The morning after flying home from Nashville, I awake in my empty apartment feeling like an imposter spying on my former life. Before the accident, despite a hyperactive social life, I have almost always been alone when at home, contentedly whiling away the hours reading and listening to music in my living room, talking to friends on the phone while cooking dinner in my tiny but efficient kitchen, watching a bit of TV in bed before sleeping. So there’s nothing obviously amiss with my solitude here. But having been in the company of family around the clock since the accident, I now find the silence weighty and foreboding.
Alert to the dangers of dwelling too much on it, I steer my thoughts to the more pleasant prospect of my appointment with Dr. Vargas and team that morning. I am keen for their view on my progress, which I suspect will be positive, and don’t want to be late. I hurry out of bed, knowing it will take twice as long to get out the door without someone to count pills, make breakfast, and call the car service while I bathe and dress.
I arrive at the hospital lobby by 7:30 a.m. to secure a place at the head of the long line for the elevator to the Adult Musculoskeletal Clinics, the various corridors of examination rooms clustered by specialty (hand, ortho, arthritis), where surgeons follow up with their patients on an outpatient basis following surgery. While all patients technically have a specific appointment time (mine is 8:30 a.m.), they are nonetheless called in roughly first-come, first-served order. Also, appointments get pushed back by as much as two hours over the course of the day as surgeons squeeze in emergency cases, so savvy patients wrangle early time slots and arrive well ahead of them.
At 8:00 a.m., a stern security guard who’s been blocking the elevator steps aside and motions the queuing patients forward. We surge toward the elevator on crutches, and in wheelchairs, splints, and slings, with the stony determination of Manhattan commuters pushing onto the 4 train at rush hour. Holding my hand a little higher than usual, I chuckle at the crazy scene, confident that people will take care not to jostle me as long as they can see my swaddled limb. My faith on this point proves misplaced, but I am at least glad to see the nonambulatory among the crowd given some consideration.
The elevator doors open onto the second floor and we pour out the door, limping, wheeling, and shuffling to line up again at the registration counters for our respective clinics. Thanks to my early arrival, I win second place in line at the hand clinic. I dig my red clinic card and appointment confirmation sheet out of my urban survival pack—the boho embroidery bag I wear crossways over my chest.
In addition to wallet and cell phone, it holds a novel to entertain me during long waits at the hospital, pen and notepad to record medical questions and exercises performed, cocoa-butter lotion for massaging my scar, a couple of doses of all my meds, a small bottle of water and energy bar with which to take them, a tube of lip gloss, and usually some insurance documentation to mail or verify with the Bellevue finance office.
The bag is hideous, but big enough for me to easily sling on and off over my splint, and not the worst of my many concessions to function over fashion in the wake of the accident. Others include a pair of perilously-close-to-orthopedic Velcro-closure shoes, a coat whose right sleeve Mom slit open to accommodate my splint, and three dark, long-sleeved jersey shirts with hugely stretched-out right arms, which altogether constitute my entire wardrobe for the moment. Erica says I look great in my skinny jeans, though, so at least the Bellevue diet of trauma and drugs is working for me.
“Rebecca Fogg,” I say, placing my plastic clinic identification card and appointment slip on the counter in front of the clerk. I smile brightly, partly because I am, ironically, always happy to be at clinic, and partly to ward off the bad administrative juju that sometimes afflicts people dependent on big bureaucracies. Like when the computer system doesn’t reflect your last several hundred dollars of payments, causing the clerk to insist you must pay out of pocket for an appointment because you haven’t met your insurance deductible, though in fact you have.
“I know, Miss Fogg!” the clerk exclaims. “You’re the one who came in with all your family that one time, right?” I nod. “That’s so nice. Not a lot of people have family like that. How y’doing?” She smiles back at me as she embosses my appointment slip with my card and places the former in a file for Dr. Vargas.
“Much better, thanks.”
“Well, you take care now.”
“Thanks, you too.”
A lot of people wouldn’t believe me if I told them these kinds of interactions happen all the time—strangers seeing me in pain, wanting me to feel better and telling me so. But they do, and they make me kvell over my fellow New Yorkers, especially when they happen at Bellevue. In her role as bouncer here at Club Miserable, this clerk sees the gamut of human circumstances every day, mostly ranging from unlucky to abominable. She also probably endures some seriously testy treatment from scared, exhausted, and frustrated patients; and if not for my opioid-induced calm, I might be one of the guilty. So when she smiles brightly, remembers my family, and wishes me well, I couldn’t feel more blessed if the Dalai Lama himself were to meditate for my well-being.
