My brother, Rick, was born with a variety of birth defects, including a left arm that ended with a stump below his elbow. I inquired if he would be eligible for the transplant, but Breidenbach said today's medical technology required a physical structure where a limb once existed.

I thought of how adding a real hand would change my brother's life. Growing up and even as a adult, I would sometimes attempt to perform routine tasks with only my right hand, for a sense of my brother's daily challenges. Driving. Buttoning a shirt. Deodorant. Try it sometime. Like the surburbanites who sleep in a cardboard box for one night to simulate homelessness, my experiment cannot capture the inescapability of such a disability.

For someone who once had a hand and lost it, I can only imagine the added frustration.

Still, the anti-rejection drugs a transplant recipient must take carry with them an increased chance of infections, complications and cancer. You don't need a hand to live, so is a transplant worth the risk?

I asked that question of Regina Armstrong, the wife of Dave Armstrong, the nation's fourth hand transplant recipient - all four by Dr. Breidenbach.

"We do know there's risks in everything that you do," Armstrong said with a smile, "Your whole life is a risk. This was the chance, I think, of a lifetime."

As she beamed with delight at her husband's surgical success, I wondered if in the excitement of the whirlwind, Regina had forgotten the inherent risks of the surgery.

As it turns out, this reporter is the last person who needs to remind the Armstrongs' of the risks associated with transplants. Their medicine cabinet already has immunosuppressant drugs because Regina is herself a heart transplant recipient from 1987, when she was 12 years old. One consequence of that transplant was the loss of her hearing. She has a cochlear implant to compensate.

She says the hand transplant will help make her husband "whole" again. I know that in a politically correct world, such a suggestion will be decried by advocates for the disabled, concerned that some disabled people will be regarded as less than complete human beings.

But, I think again of my dear brother, who in his 20's, decided to undergo a painful and experimental surgery to his face. Another birth defect was that his facial muscles did not work. Rick could not smile. He could not close his lips. Speech and eating suffered, as did his physical appearance.

Society judges so much on appearance, and because of Rick's flat expression, many people presumed he also had mental disabilities. He did not, unless you want to include relying on groanful puns for humor. A Masters Degree in journalism, however, could not compensate for first impressions.

Rick hoped that the surgery would give him a perpetual smile. The surgery did change Rick's facial appearance, giving him indentations or dimples to perhaps suggest a smile, but it did not make him "normal." Yet, I think, as Regina Armstrong reminded me, that he had to "give it a shot."

I went with my brother to another procedure to have collagen injected into one of his vocal folds. Only one of his two vocal cords worked, making his voice raspy. His voice was still raspy, afterward.

I am more reflective now of my brother's decisions and constant efforts to improve himself (too innumerable to list here) because he suddenly and unexpectedly died four months ago at the age of 46.

The night he died, I spoke aloud to Rick saying to his spirit, "now, you are whole," then immediately chastising myself for suggesting that Rick was less than a complete man on this earth. Ironically, my brother's "quality of life" is my model for excellence.

I thought of Rick so much when talking with Regina Armstrong, knowing that if asked his opinion on Dave Armstrong taking a risk by getting a hand transplant, Rick would give him an enthusiastic "thumbs up."

Or, as Rick was fond of saying, "Let's give him a hand."