An Irreversible Loss — Adrienne Pine
On the second day of the new year, I was driving the back road from Millerton to our country home in Boston Corners. The sky was cloudy and overcast, and a dull whitish light hung over the landscape. Frost tinged the dead straw-colored grasses in the fields at the sides of the road.
I had gone to Millerton to have a document notarized for Neil. I was his power of attorney, and he was lying in bed in his condo unable to get up and make the trip himself. On New Year’s Eve, he was released into home hospice with stage IV stomach cancer. The oncologist who reviewed his case reckoned his life expectancy in weeks.
For about six months, Neil had been struggling with health challenges, and his condition had grown steadily worse. He had suffered, and everyone who cared about him felt helpless to alleviate his suffering. In the beginning of October, he had surgery to remove scar tissue and adhesions from a previous surgery. It was a risky operation; the doctors hadn’t wanted to do it, but in the end they had no choice. Thirteen feet of his colon had been excised. He hadn’t recovered. He suffered from fevers and recurrent urinary tract infections. He had trouble eating and keeping down his food. He was in and out of the small local hospital, where he’d be hooked up to an IV, given artificial nutrition and hydration. After a few days, he’d gain strength, and be discharged. Once home, the cycle would start again.
Not until December, when he checked into a larger regional hospital with a cancer center did we learn what was really wrong. For nearly twenty-five years Neil had been cancer-free; no longer. Whether or not this cancer was related to his earlier cancer, the doctors could not say, since they did not have his records. However, the oncologist said that he suspected that the cancers were not related.
Having shopped for groceries and picked up Neil’s medications, I was waiting at his home on New Year’s Eve when he arrived from the hospital. The day before a peg tube had been inserted in his abdomen to drain away the bile that was obstructed by tumor. He had a foley catheter to drain his bladder, which was riddled with infection. And he also had a colostomy bag, which he had lived with for nearly a quarter century, after he had survived his first bout with cancer. After he arrived home, he collapsed in bed. He didn’t get up all night. At the time, we wondered if he would get up at all. But he did. And in those first days of January, I had remained upstate, doing what I could, which that day meant using my power of attorney to have a document notarized so Neil could receive the last installment of an inheritance left to him by a friend.
I liked driving the back road from Millerton with its twisting curves and inclines. I passed fields and farms, a pond, a meadow. There were horses and cows in the fields, and often I saw wild animals, mostly deer, wild turkeys, opossums, and sometimes foxes and skunks. One had to be careful, but that was more of a problem at dusk, or at night, or in the early morning.
Now it was mid-afternoon. Ordinarily I would have found the view dreary at this time of year, but that day it seemed to me to have a subtle beauty composed of pale and earth-colored tints. Frost glittered on the fields like a coating of sugar. I passed the immense dark red barn that was now the Re Gallery. Once it had housed hundreds of cows. Now it was a dramatic setting for large artworks, thanks to its enterprising artist owner.
At first, I did not notice the large hawk camouflaged by the tall grasses at the side of the road. Just as I rounded the bend, I saw the big, beautiful bird lift up suddenly, and I heard a thump as it struck the wheel well of the front passenger side of the car. With a sick feeling, I stopped the car and got out. The hawk lay on its back in the road, perfectly still. I looked at it. The belly band of dark streaks on the whitish under parts and the dark bar on the leading edge of the under wing identified it as a red-tailed hawk. Its tail feathers were not yet red, and I guessed it was immature.
For a while I stood gazing sadly at the hawk I had killed. No other car passed by. I did not linger long, and as I drove away, I couldn’t dismiss my sense of unease. The hawk’s death seemed a bad omen. I felt a helpless passivity, as if I were waiting for the approach of a catastrophe.
Just eleven days later, at ten o’clock at night on Friday, January the 13th, I amputated the tip of my left index finger in the door of the very same car that had killed the hawk.
We were traveling from the city to our country house, as we did almost every weekend. My husband was driving. I was half dozing in the car. About halfway through our journey, Keith stopped at a gas station to buy a cold drink. I wasn’t going to get out, then reconsidered. Did I want anything? I thought perhaps I’d take a look.
Without paying attention, I shut the car door. I felt something—I couldn’t say exactly what—and looked back. My fingertip with the whole nail on it was sticking in the car door, severed from the rest of me. In the garish light illuminating the gas station parking lot, it looked surreal. There was a crescent of dirt under the fingernail that looked sad to me now that it was no longer connected to me. All my life that fingertip had done what I wanted it to, and now it never would again.
My husband said I let out a little yelp. I have no recollection of it. He was ahead of me and stopped in his tracks.
“I snapped my fingertip off in the car door.”
He was beside me in a flash. He opened the car door and got my fingertip out of it. I hadn’t looked at my severed finger, and I didn’t look at it now, but I pressed the tip back on the finger, as if it could magically reattach. We hurried inside the convenience shop of the gas station. To the woman standing behind the cash register, my husband exclaimed that he needed paper towels, I told her what happened. In that moment when I felt hypersensitive yet numb and shocked, I was puzzled by her lack of reaction. I wondered if she thought I was an idiot, and I thought that I could understand why she might think that. She offered my husband a cloth, and he asked her again for paper towels. She gave us a couple of them, and I created a makeshift bandage. Now I wouldn’t have to look at it. We asked her where the nearest hospital was, and she said, “Carmel.”
Back in the car, I said, “You’re going to have to navigate us because I can’t do anything. With GPS he located the hospital, a small facility with only one doctor on duty in the emergency room and about twelve beds, only a couple of which were filled.
It was a cold night. They wanted me to put on a paper-thin hospital gown, but I kept on my jeans and long underwear. I unwrapped the paper towel from my finger, keeping my eyes averted as I laid the severed tip on a piece of gauze on the table next to the bed. While the nurse went to get a plastic container with ice to keep the fingertip in, I snapped a picture of the fingertip with my iPhone. Only Keith was in the room with me. I felt some misgivings, but I did it anyway.
