Two days later, on a bright Tuesday afternoon, Mom and I step through the front door of my one-bedroom prewar apartment in Brooklyn. I’ve been concerned this moment would prompt upsetting flashbacks of the accident, or a realization I could no longer live in what had been such a beloved home to me and my urban family—the site of big bashes, boozy girls’ nights, chaotic kiddie brunches, the occasional intimate dinner date. Instead, I feel happy stepping into the large, sun-washed vestibule I use as a dining room.
Mom and I slowly walk through the few rooms, relieved to see that the professional biohazard cleaning crew hired by the building management has done a mostly, if not entirely, thorough job of washing away the blood I shed on the night of the accident. I notice a few missing articles—bedroom rug, clothing that had been strewn on chairs—that I later learn were bloodstained beyond salvage and discarded on Mom’s instructions. Tired from the trip from Manhattan, I climb into my own bed for an afternoon nap, while Mom assesses the food stores in my kitchen. I appreciate her taking care of that, and that she doesn’t mind my leaving her to it.
I fall quickly into the routine established at Erica’s, awaking early each day, washing down a piece of toast with a cup of coffee, then launching into the first of three daily sets of hand exercises. Every movement results in some unnerving sensation, conjuring images of vibrating piano strings or snapping twigs, that convinces me I have screwed up the fragile landscape of my inner hand. I stick to the regimen, however, and record each completed repetition with a check on a notepad, taking heart in the rapidly accumulating marks.
After the morning exercises, I often take a half-hour walk through my neighborhood. Sometimes I go to the Brooklyn Promenade to sit on a bench and cry in the guaranteed privacy of a waterfront park in February. The crying fits feel like vomiting—involuntary, mindless, and often a relief. At midday, Mom prepares a simple lunch for us, like Campbell’s tomato soup and a tuna salad sandwich, which is pure comfort food to me, then I do another round of exercises before sleeping for a couple of hours. In the late afternoon, I catch up on health insurance admin, speak with close friends on the phone, or poke around the internet for information about hands and spaghetti wrists. After dinner, I do a last set of exercises, wash my splint, write a barely legible, left-handed entry in my journal, then head to bed. The slow, monotonous days feel packed full.
Mom settles into her own routine, preparing our meals and working her way through a long list of household chores she’s created—defrosting the freezer, polishing silver, reorganizing the contents of my kitchen cabinets, repotting a crooked plant. I detest organizing, yet appreciate organization, and therefore her intent. But her frequent questions about where to find some cleaning supplies, or whether she can throw out this or that old item, rattle me. And it upsets me that tasks I am anxious about but incapable of doing—like finding a drugstore somewhere in Brooklyn that carries a special bandage I need to reduce scarring—keep falling to the bottom of her daily list. Knowing my accident has deeply disturbed her, too, I suspect she is seeking comfort in familiar activities. But there’s no comfort in them for me.
As an avid lifelong musician, I will listen to anything at least once and have favorite artists across multiple genres. And I always have music playing in my home. But in these early weeks of recovery, it’s as if the fears, problems, and fragile hopes dominating my thoughts are loudly audible, and I can only tolerate the sparest music on top of them. Gregorian chant and Bach’s unaccompanied cello suites make up the soundtrack to our days, along with the modal choral works of Arvo Pärt, which make me think of a gray winter sky viewed through an icy, crystalline window: simple, beautiful, chilling, and a little sad. Music any more lush would overwhelm me and mock my mood. These selections reflect it in an oddly reassuring way, while somehow neutralizing its most painful aspects, helping keep anguish at bay.
I once read that for people who, like me, are passionate about music, listening to works we find compelling prompts the release of calming endorphins in the brain. That might explain why I, and innumerable other angst-ridden kids in the ’80s, had kept the bleak music of Joy Division cranking throughout our bumpy transition into adulthood. But my own explanation for music’s ability to console me is that the right piece at the right time vibrates in sync with my feelings, reminding me that whatever their nature, I am not alone in knowing them. They connect me to humanity and are therefore not to be regretted, though I sometimes wish them away.
