's just follow this, which is going downhill, at least.

You know, maybe that'll get to something eventually.

And what happened was, Hugh fell through the ice and was soaked from the waist down.

Maybe within an hour or so, it happened again.

We were always right next to each other, and he would go through, and the next time he went in up to here.

You know, it's minus 20 degrees Fahrenheit and your feet get wet.

It's a rapid decay.

(wind blowing) OSIUS: They crawled under a rock and they were just trying to keep each other warm and give each other hope.

BATZER: So we broke a bunch of these trees and got a pile of these branches and laid them on top of the snow, so we were off of the cold snow.

What we did is made a huge pile of these that we put on top of us, like a sleeping bag.

And we were just encased in these branches in this cave.

Given my experience in the mountains, I personally did not believe we would last a night.

What I didn't estimate is the power of being with someone else.

That's critical because if you're with another human being, you can hug them.

And you, you dramatically reduce the surface area of the dual body, but you double the heat source.

So, by hugging someone, you can stay alive for a remarkable amount of time in those subarctic conditions.

♪ ♪ (birds chirping) BATZER: Sunday morning was a beautiful morning.

Calm, very cold.

OSIUS: They had no idea that there was this whole search going on on the other side of the mountain.

BATZER: We didn't come back, so the cabin caretaker, he alerted the Appalachian Mountain Club that these kids didn't come back.

OSIUS: People fanned out and were checking all the routes that you'd expect, the known routes and gullies.

(footsteps, heavy breathing) BATZER: What we did was follow these trail markers.

And this moving was just very slow.

OSIUS: As they kept walking, Hugh started falling over.

By the time my eyes realized I was falling, it was too late to react.

So, I'd walk three paces and just fall over.

It was just a very strange feeling.

♪ ♪ BATZER: Monday morning, basically, we're definitely thinking we could die, you know, at that point.

So that morning, I started going out through this deep snow, trying to follow this path and, oh, maybe made it for a couple of hours and just praying, trudging along.

OSIUS: He walked and walked and then he found himself crossing tracks.

And for a second he was really excited, thinking they were someone's, and then he realized they were his.

BATZER: So I decided, the strength I have, I'm going to return back to Hugh.

I just fell back beside him and I said to him, I said, Hugh, I said, I'd failed.

I couldn't get out.

He said, "That's okay, Jeff."

And we didn't say another word for maybe a couple of hours.

♪ ♪ (wind gusting) HERR: The process of freezing to death is actually very pleasant.

Even though it was minus 20 and constantly snowing, it felt warm.

♪ ♪ BATZER: I can remember just having this thing where I just started to hyperventilate.

♪ ♪ HERR: I think we both gave up the fight to live.

We actually rationalize that the sooner we died, the better.

♪ ♪ So we actually stopped hugging each other.

OSIUS: It's hard to imagine that they could have survived another night.

(footsteps) And then by incredible miracle, Cam Bradshaw, a 28-year-old hut manager, was out snowshoeing and she saw these weird tracks and she thought, "Oh, that must be a moose," because they were so inconsistent.

So she tracked them for a long time.

♪ ♪ BATZER: It was about 2:30, just heard some noises over in the trees, real close to us and could see this girl, you know, fighting her way through the trees, you know.

She came upon us and was standing there.

And at first we were silent, because we didn't trust our minds.

And then we shouted and she responded.

(laughs) So... And she said, "Are you the guys that are missing?"

And they said, "Yeah, that's us."

And then everything went into motion really fast.

She went hurrying down the trail and I think she found some skiers and they went even faster and they got to the road, and they got word to people.

♪ ♪ (helicopter rotors beating) And then the helicopter came in and got them.

You know, a really good extraction just before it got dark.

♪ ♪ BATZER: Actually said to Hugh, I was cheering him on when nobody was around, "Just, come on, Hugh, hang in there, we need to make it a little bit longer."

HERR: We felt tremendous elation because we went from being certain of death to, gosh, we might live.

BATZER: Little did we know what our bodies would have to go through in these next days and all that in the hospital and everything.

♪ ♪ One of the staff said, did you know that somebody had died trying to rescue you?

So, I broke down and cried and just couldn't believe that that happened.

HERR: Immediately following the accident, my emotional state wasn't that of pity.

It was that of extreme anger.

I completely blamed myself for the accident and for the death of a rescuer, Albert Dow, was struck by an avalanche searching for myself and my partner, Jeff Batzer.

♪ ♪ OSIUS: Albert was out there trying to help somebody else.

He and Michael Hartridge checked Huntington.

Apparently, a cornice collapsed above and they got hit from behind.

(wind blowing) Michael was able to reach into his anorak pocket and pull out the radio and say, "We've been avalanched."

And then when the others got to him, it was apparently the most eerie sight anyone had ever seen, to see this one dachstein mitten waving above the snow.

♪ ♪ And so they dug out Michael, and they were looking for Albert, and it took a little while, and then they found him.

♪ ♪ CARYL DOW: His neck had been broken.

Probably hitting a tree, and he was killed instantly.

Immediately, the impact was shock, absolute disbelief.

SUSAN DOW: It wasn't anger, it was like, "How could this happen?"

You know?

And, and that was much more my reaction than anger.

I was thrilled that they had survived.

I think it would have been far worse for me if they had died, because then it would have been in vain, in some ways.

And that, just, to me, would have been unacceptable.

HERR: For a very long time, I was enraged.

But still having hope that I could climb out of the ashes of the, of the accident, and in memory of the rescuer Albert Dow's, in memory of his sacrifice, to actually do something with my life and to contribute to humanity.

BATZER: I went into surgery after six weeks where they worked on my fingers on my right hand, and removed those, and then also the toes in my right foot.

And then a couple of days later, I had my left leg removed six inches below the knee.