It scarcely seemed possible that it had been a part of me and was no longer, but there was no denying the evidence in front of me. I heard the doctor say that my fingertip could not be reattached. Nevertheless, the fingertip was placed on ice in a plastic cup with a screw top to preserve it. It sat on the little table next to my bed, and I did not let it out of my sight.
Almost immediately I was given a tetanus shot, and an intravenous line was inserted to administer antibiotics. As I averted my eyes and my husband held my other hand, my finger was X-rayed and bandaged. To say that Keith was a great comfort to me doesn’t come close. That night when I brought him only trouble and worry, I knew beyond a shadow of a doubt that he was one hundred percent there for me, if indeed I had ever doubted it.
Whether from shock or the influx of a massive dose of antibiotics, I felt an uncontrollable wave of nausea and threw up in a green vomit bag. At the same time my bowels loosened. I was so involved in my physical drama that at first, I could hardly pay attention to what Dr. Allison, the ER doctor, was saying, which was that I was going to be transferred to Westchester Hospital because they couldn’t treat me at Putnam.
As her words sunk in, I began to have doubts. I wondered why I should be treated in Westchester just because it was closer to Putnam, when I lived in New York City with its many renowned hospitals. But which one should I go to with the injury that I had? I had no idea. I asked my husband to call my primary care physician. At 12:30 AM, he would reach a service, but hopefully the doctor would call back. In the meantime, I remembered a hometown acquaintance living in Larchmont who had injured her hand in a fall that necessitated hand surgery some fifteen years ago. I recalled her telling me back then about calling her brother, a hand surgeon in Atlanta, Georgia, to ask him for advice. We weren’t close, but she sent me a holiday card every year, and I had her contact information on my phone. Surely, she’d know what I should do.
I called her and fortunately she picked up right away. I realized I must have waked her, for her voice sounded as if she had been asleep. I wasted no time. “Hello, this is Adrienne Pine. I know you’re surprised to hear from me. I’m calling because I snapped off my fingertip in a car door. We’re upstate in a hospital emergency room, and they’re going to transfer me. I want to go back to New York City, but I don’t know which hospital to go to. I remembered you had hand surgery. Where should I go?”
She was alert right away. She asked a couple of questions, and she said, “Go to the Hospital for Special Surgery.”
“Is that a good place?”
“Thank you,” I said, and I hung up.
“I don’t want to go to Westchester,” I told Dr. Allison. “I live in Manhattan, and it makes no sense. I want to go to the Hospital for Special Surgery.”
“I’ll try to arrange for the transfer,” she responded.
She went away to make the telephone calls. After a while, she reported, “The Hospital for Special Surgery has no ER. You have to go to Weill-Cornell. That’s the emergency room for the Hospital for Special Surgery.”
“Okay.” I wasn’t arguing. I was feeling pretty miserable. Codeine does not agree with me, and they had no other painkillers, so I wasn’t given anything for pain. I was thirsty after throwing up, but they wouldn’t let me drink or eat anything. I thought it was doubtful that I would be given general anesthesia, but it didn’t matter. At the same time, I had bouts of diarrhea, and I had to keep getting up and going to the bathroom, wheeling the IV stand with me.
While we were waiting for the approval, my primary care doctor’s partner called my husband back. She recommended two hand surgeons at Mt. Sinai Hospital and gave us their numbers. My husband left messages. When he mentioned this to Dr. Allison, she replied firmly, “You’re going to Weill-Cornell. I’m just about to get the transfer approved, and it’s taken me an hour and a half.”
“That’s great,” I replied. “Thank you very much.
After the transfer was approved, I was told that it would be another three-and-a-half hours before the ambulance arrived. In fact, the wait turned out to be more than four hours. My husband could have driven me back to the city in an hour and a quarter, but under the hospital’s rules, I had to remain under care. If my husband had driven me, it would have been considered a discharge.
It was a long night. Keith went off to the waiting room where there was a couch and he could lie down and nap. My night was wakeful, fitful, punctuated by bouts of diarrhea and nausea. The nurse gave me Zofran for the latter, administered through the IV. “It’s a miracle drug,” she claimed. “You won’t believe how much better you’ll feel.”
But it didn’t work for me. My mouth was so parched I was uncomfortable. I was given a plastic cup of water that I was forbidden to drink. All night I rinsed my mouth and spit the water back into the cup.
Sometime after 4:00 AM, the ambulance arrived from the Bronx. The EMTs were two African-Americans, a man and a woman. The woman was talkative, the man taciturn. She asked me what had happened to me. I told her. “Can I see it?” she asked with a lively interest that took me aback.
“Absolutely not. It’s bandaged.”
Her curiosity about my finger unnerved me. I didn’t want to look at it; why should she?
“I’m keeping my fingertip in this container,” I told her, “even though they told me they can’t reattach it.
The EMT expressed confidence that somehow they would find a way to reattach my fingertip. I didn’t believe her but appreciated her optimism.
By this time, I was wearing a paper diaper that was way too big for me and two hospital gowns, also way too big, tied front to back. The nurse detached the IV but kept in the port in case it would be needed later.
The interior of the ambulance resembled a station wagon with the seats out. They slid me in, and I lay on my back on a stretcher and placed the cup of water on a little ledge staring up at the bright lights. Although I wasn’t allowed to drink the water, rinsing my mouth helped me through the ordeal.
My husband would be driving back to the city in our car and dropping off our things at home before meeting me at the Weill-Cornell ER. I had my cell phone and a mobile battery charger, my health insurance card and basic IDs, a credit card, and some cash. The nurse suggested I turn over my watch to my husband, and I did. I wear a watch almost all the time, even when I sleep, and in the ambulance I missed it. I didn’t want to pull out my cell phone constantly to check the time. But even had I been wearing my watch, I think I would have lost my sense of passing time. Time had become the distance we had to travel to get to the hospital in the city.