My next appointment with Dr. Vargas comes just a few days after Mom and I return to Brooklyn, and during the trip into Manhattan I realize how much I’ve been looking forward to it. From deep within the turmoil of trauma and recovery, Bellevue has emerged an unlikely oasis, full of people who understand my ordeal and are gently coaxing me through it.
Dr. Vargas and I sit around the corner of a desk in an examination room, my bloated, discolored forearm upturned between us. Our heads bend toward each other, nearly touching. I refrain from asking questions, not wanting to distract him from the removal of my stitches. His suturing following surgery was meticulous; in a few years, the lines on my forehead will be more prominent than the scar on my wrist. Now his work is just as careful: He gently lifts each suture up with a pair of forceps in one hand, then snips it with scissors in the other. Eventually he breaks our silence.
“I showed your card around to everyone in the emergency room. They were really glad to hear you’re doing well.” I am touched that he has fulfilled my request and made a point of telling me so.
A bevy of junior residents shuffles into the room for a tutorial on spaghetti wrist, and as the residents pepper him with questions about it, I jump in with mine. He seems pleasantly surprised by my curiosity, and to enjoy satisfying it with the increasingly technical explanations I require. We are having fun. I ask how much of his training he’s completed, learning he is in the final year of his second surgical residency, shortly to begin a prestigious fellowship. I suggest that, given how much he apparently enjoys professional studies, he consider subsequently pursuing an MBA. He throws his head back and laughs, mouth open so wide I can see his molars. “Yeah, then maybe I’ll go to art school after that!”
Stepping out of Bellevue onto First Avenue afterward, I’m on a high. It’s a gleaming, blue-skied day, I’m acquiring fascinating information about my injury, and Dr. Vargas’s formidable facade is cracking. That matters to me, because I need to know that this stranger in charge of my case, in whom I’ve had to place so much trust, actually cares about me as an individual. And I can’t know that if he doesn’t return just a little of my warmth, reveal just a little of the person behind the title. Plus, I’m a nerd and want him to keep sharing his knowledge.
Early the following week, Mom accompanies me to my first full OT appointment. Given my perpetual exhaustion and mortal fear of tendon rupture, a round trip from Brooklyn to Bellevue on the subway—normally my much-preferred mode of transport—is unthinkable, requiring over a mile of walking, plus hiking up and down four long flights of stairs. So we’ve been hiring a neighborhood car service to make the trip. At 8:15 a.m., a battered butterscotch Lincoln pulls up in front of my building, and Mom hurries ahead into the frigid wind to open the curbside back door.
Hypnotic Middle Eastern pop wafts out of the car as I ease myself into the back seat, anxiously protecting my elevated arm despite its firm enclosure in the foam Guggenheim. Mom hovers just behind me with bent knees and open arms, a wool-wrapped coil waiting to spring should I misstep. Judging me settled, she reaches across my lap to fasten my seat belt. Though capable of performing the task myself (albeit slowly and clumsily), I let her do it, knowing I will have plenty of occasion to test my one-handed ingenuity over the weeks, and perhaps needing more justification for her company on this trip than the fact that I’m not quite ready to face all these Bellevue expeditions alone. I don’t belong in my old world anymore but am still slightly wary of what I’ll find in my new one.
“All set?” Mom asks, worried dark eyes contradicting her warm smile.
“I’m good, thanks,” I respond as she rounds the back of the sedan to slide into her seat.
The car rolls forward and in minutes we are on the Brooklyn Bridge, where visions of my dead-of-night ambulance crossing two weeks prior compete with a sparkling view of Manhattan against a turquoise sky, flickering and expanding behind the steel suspension ropes whipping by.
