How Do You Solve a Problem Like Maria?


One month ago today on Friday the 13th, I flew into San Juan, Puerto Rico.  I volunteered to serve as part of the VA Disaster Employee Medical Personnel System (DEMPS) to assist with disaster relief efforts after Hurricane Maria touched down on 9/20.  I fully intended to write a journal entry every day, just to capture the memories that can be so fleeting in the moment.  I wrote one short blog post on the bus ride to the temporary Federal Medical Station at the Acrópolis de Manatí that I never published, then never wrote another word until now.

Though people have asked me over and over about the experience, though I dream nightly of being there still, and though I know I am forever changed by the patients I cared for and the friendships I made in Puerto Rico, I have been unable to find the words to express what I feel and think about it without feeling completely inadequate to the task, the weight of the experience anchoring my tongue and laying heavy on my mind.

“How do you solve a problem like Maria?
How do you catch a cloud and pin it down?
How do you find a word that means Maria?”

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These lyrics from one of my favorite movies are on rewind in my head, the incongruent cheerful riff at odds with the churning emotions inside.  I am in contact still with some of the incredible people I met and worked side-by-side with in Puerto Rico.  I’ve shared some of their eloquence to give friends and family who ask a small glimmer of what it was like, but it feels a little like borrowed elegance, a little like cowardice to hold back what I’ve turned over and over in my mind like a many-faceted gem, and a whole lot like the type of pressure I feel always to paint the picture right the first time. I kept biding my time, waiting for the perfect words to come.

Then recently while at dinner in Phoenix, I had a sudden sharp pain in my L eye.  It felt like a torn contact lens, the sharp edges drawing across my sclera. I thought nothing of it, and driving to dinner with another friend, I noted a larger than usual amount of blood in the centrolateral aspect of my L eye from a subconjunctival hemorrhage.  Confirming this with my fellow PAs (really what better place for a curbside consult than at a leadership conference for PAs?), I knew it required no specific medical care.  On my 7 hour drive home from the conference, I mentioned that this had been the 4th one in less than a year or perhaps 6 months to my good friend, who happens to be an acupuncturist.  She gently reminded me that after travelling to Columbus for the National Girl Scout convention with Daughter #2, two weeks working nearly nonstop in Manatí, a short week home, then another nearly week-long conference in Phoenix, I might consider that I need rest.  Apparently the sclerology chart she sent to me indicates that the area of my eye affected points to a possible problem of the heart.

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As a former cardiology PA, I know there is nothing wrong with my heart. I also know that when I think about Puerto Rico, I feel a pressure in my chest that has nothing to do with a myocardial infarction, and everything to do with another type of blockage, the kind that comes from feeling something so strongly, and being unable to talk about it in any kind of coherent way. I get updates from DEMPS personnel who replaced us there about patients I took care of, and it makes me wonder.  How is it possible to love being home with my family and wanting so badly to be back in Manatí, in a place where I don’t speak the language, but where I understand perfectly what my purpose is?  How can it be that everything here goes on as normal, commuters driving badly to work, kids struggling with slope and y-intercept homework, and at the FMS Manatí, patients whom I cared for still have no home to go to and still have no power for basic needs? How can it be that my patients are dying, and I can’t do anymore about it now then I could then?

I struggled with these thoughts, overthinking perhaps that by talking about it, I might be exploiting the prurient aspects of seeing a disaster up-close versus the need to show people what it is really like there in this era of “fake news.” And then today, a NY Times article about the mental health crisis affecting Puerto Rico was featured, and the trolls online could not type fast enough about how we are wasting money on an island that isn’t even a real part of the US, and I told myself it was time to tell the story. The 2 questions I’ve been asked most frequently: “Is it really as bad over there as they say it is?” and “What was it really like over there?” The short answers: Yes, and terrible, but wonderful.

The long answer, well, that’s harder. That’s going to take more than 1 blog post to answer.  And I promise you, it will not be any semblance of a perfectly presented answer to the question of how to solve the problem of Maria and it’s effect on the people of Puerto Rico.  It will be my truth about the privilege of being a PA serving as one small part of the federal medical response to Hurricane Maria with fellow VA employees in the DEMPS program, DMAT, DoD, USPHS, ICE, and volunteers from New York Presbyterian Hospital.  Stay tuned–there won’t be any nuns breaking into song, but there will be cake, clowns, and cops with rhythm.  There will also be stories about patients that will make you rethink what you know about love and devotion. It was my privilege to witness all of it.

