Retired Marine Corps Sgt. John Peck is crying as he lies on the operating table, the stumps of his arms anesthetized, the room filled with lights and figures in blue scrubs.
He's been praying since his plane left Virginia the night before, asking for strength. And a nurse keeps trying to comfort him. But the enormity of what's happening has hit him, and for the moment he is overcome.
It's been six years since he stepped on an improvised explosive device in Afghanistan and became a quadruple amputee. Almost two years since he got on the waiting list for a double arm transplant. Less than 24 hours since the urgent summons from the hospital here.
Now, Peck, 31, is under a white blanket with an oxygen mask over his nose and mouth, unnerved that a dying man's limbs are headed for the operating room, and not really sure that he will make it through the surgery.
He's breathing heavily. The nurse, Jocelyn Lim, appears, leans in close and tells him to calm down, everything will be okay. After that, he remembers little: "I'm gone. . . . knocked out."
On Wednesday morning, Peck, who lives outside Fredericksburg, Virginia, made his first public appearance with his new arms at a media briefing at Brigham and Women's Hospital.
He is thought to be the second quadruple amputee from the wars in Iraq and Afghanistan to get a double arm transplant.
The 13-hour surgery was performed in August by a team headed by Simon Talbot, the hospital's director of upper extremity transplantation.
It was a complex procedure that required good timing, surgeons at two medical facilities, the help of the New England Organ Bank, and a large plastic cooler to transport the donor's limbs.
The family of the donor, a young man whose arms were an ideal match for Peck's, did not want to be identified, the hospital said.
But an emotional Peck expressed his gratitude Wednesday to the donor's family.
"Your loved one's death will not be for nothing," he said at the briefing. "Every day that I look down at our new arms, I will drive on.... and I will never give up. I will remember his selflessness and his gift until the day I die."
The donor's right arm was attached to Peck's right arm just above the elbow, and the donor's left arm was attached below Peck's left elbow, cutting through one of Peck's old tattoos.
Some of the surgery was done under a microscope, Talbot said in a telephone interview last week, and some of the stitches were as thin as a human hair.
During several interviews last week, Peck said he was doing well, aside from a frightening but temporary episode of rejection, which the hospital said often happens in such cases.
He said his arms feel good, but they do not yet feel like his. "They will," he said. He already has some faint sensation in them. But he will probably not see significant results for months, his doctors said.
He can lift the new arms, but must be careful because the bone, muscles, blood vessels and skin are healing. Swelling remains where the donor limbs are attached, and on Friday the incisions looked raw.
But for the first time Peck has been able to wear the black wristband he got to honor a buddy, Marine Corps Cpl. Larry Harris, who was killed in combat in Afghanistan a few months after Peck was injured.
After the surgery, as the sedation was wearing off, Peck, still groggy, said over and over to his fiancee, Jessica Paker, 29, who was at his bedside: "I have hands. I have hands. I did it."
On a day in early August before the transplant, Peck was in the rehabilitation gym at Walter Reed National Military Medical Center in Bethesda, Maryland, with his mother, Lisa Peck, helping him put on his prosthetic legs and arms.
His job was to practice walking with the legs - "shorties," they're called, because they're not full size - and the crutch arms, which are like metal canes.
"I don't think I've fallen yet," he said as his mother strapped on the support belt for the legs.
He eased himself out of his motorized wheelchair and steadied himself on the prosthetics. "All right, I'm good," he said.
At that point, Peck had no idea when he might get arms.
He said he learned that arm transplants were an option when doctors from Johns Hopkins Hospital in Baltimore came to Walter Reed while he was recovering. He first contactedBrigham and Women's in the fall of 2013. He went for a week of rigorous tests - physical and psychological - in January 2014, and was put on the wait list that August.
It had been more than two years since he began. The big black suitcase he had bought to be prepared was gathering dust in a closet. He was still making regular visits to the hospital in Bethesda for physical therapy.
"My nerves," he said, as he began walking laps around the room. "I'm mentally exhausted. . . . Everywhere I go, even here, even right now, I have to have a game plan on how I'm going to get there."