And then a couple days later, Hugh had both of his legs removed, about seven inches below the knee.

♪ ♪ HERR: Lying in the hospital with my limbs amputated, my future was just a black hole.

I had never met anyone with limb loss.

I'd never met anyone that used a prosthesis.

So I had zero information on what life would be.

I asked my rehabilitation doctor what I would be able to do.

He said, "What do you want to do?"

And I said, "Well, I want to drive a car, "I want to ride my bicycle, and I really want to return to mountain climbing."

And he, without hesitation, said I'd be able to drive a car, but with hand controls, but I'm afraid you'll never be able to ride a bicycle nor mountain climb again.

♪ ♪ I received my first pair of limbs.

The mechanical attachment of the limb to my residuum was actually made of plaster of Paris, and they told me, even if you can and want to, do not walk without crutches or canes, because we're afraid the plaster will crack.

I cried for about 24 hours.

And I think it's a common experience for people that go through this.

They shake their head, in this day and age of space travel and automobiles, are you kidding me?

Are you kidding me?

And so I sheepishly took what was given to me for prostheses, and with my brother, we ventured into the same mossy wet cliffs in Pennsylvania shortly after my limbs were amputated.

I can barely walk, but once I was at the cliff gripping the rock with fingers and toes, I just felt completely at home.

It was silly of me to listen to the doctor.

It was silly because he didn't know me, and it seemed that he didn't know technology.

I began tinkering and designing variants of my prostheses that were more conducive to the vertical world of rock and ice climbing.

♪ ♪ JIM EWING: Hugh, climbing as strongly as he did back then, was kind of a challenge to people; it was, you know, kind of putting his finger in their eye.

So, people were looking for excuses for why he was a stronger climber than they were, perhaps.

Maybe he can stand on smaller edges than everybody else, or maybe he can extend his leg longer so he can reach the hold easier, but having witnessed the struggles that he went through as a bilateral amputee, that's, that's a bunch of hogwash.

HERR: I realized firsthand the extraordinary capacity of technology to heal, to rehabilitate, and in my own case, to extend physicality beyond natural levels.

And that is what inspired me to go to school, and to more deeply learn mathematics, engineering, and design.

Because I thought to myself, if I had this level of success with just skills in the machine shop, imagine what I could do if I deeply understood physics and engineering.

So there I found myself in mathematics class.

♪ ♪ (crowd cheering) (explosion) (people screaming) POLICE RADIO VOICE 1: What was that on Boylston Street?

POLICE RADIO VOICE 2: 833, something just exploded at the finish line.

POLICE RADIO VOICE 3: Two devices just went off at Boylston and Exeter.

All units, extreme caution.

CARTY: I'll never forget when we heard about the bombing.

(people screaming) Someone came into the O.R.

and said, "I think there has been a bombing at the marathon."

I also happened to be on call for plastic surgery at the Brigham on that day.

POLICE RADIO VOICE 1: Delta 984, sir, go.

POLICE RADIO VOICE 3: We need help from the medical tent.

Get as many people as you can up here from the medical tent.

CARTY: Here were all these young, healthy patients who had amputations in the field or were requiring amputations after the fact because of the severity of their injury.

But they still had material that could be used for reconstructive purposes that we were throwing away at the time, because that's how standard amputations are done.

(sirens, police radios) If we are able to come up with a better way of doing amputation that fully augments a person's ability to achieve increased levels of function, that is a much different package.

So, what the marathon inspired was really, frankly, for me to get off my ass... (chuckles) and crystallize this into something that was operationalizable.

♪ ♪ TYLER CLITES: For hundreds, thousands of years, amputation has been viewed as a procedure that's done when there are no other options.

So we try to fix it in all these different ways.

And that doesn't work.

And the last thing we do is we take the leg.

Because of that, not much scientific effort has been put into changing the way that that surgery is done.

And so, fundamentally, the surgery hasn't changed since, really, the Civil War era.

♪ ♪ CARTY: Now, to understand the limitations of traditional approaches to amputation, it's critical to first understand how our limbs work normally.

Muscles in our limbs work in tandem with each other, with each pair joined by a tendon.

So when I bend my wrist, muscles on one side contract, and complementary muscles on the opposing side stretch.

Or, when I point my foot up, a muscle in the front of my leg contracts, and a muscle in the back expands.

Sensory nerves located in muscles and joints, called proprioceptors, detect each stretch and contraction and send signals to the brain via the nervous system.

The brain actually uses this awareness of the movement of those muscle pairs and creates a spatial, almost visualized, map of where the limb is in space.

This feedback is how we sense the motion of our limbs and joints and their position with exceptional accuracy.

It's how I can touch my nose with my eyes closed.

Or walk up a flight of stairs without having to look down at my feet.

We call this proprioception, and it's essential for our ability to move naturally.

♪ ♪ SHRIYA SRINIVASAN: Proprioception is our ability to sense the world around us.

It's the way that we know our joints move in space, how fast they're moving, how hard they're pushing, how stiff they are.

The amputation paradigm today basically throws sand over the whole thing and calls it a day.

And so it leaves all these wires just hanging.

Nothing's connected properly.

CARTY: In a standard below-knee amputation, there's an incision that's made in the front part of the leg.

And we go down and we basically, we cut the bone, and the tissues in the back part of the calf are left a bit longer and essentially are able to flap up and provide coverage at the end of the limb.

That muscle flap turns into a big ball of scar.

It provides good padding, but the muscle pairs are no longer connected, leading to the loss of proprioception in the residual limb.

If that patient thinks about moving their phantom ankle, muscles in the front part of their leg may contract, but the ones in the back no longer stretch in connection, and vice versa.

This causes the brain to receive conflicting and confusing signals, creating all sorts of issues for the patient, including phantom limb pain, and difficulty using the newest prosthetic limbs.