Special thanks to my husband, my mother, and my friends who took over mom duties at home so that I could go and serve. I could not have done this without their support.  I love all of you more than I can say.

If you’d like to help the people of Puerto Rico:  https://www.fema.gov/news-release/2017/09/22/how-help-after-hurricane-maria

This is the main page for up-to-date resources and information on the federal response to Hurricane Maria:  https://www.fema.gov/hurricane-maria

This link will take you directly to the statistics for Puerto Rico: https://www.fema.gov/disaster/4339

The NY Times article about the mental health crisis in Puerto Rico that finally broke the dam holding in the words:

 

 

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The Inverse Law of Bathrooms & Nighttime Vomiting


My husband is downstairs watching Band of Brothers, Season 25, Episode 36,000,000 of men shooting and shouting at one another, blankets tossed aside as his fever breaks finally from the flu that snuck up on him this morning.  I don’t find this at all relaxing, the profanity and underlying violence of the voices making me flinch as I check his temperature, but perhaps we are both just punchier than usual from lack of sleep. Last night, in the midst of a dream about penguins finding their way home, the sound of 4 sharp bangs dragged me from visions of Antarctica.

“What was that noise?” I whispered to my husband, immediately awake and frightened.

“What, what? What noise?”

Four more bangs in quick succession followed.

“That noise!” I said urgently, nearly pushing him out of bed.  He stumbled out into the hallway, coming back within a few seconds, as I was putting on my robe.  In the darkness, I am less blind than usual, knowing the layout of my own bedroom, but somehow I missed my middle daughter making her way towards our bathroom. She had been the one banging on her own door to signal the end of her vomiting in her doorway and her need for assistance, as her own bathroom was missing not only the toilet, but a working sink as we are in the midst of removing the 80’s funk which permeates our entire bought-in-a-foreclosure home.

I was not great at physics though I was blessed with great teachers and professors.  Physics is a fun science full of demonstrations, and on tests and homework, I had little difficulty, completing calculations and solving equations so long as I stuck to rote memorization.  In real life, however, during physics lab when those principles had to be played out in real time with gravity at work, I usually failed miserably at predicting how the world actually works.

Last night, however, a real-world situation presented itself and I immediately was able to write a new axiom, and though it is based on a single observational study, I offer it up as a truth that I would recommend to anyone as worthy of remembering.  I am calling it The Inverse Law of Bathrooms and Nighttime Vomiting also known as the ILBNV (pretty catchy, right?).

The person farthest from the closest working bathroom will be the most likely to have an episode of nighttime vomiting, and also most likely to expel the entire contents of their dinner the farthest distance in the shortest amount of time.  

Splitting duties, I took care of cleaning up the daughter, who apparently upon evacuating the contents of her stomach immediately felt better.  My husband, bless his heart, cleaned up much of the mess, electing at 3 am to finish the rest in the morning.  I describe my 2 youngest children as one who never stops talking, and one who never stops moving. Having realized quickly that ILBNV was now in play, I moved her downstairs to be nearer to the bathroom.  Once she was tucked in, and after climbing into bed with her, however, she could not wait to begin describing to me in great detail exactly how terrible vomiting feels, smells and sounds.  By the time she finally fell asleep, I was lying in bed wondering if the twinges in my stomach were my imagination prompted by her vivid descriptions, or actually the beginnings of an exception to the ILBNV.  Thankfully, the axiom held true, and I awoke at 6:30 am to find my husband groping his way one-eyed towards the coffee-maker.

On days like this with just a few hours of sleep, knowing I’m facing getting the kids off to school on time, followed by a full load of patients, then Girl Scouts and piano lessons, then dinner, homework, bedtime and clean-up, I try to remind myself that I once couldn’t wait to be a grown-up. Most of the time, it works, and I’m grateful to be living the dream as they say. Having now penned the ILBNV and with my place in physics history now secure, I’m thinking about quitting my day job, once I find where I put those bonbons I’ve been hoarding.  I’ll look for them just as soon as I finish cleaning up the rest of the mess from last night, as the husband is now in no shape to be scrubbing carpets or walls. It’s a glamorous life, but someone has to do it.

