My Hands

Don’t touch that! What glove size are you? Watch your hands. My hands are well traveled by now—a year of clerkship puts a lot of experience in your hands. I’ve sutured lacerations on the belligerently inebriated. I’ve held the hands of grannies as they climbed onto the examination table. Many, many babies have gripped my index finger. I’ve palpated lymph nodes, cervixes, and prostates across the province. I know how to hold my stethoscope properly, like an internist. I don’t think I really thought about how much of medicine involves hands until my surgery rotation during clerkship. It seems obvious—tying, suturing, and cutting are clearly all about manual dexterity. They are skills that are taught and practiced, but it is more than that. During one of my days on thoracic surgery, we brought a young man into the operating room whose stomach contents were coming out of his chest tube. My job for the next four hours was to retract his heart for the surgeons. The flexible strength and elasticity of this organ was palpable through the metal retractor I held, and the patient’s life beat through my body. It was an incredible moment. Never had life been so clear to me as when the surgeon took a break and put my hand on our patient’s pericardium. I felt my pulse and his heart. Our rhythms were not in sync but we were the same—we were both alive. It was a grueling surgery, but it was amazing. The surgeon fixed the esophagus and stomach, and the patient lived. During one of my nights on general surgery, we brought another young man into the operating room. He had been absolutely fine three weeks ago, when he suddenly couldn’t keep anything down. The small bowel obstruction we saw on X-ray became something even worse on CT—cancer, likely pancreatic. No warning of painless jaundice. No weight loss. Maybe some night sweats. My job for the next four hours was to retract part of the intestine while the surgeon did a roux-en-Y gastric bypass to buy this gentleman some time and some quality of life. Partway through, the surgeon placed my hand on our patient’s intestine. It was hard and lumpy. The texture was all wrong. He let me run my hands along the length of our patient’s bowel with him—parts of it felt grainy and rough. We spent most of the operation in silence. It was cold and late. And we weren’t going to save him—help him but not save him. In surgery, my hands held life and death. I’ve held the strange weight of a leg as you hand it over to the nurse during an amputation. I’ve felt the unbelievable stretch of a skin graft as the surgeon staples it over a massive burn and the rush of air around my index finger as I clear the opening for a chest tube. I’ve understood the sorrow of the abnormal strength in a young trauma patient’s grip who has just earned the label of C6 quad. I’ve given my pen to the attending to sign a death certificate. My hands have changed and so have I along with them. I know who I am as a person, and I’m finding out who I might be as a physician, with a growing confidence in my abilities. My hands are the entryway, from the very first handshake with a patient, and they are one of the tools I am learning to use to connect with and care for my patients. My hands are a part of me and of my presence in medicine. Scrub in. Can you feel that? Hold this for me. Acknowledgments: A sincere thank you to Dr. Jonathan White of the University of Alberta Faculty of Medicine and Dentistry for encouraging the practice of reflection during the surgical clerkship rotation.

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