HERR: So my limbs were amputated, obviously, in a conventional way.

What that means is the muscles in my residuum here were stitched down a constant length.

When I try to move my foot ankle, it feels like my feet are in rigid ski boots.

CLITES: Now we have all this technology.

We have advanced robotic limbs, we have advanced ways of talking to nerves and muscles, and yet we're still doing amputation the same way.

So, our goal in designing this procedure was to fundamentally change the way that amputations are done to optimize the limb for communication with an advanced external robotic device.

HERR: The inception of the idea came from little domains of knowledge of how, A, the musculoskeletal system works linked to the nervous system, and, B, knowledge about how the body is controlled, and how robots are controlled.

And I also knew that the fundamental motor unit of biological systems is not one muscle, but two muscles working in agonist-antagonist pairs.

It's fundamental to how we work as humans.

So one day I just thought of, let's link them and take two motor nerves and get the motor nerves to grow in and create a little biological joint.

My level of education in surgeries was almost zero.

So I did not know what was possible.

How are you feeling?

Yeah, they just got the IV in you?

Just now, yeah.

Okay.

HERR: It was around then that I met Matt Carty.

CARTY: Hugh and I were both interested in revamping limb amputation, and ultimately decided to focus, at least in part, on how we restore proprioception.

We had done a series of early conceptual drawings and discussed the idea of creating a biological joint to maintain the muscle pairings typically lost during amputation.

Using tendons and bones we typically throw away, we designed a series of pulleys and small pivot points to connect muscles, so that they work in the dynamic way they were intended to by nature.

Our hope was that by restoring proprioception, patients would be able to not only perceive where their phantom limb was in space, but actually would be able to better use a prothesis that was specially adapted to their modified limb.

By the time we had ironed out those details, we felt pretty confident that we would be able to do this safely in a live human being.

The first subject we looked for, someone that was generally healthy.

Someone that was mentally prepared, mentally tough.

We then needed somebody who, of course, needed an amputation.

INTERVIEWER: All right, I think we're ready to go.

CARTY: I like to make the comparison to recruiting the first astronaut.

INTERVIEWER: Just count to five one more time.

One, two, three, four, five.

♪ ♪ ♪ ♪ JIM EWING: We're on our way to Boston, to... say goodbye to my left foot.

CATHY KING: How are you feeling emotionally?

I am absolutely terrified.

(Cathy chuckling) But I'm also very excited.

C'mon, Hugh.

Oh, I see the family of ants.

Yeah, isn't that cool?

Yeah.

JIM EWING (voiceover): Hugh and I first met maybe in 1984 or 1985, somewhere in there.

Here, you wanna carry that?

No.

Would you carry that?

HERR (voiceover): Yeah, I was a climbing bum living in New Hampshire, and putting up first ascents on the cliffs near North Conway.

That's where I met Jim, we kind of... lived in the same quarters.

JIM EWING: Back around the time that I met Hugh, I had a much darker view of the world.

I had kind of drawn all over my climbing shoes a bunch of weird designs, and then I wrote on the side of a left shoe, I said, "Life sucks," and on the right shoe, "Then you die."

And Hugh saw that, with his legs off, and he looked at me, and he said, "Does life really suck, Jim?"

And what do I say to a guy who's sitting there, bilateral amputee, like, maybe it doesn't suck so bad.

HERR: He's an extraordinary climber, a very gifted climber, and, you know, like me, has been climbing forever.

This is Jim's number one love, besides me and his daughter, of course.

He's been climbing since he was 12.

And from that moment, I think he just took to it, like it just hit his soul and a spirituality for him, I'd say.

JIM EWING: When I look back on my climbing career, the things that I cherish the most are the experiences.

I don't always remember the name of the climbs that I did, but I remember the person that I did it with.

I was seven the first time my dad took me outside rock climbing and it was just me and him.

I liked it, but I was terrified.

We'd always go on trips, and we'd definitely do a lot of climbing then, up until the accident.

JIM EWING: The accident was on December 26, 2014.

My daughter, Maxine, and I were climbing a cliff on Cayman Brac, in the Cayman Islands, that I hadn't been to before.

MAXINE EWING: My dad was doing a harder route that I hadn't attempted, and I was belaying him, he was... pretty high up.

JIM EWING: I started up the final headwall and realized that I had kind of the wrong sequence set up, and so I went to step down back to a ledge and take a rest, so that I could figure it out.

In sort of shifting myself, getting back to the ledge, my right foot slipped off.

I fell maybe five feet, and stopped briefly.

And then fell again, just a couple of feet, stopped briefly, and then went all the way to the ground.

They tell me that I fell approximately 50 feet.

I was breathing, taking deep breaths, I'd really gotten the wind knocked out of me, so I said, "As soon as I catch my breath, I'll roll over and get more comfortable."

And even though I never caught my breath, I tried to roll over anyway and realized my pelvis was broken.

I was calm.

Everybody else around me was hysterical.

The injuries were my left ankle.

My talus bone was crushed.

I had fracture of the left wrist.

And probably at the time the worst injury was I had a full pelvic ring fracture, front and back was completely destroyed.

Then there were a bunch of minor things like compression fractures in my vertebrae and ribs that were torn away from my sternum, bruised lungs.

Sounds like enough, really, but it was, it was a lot.

KING: I remember one time approaching the ICU with Maxine and I could hear this, this screaming, and I'm thinking to myself, "Oh, my God, that's horrible.

Like, that can't be Jim."

And sure enough, it was Jim and it was awful.

As a nurse, I've been a nurse for nine years, and I've never seen anything like that.

(birds chirping) Maxine had her own struggle and process with this whole thing.