I begged the EMTs to turn the lights off and the heat on. The inside of the ambulance was freezing. I had my down coat laid over me, but I was still cold.
“There’s only heat in the cab,” I was told.
They weren’t kidding, but they did turn up the heat in the cab so high that after a while the interior of the ambulance was quite warm.
Yoga breathing got me through that ride and through that night, deep breathing that begins with a slow measured inhalation followed by a slower, deeper exhalation. At the bottom of the breath, all the air is forcefully expelled, creating a vacuum in the lungs that air rushes to fill in an effortless inhale. The lungs continue expanding with breath forward and back and from side to side. This kind of breathing not only moves all the dead, stale air out of the lungs and rejuvenates the body with oxygen, but it also creates a deep feeling of relaxation that is very powerful. All through that long ambulance ride I concentrated on breathing. I tried not to think of what lay ahead of me or what was behind me. I wanted to see the stars out of the ambulance windows as I lay on my back, but my line of sight was not at the correct angle. Instead, I got the night glare of the lights over the interstate. After what seemed a long time, we got off the highway. We drove through the Bronx and crossed into Manhattan. Soon, I knew, we would soon be at the hospital at East 68 Street and York Avenue.
I called my husband on my cell phone. He had almost reached our apartment, where he would unload the car, and then head over to the hospital.
At five-thirty in the morning, the Weill-Cornell emergency room was packed. Every room was full, and the hallways were lined with sick people on gurneys. My husband arrived soon after me. I didn’t mind that there was no bed. “Nothing’s wrong with my legs,” I declared. I was tired of lying down.
On the plus side of the long wait for my transfer and ambulance was that that the Weil Cornell emergency room was expecting me. A team had been alerted, and my paperwork transferred with me. Still, I had to wait about an hour or so. I asked the physician’s assistant, who was organizing my paperwork, if there was anything besides codeine that she could give me for pain.
I hesitated and then said, “Okay.”
Noting my ambivalence, she said she would bring me “a baby dose.”
However, she disappeared and never came. Meanwhile I sat on a chair wearing my down coat over the two front-to-back too-large hospital gowns from Putnam Hospital. In the pocket of my coat was the sealed plastic cup holding my fingertip on ice. In my right hand I still held the cup of water I had brought with me. Every now and then, I swished out my mouth.
At last, my name was called. Two doctors had arrived, and I was ushered into a small room where one of them was waiting for me. I soon learned he was Dr. James Evans, a first-year resident from St. Paul, Minnesota. He asked about the X-rays of my finger. Apparently, the ones taken in Putnam Hospital had not traveled with me. Very gently he laid my hand on the table and X-rayed my finger again.
The other doctor arrived with a sealed metal box of sterilized surgical instruments. This was Dr. Rudy Jastrow from Nebraska, a third-year resident. He would perform the procedure, and Dr. Evans would assist.
Both doctors ignored the fingertip I had brought with me, confirming what Dr. Allison at the Putnam Hospital had said. “The vascular system of the fingertip is too small to reattach, but honestly, you’re better off this way,” Dr. Jastrow informed me. “Often with reattachments there is not a good outcome in terms of sensation.”
I looked away while Dr. Evans gently unwrapped my bandage, and they examined my wound. Though I wasn’t ready to look at it myself, I wanted to hear what they had to say about the injury I had inflicted on myself.
The tip was amputated just past the distal inter-phalangeal joint. The doctors told me that I had lost the nail bed and would never have a nail. My injury was a crush, and there were bits of bone sticking out and pieces of crushed bone inside the bone. They would give me a digital block, which was a local anesthetic, cleanse and debride my wound, and then stitch my finger back up. Because the tip had been cut at an angle, there was some skin to help form a finger pad.
At first Dr. Evans tried to simplify his explanation but I told him that there was no need to; I had learned anatomical terms from my study of the skeletal-muscular system the previous year in an anatomy class for yoga professionals. I told him my interest in anatomy had grown out of having sciatica. “I was never interested in learning about my body until it started falling apart. Now I’m fascinated. I think all schoolchildren should be required to study human anatomy,” I said.
The two residents agreed wholeheartedly. They were young and fresh-faced, with strong healthy bodies. They radiated strength, compassion, and competence. They asked for the narrative of my night, and I told them. They approved of Putnam Hospital’s administering the tetanus shot and intravenous antibiotics. “They did exactly the right thing.”
Dr. Rudy Jastrow gently probed the sides of my finger, noting that I had feeling, and I could flex the finger—all good signs. I took the doctor’s words to heart. “Don’t even worry about what your finger looks like,” he said. “The first thing you need to do is avoid an infection. The second is to restore functionality. After that you can address the appearance.” He said my finger would take one year “to resolve.” I mulled over the word, “resolve.” What did he mean? I wondered, but now was not the time for conversation, not when he was about to operate.
I didn’t watch him debride my finger and sew it back up. I have no memory of how long it took. My husband remained at my side. After the procedure was finished, my finger was bandaged—first in a smaller bandage and then a larger one. The residents said goodbye, and I thanked them, and they left. My husband and I remained in the room while I took off the two hospital gowns tied front to back that I had worn since I was at Putnam Hospital and changed into the clean clothes that my husband had brought me from home. Then my husband surprised me by encouraging me to do something that was characteristic of me, but not of him.
All through the procedure, my fingertip had been sitting on a shelf, still in the sealed, ice-filled plastic container. The residents had not so much as given it a glance. To the hospital, it was medical waste.
“Let’s take it with us,” Keith said. “In the spring, we’ll bury it in the garden.”
“Yes,” I replied. “I don’t want to leave it here.”
It came home with us and we put it in the freezer. Most people, I knew, would consider this a macabre act, but Keith understood me, and I was grateful to him.
It was about nine am when we finally got back to our apartment. Only twelve hours had elapsed since we got our car washed on First Avenue before heading upstate. It had been a long night, and we collapsed on the bed and fell asleep.