This somewhat flattened York peppermint patty found at the bottom of my travel bag is the closest thing to a bonbon I could find. Luckily, it was still delicious.

This somewhat flattened York peppermint patty found at the bottom of my travel bag is the closest thing to a bonbon I could find. Luckily, it was still delicious.

Today I am grateful for stomach bugs that last only 24 hours, a good sense of humor, and bonbons in all forms!

 

 

 

 

Swallow It


As I sit here with an ice pack and foot propped up, it occurs to me that the old adage that doctors make the worst patients should be amended to include all medical providers.  In my work, on a daily basis I dispense medical advice that I frequently ignore.  Not because I think I’m ten foot tall and bullet-proof, but because I’m busy running around taking care of other things before I realize that I haven’t had a single thing to drink all day (hence the three kidney stones), or busy running around and not watching where I’m going (hence the three sprained ankles in three years).  Is it any wonder my mother is always admonishing me to slow down?

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I am a firm believer in the mind-body connection.  Since I started practicing medicine, I’ve seen what stress can do to our bodies.  Like most women I know, I carry all of my stress in my neck and shoulders, the non-ergonomic office chair and computer set-up, of course, contributing to the problems.  My husband, on the other hand, feels his stress in his stomach, having difficulty eating when he feels stressed out (I wish I had that problem!).  The brain is the most powerful organ in our body with its ability to effect changes which may seem magical to those not confronted with these cases every day.

Though both branches of my family have survived wars and strife, my recognition of PTSD has grown by leaps and bounds through my work with veterans.  Time after time, I am struck by the stories my patients tell of how ill-equipped they were psychologically to deal with what they saw and did.  Many veterans came back from Vietnam or Korea, and stated that they had no problems with “shell-shock” like other veterans they knew, raising families and working steadily at jobs that built this country, until they retired.  Then suddenly, they find themselves experiencing palpitations and sweaty hands in crowds, nightmares/vivid dreams of people and places they have not thought of for years.  They come in genuinely confused, some of them undergoing cardiac testing for these symptoms which make no sense to them.  After years of looking forward and striving for the next thing, retirement affords them space and time to look backwards, and they find their past is catching up with them.

One veteran told me that shortly after he arrived in Vietnam, he spoke to his supervising officer about his doubts that he could deal with all of the death he was seeing.  This was a man whom he respected, a grizzled veteran of many military maneuvers, and so he took the man’s advice to heart.  “Swallow it,” the young soldier was told.  “If you don’t, it will eat you alive, so swallow it, because we don’t have time for it now, and your job is to stay alive.  Just stay alive.”  I am not a psychologist or expert on PTSD, but I found it interesting that the veteran’s main complaint was debilitating stomach pain with extensive gastrointestinal testing over many years which has been negative.

I’ve had other patients come in with complaints of dizziness.  In medicine, a complaint of dizziness needs to be further clarified in order to narrow the differential diagnosis.  My question to patients with dizziness or lightheadedness is usually asking them if they have a sensation of feeling woozy like they are about to pass out, a spinning sensation either of the world spinning or of themselves spinning, or a feeling of being off-balance.  I’ve learned that besides trying to figure out all of the medical reasons for a patient’s symptoms, it is important to ask questions about how the rest of their life is going as this will have an effect on their symptoms.  It never surprises me that the patients who will share that they are feeling lost or confused, will also describe their dizziness as a feeling of being off-balance, often times associated with blurry vision or tunnel vision.  Is it any wonder that those who most feel out of control emotionally have symptoms that mimic having lost sight of where they are going or where the ground is? Some have literally used the words, “I don’t know which way is up.”

The words that people use when describing their symptoms and telling their stories can be revealing.  Perhaps because I love words so much, I think they are important and I try to pay attention to how people describe their pain.  In our training as PAs, we are asked to be very specific in how we document pain.  Some patients will laugh a little at my question, ‘Would you describe the pain as sharp, stabbing, squeezing, pressure, aching, burning or something else?’ but it helps people to find the word that best describes their pain.  As medical providers, we have a lot of experience dealing with pain, and though I cannot truly “feel” their pain, I always feel that if I can help them name it, it will have less power over them.

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One method frequently used to help patients categorize their sensation of pain.