JIM EWING: Unfortunately, I set things up kind of carelessly that day in a way that made it impossible for her to hold the fall.

MAXINE EWING: There are occasional moments where I felt guilty and then I would tell myself that it was my fault.

But I do know that it wasn't.

JIM EWING: You know, I spent six months basically off my feet.

It reached a point of recovery that was unsatisfactory, and then started going downhill.

Once the cartilage in the ankle started to break down, and the bone had died, it was all downhill from there.

Every step was painful.

Stepping off a curb or having a sudden change in angle of the foot was excruciating.

KING: The only option for the pain relief would have been to have a fusion, and that would have made him lose a lot of mobility and functionality, and that would have put a huge damper on all of his outdoor activities.

JIM EWING: That was when I started really thinking about amputation.

I contacted Hugh to talk about what life would be like for me if I chose to have my foot amputated.

(indistinct chatter) HERR: In the beginning, it was just trying to help him as a friend.

And we met several times, and he relayed to me how much pain he was in.

At one point, we were sitting in my car just outside the lab, and he just started to weep 'cause he was in so much pain.

He just, he sat there in my car and sobbed.

That was... (sighs) And that's, I think, that's when I realized that, you know, pursuing an amputation would, would dramatically improve his life.

Just getting rid of that pain is just a necessity.

There's no life with such excruciating pain.

It never stops.

A lot of those early conversations was me describing to him exactly what my life is like, what I'm able to do, what my limitations are, and also where technology's going, where we'll be five years from now, ten years from now, and so on.

And of course, I mentioned what we were working on, and...

I had basically no expectation that he would want to be the first human to undergo this procedure.

So I was actually surprised, in the end, how everything unfolded.

(chuckles) I think right then and there I decided that was time to amputate.

There was a pretty long vetting process that we did together, and he needed to think about things, and we needed to think about things.

♪ ♪ JIM EWING: You know, I thought, I'm just this guy from Maine and I'm meeting this big Boston surgeon, but Dr. Carty put me at ease pretty much straight away, and he stayed in the room with me, answering lots of questions.

We needed to be sure that Jim understood that this was a little bit of a black box and that we're going to be making up some of it as we went along.

And he was very thoughtful, and at the end of the day provided consent and then we moved forward.

♪ ♪ KING: If someone said to me, "You have to cut that foot off," if I had to put myself in his shoes, it would be terrifying.

♪ ♪ ♪ ♪ JIM EWING: How long are we expected to be under today?

About four hours.

About four hours, okay.

A typical amputation usually takes about two-and-a half, Yeah.

and building in additional time for what we're planning on doing, I'm guessing around four.

Sure.

Okay.

Okay?

All right, my friend.

CARTY (voiceover): To think that, here's a guy who is jumping off this cliff, no pun intended for him, but we're all doing this together, and, um, we were suitably nervous, just because it was a little bit unknown.

...is sixty... For now.

Scared?

Emotional?

It's going to be good, it's going to be great.

♪ ♪ Bye, hon, love you.

Love you, too.

Good luck, see you later!

♪ ♪ (machinery beeping) ♪ ♪ CLITES (voiceover): We were invited to participate in the actual amputation.

SRINIVASAN (voiceover): We'd practiced and rehearsed the surgery with Matt many times, and so on that day, we were there to just see it happen and provide a little bit of input wherever we could.

CLITES (voiceover): I'm sitting up in an observation room with a microphone, it goes directly to Dr. Carty's ear as he's doing the surgery.

I'm telling him things like, "Hey, we had talked about putting these there," or "Hey, we should measure that."

He's asking me questions as we're going, so it was very much an interactive process.

CARTY: This really was a reflection of the fact that we had been building up to this for several years before ever implementing it in a human being.

So, part of the point of our communication was to remind each other of all the steps that we had defined in the animal lab, and the cadaver lab, to make sure that we did it right when it came time to do it with Jim.

CLITES (voiceover): It was great to be a part of that.

(machinery beeping) CARTY: Things went fine, he's safe, he's awake.

KING: Oh, awesome.

CARTY: It's a complicated operation, it's the first time anybody's ever done it, so... KING: Yeah.

it was, so we took time in order to see everything.

This is Tyler, this is Shriya.

Hi, Tyler.

CLITES: Nice to meet you.

They both work with Hugh at MIT.

Oh, okay, you're observing So, they're going to be some of the, yeah, they're gonna be some of the bridge team and as Jim starts working with the prosthetic element.

Okay.

So, we'll get him through the acute recovery, and then we'll get working in terms of his rehabilitation.

And then, as I said, there'll be a, there'll be a transition when, when you all start seeing these guys a lot more.

♪ ♪ JIM EWING (voiceover): It's hard emotionally, just day-to-day.

Sometimes it feels like two steps forward, a few steps back.

When I'm in a lot of pain, you know, I start to have doubts about was this the right thing to do?

Of course, there's, there's no going back at this point.

The pain that I experienced in my ankle before my foot was removed, that is pretty much completely gone.

The only thing remaining is the nerve pains.

I can actually stop the pain a little bit temporarily by just waving my hand or my other foot below my stump it, and if I look at it and do that, it just kind of tells my brain, you know, "You can forget about that pain, that pain isn't actually there."

You're probably the best possible person that we could have as a first, first patient to go through this.

Because you're actually strong, you have a lot of stamina, you understand the broader context of what we're trying to do, and you're also incredibly nice.

And so I really appreciate that, I know, I know.

(laughs) My daughter will laugh when she hears that.

(laughter) So what we can say today is that things appear as though they're continuing to be moving the way that we want them to be.

At this point, it's all about healing and rehabilitation.

That's with regards to the biology, With regards to the technological side, we're going to soon segue to Jim working with our partners across town, to get fitted with a prosthesis that can utilize some of the unique capabilities that his revised limb will offer.