* * *
A calamity can occur in an instant. The trauma reveals itself in stages, perhaps only as much as we can bear at a time. For two weeks, I avoided looking at my finger. When I scrolled through the photo on my iPhone of the severed tip resting on the scrap of bloodied gauze, I felt physically ill. But even though I didn’t look for it again, neither did I delete it from my phone.
The first few days after returning home from the hospital, I felt emotionally numbed. At the same time my body felt abnormally sensitive. I could eat only the plainest foods. For several days I existed on scrambled eggs and white rice. Exotic smells made me ill.
I lay in bed and read. When I am low, I have often found it a great comfort to reread a favorite book that I haven’t read in long enough to have forgotten parts of it. Sometimes while rereading I will suddenly remember what lies ahead, like driving on a curving road when you suddenly have a glimpse of what’s around the bend. Reading is a great pleasure and consolation for me, and I consider this aspect of rereading, when suddenly you anticipate what’s next after you’d forgotten it, one of reading’s great pleasures. And so I looked for a book I already knew and loved, but didn’t entirely remember.
In the cabinet under my night table, I found Iris Origo’s The Last Attachment, her narrative of Lord Byron and Teresa Guiciolli, encompassing Byron’s years in Italy and leading to his tragic death in Greece. The last time I had put it down, months ago, I had been somewhere in the middle, because there was a bookmark. I picked up where I had left off and read it almost to the end, then skipped ahead to the very end and came back. And when I had finished that, I went back to the very beginning and started over.
The undisciplined way I read mirrored my undisciplined life. I slept in yoga pants, a long-sleeved tee-shirt, and a very warm sweater vest my great-aunt had knitted for me from Aran wool my husband and I had bought over three decades ago during our honeymoon in Ireland.
I had been told to keep my finger elevated above my heart at all times in order to reduce the swelling, and this I did not find hard to do. I also was not allowed to get the finger wet. My husband gave me a sponge bath in the bathtub. I cleaned my face with a waterless cleanser and toner. And when my hair got dirty, I went to the beauty parlor across the street and had them wash it for me. Close friends came to see me and brought or sent food.
Their suggestions, their gifts, and visits made me feel loved, as did the affection from my friends and family. I yielded to a self-protective urge. I told only the people that I thought would be kind to me. And some people I told only in stages—first in texts, and then in phone calls. One of the first people I notified was my rabbi. I sent her an email, informing her of what had happened and asking if she would make a pastoral visit.
She came and was a great comfort to me, taking my injured hand between her soft palms, offering a prayer for healing.
V’yishlah lah bim-hera
r’fu-at hanefesh u-r’fu-at hagoof,
b’tokh sh’ar holei Yisrael v’holei yoshvei tevel,
hashta ba’agalah u-vizman kariv,
My eyes filled with tears as the Hebrew words washed over me. I had tried so hard to be strong and remain calm through my ordeal. Now I could let go and focus on healing.
I rested in bed, watching the progression of daylight through the window falling across the bedspread, and I sank into a reverie. It was as if I could feel the texture of time. Or perhaps I could see through the texture of time, as if time had become translucent. I felt close to eternity.
These moments did not last. Eventually I would succumb to boredom or restlessness or pain. But they did exist, and they were a consolation.
Of immediate concern was my follow-up visit with a doctor. In my discharge notes from the ER, I was given the telephone number of the referral service at the Hospital for Special Surgery, instructed to see a hand specialist in three days, and my family doctor as soon as possible.
I was discharged on Saturday. Even before I managed to reach the referral service on Monday, I felt anxiety about scheduling an appointment. The referral service provider gave me the names and contact information of three doctors. When I called the first doctor, I was asked what was the matter with me and told quite loftily that the doctor would probably not accept my case. No one called me back, and I wondered if a severed fingertip was simply too pedestrian for this doctor to consent to treat. If that was the case, I didn’t want him to be my doctor either.
The second doctor was a Taiwanese-American woman. On her video on the HSS website, she spoke of how she decided to become a hand specialist after she learned how common hand injuries are in Asia, where employee protection standards are not as rigorous as in the United States.
I called and spoke to her office assistant, who said she would discuss my case with the doctor and get back to me. She called to say that the doctor would see me in two weeks.
“But Weill Cornell ER says I must see someone on Tuesday, and today is Monday,” I said. “I need to see someone tomorrow. Can’t she work me in?”
“She doesn’t think she needs to see you tomorrow. She doesn’t think she needs to see you for two weeks.”
“But she hasn’t examined me, and my discharge papers say otherwise,” I argued. I wondered if my injury was not severe enough compared to the calamities suffered by Asian workers. I’d struck out twice.
The third doctor was on vacation for the next week and a half. Feeling frustrated, I called back the referral service. “You have to give me more names.”
The woman I spoke to took pity on me. She said she would find a doctor for me and call me back. “Dr. Aaron Shapiro will see you on Wednesday,” she said when she phoned. “That’s the best I can do.”
“Thank you so much,” I replied. “That’s only the day after Tuesday.”
Dr. Shapiro’s office was expecting me, and I set up the appointment. Later I looked up the doctor on the HSS website. He had gone to UCLA Medical School. Coincidentally, my doctor friend Susanna had taught a medical ethics course there for some 25 years.
Susanna didn’t remember Dr. Shapiro, but when I read her his biography off the HSS website, she commented that he must be an excellent doctor, because the orthopedic fellowships he had held were very competitive. “He’s had twenty years of advanced training, and I am sure he’s very competent.”
I was relieved, but nervous. I hadn’t really faced my injury yet, what was ahead of me, what it really meant for me. All day long, I held my left arm stiffly bent at the elbow, the hand elevated and at a distance from me. I tried not to think about it, not to look at it. But at the doctor’s office, I would have to confront what it meant for me.
My husband delayed going to his office that day to accompany me, and a friend who lived nearby dropped in so I could give her theater tickets to a play that evening that I did not feel well enough to attend. They were both with me when Sara, the physician’s assistant, gently unwrapped the large bandage. Underneath was a smaller yellowish bandage stuck onto the wound with dried blood.