As medical providers, sometimes we can be so focused on the disorder, we forget that mind-body connection.  No matter how many times we read the study about how pretending to smile actually improves a person’s mood, we point the arrow from body to mind, and forgot the power the mind has over the body.  One of my most memorable patients during my psych rotation was a woman who had been diagnosed with somatization disorder (which in the DSM-5 has now been replaced with the broader category of somatic symptom disorder in order to “remove the mind-body separation that is implied in DSM-IV”). She reported paralysis and loss of feeling from the waist down, though all testing and imaging was normal, and there was no report or sign of injury or external trauma. She had been there for weeks undergoing test after test before she was moved to the psychiatric ward. Other patients have reported blindness, others deafness. She would speak cheerfully of everything but the broken engagement that had occurred just prior to her hospitalization, that event a black hole into which all memory had vanished. Was it chance that this woman had lost half of her body, her better half perhaps? Or that she was numb, and paralyzed to the point that she could not move forward or backward?

At the time, though, I was in my first rotation in my second year of PA school. My job was only to learn everything I could about somatization disorder which was thought to be very rare in order to prepare a presentation for the rest of those in our consult service, round on this patient every morning, as well as attending to any new consults that came in that day. My job wasn’t to diagnose this woman with heartbreak, though I thought most likely it was true.

As a PA working in cardiology many years later, I would learn about Takotsubo cardiomyopathy aka stress cardiomyopathy or broken heart syndrome, in which the heart muscle function is dramatically affected in approximately 85% of cases by an emotionally or physically stressful event. Patients normally arrive at the hospital with symptoms mimicking a heart attack, including chest pain and difficulty breathing. Actual visualization of the coronary arteries usually reveals no evidence of significant atherosclerotic plaque to explain the dramatic change in the heart’s ability to pump efficiently or the change in the actual shape of the heart muscle itself.  In most instances, the heart muscle function returns to normal by the time of the patient’s discharge (usually within a week).

Figure 2.

Called Takotsubo after a Japanese ceramic pot used to trap octupi, this is a dramatic change in the normal shape of the heart (Credit: Circulation 2011; 124)

The more we learn though, the greater distance we put between ourselves and our patients.  We think we learn enough to make a difference, gaining the tools and knowledge to ease suffering and effect cures.  We gather information, nod sympathetically, lay hands on our patients, and dispense knowledge and prescriptions with impunity, doing our best with what we know. Our patients get better, mostly, but sometimes they do not, and we blame ourselves. We want that distance because we want to believe that we can help our patients. We want to believe we do know enough to make a difference. We forget though, we are ourselves human as well. It is a bitter pill to swallow–“Cure thyself!” we are told and tell ourselves, though we no more listen to our own advice than our patients might. We stumble, and curse the ground, and forget that perhaps,  our mind wants us to listen, and slow down. We learn again, what bruising, pain, and heartbreak can do, and in doing so, close the gap between us all again.

 

 

In Which Several Unusual Events Occur


The day began innocuously enough, pushed to a small sliver of the bed by an exceptionally warm little boy who had shown up at my bedside late last night or early morning depending on if you see the glass half-empty or half-full. He has not crept into my bed in months, but his tear-streaked little round face in the moonlight tugged at my heartstrings, and I could not send him back to his room. Little did I know the surprises the day would bring.

In which a patient faints and technology intervenes:

My patients were not unusual, kind and full of stories of living overseas, but one of my colleagues had the opportunity to use a new device we were just briefed on recently when his patient felt dizzy then lost his balance. The premise of this device is stunning in its simplicity.  As no one in our facility is allowed to lift anything or anyone greater than 30 lbs, it uses a small portable battery-operated generator that allows what looks like several stacked air mattresses to fill sequentially, until the patient is raised to a height that makes it easier to transfer to a gurney or hospital bed.

In which a snowstorm appears suddenly in the desert:

Leaving work, though as always I am grateful for rain in a state that has been drought-stricken for so long, the chill and ongoing downpour had me planning for a quiet day of snuggling in front of the fire watching movies with my husband.  The rain quickly turned into snow as I drove home, which in this high desert place is not usually seen until November 30th, making roads slick and visibility poor, but turning the landscape into a winter wonderland in minutes.

