June 2007 | Back to Table of Contents
Perspective
The Master's Hands
By Harrison Farley, M.D.
A simple surgery restores function to fingers and reaffirms faith.
In 1947, I took a required class in Old Testament at Westminster College in Fulton, Missouri. An immature 18-year-old fresh out of high school, I found myself among many returning World War II veterans. The ex-G.I.s argued about everything, and I soon copied their style. When our class discussed the biblical character Samson, I demanded that my professor, Dr. McQueen, explain how a man with the faults of Samson could be part of God’s plan for the Hebrew people.
“Well, Farley,” he replied. “God can use a crooked stick to good advantage!”
I considered his answer, then just a well-turned phrase designed to quell a student bent on stirring things up. Twelve years later, I had reason to recall it.
In 1959, after my own stint in the Army Medical Corps, I was serving as chief resident in general surgery at Minneapolis General Hospital. In those days, there was no orthopedic service as such, only the fracture and orthopedic division of general surgery, which every Monday afternoon held a clinical conference, during which practicing orthopedists would lend their expertise. During the slow week before Christmas, one described a rather simple operation for a debilitating hand condition called Dupuytren’s contracture. Dupuytren’s is a progressive tightening and thickening of the fascia in the palm of the hand, the layer of tough tissue just beneath the subcutaneous fat and above the tendons. It begins as a slight problem, with the development of tight bands just under the palmar skin of a patient’s fourth and fifth fingers. Eventually, the fingers curl downward, becoming fixed.
The procedure described by the orthopedist was to introduce, under local anesthesia, a narrow blade into the side of the hand and rotate it over the fascia, cutting it as the finger is extended. Quite simple, actually, but it had to be done with care so as not to injure the important flexor tendons underneath. If the joints were not frozen, the fingers would straighten immediately. A more complete but riskier palmar fascial excision is performed today.
On our service at the time was an 80-year-old man named Ned, who had fractured his hip in a fall at his nursing home. We had pinned the bone, and he was starting physical therapy. A heavy smoker who was not averse to a drop of booze, Ned had a deeply lined face. He had grown a scraggly gray beard, his hair was wild—in the manner of Einstein, and he was extremely thin. Although weathered by life’s trials and tribulations, he was clearly a survivor.
Yet, he was hampered by Dupuytren’s. Wouldn’t Ned be a fine patient for my first attempt at the new procedure, I thought. When I approached him about the idea, Ned, like most of our patients in those days, was trusting and eager to oblige his doctor. I explained to him that although I had never done the procedure, I expected it to go without a hitch.
“That’ll be fine, Doctor,” he said. “If you think it’s right for me, go ahead.”
I wheeled Ned to the elevator and up to room D, the smallest operating room in the surgery suite of the old hospital. After his hands were prepared and I had scrubbed, gowned, and gloved, I injected a local anesthetic and then performed the operation without trouble. To my surprise and Ned’s delight, I could fully extend his fingers. I applied a light dressing to each hand and wheeled him back toward his room.
As we passed the Green Room, where residents, interns, and medical students hung out, Ned asked me to stop.
“Is that old upright piano working?” he asked, pointing to a scratched Kimball standing against the wall.
“As far as I know it is, Ned,” I answered, although I’d never heard it played.
“Care if I try it?” he asked, lifting his lightly bandaged hands and proudly displaying to me the restored mobility of his fingers.
“Go ahead,” I replied. After all, he’d just let me try out a new procedure on him. Why not indulge the old guy?
I helped Ned move from the wooden wheelchair to the piano bench and watched as he sat for a moment deep in thought. Then he began to play. At first he was rusty, but soon what music came forth from that old piano! Wonderful Christmas carols, beautifully played by a master. And I saw for the first time the span of Ned’s hands and his obvious command over the keyboard.
“How long has it been since you played the piano, Ned?” I asked, incredulous.
“It’s been a long time Doc, but look at these!” He held up his hands and wiggled his fingers. “It comes back easily.”
He explained that for 25 years, he had accompanied silent pictures at the old State Theater on Hennepin Avenue.
As I wheeled Ned back to his bed on the men’s fracture ward, I realized that I had performed Ned’s surgery more for my own benefit than for his. Yet, here was this marvelous result. I recalled the words of Dr. McQueen: Was it an accident, or was I the crooked stick in a larger plan? MM
Harrison Farley is a retired surgeon from St. Paul.