Sweat beaded on his forehead as he walked, his prosthetics clanking quietly on the floor. "I am unwilling to accept this until the day I die," he said.
His ultimate dream is to be a big-time chef, he said.
"My goal is to do arm transplants, do some traveling, learn different types of food, take like cooking courses across seas, like Tokyo, China. . . . Florence, places like Paris," he said. Then become a Food Network star.
"That's all I want to do," he said. "It could be easily accomplished. Well, not easily, but it could be accomplished. It's just up to me. How hard I try. How successful the arm transplant is."
He said he asked the doctors at Brigham and Women's if he would be able to work out again after the transplant.
"They were like, 'Yeah,' " he said. "Can I work on my car?'. . . They were like, 'Yep.'. . . Can I cook again? 'Yep.' "
Okay, he said, "I want to be in your guys' program."
On May 24, 2010, Peck was on patrol in a small village in Afghanistan's Helmand Province. The Marines were entering compounds, meeting residents and looking for weapons or the Taliban.
The last place they visited that Monday was a compound were nobody seemed to be home. He said the Marines had been warned: If no one's home, don't go in.
But his commander was suspicious and decided to poke around.
Peck, who was handling a metal detector, entered the compound first and swept the area for IEDs. "Everything was clear," he said.
"I went to go tell my sergeant I was going to go outside," he said. "I went to go turn around, and that's when I took my step forward, and got flung through the air."
Peck had been in the Marines since 2005. He was the son of an Army nurse and grew up in Rockford, Illinois.
He had served in Iraq in 2007, and said he suffered a traumatic brain injury in an explosion there that August.
He was manning a machine gun atop an armored truck when the truck hit an IED. The blast threw him in the air, and when he came down he struck his head on the machine gun.
He had suffered a concussion, and after further evaluation was sent home to his base in the United States. He underwent treatment, recovered, and reenlisted in April 2009.
A year later he was in Helmand.
As the blast tossed him that day, he felt a blow to his head, which he thinks may have been from one of his amputated legs. He doesn't recall hearing or feeling anything.
"My system was already in shock," he said. "There was no pain at all."
He remembers screaming, "I don't want to die here!"
He had instantly lost both legs above the knees, and his right arm above the elbow. His left arm was all but gone, and was later amputated below the elbow.
As he told the story, he paused.
"Sorry," he said. "It's still. . . . like a fantasy. Sometimes I just can't believe it. . . . I think about it and I recall this, and it surprises even myself. "
An amiable man with a brown beard, Peck was recounting the tale as he floated in the swimming pool of the home provided by a charitable organization.
He was a pale, thoughtful figure in a blue bathing suit, with a large back tattoo depicting a prone man with fire coming from his chest.
As he reflected, his cellphone rang nearby.
He asked someone to see whether it was a New England number.
A few weeks later, he was lounging alone on his living-room couch watching television when his cellphone rang again. He glanced at the screen, saw that it was from a doctor, and knew that this was the call.
It was Talbot, the transplant surgeon in Boston.
An ambulance would be waiting for Peck at Boston's Logan International Airport as soon as he could get there.
Peck was overjoyed, but then realized somebody was dying to enable his transplant. "I felt terrible," he said.
But he was about to join former Army Sgt. Brendan Marrocco, who is thought to be the only other military quadruple amputee to get a double arm transplant.
Marrocco was injured in Iraq in 2009, and had his transplants at Johns Hopkins in 2012.
In a recent telephone interview, Marrocco said he and his arms were doing well.
Peck's double arm transplant was the fourth at Brigham and Women's. Worldwide, about 80 arms have been transplanted in about 60 patients, doctors have said.
Although Peck said he had significant out-of-pocket expenses, a spokeswoman for Brigham and Women's said the hospital covered the cost of the surgery and the physicians volunteered their time.
The operation began at 12:33 p.m. and concluded at 1:56 the following morning.
Many hours later, when Peck's head cleared and he realized he had new arms, he was filled with gratitude.
"It was just pure love," he said. "And it will remain like that."