Thursday, July 05, 2007

Working Hands

His hands told his story.

Theirs was a story of manual labor, for several distal phalanges were missing. Work was his life. Scars adorned the dorsum of several fingers and the skin was hyperpigmented from the sun. A few bruises were present from blunt trauma since they remained active still.

But the thinness of the skin was also telling, as each tendon sheath was now clearly visible beneath its crepe-like veil; each distorted joint more clearly visible. The thenar and hypothenar eminences, too, were wasted. Clutching a fork or spoon had become a challenge.

I noticed a small pearly nodule of the dorsum of his hand, just proximal to his index finger whose distal phalyx angled abruptly from arthritis. The nodule was smoothly circumscribed, with a small arteriole visible near the crest of its prominence. A basal cell tumor, I wondered? Near his wrist, was the irregular pulse that still pounded as it struggled to supply these hands with blood.

“I’m worried about that port they want to put in my arm,” he said. “My left hand isn’t worth a damn, but they can’t put the damn thing in there, since my vessels are so small. It seems they must use my right arm. But that’s my strong hand. I need it to use my walker. They think I won’t be able to use my walker for three weeks, and if I stop moving, well, hell, I might as well be dead."

“Maybe you could have physical therapy during that period of time,” I said, reaching for some consolation. The need to mention the nodule on his hand seemed unimportant.

“I think I've used up my Medicare allocation."

I wasn't sure. I should know this.

His hands shook as they reached for the eleven pills on his table. His right thumb and index finger opposed with difficuly to grasp each pill separately. His stuttering hand placed each pill slowly in his mouth, one after another. He reached with his two hands to grasp the cup of milk. They wavered as they brought the cup to his lips as he tried to wash the particles into his stomach.

"It's just so hard, you know. Driving an hour to dialysis, feeling like hell the rest of the day, just so I can feel good four days out of seven. And I just keep getting weaker. I worry about this, you know. And if they take my arm for that shunt, I won't be able maintain my strength, that'll be it. But then, what choice to I have?"

"You don't have to have the shunt, you know."

"I know, but I want to give this dialysis thing a try. Maybe I'll feel a little stronger, I don't know. If I don't, then to hell with it." He paused, then he asked reflectively, "If I didn't have the shunt, what will happen? I was told it might be ugly, especially for my wife."

"It doesn't have to be."

"I mean, how could I be sure I die with dignity? I don't want to be lying there in my urine and feces in front of her." (He pointing with his crooked finger to his wife).

"Hospice can really help," I told him. "They deal with these kinds of issues all the time. You have to decide if you want to be in your home or a hospice facility."

He said nothing. I felt impotent.

His hands reached for his walker. They grabbed the handles like they had hundreds of times before, then he rocked forward and back three times before lurching forward to stand on his wobbly legs. He stood for a moment to gain his bearings. His left hand could only lean on the walker; the heal of that hand steadied his balance while his right hand grasped the walker a bit more firmly.

"I'll give it a try a bit longer," he said.



Anonymous said...


I think it is easy in theory to talk about discontinuing care and avoiding heroic measures. Much harder to do in practice, because so often it's not a clear line that's being crossed; it's a long slow decline with halts and plateaus and even the occasional temporary reversal.

I plan to shoot myself long before I reach the point this gentleman is at. This is not what I want for my life.

Anonymous said...

This story really hit home ... and actually put a cold fear in the pit of my stomach.

I hope that, somehow, this man is able to find some peace.