With her mother driving, the periodic trips to a Long Island prosthetics maker are an attempt to regain what was lost when misfortune and infection conspired against Smith 18 months ago, resulting in the amputation of all four limbs.
Pneumonia contracted during pregnancy transformed into sepsis, a potentially lethal blood-borne infection. That in turn, evolved quickly into septic shock, a cascade of turncoat immune system components that forced her into a coma and choked off the blood supply to her limbs.
Now, Smith, 28, is the reluctant beneficiary of a new generation of highly advanced replacements, part of a revolution in bionic and near-bionic prostheses primarily designed to help soldiers who have lost limbs in Afghanistan and Iraq. Her story is one of trial and error as she attempts to recapture the simple graces of human movement -- a challenge, Smith acknowledges, with artificial limbs.
"I was depressed for a while, but I snapped out of it," said Smith, who had one arm amputated below the elbow, the other above. The situation is similar with her legs: one was amputated below the knee; the other above.
"I am only 28 and I have so many years ahead of me," Smith said, even as she considers a future with body parts made of composite materials, stainless steel and plastic. As much as she would like to, Smith admitted, she cannot undo the past.
Her mother, Roxanne Smith, who has been helping Shannon at home, recalls only a brief period of low morale. "She would say things like, 'I'm never going out of the house again,' " said the mother, who's now witnessing her daughter's rebirth.
Illness overwhelms her
A vocational college graduate, Smith was living in Las Vegas and working as a pharmacy technician before her medical crisis, looking forward to a future thousands of miles from Buffalo's dreary winters.
"I was six months pregnant and everything was perfectly fine until I woke up on Dec. 5, 2010," she said. "I really wasn't feeling well, so I went to the emergency room."
Diagnosed that day with pneumonia, Smith was swept into a surreal odyssey that caused the death of her unborn child and triggered hemorrhaging from her eyes, ears, nose and mouth. She drifted into a coma.
Sepsis can result from any infection and moves quickly -- insidiously -- morphing into septic shock, experts say.
Smith was put on life support at the Las Vegas hospital where doctors told her mother the case was the worst they had seen.
In addition to the overwhelming infection, Smith developed disseminated intravascular coagulation, an extreme condition that occurs when the balance between bleeding and clotting is disrupted. Excessive bleeding and clotting injures vital organs.
Dr. Robert Schneider, a leading septic shock expert, having discovered the gene that underlies susceptibility to the condition, said no one is immune to the disorder.
"Septic shock is almost always caused by bacterial infection that enters the systemic circulation," said Schneider, the Albert Sabin professor of microbiology and molecular pathogenesis at NYU Medical Center in Manhattan. "There can be many causes, some of them pretty innocuous, from simple scratches to pneumonia."
Schneider, who is not involved in Smith's case, describes septic shock as the No. 1 killer of patients in intensive care units. The National Institutes of Health estimates more than 700,000 people in the United States are affected annually by septic shock and about 30 percent die.
A hallmark of the condition is the so-called cytokine storm -- an uncontrollable surge of immune system components, Schneider said. Rather than protecting the body and quashing invasive bacteria, the storm destroys vital organs.
In Deer Park, Vincent Benenati, chief executive and founder of East Coast Orthotic & Prosthetic Corp., is one of two company experts who supervised the production of customized limbs for Smith.
"She's so challenged," Benenati said. "She just got her arm . . . and she sent me a video waving when she got it. Just think of what this young woman would be like without these devices." The arm has a "training" hand attached for now.
"I took her and her mom out to lunch a few weeks ago and her mom had to feed her. It was so sad," he said.
Smith, who has a 3-year-old son, Oliver, said she and her family chose the Long Island artificial limb-maker after having read about its successes. The company operates a rehabilitation center in Buffalo.
Benenati said Smith has received an exceptionally high-tech limb for her right leg because of the above-the-knee amputation. The limb on the left is less complex, but nevertheless has special engineering designed in Benenati's lab. A less-advanced limb was used on the left because Smith still has her natural knee, which helps maintain balance and sure-footedness, Benenati said.
The electronically sophisticated leg, known as the Rheo Knee, has an embedded microprocessor to detect changes in terrain during walking, he added. The knee makes adjustments to prevent falling and instantly adapts to slopes, stairs and rocky surfaces.
Christopher Berger, a professional prosthetist, helped Smith put on the leg and learn how it works.
"There's so much design and engineering that goes into all of our patients, but there is more in-depth [engineering] with this particular patient because she lost all four limbs," said Berger, another executive with the company.
Fingers with finesse
Both artificial arms have hands with sophisticated electronics, he explained. The arms detect electrical signals in Smith's arm or shoulder and relay that energy to the hands.
"Basically, they [the arms] have electrodes built into the socket and are placed over the muscle," he said. "The electrodes pick up the signal [from the muscle] and transfer it to the microprocessor in the hand."
Benenati said Smith's state-of-the-art hands, known as the bebionic myoelectric hand, will allow her to pick up a Styrofoam cup without crushing it. Earlier electronic hands were so powerful they crushed cups and pained others during a handshake. The hands have fingers capable of articulating movements fine enough to pick up a dime or credit card.
"She moved her fingers for the first time. She's so excited," Benenati said. "I saw from the video they sent me."
He said Smith's private health insurer covered the majority of costs for all limbs, but initially fought paying for the hands because of the expense
The Rheo Knee cost $40,000; the below-the-knee prosthetic was $15,000; the full arm plus hand, $100,000 and the below-the-elbow limb and hand, $25,000, Benenati and Berger estimated.
"There are co-pays that insurance doesn't cover," Roxanne Smith said, referring to the multiple surgeries, medications and therapies her daughter has faced. She has set up a nonprofit fund to help her daughter pay mounting medical bills. As of this week the fund had grown to $17,000.
Smith undergoes rehabilitation sessions daily in Buffalo, aimed at developing "central core" strength, she said, because she lacks the strength derived from the muscles of natural legs.
Her new arm has a "training" hand attached for now.
"You see the smile on that young woman's face? That's what it's all about for me," Benenati said, referring to Smith's unflaggingly upbeat personality. "She can really put those arms and legs to use. She's going to be independent one day."
Smith plans to fulfill Benenati's prediction.
"I came through the worst possible situation," she said. "I am still here."