At Bellevue, we move slowly from car to revolving doors, then down a ramp into the lobby—a modern, soaring glass atrium constructed around the 1930s brick edifice of the building. Bathed in natural light, the space teems with slow-moving patients and fast-walking, white-coated doctors, and absorbs all but the muted, indistinct remains of their conversations. From atop the ramp, this picture of industrious calm encourages me, though I know it belies the suffering and sorrow of people throughout the building. Level 1 trauma centers like Bellevue are the scene of a lot of sad stories.
Our driver’s licenses, my red plastic patient identification, or “clinic card,” and a doctor-signed appointment slip gain Mom and me passage through two police-manned checkpoints and a patient registration line, where I pay over $200 for my appointment thanks to a high-deductible insurance plan and a disagreement between Bellevue and my health insurance company as to whether outpatient therapy is an in- or out-of-network service. Finally, we arrive in the Upper Extremity Occupational Therapy Room.
Before my accident I, like many New Yorkers, associated Bellevue with its mean beginnings over two centuries ago as a public psychiatric hospital, and imagined it as a grim, squalor-filled building crammed with the forgotten mentally ill. But the facilities I’ve seen so far have been impeccably clean and seemingly well-equipped, if utterly lacking in the contemporary decor and comforts of the city’s private hospitals.
The OT room’s bright, almost cheerful aspect is another pleasant surprise. In the center of the room stand four white, kidney-shaped Formica-topped tables, each accommodating four patients and one therapist, and strewn with objects providing the day’s rehabilitative challenges: lumps of putty in gradations of blue and gray, fuzzy piles of red and yellow yarn pom-poms, jars of green-swirled glass marbles, and small wooden pegboards with tiny metal pegs.
On the north and east walls of the room, two long banks of windows frame great, penetrating shafts of sunlight and a panoramic view up the East River. Two 1950s-era metal desks against the north wall support a couple of old computers and stacks of medical reference books, while waist-high shelves, packed tight with bins of colorful therapeutic tools and toys, line the east wall. On the river, stubby red and black tugboats chug back and forth performing the routine miracle of rotating an errant container ship on its axis, pointing it south toward New York Harbor’s deeper waters.
On the south wall, immediately to the right of the door, a sternly efficient receptionist sporting a flaming-red beehive and pink plastic glasses sits at another vintage desk, checking patients’ identification—yet again (do people really try to crash this party?). Behind her, scores of aging hospital policy memos paper a wall of moss-green cabinets.
On the west wall, just left of the door, a curtained bay encloses a single bed and chair where, I later learn, prisoners undergo therapy, guarded by policemen and out of other patients’ view. Next to the bay a red and blue Velcro dartboard and two large, color-coded posters illustrating the human nervous and musculature systems hang over an industrial steel sink, where patients wash city grime off their hands before handling shared tools, and relearn household chores like dish washing and food preparation.
In the far-left corner of the room, a waist-high counter supports a yard-long, covered metal vat of boiling water used to soften the hard plastic sheets from which custom splints are constructed. The splinting station, a shelved cart on wheels parked next to the counter, houses gauze bandages, adhesive Velcro strips, wire, measuring tools, and cutting implements.
Glancing first at the communal tables and brightly colored toys, one might mistake the room for a kindergarten, if not for its denizens. These include a man whose arm ends at the elbow kneading a wad of gray putty with his stump; another man, with an angry welt winding the length of his forearm, laboring to pinch fluorescent clothespins from one pole and attach them to another; and a woman with gnarled fingers grimacing as she transfers a gallon of water from one bucket to another by absorbing and disgorging it with a sponge.
The injuries across the room are a breathtaking collection of misfortune—many the kind of shocking afflictions people instinctively avert their eyes to avoid, before the mind can ask, What if that were me? I might have shied away from them as well, but having stared into the bloody mess of my own arm, I realize I can now not only look at terrible injuries without flinching, but I can also see the people behind them, and long to know their stories.
Deeply creased faces, calloused hands, and somber discount-store clothing—the anti-status symbols of the working poor—abound in the OT room because Bellevue treats people regardless of their ability to pay. Despite my corporate job, health insurance, and overpriced jeans, however, I already feel more at home in this room than I have anywhere else since the accident. I have a severe injury and all its accompanying pain, confusion, and anxiety about the future in common with my fellow patients, and this shared experience counts for much more than any differences between us.