♪ ♪ HERR: The mission of my research group is to advance design technology that normalizes, or extends, human physicality.

♪ ♪ So here you see the bit of the history of our knee and ankle work.

This was the first mechanism that we actually tested on a human, and their metabolic cost of gait was reduced.

This was eventually commercialized into a package that looks like this, called the BiOM Ankle, and today I'm wearing the most recent, which is called the emPower Ankle.

So here's the packaged battery, a modular battery that just snaps in, and you push here to boot up.

We now have a product that's been fit on approximately 2,000 people, half of which have been wounded U.S. soldiers.

I've always been intrigued by human augmentation.

It's a great human narrative.

It's about human improvement.

It's about technology and tools.

It's what humans do.

Oh, my God, I can't believe it!

(laughter) It's just like I've got a, a real leg!

HERR: Of course, I'm not alone in that excitement.

Every student in this lab is just utterly fascinated and intrigued by the process of human augmentation.

CLITES (voiceover): Hugh is my PhD adviser.

The logistics of our relationship is that I'm a research assistant in the lab.

It's Hugh's vision, and he delegates projects to his students and he's always very involved in those projects.

And then we find ways to make those things happen.

And kind of... we're the foot soldiers, we do the groundwork.

EMILY ROGERS (voiceover): We have so many different types of projects going on, you know, from the neural engineering to mechanical design, so they're... you know, therefore putting in a lot of hours trying to get these projects done.

SRINIVASAN (voiceover): It has been a challenging place, and I love the challenge, and I love the opportunities that come with that challenge.

I probably work about 80 hours a week, so quite a bit.

MATTHEW CARNEY: I think it looks pretty sweet.

I don't know how well it's going to work yet.

I think the expectations for us are insane.

The way I always say it to myself is, Hugh's like, "At the end of the day, I want new legs!"

(chuckles) "Give me better legs-- what can we do, we're at MIT.

Make me nice legs."

Uh, but... and it's true, like, what can we do?

I think it's important to push hard.

(voiceover): We're building a four degree of freedom leg that has a knee, an ankle, a sub-taylor, and an MTP joint.

It's a substantial improvement over the BiOM, according to the numbers, if it actually performs that well.

This has a way larger range of motion and more power, also.

MAN: Has Hugh seen it yet?

CARNEY: No.

I just built this at like 3:00 a.m. last night.

(chuckles) (phone keyboard clicking) I was just responding to Hugh.

He said, "Sexy."

I'll take that.

(chuckles) I think he'll be happy with it once he gets to wear it.

Especially... hopefully, it'll perform better.

All right, let's do this thing.

HERR: I take very seriously the culture of the group.

It's critical that I accept people into the lab that are passionate about what we're working on.

In times when a lot of work needs to get done, it's probably at least 70 hours a week.

In more mellow, relaxed times, maybe 50 hours a week.

So, it's MIT, it's, it's not a walk in the park.

CLITES: I basically say, T-one minus T-two, which is the total torque applied to the joint, equals a dynamic equation that represents the joint.

And that's the inertia matrix?

CLITES: Yes.

(voiceover): Often in research, one of the problems that we have is that the people doing the research are not the same people affected by the thing that they're researching.

(prosthesis whirring) Hugh breaks that dynamic in a very powerful way.

HERR (voiceover): There's a very interesting dynamic on how society views the human body, and human ability, and human disability.

My legs were amputated, and the whole world says, "Oh, that's such a sad story."

The whole world said, "You're now a cripple and your life is kind of over."

After 12 months post-surgery, I started climbing better than I achieved before my limbs were amputated, climbing wall surfaces that no human had ever climbed before, whether with biologic or synthetic limbs.

And then suddenly, the narrative changed overnight to statements of, "You're cheating, that's not fair, how dare you."

To being a threat.

I actually had one competitor that threatened to cut his own legs off to compete.

♪ ♪ When we have all these bionic interventions at our disposal, the individual will be able to design their own physicality, design their own cognition and emotional experience, will be able to sculpt their own identity.

In that future, when we look at the normal, innate biological body, we will go-- (yawns)-- "So boring."

(chuckles) ♪ ♪ KEISHA RAY: I think society, in response to enhancement, in response to bionic body parts, will be a lot of people who will be scared, right?

They may call out things like cheating.

They may say that things are unfair if someone with bionic body parts has easier access to things.

And I think that's really at the heart of it.

So, there's already disparities that are beyond our control that affect our lives.

You can think of disparities in access to health insurance, particularly private health insurance.

So if Black and Latinx people, for example, have lesser access to health insurance, that means they have lesser access to artificial limbs, particularly those that are very technologically advanced, like bionic limbs.

One way that we can rethink access and make it more equitable to people is to rethink the way that we think about these artificial limbs and bionic limbs.

We think of them as enhancement, almost, like, cosmetic, right?

That you don't really need these limbs to live a good life, and if you do want them, then you're going to have to pay for them, because we think of it similar to, like, a rhinoplasty or, you know, augmenting the body in some cosmetic way.

But if we think about bionic limbs as more of therapy, as treatment, as more of something that helps people live an average life, then we can start to take away some of the disparate access to artificial limbs that are very technologically advanced.

HERR (voiceover): We want to really provide a delivery platform for bionics to everyone in the world.

So we want to launch a mobile delivery platform for bionic limbs in Sierra Leone, Africa.

So the framework is to have a mobile, rugged vehicle and inside it has CT scanning, 3D printing, computational computers.

And we'll literally drive around from village to remote village and build limbs and fit people with limbs.

We not only want to, you know, create the future of functionality in bionics, but we also want to create the future on how that technology is delivered to people, independent of where they live across the world.

♪ ♪ When you look at the human timeline, us human animals are extraordinary at devising tools and using tools.