I looked at it and looked away, suddenly overcome by tears.
“It’s okay to cry,” Sara said.
“Are you going to take off the bandage?”
“I don’t know. Maybe. Maybe not. We’ll see how it goes.”
With some tweezers, she carefully lifted off the yellow bandage and laid it on the metal examining table. The bandage with dark with rusty dried blood. I still could not bring myself to look at the finger, but Sara said, “It looks great.” I found that hard to believe. She explained that there was no infection and assured me that I was going to be okay.
Dr. Shapiro came in, and I told him what my friend Susanna had said about him, wanting to establish a rapport, for him to take good care of me. He had reviewed the X-rays. “Did you know there’s still part of the nail bed left?”
“The residents said I lost the nail bed,” I replied.
He shook his head. “You still have a piece of it,” he said.
“Will it grow back into a nail?”
“It could be a blessing or a curse,” he explained. “Usually, it’s a problem because the nail grows in strangely, at a perpendicular angle, or curved under. If that happens, I’ll have to do another procedure to remove it.”
I took in that information and filed it away. The thought of another procedure was just too much for me. I would deal with it when the time came.
In childhood, I naturally shrank from physical risk. Other than a broken arm when I was ten years old, I had managed to avoid most injuries. I didn’t let myself relive that moment when I closed the car door on my finger. I knew I had to focus my strength on getting better. I had to protect myself, and that also meant protecting myself emotionally from those who were not supportive, or did not wish me well, or even those who may have meant well but did not act well.
I developed this survival strategy over time. That day in the doctor’s office I listened carefully. I felt grateful that such care was available to me. I appreciated Sara’s gentle touch as she carefully put another clean yellow bandage directly on the wound. She loosely wound a new gauze bandage around my finger, wrapping it around my palm and the base of my thumb. At home I would continue with antibiotics and Tylenol for pain, keep the finger elevated and protect it as much as possible.
At my next visit one week later, Dr. Shapiro and Sara were pleased with my progress. Sara replaced the large gauze bandage with a small gauze sleeve to slip over my finger like a sock. Dr. Shapiro wrote a prescription for occupational therapy and sent me across the street to the Hospital for Special Surgery’s OT department for Hand and Upper Extremities. The OT, Alex, made me a splint to wear over the finger when I left the house, and I scheduled several sessions.
Sara had given me extra gauze sleeves to replace the one I was wearing, but I avoided kitchen work; I did not cook or clean, and the sleeve didn’t get dirty. I continued to have my hair washed at the beauty salon across the street. The following week Sara removed the yellow bandage and the gauze sleeve.
Two-and-a-half weeks have passed, I thought. My birthday has come and gone. At the age I am now and for the rest of my life, I will live without my fingertip, and the time has come for me to look at it and accept it. And so I did.
I wasn’t wearing my glasses, and that close my vision was blurred, but I could see it, and I saw enough. A large scab had formed over the wound. The new tip of my finger was still very swollen, though the swelling had gone down. In my mind, I heard the echo of Dr. Jastrow’s voice: “Don’t worry about what it looks like. Concentrate on getting back functionality.”
“It’s okay,” Sara said soothingly. “You’ve been through a trauma. Baby steps. You’re doing great.” She asked me to flex and extend the distal joint of the finger repeatedly. It was difficult, the swelling made my finger feel terribly tight, and, as hard as I tried, it would not flex as much as my other index finger. But Sara pronounced herself satisfied.
She took an ordinary band-aid, tapered the sides and ends with a scissors and fitted it over my finger. “That’s all you need now,” she said, “just the band-aid and the splint over it when you go out.” Now I was allowed to get the fingertip wet but not soak it. Dr. Shapiro was going on vacation, and I would not see him for three weeks. Before I left, he urged me to try and use my finger as much as possible. While he watched, I tried to press the home button on my iPhone, but it was too painful. “Then don’t do it,” he said, “not yet.”
The slightest touch was excruciating to my damaged nerves. At the occupational therapy appointment, the OT told me that the goal was to desensitize my finger. I had a window of time, and if I didn’t succeed, my finger would never be desensitized. What I needed to do, she said, was to bombard my finger with all kinds of sensation. She gave me a bowl of glass marbles and asked me to pick them up one by one, holding each between my index finger and thumb. It was astonishing how difficult this was for me.
In the meantime, she refit my splint, which was too big now that the bandage had been removed. I told her I had marbles at home, and she told me to practice twice a day. I should also try rubbing my finger gently over different textures, such as a terrycloth towel. When I was a little better, I could try immersing my finger in a bowl of raw rice grains or dried chickpeas.
In the days immediately following the injury, I had naturally begun to extend my forefinger beyond the others, in order to keep it out of the way and avoid using it. This practice was a big no-no, according to Alex. If I continued, I would damage the tendons and muscles of the forefinger. What I needed to do was to try to use the finger normally. Alex gave me a buddy band to wrap around my first two fingers to keep them together. She also gave me a roll of stretchy, self-adhesive Koban tape to wear for protection when I didn’t want to wear the splint.
My finger was injured but the rest of my body yearned to move, my muscles to be used. I emailed two of my yoga teachers about my injury. Jenny and Aiko wrote back with sympathy and practical advice and visited me at home. Jenny came first, bringing gluten-free brownies, flowers, and friendship. She sat with me and cheered me up and gave me tips on how to adapt my yoga practice to my current needs. I told her how yoga breathing had gotten me through that bad night of the accident, and she encouraged me to continue with a daily breathing practice and shared tips and ideas. She suggested that I strap my left arm to my chest so I wouldn’t worry about its placement while I moved the rest of my body freely through some standing poses.
