If this were a single finger other than the thumb, it seemed quite possible the hand surgeon would opt simply to complete the amputation. But this was the thumb—the digit that, because it could be pressed against the pads of the other four fingers on the hand, created the opposition that, in essence, separated primates from other animals. Writing, grasping, fine motor skills. For life to go on as it was for this youth, meticulous reimplantation was critical.

And preserving anatomical relationships and circulation had to be Lou’s mission. But first, there was the matter of the kid himself.

Lou grabbed a towel and laid it over the boy’s hand. Instantly, the white cloth became soaked in crimson.

“Joey, is that your name?” Lou asked, supporting him by the shoulders.

“Joey,” the kid managed. He began shrieking again and raised his hand to eye level. Heavy drops of blood fell from beneath the towel.

“He just stuck his hand in there!” the chef cried out, the heavy, blood-covered blade still in his hand. “I never saw him. Jesus, Joey, what in the hell were you thinking?”

Joey’s fair, freckled complexion was ashen—one of the early changes of shock.

“All right, Joey,” Lou said, “I’m going to lower you down.”

“Here you go, Doc,” someone said.

A box of disposable rubber gloves appeared on the high bench where the accident had occurred. From his earliest days in the hospital, Lou had to battle against the intense urge to dive right in and help whenever there was an open, bleeding wound. Then articles began appearing in the literature reporting the surprisingly large percent of HIV-positive patients found in sequential testing in both inner city and suburban emergency wards. And finally, conversion to positive happened to a fellow moonlighter who didn’t follow protocol, in a small, affluent community hospital, fifty miles outside of D.C.

“Please, no one come near the blood without having gloves on,” he said, donning a pair and quickly backing it up with another. “One of you roll an apron under his neck and someone else get his legs elevated with something under his knees and ankles. The higher, the better. If there’s a blanket around, put it over him. And I need towels. Lots of towels.”

He brought his mouth next to Joey’s ear.

“Joey, my name is Dr. Louis Welcome. Call me Lou. Hang in there with me and we’ll get you fixed up. Okay?” He took a clean towel and slid it in as a replacement for the blood-soaked one. “Do you have any allergies to medications?… Any past surgery…?”

He craned his neck back until he made eye contact with his father. Then he pulled his car keys from his pants pocket.