I mean, no other animal comes close.

(machinery whirring) We design and build hammers, and we pick them up and we drive in nails.

♪ ♪ It's a tool, it's separate from our bodies.

It's something we use, but it's not an integral part of self.

♪ ♪ We're now entering a new era of human technology interaction that's non-tool-like, where there's a seamless integration between human physiology and electro-mechanics.

CLITES (voiceover): I've been on this project since I started my PhD.

When I came in, it was sort of a set of ideas that was in the process of coalescing.

And then I started to drive it through to where it is today.

How strong was the contraction?

Maybe, um... two.

CLITES (voiceover): If we're successful here, we hope that we'll be able to demonstrate the first real time that a robotic limb has been truly integrated with a patient's sense of self via proprioceptive sensation.

For that to happen, a lot of different pieces have to come together.

The surgery has to work.

The control system has to work.

The robotic limb has to work.

Any pain there?

Nope.

CLITES (voiceover): Our goal in the first session testing with Jim was to get a sense for exactly what types of signals we would be looking at, and the ways in which we could use those to control the prosthesis.

CARTY (voiceover): This type of technology, these newer approaches to prosthetic development, hinge on use being able to connect technology to the human body.

The primary way we do that is through the use of electrodes, which are small wires that are able to pick up the action of muscles in Jim's limb and transmit them to the technology.

There are two ways that we can do that.

One is through a surface-based electrode, which is essentially a sticker that goes on his leg, and is positioned directly over these moving muscles.

One of these wires is able to pick up the motion of these muscles and transmit it to his prosthetic device.

CLITES: Okay, go ahead and pick up.

CARTY (voiceover): There's another version of this, however, which is referred to as a needle electrode, which basically goes through the skin, and is able to penetrate directly into the muscle and not only pick up information like a surface electrode, but actually receive information back in the form of functional electrical stimulation.

At this point, we need to see if this works, and see if we can connect Jim's body to this newer technology through the use of these electrodes.

CLITES (voiceover): We focused our efforts primarily on these needle-based electrodes to get a sense for what it was going to be like to work with those and what types of signals we'd see from them.

And we ended up seeing a lot of noise.

I ended up spending a bunch of time running around trying to denoise the signal, and had trouble with that.

Rest, two, three.

Dorsiflex, two, three.

Rest, two three.

Do it one more time, invert.

It's too... it's not behaving.

♪ ♪ (voiceover): So about a month after the first session, we put the needles back in and we recreated the test setup from the first session and we also had the robot present.

And we're kind of focusing our efforts on that.

The EMG signals were still not where we ended up wanting them to be, but they were better, and so we were able to connect Jim to the robot for the first time.

I want you to cycle up and down.

(prosthesis whirring) Stop.

(voiceover): There wasn't much of a feeling of connectedness to it.

CARTY: Is there any value in calibrating his control with his right leg first?

It's the electrodes that were... yeah, I think the controls are...

I mean, they're, they're... we know they work.

Um, I think something's happening with the signal.

Tap your foot.

(prosthesis whirring) JIM EWING: The movements are very sensitive and very subtle, just the slightest contraction causes movement.

I'm trying to make it so you don't have to work harder.

Right.

Would you like it to be less sensitive?

No, I think I want it like this for right now, and let my brain adapt to the softer motions.

Okay.

(voiceover): Jim is the right person for the job.

Part of it is that he is unselfishly willing to sort of put himself out there and try something new, not knowing exactly what's going to happen.

Painful?

Stop yup, yup, yup.

Okay.

(groans) Where was that?

That was on the surface.

JIM EWING (voiceover): I can speak to them about what I'm sensing and what I'm feeling with the robot leg.

That's the big toe.

What's actually happening with the big toe?

I feel like I'm just bending it over.

With the big toe?

With just the big toe.

We might be in the, the electrode might be in the wrong muscle.

HERR (voiceover): So much of it is the human telling the researchers what he or she feels.

So we needed that very robust level of communication with the patient.

That's about a 60 percent contraction.

CLITES (voiceover): The things that we're doing here in this lab, Jim will not take home with him.

So, we're a research institution.

What we're doing is pushing forward the boundaries of human knowledge in this area.

The hope is that it will lead to commercial products that are covered by insurance, that people are able to go out and purchase and put on and take home and use.

But are our goal here is not to create something that Jim would then take home.

How's it going?

CLITES: We're still, we're still working; we're still getting some data.

We're doing some stim now.

HERR: Okay, cool.

Call you later.

All right, sounds good.

(quietly): Call me, baby.

What are you guys working on now?

We're moving on to electrical shocks.

(laughter) Tyler likes to call it stimulation.

(laughs) CLITES: Shock therapy.

You know, Tyler, you don't have to turn it up quite so high.

(laughter) ♪ ♪ CLITES (voiceover): We got off to a slow start.

Jim, contract.

And relax.

(voiceover): We were worried at first because we spent quite a bit of time placing the fine wire electrodes, which are the ones that go into the muscle.

Continue to bump, and see if there's a...

Right there.

You relaxed, Jim?

Contract, relax.

(voiceover): We had him put his liner on and then the socket on over it.

The hope was that that would help pull things in place.

We left the clinical space, came down here, plugged the electrodes in, and none of them were working.

Tyler, we're sure that none of these are, none of these are working?

I'm double checking.

All right.

One of them is disconnected right now, by the way.

CLITES: Yeah, I know, it's the LG.

Can you lift the liner?

Sorry, lift the socket off the chair.

Just going to hold that up.

CARTY (voiceover): There were a couple of challenges that we didn't anticipate with the needle electrodes.

First of all, it was difficult to find Jim's muscles the first time.

The needles were actually a little bit painful for him for placements, so we needed to make sure that he was comfortable with us placing them.