Akiko brought me a special gift, a tiny figure of the elephant god Ganesh and the following mantra, “Aum Shri Ganeshaya Namah.” Ganesh, Akiko told me, is the god of overcoming obstacles. And sometimes he will put obstacles in our way, that we need to overcome. “May Ganesh and his mantra protect you and remove all the obstacles that lie along your journey to recovery,” she said. And she kissed my damaged fingertip.
She told me how to do yoga poses against the wall rather than on the floor, so they weren’t weight-bearing. She sat and drank tea with me, and we talked about our daughters who are nearly the same age.
Exactly one week after the accident I was scheduled to give a reading. The venue was a prestigious Manhattan bookstore, and I had received the date months before, long before I realized that it would coincide with Inauguration Day. I had asked a friend of mine, a Mexican poet married to an American and living in Manhattan, to read with me. In December, when plans for the protest were brewing, and some people I knew were planning trips to Washington, I wondered briefly if I should try to reschedule and decided against it. It had not been easy to schedule that date in the first place, I did not want to disappoint my friend Serena, and plenty of people were staying in New York and planning to join the protest there.
Before the accident Serena and I had discussed the reading. I would introduce her and read the English translations of her poetry published in her recent collection, which was bilingual. We had been planning to meet at one of our favorite cafés.
Immediately after the accident, I put off making a decision about the reading. I did not call the bookstore. I emailed Serena about what had happened to me, but I never said anything about canceling. I only said I couldn’t meet her at the café, and could we work together by phone and email.
Preparing for the reading was good for me. It reminded me that I was a writer, even though for the present I had lost the mind-hand connection essential to my writing, when words seem to flow from my mind through my fingers and onto the screen or the page. It doesn’t matter whether I am typing on a computer or writing by hand with a pencil or pen. What is necessary is that the effort of the process not intrude into my consciousness so I become aware of how I am writing instead of what I am writing.
That was impossible now. My finger hurt too much to write by hand, and typing on the computer was possible as long as the second finger of my left hand pressed the keys of the index finger as well as its own. I could type this way, but I felt strange about it, because in order to do it, I had to extend my index finger beyond the others, in precisely the way that Alex had told me NOT to do. Writing was physically difficult for me. But editing a poetry translation was a good task for me. There wasn’t a lot of physical writing to do, but it still engaged the same parts of my brain as writing did. I met the challenge and gave the reading. My finger was still in the big bandage then, but people who didn’t know about it didn’t notice it, including Javier, the bookstore manager who curated the reading series.
To our small audience, Serena and I spoke about nurturing community and honoring diversity, instead of building walls between us as nations and individuals. We emphasized what connects us rather than what divides us. In my introduction to her poetry, I spoke of Serena’s evocation of “La Mujer prisma,” the “Prism Woman:”
an archetype for the millennium, a wife and mother raising a family in a fast-paced global city, whose complexities call upon her ingenuity, resourcefulness, and warrior strengths. She is worldly, successful, bound by tethers of love to her family, at the height of her powers. By day, she is what the world and her family insist that she be; at night, another self emerges, spiritual and sensual, with the cold fire of the changeable moon.
“Today,” I concluded, “when we have inaugurated a President who is unfit for the office and whose history of assaulting women and hostility to feminism and women’s issues needs no introduction, ‘La mujer prisma’ is more necessary than ever. In these dark days, let us look to her as an inspiration to prepare and gird us for the struggles that lie ahead.”
Even as I spoke, I felt my own words flowing through me and encouraging me. My path of healing loomed ahead of me, stony and difficult, but I felt empowered; I started to think that I was really going to be okay.
* * *
This narrative began with Neil—with his illness, his fatal diagnosis, my worry and wish to help. And although this story soon shifted its focus to my injury and its aftermath, that doesn’t mean I ever stopped worrying about Neil. He was always on my mind. I called him frequently and kept in touch with him, but I also took the accident as a warning: I had gotten in too deep, and I couldn’t keep it up without damage to myself.
I don’t think the accident would have happened had I not been so consumed with Neil. That was why I wasn’t paying attention when I got out of the car at the gas station that night, why I hadn’t noticed that I hadn’t stepped clear of the door before I closed it.
After the accident, it was another week before we went upstate. By that time, two other female friends of Neil had taken charge. Indeed, their influences had begun to make themselves felt in the three weeks between Neil’s diagnosis and my accident, and my efforts to maneuver around their hostility had taken a toll on me. The power that Neil had given to me they took away—not de jure but de facto. They disliked me and were jealous of the trust Neil had placed in me. They convinced him to leave them money and to do it in such a way as to bypass the will and my future role as executor by naming them beneficiaries on his investment account that was managed by the brother of one of them. I wasn’t sure what Neil understood of the financial arrangements he let them set up for him. When I asked him about it, he was unclear. Yet it was his choice. And so I stepped back. I moved from the foreground of his life to the middle ground.
In retrospect, the accident was a clear sign to me that I was more fragile and susceptible than I knew. At the same time, I was lucky that the damage was as limited as it was. Next time might be different. I knew I had to protect myself against such a “next time.”
I availed myself of the avenues of healing that were open to me—physical, mental, spiritual. I learned all over again that I was blessed in people who cared about me. Sometimes it seemed as if my injury were a mirror reflecting back truths to me I had not known. In time, I found another role with Neil. We—Keith and I—became his good friends again. We shared some happy times together. Because Neil, too, confounded the predictions; he lived months longer than the doctor said he would. As I write these words, he is still living. His survival, tenuous and determined, is a reminder that, although we must put our trust in our doctors, they don’t know everything.
Dr. Shapiro and Sara both warned me that the healing process for my finger would take a long time. Indeed, it seemed to me that, with each visit to the doctor’s office, the prognosis of how much time it would take grew longer. At first Dr. Shapiro said the swelling would last six months, then he extended it to one year, and then eighteen months. Sara told me she thought the swelling might never entirely go down. Yet at the same time they both assured me that the finger was healing splendidly.