I make a beeline for my favorite seat in the waiting room, near the doorway where the clerks none too loudly summon patients by name, so that I don’t miss my cue. Patients who don’t respond promptly essentially end up on standby for an appointment, and can expect a good long wait before the overbooked doctors manage to squeeze them in. I remove my splint in preparation for a round of hand exercises, having learned that the only way to get through all the prescribed daily repetitions, plus massage and splint washing, is to make them the priority activity for any waking moment in which my left hand isn’t needed for eating or grooming. All other business or pleasure has to come second, otherwise I end up sitting in bed late at night, worn out and fighting sleep and anxiety to finish the last few rounds.
As patients begin to arrive in a steady stream, we regulars in the Upper Extremity Occupational Therapy Room recognize and greet each other. A middle-aged woman spotting me from across the room smiles, then raises her brows and points to my hand. Each week she brings her elderly father to therapy, along with her young son. The son plays contentedly with his toy dinosaurs for the duration of each appointment, utterly unfazed by the physical deformities surrounding him. I don’t speak Chinese and the woman doesn’t speak English, but I easily understand her “How’s the bum hand?” gesture, and reciprocate with a “Doing well, thanks” smile and “What about your dad?” nod. Good, he’s doing better.
Then I quickly exchange statuses with Kelly, a Good Samaritan whose reward for trying to separate a couple of scuffling dogs had been a big bite into her little finger, as she edges past me to take a seat in the back of the waiting room. She and I clicked immediately when we met, and when we are occasionally assigned to neighboring examination rooms at clinic we hang out in the hallway, happily kibitzing until some nurse shoos us back into our respective rooms to await our physicians.
Next, I welcome a guy named Mike as he sidles into the seat next to me. Having long since revealed the causes of our sorry accidents to each other (his hand was macerated by a slamming steel door), we launch into an entertaining round of Who’s Your Favorite Doc? I feel mildly treacherous for having gossiped about my dream team, then cut myself some slack. It wasn’t admirable behavior, but it wasn’t malicious, either—and it felt nice to have a carefree laugh with a fellow patient.
At 9:30 a.m., a dreadlocked, Rasta-capped clerk in a wheelchair escorts me back to one of the hand clinic’s eight small, white examination rooms. Perched on the exam table, I am no more than a few pages into my novel when a resident walks in. I’m disappointed, first because he isn’t Dr. Vargas, though that isn’t especially surprising, since the chief resident is rarely the first one through the door; second, because he isn’t Dr. Matthews. In fact, I don’t recognize this guy at all. Given Bellevue’s function as a teaching hospital, residents not involved in my case often examine me as a learning opportunity. But if that’s his deal, it’s unusual for him to be here without one of my team.
The resident nods hello as he passes me to take a seat at the desktop computer. “How’ve you been doing?” he asks, as if he knows me.
“Very well, thanks,” I respond distractedly. Have I gotten the appointment time wrong? Have I missed my team’s last day?
He pulls up my record on-screen and scrolls through it. “How’s the pain?” This is the first of a number of routine questions designed to flag potential concerns. I respond that the pain has been lessening, though I still require hydrocodone around the clock, which he deems normal.
“Would you like me to tell you everything that was severed and repaired, Dr. . . . ?” I ask, believing I need to orient him to my injury and repair. Otherwise he’ll need to scroll all the way back to the first entry in my record to acquire this essential information.
“Ed. Ed Espinoza. Thanks, but I’m all up to speed. I actually participated in your surgery,” he responds.
“Oh, I’m so sorry! Thank you for everything . . . I . . . didn’t remember you.”
“That’s OK.” He smiles. “You had a big team. We never actually met.” I want to know who else I’ve neglected to appreciate, but I have too many burning questions to cover in this brief appointment to waste a proverbial bullet on that one.
Dr. Espinoza asks a few more routine questions, pecking at the computer keyboard as I answer. He knows what he’s doing, but we have no history with each other. So I hold my questions for . . . whichever familiar guy shows up. Then he rises from the computer and steps in front of me. Wait—he’s going to do the physical exam, too? Where’s my dream team? I hold out my hand and he begins to tear apart the Velcro strips that hold the splint to my hand, very slowly as if trying not to make any noise, though I guess he’s just taking care not to hurt me.
“Here,” I say, waving his hand away and ripping the strips apart in quick succession—one, two, three, four, five—freeing my hand of the splint with the confidence of a veteran parent extricating a toddler from a poopy diaper. I’ve come a long way on this skill myself.
“Show-off!” he quips good-naturedly, if a bit sheepishly. I have embarrassed him and feel a frisson of shame.
“Hey, kiddo! How’s the hand?” Dr. Matthews bounds through the doorway, smiling and shaking my left hand with his. He reminds me of the heavyweight rowers on my college crew team: big and affable, made winning look easy.
“Hey! Hand is good,” I reply, instantly matching his energy and cheer. Dr. Espinoza steps aside without a word, allowing the more senior Dr. Matthews to take over the physical exam. “OK, I’ve got to ask . . . did you ever row crew?”