In which a sleeping man surprises me:

Walking into the house, it was unusually quiet, and I found him sleeping on the couch. He is not one who usually naps, preferring to stay on a normal sleeping schedule when home, however, I knew he’d had 8 calls after midnight, the last a structure fire at 6:30 am, so I was glad to see him getting some rest.

In which a tree decides it has taken all it can take:

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As we prepared dinner, we noticed that one of our trees in the backyard had cracked beneath the weight of the heavy wet snow. It fell over as quietly as if it had just suddenly decided to lay down and rest without a noise.

In which the children try exotic tropical fruit:

My littlest ones have a habit of asking to try all manner of fruits and vegetables in the grocery store, and though I love that they love fruits and vegetables, the practical side of me is unwilling to pay $5 for 1 piece of fruit, especially when we have no idea if it will taste terrible. In the produce section of our grocery store, there is a section in which they sell very ripe fruit that needs to be eaten quickly for 99 cents/bag. Today, one of the bags contained both 2 dragon fruits and several star fruit.  While I cooked dinner, they looked up how to cut them up, and everyone got to try dragonfruit and starfruit appetizers.  Verdict?  Dragonfruit have a beautiful magenta color on the outside, but the interior is black and white, with a refreshing sweet taste and seeds similar to a kiwi.  Definitely delicious!  Starfruit when exceedingly ripe is NOT delicious with a consistency and texture like a cucumber without the seeds.

In which we have turkey cutlets, sweet potatoes, and cranberry sauce, although it is not Thanksgiving yet:

While at the grocery store, I also saw turkey cutlets on sale, so decided to try a new recipe, or more accurately, I decided to take a few different recipes and then combine them together, add my own combination of spices, and throw them on a bed of kale and spinach.  wpid-20151116_184720-1.jpg

In which we all enjoy a moonlight romp in the snow, especially the dog:

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Today’s accumulation was between 3-5 inches depending on which side of town you lived on.  Numerous snowballs were thrown, a snowman was resurrected, then lost his head, and much rolling around across the front lawn occurred.

In which we all made wishes, and watched them sail into the night sky: 

My husband had been given 2 paper lanterns at the lantern festival where he and his crew were staged to make sure no fire-bearing paper bombs started any forest fires.  He brought them home for us to experience the magic. We watched them drift upward until they were indistinguishable from the stars, as we made silent wishes.

In which we all go for a moonlit snow hike despite it being very close to bedtime:

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Hiking down to the store to return movies was more fun secondary to the slip and slide factor, and the children enjoyed the opportunity to be outside so close to bedtime.

In which we end the day in front of the fire finally: 

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No hot cocoa as requested by the chocolate lover, but we did all warm our frozen feet by the fireplace, then upstairs for bedtime prayers and getting tucked into bed, cozy after the snowy adventure.

Tonight I’m grateful for days filled with the ordinary and the unusual.  I’m thankful to live in a place full of surprises. I pray for days like this for all of you, spent with loved ones in simple pleasures.

 

 

 

Hello darkness, my old friend


Steve Inskeep woke me up way too early this morning.  No, I haven’t thrown over my husband for someone new.  For those of you who aren’t familiar with him, he sounds way too chipper to have been up for hours as the host of Morning Edition on NPR. With Daylight Savings Time this weekend, theoretically, we all got 1 more hour of sleep last night, but in reality, I spent 1 more hour awake, and started yawning as soon as darkness fell.  Now it really feels like autumn has arrived, and winter is coming ;-).

Hello darkness, my old friend

Hello darkness, my old friend.

The news is filled at this time of year with the same stories from last year about whether or not we should continue with Daylight Savings Time. As we are among those who have eschewed cable TV for streaming services and the local evening news is filled with hype-filled emptiness, I like to get my news as I get ready for the work day and on my drive in to the hospital. This morning, the words “in Detroit” made my head snap towards the radio.  Having trained in Detroit, and grown up driving “Downtown” to the RenCen and Hart Plaza, I miss my old city. I never knew it in its glory day.  The Detroit I knew was already worn around the edges.  The grand architecture which makes it an attraction for photographers, film makers, and crazy tiger owners, is crumbling and the infrastructure which has been neglected for so long is struggling to take care of the residents of my former city.