Beth, the therapist who crafted my splint at last week’s surgical checkup, greets Mom and me from across the room like a confident hostess welcoming new friends into her home for the first time. I’m suddenly embarrassed to have needed Mom here with me, but if Beth thinks it’s strange I’ve brought her, she doesn’t let on, graciously showing us both seats at a table near the door. She sits to my right at the end of the table, rests her elbows on it, then props her chin on her folded hands and smiles brightly, as if she’s about to hear the titillating account of a girlfriend’s recent date.
“Well, Miss Fogg, it’s been a couple weeks, right? How are you doing?” she asks. I’ve noticed that all the therapists address us patients as Mr., Mrs., or Miss—a formality that feels antiquated, but in signaling respect perhaps helps build trust with a vulnerable population.
“Good, considering,” I reply with a laugh. The absurdity of this whole situation never escapes me.
“Yeah, that was a crazy accident, right?” she responds, green eyes squinting sympathetically. Clearly the exploding toilet is noted in my file. “Well, let’s see what we’ve got,” Beth continues, unfolding a sterile cloth on the table in front of me and gesturing to me to remove my splint.
Laying my right hand palm up on the table, I use my left to release the Velcro straps that secure the close-fitting shell to my fingertips, palm, thumb, wrist, and forearm. Next, I gingerly pull on the tip of my right middle finger to free the hand from the splint, then lay it on the sterile cloth. I’m not yet used to the disturbing sensory incongruity of watching my left hand touch the denervated areas of my right hand while feeling nothing whatsoever in those areas. If I closed my eyes, I’d think I was touching another person. Yet I can still . . . almost? . . . recall the sensations of ruffling soft hair and smoothing silky fabric with my right hand, and wonder how quickly these sweet, tactile memories will fade. Dr. Vargas has prepared me for the fact that whatever sensibility I regain upon regeneration of the severed nerve will be highly impaired.
Finally, I tug off the fingerless jersey glove that protects my hand from chafing against the plastic, and again gently lay the hand down onto the sterile cloth. Even untethered, it retains the shape of the splint—a lobster claw, slightly agape—after two weeks of disuse and round-the-clock confinement. It doesn’t feel, it doesn’t move on its own, it still doesn’t even look like a real hand. It may as well be a prosthesis.
“You don’t have to be so careful,” Beth chides. “It’s your hand, and you’re not going to hurt it just doing that.” I’m not so sure about either of those statements. “Ah, you got your stitches out,” she continues, leaning in to examine the wound. “The scar looks great! You won’t believe how much it’s going to fade. Dr. Vargas does an awesome job.” Mom and I smile at each other. It’s reassuring to hear a knowledgeable third party’s endorsement of Dr. Vargas’s work—though I’ve already started referring to him and his assisting residents as my “dream team” among family and friends.
Next, Beth uses a measuring tape, and instruments resembling a protractor and a single-fiber paintbrush, to measure the length of the scar, then the sensation, circumference, and range of motion of the wrist and fingers of both my hands. Ah, numbers! Finally, a way to understand my progress in this race toward recovery. Eager to know today’s score, I crane to see the figures Beth records in her notebook, but realize I don’t know whether they’re good or bad.
“We can use your left hand as a benchmark for size and strength, and range of motion, because your right hand’ll definitely get back to normal size and, we hope, close to full strength and range of motion,” Beth explains. “But for sensibility, independent finger motion, and dexterity, the injured state has to be our baseline.” She doesn’t need to say that this is because recovery on these dimensions is highly variable, will surely be incomplete, and has a lot to do with luck. I get it: Never say never, never say always. No one knows where my finish line lies.
Finally, Beth asks how I typically use my hand at work and play, so that once the repaired tendons have healed, she can design an exercise regimen to help me develop the function needed for my routine activities.