“Yes, I did,” Dr. Matthews says, nodding and chuckling, I suppose at the unlikeliness of this fact surfacing in a medical context. “You?”
As we fall into easy rowing banter, I feel another twinge of guilt about Dr. Espinoza. Is it obvious he isn’t in my Favorite Docs Club? But it passes quickly. If he’s noticed my greater ease with Dr. Matthews, he won’t be offended. He’s a professional and will be glad I’m feeling comfortable.
Dr. Matthews holds my wrist lightly in his left palm and places the tips of his right index and middle fingers just above the scar, where the live segment of the transected nerve still functions, and begins tapping lightly toward my hand. I can feel his touch on the surface of my skin above the scar, but not below it, where the dead segment of the nerve has disintegrated. However, inside my wrist, beneath that numb patch of skin, his taps set off what feel like tiny explosions.
“You feel anything there?” he asks.
“Yeah . . . I mean, sort of.” I envision golden fireworks, flaring and dying in succession against the red-brown muck of my muscles, and search for words to describe the sensation. “Not on the skin, that’s totally numb. But . . . inside my wrist . . . sparks, tingling, wherever you tap.”
“That’s good. That means the live end of the transected nerve is regrowing,” he responds. “It’s called the Tinel sign.”
How auspicious. And what a simple means of measuring the progress of the all-important nerve, one I can use myself. I scrawl Tinel in my notebook and look forward to Googling the term when I get home.
“Where does it stop?” he asks, continuing to tap into my hand along the path of the severed nerve.
“Here,” I point, about an inch below my wrist crease. “How long will it take for the nerve to grow all the way back?”
“Everyone’s different; there’s no set pace. But on average you can assume it takes a couple weeks after repair to start growing, then it can grow about a millimeter a day. In that case, you’re right on track: your repair was about a month ago, and the nerve has covered fifteen millimeters.”
Suddenly there’s another pair of hands in the mix. Dr. Vargas has slipped into the room, just when I’ve given up on seeing him. Gratitude, a long-suppressed yearning for good news, and the desire for his esteem well up in me, and I greet him with the warmth of an old friend, which in my mind, he is. Does that make me a cliché, the idolizing patient? Probably. Doesn’t matter. Inspiration, in any form, will speed my recovery. I figure the end justifies the means.
“All right. Let’s have a look,” he says as Dr. Matthews cedes his place in front of me. Dr. Vargas reaches his hands nearer, palms open upward. In opera the gesture would represent a tormented soprano’s plea for mercy from a bitter lover or punishing god. Here in clinic, it is how every medical professional I encounter beckons for my right hand, answering my unspoken call for help.
You can’t ignore hands that are touching you, so at this point I know Dr. Vargas’s almost as well as he knows mine: larger even than my wide-reaching instrumentalist’s hands; lightly freckled; the archetypal surgeon’s slender fingers, finished off with close-cropped, oval fingernails. Unhesitating and deft, they speak of his insight and determination when he is silent.
Dr. Vargas examines the knitting wound, repeats the Tinel test, and notes the color throughout my hand, then delivers the happy verdict: good progress, with blood flow adequate despite closure of the severed artery, and the hopeful signs of nerve regeneration prickling and tingling in all the right places. Next, he grips my fingers—still frozen at a ninety-degree angle to my palm—and slowly pulls them back toward him about a half an inch, to stretch out the repaired tendons, which scar tissue and disuse have rendered inelastic. It feels like he’s pulling my hand off, yanking the muscles and tendons out of my arm like meat from a lobster claw. The pain is almost as bad as the intense burning I felt in the hospital after the accident. I paste a neutral expression on my face to mask my reaction because, like any self-respecting former college athlete, I know that the only thing worse than feeling pain is admitting to feeling it.
“Does that hurt?” he asks.
“A little,” I answer.
Dr. Vargas pulls my fingers back a quarter inch more. I envision my tendons snapping, curling up, and retracting like broken guitar strings. The fear of rupture intensifies my pain, but I trust Dr. Vargas, so rightly or wrongly, I don’t protest. I do, however, appreciate the distraction of Dr. Matthews’s conversation.
“You know this is our last day in Plastics Clinic, right?”
“Yeah, I know. I’m really going to miss you guys,” I reply. “Where do you all go from here?”
As Drs. Matthews and Espinoza excitedly tell me about their next posts, Dr. Vargas continues to inflict pain in opening my hand. Without looking up, he says, “I’ll be filling in for my successor here in a couple months. You could make an appointment to see me then.”
“Thank you so much . . . I will definitely do that,” I say. “Consistency really means a lot to me these days.”
He looks up at me with a nearly imperceptible smile. “It’s as much for me as it is for you. I want to know how you’re doing.”