They tended to fall out when he put on his socket, and the stickers weren't adhering appropriately in order to hold them in place.

So, it was basically a failure.

CLITES (voiceover): So that was, that was tough, it caused us to kind of pause and reconsider our options.

And what we decided to do is move forward with some of the surface electrodes that we had so that we could give Jim the opportunity to at least control the prosthesis.

And we weren't sure how well they would work.

Invert.

It's close.

There you go.

CARTY: Wow.

Got it.

Tell me how it feels compared to last time.

Much smoother, more matching what I'm doing in my brain.

Last time you were complaining about it being very, very sensitive.

Yeah.

So now it's much less sensitive.

Do you feel that?

Yeah.

Okay.

It's more predictable.

I mean, it's more what I think I'm doing.

CLITES (voiceover): It was really immediately apparent that things were going well.

♪ ♪ Okay, very gently.

Gabby, can you power it up?

How does it feel having it on?

It's pretty amazing, actually, to have the foot moving in the directions that I'm thinking it's moving.

I mean, it... looking at it sitting over here, is not the same as it being there.

That's really good to know.

(voiceover): As soon as we put the robotic prosthesis onto Jim's socket and mounted it to his leg, there was this moment where he just sort of started to play with it.

(prosthesis whirring) It's really cool to feel it through my knee.

Feels like there's a foot there.

♪ ♪ This is intuitive for him, that's huge, it's like the iPhone.

CLITES: Hugh's going to be pissed.

(chuckles) Why?

He wasn't here.

He's also gonna be pissed that you're way better at this than he is.

It's his own damn fault.

Yeah.

Trying to flip the block over here.

Nice, that was awesome.

Yeah.

All right.

JIM EWING (voiceover): The muscle actions aren't exactly the same as a natural foot.

My brain had to adapt a little bit to make things work the way I wanted, but it happens so quick.

Literally, within minutes of having it all connected, it starts becoming part of me.

That's what we're going for, you know.

To whatever extent we can get people to feel as though they haven't lost a limb, that is in some ways our minimum bar, and that was the energy in the room that day, it was Jim feeling whole again.

And that was kind of a spiritual experience.

I've chosen a special song for this.

(chuckles) ("Walk this Way" by Aerosmith playing) You know this song, right?

JIM EWING: Yeah, of course.

♪ ♪ CLITES: Okay, I am recording now.

Go ahead, Jim.

HERR (voiceover): There's a debate within the bionics world as to...

Okay, and stop.

HERR (voiceover): ...how good the neural connection would have to be for things to just be completely intuitive.

CLITES: Jim, you can step.

Wow.

HERR (voiceover): So, what we just saw there was Jim step down a step and not even think anything consciously.

The foot did the right thing.

When he went up the step, toes went toes up, dorsiflex, and when he went down, it reached down.

So those spinal-level circuits are still active.

He feels enough feedback to the spinal cord that everything triggers naturally.

CLITES: Hugh, did you put on cologne today?

No.

You smell very... Did you?

It's very nice.

Somebody's got a nice fragrance smell going.

You know I have to sign your thesis?

(chuckles) HERR (voiceover): What we observed with the emergent reflexive biomechanics mediated through the mechatronic device is what we thought would occur, but didn't quite believe that it would occur.

(chuckles) So when I saw it, it supported the really intellectual idea that if you give the nervous system enough sensory information via nerves, that the brain knows exactly how to control the mechatronic device.

All right, give me a lift.

CLITES (voiceover): With everything we do, there's always a desire to explore not only how these systems work in the confines of the laboratory, but also out in the real world, and that's a challenge because all of our measuring equipment is confined to the lab space.

So knowing full well that Jim was an avid climber, the decision was made to design a robotic leg specifically for rock climbing that Jim could use in the field.

And a series of studies could be run on Jim while he's climbing on a wall using this new robotic limb.

JIM EWING: It's really kind of futuristic looking.

Adequately futuristic looking.

CLITES (voiceover): Emily Rogers is a graduate student who kind of took point on that project, and she designed this phenomenal system that is field ready.

Height is good.

ROGERS (voiceover): It will allow the wearer to plantarflex and dorsiflex, and also will provide inversion and eversion.

The power requirements are going to be fairly low compared to a powered prosthesis that you would use for walking.

They'll be able to manipulate their foot in free space and position their ankle to whatever location they want it.

And then when they place it back on the wall, the ankle will lock in that position.

JIM EWING: This is going to be fun on the wall.

CLITES (voiceover): As we're brainstorming different ways to do this, Hugh had the idea to go back to the Cayman Islands, to enable Jim to climb in the same place where he was injured.

♪ ♪ JIM EWING (voiceover): I always knew that I would go back, so going back now with this cutting edge technology is kind of fitting.

It's showing that the human spirit, let's say, and ingenuity can overcome a lot of things.

♪ ♪ Do you notice that the Cayman Airways logo is a turtle with a prosthetic leg?

(chuckles) I hadn't noticed that before.

I think I'm offended.

♪ ♪ The hard part is always finding, like, where the trail is in here.

The route goes up through those tufas, so I fell from, basically, where the tufas are and landed...

There's one actual stalactite coming down.

Yeah, so to the right of it.

To the right of that, in that area.

Yes.

Holy cow.

I guess it is like 40 or 50 feet.

(chuckles) So, anyway.

How did you survive that?

This sucks, right?

Like, it sucks that this happened.

Yeah.

Um, but to see where all that started has been...

It's come full circle now.

Like, you know, we're back here climbing with a robot foot.

I mean... Yeah, it's crazy.

How incredible is that?

♪ ♪ HERR (voiceover): I am, I would say, green with envy of Jim, because I don't have that level of neural implant yet.