A live tiger got loose in the old Packard plant during a photo shoot. (Photo: Andy Didorosi)

A live tiger got loose in the old Packard plant during a photo shoot. (Photo: Andy Didorosi)

What I heard today though wasn’t yet another mock-sad exploitation of the dark days of Detroit.  Instead it celebrated the success of a program implemented to bring suicide levels to 0%.  No, that is not a typo.  The goal of the program was actually to prevent suicides and thus bring the suicide rate down to 0.  Now anyone who’s every been at a meeting, no matter where it is, whether for work or the PTO or your local library guild, can imagine the silence that most likely followed that proposal. The thinking among a lot of health care workers and psychologists is that it is impossible to prevent every suicide.  This is a growing problem among veterans all over the country, and one that has been highlighted in the media as an example of how the VA is failing our wounded warriors.  As one of those left behind to question why, any reduction in the suicide rate is a miracle.

This is the first I’ve heard of any success stories, and this is truly a success, and has been for many years.  After embracing the idea, which must have taken a complete paradigm shift, the Henry Ford Health System, the same one that took care of my family for years, was able to achieve their goal for at least 2 years.  In 2009, the suicide rate among the high-risk mental health population was zero. Even now, it is 80% lower than before the start of the program.  And this was during the heart of the recession, when there were plenty of factors to make anyone depressed, plenty of reasons that someone might look into the heart of darkness, and decide the pain and shadows are too much to bear any longer.

Today on All Souls' Day, residents of New Orleans must show iID to be allowed to come to the historic St. Louis Cemetery No. 1 to pay their respects to those who have died, following a new directive by the Archdiocese of New Orleans, prior to my visit there.

Today on All Souls’ Day residents of New Orleans (another city that has seen it’s share of darkness) must show ID to be allowed to come to the historic St. Louis Cemetery No. 1 to pay their respects to those who have died, following a new directive by the Archdiocese of New Orleans (prior to my visit there).

How did this happen?  Henry Ford Health system is not situated in a rich community filled with deep pocket books.  When I trained there, most patients were on Medicaid or some type of assistance. Though the people I worked with were all hard-working, dedicated professionals, they are no different from health care providers here, or anywhere I believe. The answer, I think, lies in turning upside down the presumption that nothing can be done, and aiming for complete eradication of the problem of suicide.  And though a complete analysis of this phenomenon hasn’t occurred yet, all signs point to the possibility that the extensive work put into achieving these results has actually saved this medical system money.  While we have politicians spouting sound bites about how broken our health care system is, in Detroit, a symbol of decay and decline, some big dreamers actually are making a difference in patients’ lives, and managing not to make the bottom line worse.

Why isn’t this story all over the news at night instead of Donald Trump’s unnatural hair do?  I think it is because we have a tendency to focus on the negative and the darkness. In optical illusions, we have to train our eyes to see beyond the negative spaces.  To see what is right there in front of us waiting to be revealed, we need to let go of our preconceived notions, and be open to a new perspective.

What do you see first? The beautiful curves of the chalice, or two faces about to kiss?

What do you see first? The beautiful curves of the chalice, or two faces about to kiss?

What can we do on this Feast of All Souls, to turn away from our old familiar friend darkness and negativity? For me, I’ll start with welcoming the light of morning, instead of mourning the darkness that comes too soon.  I’m thankful today for all those in Detroit working hard to make the impossible possible, for news that manages to highlight positive stories, and for the blessing of warm covers on chilly mornings.

Holding Hands


My father has hands like bricks, reddened and hard, fired through years of tilling Michigan clay, lifting dirty tires in February winds on the narrow shoulders of freeways, and sanding smooth the doorways of the house in which he has lived since 1977. I never thought much about his hands, except as a kid when I’d done something wrong and feared his wrath. In the days before time-outs and worrying about self-esteem, my father’s hands were scarier than a belt or a “wisdom stick”. My grandmother and mother used switches we had to pick ourselves from the two oak trees in the front yard, but my father’s hands were tough enough to make us think twice. Punishment meted was swift and painful which we earned often enough between the four of us, mischievous and curious as we were. We didn’t view it as abuse, given the nature of corporal punishment at the time, in fact, preferring a swat on the behind to being grounded or other non-corporal punishments.