By that time, I had gone from bandages to band-aids, from elevating the hand and not getting it wet, to getting it wet but not soaking it, to attempting to use it as I had been accustomed to. A large scab formed over the wound, then it fell off, and the skin underneath peeled numerous times. Sara explained that because my finger was so swollen, the skin was already dead when it formed because it didn’t have a blood supply. For several days I kept applying a Vitamin E oil to my fingertip as the skin was repeatedly sloughed off. I used almost half the little bottle because my skin peeled so much. Eventually the skin stopped peeling, and the scab was gone.
Then came the ordeal of the sutures. I had been told that the sutures would reabsorb, but they did not. Over the next couple of months, I endured episodes when the swelling and pain would increase until I was quite uncomfortable, and then a suture would work its way out of my fingertip, a process that could take anywhere from three to ten days. It was like having a splinter times ten. Sometimes it seemed as if my finger were giving birth to the suture. The swelling and pain would increase by degrees until finally the suture poked out of the skin. It gradually worked its way out. Then came relief and a decrease in swelling. The sutures were one-half to three-quarters of an inch long when they came out. Somehow, I had expected they would be like thread, but they were like little wires. I think they were made out of animal gut. Perhaps it was for the best that my body didn’t want to absorb them, even though the process of expelling them was painful.
Four times I experienced the expulsion of the sutures. The fifth time my fingertip swelled what came out was the residual nail growing in oddly, just as Dr. Shapiro had predicted. It looked like a diagonal sliver peering over the back of my fingertip, a moon rising over a plateau. After a while, it caught on clothing, and I had to file it down. It was an annoyance, but it didn’t hurt except when it caught and bent backwards. What was painful was the swelling just behind the nail.
I had come a long way toward desensitizing the new fingertip, but that bump of swelling just behind the nail was a problem When I brushed the back of my finger against any surface, the pain was compelling.
In the middle of April, I made an appointment with Dr. Shapiro to ask him about it. In the beginning of the month, he had said that he didn’t think I needed to see him anymore, and he didn’t think I would benefit from more occupational therapy. “However, I’ll always see you if you need me,” he assured me.
With the eruption of the nail and the increased swelling, I thought I did need him. He said that he couldn’t tell if the bump of swelling was caused by the residual nail bed, as I hypothesized. He advised me to try and live with the nail as it was. If he removed it, it would be another procedure from which I would have to recover. Contradicting what he had said on the previous visit, he ordered more occupational therapy for me.
I had the feeling that Dr. Shapiro was prescribing more occupational therapy as a way to get rid of me. It seemed to me that he thought my improvement was good enough, and I should move on, leaving him to concentrate on more urgent cases. “Stop worrying about your finger,” he ordered me. “Worry about Trump. Or anything else.”
I was already plenty worried about Trump, and I also had a fractured tooth and an abscess that was taking my attention. But I was acutely aware of my poor, wounded, swollen fingertip every minute of the day, and I wanted to get better than I was. I followed Dr. Shapiro’s instructions and walked over to the occupational therapy center, handed over my paperwork, and made an appointment.
Over the past ten weeks, I had already had six occupational therapy appointments, five with Alex and one with Emily when Alex was on vacation. I had progressed through a series of ever more difficult exercises that involved, in Alex’s words, “bombarding the finger with sensations.” I remember one afternoon when the simple task Alex asked me to do—compress the two ends of a clothespin together to open the other end—was so incredibly painful that tears filled my eyes. One day about a month later, after I’d successfully poked holes into a tub of light-blue medicinal-quality silly putty, Alex remarked, “That’s the first time I’ve seen you smile.”
I hadn’t been aware of the fact that I wasn’t smiling.
I had scheduled eight occupational therapy appointments in all, but during the period when my finger began to spit out the sutures, the swelling increased so much that therapy seemed counterproductive. In the meantime, the occupational therapy prescription expired. When Dr. Shapiro wrote me a new prescription and I scheduled the visit, I hadn’t had an appointment in over a month.
The night before the appointment, Alex emailed me to reschedule, but I never saw the email. I received a phone call that morning asking me to come in half an hour instead of at two o’clock. I live at the other side of Manhattan from the Hospital for Special Surgery, and even with a car service, I needed to allow forty-five minutes, depending on the traffic. And furthermore, I was in the middle of a cooking project, and I couldn’t drop it. I objected and was told I could keep the original appointment.
When I arrived, I learned that Alex had been called away to a meeting, and I was reassigned to John. This change proved to be fortuitous, because John brought a new perspective to my treatment, and he made a compression bandage I could wear.
Alex had also wanted me to sleep with a compression bandage over my fingertip. She said it would reduce the swelling and help to reshape the fingertip. The problem was that the bandage she gave me was so tight that it hurt after only a few minutes. Even had it fit, the bandage had a gel lining that didn’t breathe, and when I took it off, my fingertip was soaking wet.
When John advocated a compression bandage, I told him about my problem with the bandage Alex had given me. “The bandages we get don’t come in enough sizes,” explained John. “The size Alex gave you is too small for almost everyone, even with a normal fingertip, and the next size is too big. We need in-between sizes. But I’ll make you a compression bandage that fits.”
After measuring my finger, John went over to a sewing machine I hadn’t noticed before and sewed a seam through the too-big bandage, altering it to the dimensions of my fingertip. His sewing was crude, but it worked. The bandage he gave me was not too tight, and I was able to sleep with it. I was able to bear the sweating. As I am continued to wear it, it helped to reshape my finger.
My health insurance approved the four new visits that Dr. Shapiro prescribed for me, but John didn’t think I needed them. “Just use your finger in normal activity, as you’ve been doing, as much as you can,” he said. He reassured me that if I required a new bandage or had any other need, I could email him and come in, and he would help me.
John disputed what Dr. Shapiro had said. He was “almost one hundred percent certain” that the swollen bump on the back of my fingertip was due to the nail. “The nail bed extends behind the nail,” he said. “That’s exactly where it is.”
“I know that,” I said. “I thought so, too.”