“And I want to be able to play violin,” I add, after covering essential activities like typing, cooking, and household chores.
“Did you play violin before?” she asks.
“Yes!” I reply. Dr. Vargas had asked the same thing. Do all medical professionals doubt the existence of musicians?
“Really? Oh, OK. Y’know, I had to ask because a lot of patients joke about that,” Beth explains. “Like, they’ve lost a couple fingers and tell me they want to play piano, but they never did before.” My first taste of amputee humor. Sick, and kind of funny.
After booking my next several appointments with Beth, Mom and I head out, my thoughts consumed by the therapeutic challenge ahead.
Back in OT by myself two days later, Beth seats me at a table with a couple of other patients, then leaves to fetch some supplies. Opposite me a young man sits in front of two stacks of large orange and yellow plastic cups—one short stack, one tall. He inhales, grasps a cup on the tall stack with a trembling left hand, pulls it free, conveys it to the short stack, places it on top, exhales, then repeats the steps until all the cups stand in one stack. Red-faced and sweating, he pauses before performing the same exercise in reverse.
Lumpy, zigzagging scars cover the palm of his bloated hand, whose flesh is a deep, mottled pink. And long metal pins protrude from his fingertips, each pin topped by a small white plastic ball. The pins glint and undulate as he works, reminding me of sea urchin spines in a sunny ocean surge. As I watch him, I wonder what simple tasks I might, or might not, ultimately be able to perform.
“God, I hope I can do that someday,” I sigh to myself.
The man looks up at me. “Oh, you will,” he says.
Beth returns with a sterile cloth for the table, a bottle of hand lotion, and a manila file bearing my name. She pulls several typed pages out of the file that turn out to be Dr. Vargas’s dictated report of my diagnosis and surgery. She reads aloud to reacquaint herself with the details of my case: “Complete transection of flexor digitorum superficialis, digits 2, 3, 4, and 5; flexor digitorum profundus, 2, 3 . . .” The words wash over me like those of foreign tourists on the subway, except I am dying to know what they mean.
No longer content merely to understand my injury in the simple terms Dr. Vargas has used to explain it to me, I’m determined to comprehend the minute details of the wounded anatomy, how the surgeons have repaired it, why they’ve done it that way. That operative report, the lucky find I didn’t know existed, will be my Rosetta stone. I’m eager to dig into it, once I’ve obtained a copy from Bellevue’s Department of Medical Records, since Beth can’t release it to me.
She does, however, provide a tantalizing overview of its contents, referring to an anatomy book to show me exactly how many and which tendons, nerves, and arteries have been severed, and describing the functions they’d once performed. A visual learner through and through, I often see concepts as images in my mind, and draw charts and pictures to sort out my thoughts. Beth’s illustrated tour begins to drive home the meaning of the medical terms I’ve heard so far, and the appalling extent of my injury. Studying manufacturing in business school, I learned that the more moving parts in a machine, the more likely it is to break, the more difficult to repair; so Beth’s tour also explains why she and Dr. Vargas can’t assure me of a good recovery. The surgeons having done their best, only my compliance with Beth’s prescribed therapy can improve chances of that.
Recognizing this, and fortunate to have paid leave from work to focus on recovery, I’ve been very diligent with my exercises. “I can tell when people aren’t keeping up with their routine because they’re all stiff. You’re doing great.” I beam like a third grader entrusted with hall-monitor duty, clearly more enamored of the role of teacher’s pet than I should be at my age, but willing to accept any reward for the hard work I have no choice but to do.
With ten minutes of the appointment remaining, Beth pushes her notes aside, dons purple surgical gloves, and squeezes some lotion onto my forearm, gently massaging it into the skin around the wound, then blending it downward from the wound to my elbow. “This will help reduce swelling by pushing fluids toward your lymph nodes,” she explains, “and keep too much scar tissue from forming on the tendons, so they’ll glide better.” She adds this light massage to my daily regimen and wishes me a good weekend.