One wall in the waiting room of the business establishment of Joel Dwyer, C.P.O., in West Barnstable, just off 6A, is covered with newspaper clippings, cards and letters.
One of the cards, printed in a seven-year-old's hand, thanks Mr. Dwyer for making him a water-proof leg "so I can go swimming."
Another, more recent, came from an old customer who saw Mr. Dwyer's ad in the last issue of this publication. "I made a brace for the gentleman 12 to 15 years ago" Mr. Dwyer recalls. "He said I was the only one who gave him hope that he wouldn't have to wear the brace forever; that the nerves would come back...and five years later they did. He said, 'I remembered that I never did thank you.'"
The C.P.O. after Mr. Dwyer's name stands for Certified Prosthetist and Orthotist and the two letters we just cited represent the difference between the two disciplines. Prosthetics is the replacement of body parts; Orthotics is the support of body parts. One phrase in the more recent letter reminds Mr. Dwyer of his true calling. "We're in the hope business," he says.
What makes Mr. Dwyer's enterprise stand out is that he may be one of the last of his profession, who, with his staff of two technicians, individually hand-crafts every prosthetic device through every step of the procedure.
"We've been here 27 years and we're just an old mom-and-pop," Mr. Dwyer related recently, "We see every patient and we do it the old-fashioned way. It's a hands-on, crafty thing. We may be an anachronism, but that's the way we want it."
Mr. Dwyer didn't start out with this profession in mind. He studied business at Babson College, biology at Kansas State and also worked as a carpenter. While renovating a hospital building in Boston he saw maimed veterans returning from Viet Nam and the wonders of prosthetics in helping them return to an active and useful life.
It was a worthwhile field where he also could continue to work with his hands. More studies at New York University, a two-year internship, a week-long examination and Mr. Dwyer was certified to hang out his shingle. He and his wife Darlene, who runs the office, moved to the Cape in 1982.
Today, he's the only P&O practitioner whose entire operation is Cape-based. Others headquartered off-Cape utilize a central fabrication procedure. It's the difference between ordering a suit off the rack (and getting it altered) and getting one custom-made from the start.
"We make a mold of the 'residual limb' (arm or leg) for a better match and then get it modified. Then we take a cast of that, make another model and then do further modifications. We do multiple fittings and that pays off in the end," he says.
In addition to the change in competition where large outfits now dominate the field, Mr. Dwyer says the biggest differences since he started out have been the introduction of "high tech and low reimbursements."
Such items as exotic materials for prosthetics such as titanium and computer-driven limbs, including a mechanically stimulated knee that locks automatically if you trip and one on the way that "anticipates what you do and has a motor to lift the leg."
The prosthetics are expensive. A basic limb can average $6,000 to $15,000, it's $20,000 on average if a knee joint is involved, and $40,000 for a full leg. Mr. Dwyer complains of a constant battle with private insurers over reimbursements.
What about Iraq?
Body armor does save lives, Mr. Dwyer says, but survivors who otherwise might have been killed, often return home with profound head injuries and amputations.
Mr. Dwyer says military hospitals "take good care of these guys" and they have their own shops to do the work.
However, as a certified Department of Veterans Affairs contractor, he expects to be taking care of the Iraq amputees five or 10 years from now as the prostheses wear out and fits have to be changed, just as he's done for veterans of earlier conflicts like Korea and Viet Nam.
Among civilians, most clients are older and require braces for stroke victims and prostheses to replace amputated limbs of diabetics. Motorcycle accidents produce the next highest number of amputees with two interesting subsets: most are middle-aged men, and there are increasing numbers of women.