The distinction meant something to me because of the decision I would have to make down the road about whether to have the residual nail removed or not. Dr. Shapiro had asked me to try and live with it. In terms of living with a small piece of misshapen nail that wasn’t very attractive, I thought I could live with it, but if it were the cause of the worst of my swelling, and the swelling didn’t go down on its own, I didn’t think I wanted to live with that.
As time went on and my finger grew less sensitive, I found the swelling to be hardest part of it to bear. In the aftermath of the accident, I had thought that getting used to the change in the length of my finger would be hardest. But perhaps because I was relatively fortunate in having lost only the tip of the finger, the swelling was worse for me.
Sara said it was because the fingertip is so small that any amount of swelling is significant. Over a larger area of the body, like the knee, for example, the swelling would be more dispersed. But there is not a lot of space for swelling to go in a finger.
* * *
After the accident, I contacted a college classmate who at our reunion the previous autumn had spoken publicly and candidly of the crises she had faced. While pregnant with her first child, she had suffered a devastating stroke on the right side of her body and had to be airlifted across the state of Massachusetts to Massachusetts General Hospital. She recovered thanks to the excellent medical treatment she received, and her child, a daughter, survived, but she was left paralyzed on the right side of her body, and she is right-handed. She had to learn how to write with her left hand, to drive a car only with hand controls, and make many more adaptations. Through it all, she benefited from her husband’s intelligent and loving support. She went on to have a second child, a son, without difficulty and managed a successful legal career.
Then came September 11, 2001. Her husband was giving a speech at a breakfast gathering at the Windows on the World restaurant in the North Tower of the World Trade Center, and he perished.
With bravery and determination, my friend managed to raise two beautiful children who are a credit to her and her late husband. I wrote to tell her about my accident:
I want to let you know that through all this, the thought of you is an inspiration to me. When I think of all you have overcome with courage and grace, it gives me fortitude to deal with the loss of this piece of myself.
With admiration and affection,
She wrote back:
So sorry to hear of your accident, and so glad to hear from you.
You are very kind to consider me an inspiration, but the truth is, we all do whatever is needed, particularly we women who often have to get our families through difficult situations.
Please focus not on the little piece of you that you lost but on the enormous part of you that you still have.
Her words were a comfort to me.
Another consolation came from an acquaintance, a photographer and artist whom I have come to know over the many years I have lived in my neighborhood. One evening she invited me to her apartment for a glass of wine. I thought I was familiar with her photographs, and indeed I owned one of them, but I hadn’t known that she had completed a series of works in full color documenting surgeries in progress. She showed me her portfolios. There were a pair of Siamese twins joined at the head who were successfully separated and a person whose entire ribcage was removed and then put back. There were photographs of breast cancer surgeries and breast reconstructions, bone grafts and skin grafts.
I was in awe of the photographs and what they showed. Truly, in the grand scheme of things, what had happened to me was pretty small potatoes. I told her so, and she replied, “That’s what I wanted you to see. You’ll be fine.”
* * *
On June 19, after a hiatus of two months, I went to see Dr. Shapiro. Five months had passed since the accident. Dr. Shapiro was pleased with my progress. I told him that I could write and type pretty well. What were hardest for me were the twisting actions with my forefinger and thumb and compression between the forefinger and thumb. Dr. Shapiro said that these functions may get better with time. I talked about my continuing problems with swelling, and again he said it would take 18 months for the swelling to go down.
“It’s not like a real fingertip,” I said. “I don’t have that sensitivity. There are still micro-areas of hyper-sensitivity and numbness.”
“That, too, may improve with time,” he said. “Although of course we can’t predict the future.”
He examined the little nail growing in at a diagonal.
“You told me to live with it, and I’m living with it,” I said. “I file it. I don’t know what else to do with it.”
“That’s about all you can do,” Dr. Shapiro said. “It looks good. I know you don’t think so, but it looks much better than the last time I saw it. You may actually have a functional nail here.”
“What do you mean by that?” I wondered. I couldn’t imagine that the nail would really grow back in.
“I mean it may offer your finger some protection,” he said.
I had brought in the compression bandage that John, the occupational therapist, had altered for me and showed it to Dr. Shapiro. He said I didn’t need to wear it. “Just live your life as normally as possible,” he said.
“So I don’t need to see you anymore,” I said.
“I thought so,” I said. And as he turned to go, I said, “I have a present for you.”
I gave him a jar of my homemade organic blueberry jam. “I even picked the berries,” I told him. “I hope you and your family enjoy it.”
And I gave him a hug.
* * *
Sara stopped in to see me before I left. She was glowing. She said her baby was due in four days, but she didn’t think it would come until the following week. “Girl or boy?” I asked.
“Girl.” In response to my questions, she said she would name her daughter Willow, and she would be on maternity leave for four months.
“It’s nice you’ll have all that time,” I said. “Willow will be rolling over on one side by the time you go back to work.”
She smiled at that thought and then asked to see my finger.
“It looks great,” she proclaimed.
“People hardly notice it.”
“See what I told you?”
I couldn’t help it; my eyes filled with tears, and I saw, in response, her eyes prick up, too, in sympathy, and then the moment passed.
“I wish you an easy and successful delivery.”
She nodded. “That’s what we all hope for.”
I gave her a jar of my raspberry jam as a gesture of thanks.
When I paid my co-pay, Nikki, the bookkeeper said, “I see you don’t have to come back. I hope you have a nice summer.”
I had six appointments with Dr. Shapiro and nine occupational therapy appointments. I got better over time, just as they all predicted. And so I am living with it. I have come to realize that the healing process is unique to each individual, even those with a similar injury or disease, and I am grateful for all that I did not lose. And I am going on with my life.
Adrienne Pine‘s creative nonfiction has been published in The Write Place at the Write Time, Tale of Four Cities, The Yale Journal of Humanities in Medicine, Carte Blanche, Feminine Collective, Gravel, Shark Reef, and other venues.