My hands look more like my mother’s, slim with longish fingers for the small hands that I have. I always wanted bigger hands with longer fingers, thinking them elegant and more agile for things like playing piano or building things. Having small hands can be advantageous though, as I discovered the first time I participated in an exploratory abdominal surgery. Surgeons will frequently talk and joke during surgery, but during this one, as I stood very still trying not to contaminate the sterile field while holding retractors, one of them asked who had the smallest hands in the room. Surgical gloves are sized from 5.5 to 9 and specific to right and left. OR techs and nurses know what size and type a surgeon prefers to wear and everything is set out prior to the procedure. If you are new, they will ask you what size glove you wear, then help you to put them on to maintain sterile fields. I wear a 5.5 or 6 depending on what is available, and so the nurses pointed to me. Because I had the smallest hands, they asked me to insert my hands into the patient’s abdominal cavity to break up adhesions around the liver. The feeling of sliding my hand around someone’s liver was incredible, smooth and strangely slick, and thrilling to me.

I never thought much about anyone’s hands until the day my future husband asked to hold mine. When I was young and dreamed about the man I might someday marry, I never thought much about what he would look like, let alone what his hands would look like. As little girls, my next door friend Amy and I would hum the marriage song as we processed across the family room, holding a worn bunch of plastic flowers. The husbands we married were incidental, a necessary part of the process to get to the next step which was stuffing a baby doll up our shirts to pretend we were going to be mothers. This would be followed by pretending to be Princess Leia or Lady Jane from GI Joe. Our summers were filled with acting out fanciful scenarios of heroines and heroes with our brothers. I never pretended to hold hands with anyone though, never realizing what a lovely part of being with someone that it is.

In romance novels, a lot of the descriptions center on kisses between the main characters. Rarely do they talk about the sweetness of holding hands.  It is said that the handshake evolved from the ancient custom of a showing of hands empty of weapons. I think the knowledge ascertained from holding another’s hand in yours can be greater than just knowing they do not hold weapons. In my present work, I check hand-grip strength on patients regularly. It is a part of our diagnostic tool set, telling us if there is weakness or tremor, but patients will look at my hands, concerned that they will squeeze too hard.  I’m learning not only about grip strength though when I hold their hands. I can tell what kind of work or hobbies they do, if there are lesions that haven’t healed, if they bite their fingernails, or if nerve damage is present, among other things.

When I held hands with my husband for the first time, I was struck by the similarities between his hands and those of my father’s.  Though we were largely strangers to one another, his hands were familiar to me.  I understood instinctively what kind of person he was, though I could not have put it into words at that moment as young as I was.  Once while we were dating, he apologized for the state of his hands, rough from the work he had been doing.  I told him what I still believe today, that there is no shame in hard work.  His hands are never raised in anger to our little ones, though they are just as mischievous as I ever was.

The church in which we worship holds hands during the Lord’s Prayer, an act which always makes my children a little wary.  They don’t want to hold hands with someone who is not part of our family, and I never force them to, but they are frequently rewarded with a smile from an elderly person who might be sitting near our less-than-angelic children.  Some might call this practice unhygienic, and in fact, there are times when they are ill or someone else is that we don’t hold hands, but in that there is still a lesson about how we care for others in the community by respectfully declining.   They are learning too what it is to be connected, to know the feel of someone else’s hand, to be gentle in the way they grip arthritic fingers, and not to fear the unknown.

There is something powerful in the act of holding hands. It is an act that literally and figuratively connects us. As mothers we have known the secret feeling of children dancing within our wombs, like stars slowly spinning within the nebulae of our own personal gravity, but for our men, it is the grip of their baby’s tiny hand around their finger which shifts time and space.  As I watch my children grip their grandfather’s hand walking with him on a mountain hike, his other hand gripping the walking stick shaped with loving care by my husband’s hands, it occurs to me that I stopped holding my father’s hands after childhood, when I no longer needed his help to walk.  I remember the feeling of my hand in the crook of his arm as he walked me down the aisle of our church and the way it felt when he put my hand in my husband’s, like a blessing and an absence all at once, and I know it is too soon to let go.

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My little guy hanging onto his grandpa.

Today I am thankful for all the hands that shaped my life along the way. I am grateful for silly internet pictures of otters holding hands to remind us that we are all connected, and pray for the strength to hold on, for as long as we are blessed to have those we love in our lives.  I’m wishing my father a blessed 80th birthday, and praying for many more birthdays like this.