Hands

I wrote this essay a few months into rheumatology fellowship:

Our hands are so integral to our lives that we often take them for granted.  They push us off the floor and keep us upright as we learn to walk.  In grade school and college, they write, type, and text for us with perfect obedience.  They mash down on video game controllers to help us defeat virtual enemies.  They grip, throw, or catch something in nearly every sport other than soccer.  They steer automobiles, bring coffee mugs to our lips, and apply makeup to our faces with dexterity developed over years of unself-conscious use.  They hold others’ hands and bodies as we fall in love.  They transcribe our poems and stories and actualize our drawings and paintings.  They pluck guitar strings and strike piano keys.  If we are lucky enough (or unlucky, depending on our perspective) to become old, they will grasp canes, walkers, other people, and sturdy objects to steady our frail bodies in ambulation.

As we soar along the arc of life, we remain largely unaware of our hands until their use is abrupted.

We are nothing without our hands.  As a first-year rheumatology fellow, I see all sorts of hands.  I see the hands of the “worried well”, the normal-appearing but paresthetic, hypesthetic, and tender hands of those with repetitive strain injuries, the knobbly hands of the many with osteoarthritis, and the profoundly disfigured and dislocated hands of people ravaged by decades of uncontrolled rheumatoid arthritis.  One older woman, the sole caregiver for her husband, had rapid-onset digital necrosis in both hands and was found to have vasculitis on kidney biopsy.  The distal halves of most of her fingers have shriveled like flattened toads on a highway.  They will eventually fall off on their own.  I have seen the doughy, mammilated hands of a 30-something woman with multicentric reticulohistiocytosis, an extremely rare disease.  The bones of her fingers have slowly resorbed and fractured over time, telescoping her fingers into a “Marshmallow Man”-like appearance.  She is homebound, unable to write, type, draw, paint, drive, or even use a touch-sensitive tablet without pain.  Like anyone else with significant hand pathology, she is profoundly disabled.

Over the past couple of months of seeing such cases on a daily basis, I have moved from obsession and horror to cool acceptance.  I have become mindful of hand health.  I have also become more productive.  The health of my hands, eyes, and the rest of my body will not wait for some ideal future time that is perfect for creativity.  As time passes, it becomes more and more likely that something will go wrong, so now is the time to write, draw, paint, learn a musical instrument, and to be otherwise creatively engaged.

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4 thoughts on “Hands

  1. Very touching post; my mom had very bad rheumatoid arthritis (actually it might have been psoriatic arthritis; I remember doctors going back and forth on what they thought the diagnosis should be). This happened while I was a child, and only now do I realize how much more difficult life must’ve been for her not being able to use her hands much anymore.

      1. Unfortunately, I don’t think she did. She ended up trying several different medicines for her arthritis, but by the time it was diagnosed it had already progressed to a very severe state. (In earlier years she had been diagnosed [perhaps improperly?] with gout and when she first started having her autoimmune arthritis problems in her hands, she thought it was gout and reacted accordingly by trying not to move her fingers.)

      2. You’re probably right. It’s unlikely for gout and rheumatoid arthritis (RA) to be present in the same patient. Also, RA should be treated sooner, not later.

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