I've met with Dr. Carty as a patient and the next step is to image my legs and look at my nerves, and neuromas, and muscles, and see, see what can be done surgically.

Even I have no idea what my physicality will be a decade from now.

I'm sure it'll be very spectacular.

(waves crashing) ♪ ♪ CLITES (voiceover): We're moving to a place where it no longer matters what your body parts are made out of.

Whether they're muscle and bone or whether they're metal and carbon fiber, It's this beautiful merging of the synthetic and biological into a body.

♪ ♪ (crowd applauding) HERR: Ladies and gentleman, Jim Ewing, the first cyborg rock climber.

(cheers and applause) NEWS ANCHOR: Remember that bionic arm that Luke Skywalker got in one of the "Star Wars" movies?

Well, modern medicine is getting closer and closer to making sci-fi a reality.

NEWS ANCHOR: These smart limbs being developed at MIT are possible because of the Ewing amputation.

CARTY (voiceover): We were able to obtain a pretty significant grant from the Department of Defense.

So we're gonna have a total of 20 patients who are undergoing the Ewing amputation, or it's above-knee analog, and be able to compare those to a group of 20 patients who undergo a standard amputation.

Am I going stump nude?

SRINIVASAN: Yes, please.

Stump nude.

SRINIVASAN (voiceover): So far, the data has been really encouraging.

These patients have seen an incredible transformation in their general quality of life, before and after the amputation.

(prosthesis whirring) When you see a patient move their robotic prostheses for the first time.

I can do ballet with my foot.

SRINIVASAN (voiceover): The smile on their face is just incredible.

I don't know, it just feels like it makes sense.

We've also had three patients who have had an above-knee or transfemoral amputation.

For the first time, you know, some of them have been able to actually move their ankle joint.

It's like a weird connection because it's, like, I know it's a foot, you know, it's not... it doesn't look like my foot.

Mm-hmm.

But it's, like, I'm moving it, so it's my foot.

If that makes sense.

Yeah, no, that's good.

Foot in, and relax.

PATIENT (voiceover): You run into these same patients throughout the study, or going to, you know, check in with Dr. Carty.

And you come in and, "Oh, look at this, you're missing a leg.

Are you one?"

"Oh, I'm number this, I'm number that."

And so, now we're like Facebook friends, it's kind of nice.

It's a little community.

♪ ♪ JIM EWING (voiceover): Here it is almost two years later since my surgery and coming back to where it all started in support of patient number nine.

(indistinct chatter) (voiceover): I know what the patients are going through, it's a difficult decision.

And once you make the decision, it's quite the emotional roller coaster while you're waiting for the surgery.

They bring in heated blankets?

CARTY (voiceover): We believe that the amputation by itself is just a better amputation, and that that has certain intrinsic advantages, even if those patients never had access to a high-fidelity next-generation prosthesis.

But when you combine the modified amputation with the next generation prosthesis, that's when really magical things start to happen.

The amputation we call the agonist-antagonist myoneural interface, or AMI for short, we refer to it as the Ewing amputation when it's below the knee.

Since those early days, we've applied the AMI amputation above the knee, below the elbow, and above the elbow.

Over 30 people have now received the AMI amputation.

So, we've amassed a tremendous amount of scientific data to more deeply understand the impact and the clinical efficacy of the technique.

We have further evidence that it improves bionic limb control.

We've also measured reductions in pain.

And furthermore, with fMRI imaging of the central brain, we've shown with direct evidence that the amount of proprioception as a person's moving their phantom limb, in the case of an AMI amputation, is the same level, statistically, than a person with intact biological limbs, which is truly remarkable.

♪ ♪ I think in 20 years, limb amputation will not be a disability, and there will be several dimensions that are actual augmentation.

That is to say, people with limb amputation can do certain things that people with innate, natural bodies are not able to do.

To run faster, to jump higher, to do all kinds of things that we can't even imagine today.

If I don't want to alter my body, but I see that altered people are getting the rewards and the spoils of the world, they're getting the money, they're getting the fame, right, they're getting the fortune, then I might say, "If that's what it takes to get those things, then I will."

So, whenever we attach things that are of great consequence to people to their abilities, that's when we have to start thinking about, is it coercive to attach goods to the abilities of the body?

I think we really have to educate people.

We have to educate people in the same way that we had to educate them about racism and sexism, is the same way we'll have to educate people about able bodies and disabled bodies, and enhanced bodies, right?

Because we really are creating another category of person.

And when you create another category of person, that's going to really tug at people's sense of self, but also how people operate in the world.

How they hire people, how they put people in the classrooms, that kind of thing.

So, we really have to make sure that people are understanding of what it means to be this enhanced body, and what it means to be an enhanced body among other unenhanced bodies.

CEREMONY HOST: Since 1849, there have been over 150 casualties in and around Mount Washington in the presidential range.

None of them have been insignificant.

We're here today to honor and pay tribute to Albert Dow by dedicating this sudden weather exhibit.

CEREMONY HOST: So, the plaque you're about to see says, "Albert H. Dow III, climber, rescuer, friend."

(cheers and applause) HERR: After we were pulled from the mountain, I was profoundly confused as to why I was alive and Albert had perished, and I still don't understand.

But I... the only thing I could control was to... how I, how I live my life, and Albert put forth tremendous service in his life, and I thought it would be a disgrace to his memory to give up.

So, thank you, Albert, for all your inspiration to me, and to so many other people.

And thank you so much for venturing out in the young winter of 1982, in search of two lost boys.

Thank you.

(cheers and applause) (voiceover): My goal was to not give up, to not succumb to pity, to use every cell in my body to try to do something worthwhile with my life because of Albert's ultimate sacrifice.

I'm certainly still on that journey.

I really feel that we're, we're just getting started.

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