Jock

On first meeting over the years, many patients have asked me if I played football. I'm sort of a big guy and, during some cycles of my life, have actually looked in reasonable shape. The answer would be in the affirmative, with the qualifier that in general I was comparatively lousy at it. Slow. Not particularly agile; hypo-endowed with the killer instinct. (I was captain of the high school team, and was honorable mention all-city, on a team that finished dead last and never won a game. At halftime of my final game an assistant coach finally got to me: the Knute Rockne rah-rah never worked, but this guy managed to shame me. You coulda been a leader, you dogged it, etc etc, such that I got a little steamed had a noteworthy second half, made a few tackles, a sack or two, blocked a punt; so the opposing coach gave me a nod at voting time.)

Probably it was my first game that did me in. I knew literally nothing about football before high school. My dad, unrealistically wanting bragging rights, convinced me to turn out for the freshman team, and to sign on as a fullback. I didn't know that position from the missionary position, which I also didn't know. Within a day or so, after observing me trying to execute a cutback, the coach said, uh, I think you need to be a lineman. We practiced, I learned, vaguely, what I was supposed to do, and we had a game. Before play began, the guy across from me said "I'm gonna kill you, mutherfukker" after which, when the ball was snapped, he popped me one in the face, resulting in a bloody nose and a revelation. Returning to the huddle as the quarterback called the next play I said, "Hey, I have a bloody nose..." He continued the play-calling. "Excuse me, I have a bloody nose. I need to lie down." With derisive disbelief, the quarterback looked and said, "You BABY!" It was then that I realized in football, you play hurt. Your mommy doesn't give you a cold wash rag and say nice things while gently squeezing your nose.

I kept playing for the next four years, mostly screwing around with my buddies, not too worried about the score. We shared an attitude.

In college, at the end of freshman year, during which I mostly rode the bench, I discovered rugby and never played football again. Our team was actually good; we were East Coast champions, beating much larger schools, Ivy League heavyweights, and I got inspired enough actually to get in shape, run a few miles a day, pump a little iron. Despite the fact that the team was run by a rival fraternity I made my way to the A team by dint of making myself better than the favorite (and frat-brother) of the leadership.

In five years of football and four of rugby, I was never seriously hurt until I returned to my college during the first year of med school. My former team was playing a traditional rival in rugby, and that team was a man short; I was pressed into action, playing for the enemy against my old mates. In a desperation tackle I lunged at a halfback, caught his collar and hung on, somehow managing to detach the tendon of the flexor digitorum profunda of my right ring finger. The required surgery was just before a pathology final. Operating my old-fashion microscope, with its clunky machinery, right hand in an above-elbow cast, was a challenge. And the professor was unamused when I hollered out half-way through the practicum, "Would someone like to come over here and twist my knobs?" It did, however, lead to a romance with a classmate that lasted a couple of years...

[I have realized I've told part of this before. Which means it's confirmed: I've officially run out of things to say. Sorry.]

Swan Thing or Another

I played rugby in college; that's me in the picture. We were a damn good team -- East Coast Champions a few times, played in tournaments in the Bahamas over Spring Break (yes, we did play.) The only time I got hurt was when I returned to Amherst during my freshman year in med school. It was a rugby weekend, and the opposing team was short one man, so I played for them, against my former team. Bad karma, I guess: in a desperation tackle, I collared a guy and my grip was stronger than the flexor digitorum profundis tendon on my right ring finger. After the game, when I tried to make a fist, the finger wouldn't flex. Bummer. Especially for a future surgeon. So I had it operated on.

Stupidly, rather than seeking out a hand surgeon (there were a couple there of great renown, including one with a fabulous name: Kingsbury Heiple. During one of our orthopedic exams, one of the students had written on the blackboard "Kingsbury Heiple is not a flavor of ice-cream.") I went to the student health service, who referred me to their default surgeon. And, rather than having the decency to send me on, he did the operation himself. Why not? He'd never fixed one before, and wanted to give it a shot. In my career, taking on an operation about which I couldn't honestly feel I was as skilled as anyone was something I never ever did. Back then, the concept didn't compute, and I never thought to ask the man if he knew what he was doing. He did, I found out later, ask ol' King how to go about it.

My important recollections about the peri-operative time are these: in the recovery room I must have moaned, because a nurse stabbed me in the thigh with some demerol. My thigh hurt much longer than my hand. I had one more shot of demerol the next day. It felt so good I told myself "never again!" I was casted to above the elbow, and had to take a pathology final that way: having trouble operating my microscope I asked if anyone would "come over and twist my knobs." I passed. The tendon was held in place via a wire looped through it, the finger-bone, and my nail. Removing it later hurt like hell. Probably would have been worse, had the surgeon not accidentally cut the medial digital nerve, making half my finger numb.

Which brings me to the climax: the surgeon had been so excited by the operation and the mechanism of injury that he told me he planned to publish an article about it. After the several weeks it took to get my finger mobile again, we ran into each other in the hospital and he had a look. No article ensued.

The finger, in repose.


The scar, following the course of the digital nerve.

A classic swan-neck deformity. Undesirable.

The tip is permanently bent, too. It moves, but not all the way up. Once in a while when grasping an instrument with thumb and ring finger through the holes, I have to try twice to let go of the damn thing. Not a big deal. They say you should find the good in the bad: for a long time the side-numbness of the finger bugged me bigly. I'd find myself constantly rubbing it, for some perverse reason drawn to (if that's what it was) the weirdness. When I touched that part of my finger to something else, it sort of creeped me out. A year or so later it occurred to me that I was no longer noticing. My brain had bought the feeling as normal and no longer brought it to my attention.

Which gave me a perfect demonstration to patients on whom I was planning axillary node dissection (most often for breast cancer): there's a possibility of a numb spot on the upper inner arm. It could bug you for a while, I'd tell them, but eventually you'll stop noticing. And then I'd show them my ridiculous finger, proving I knew of what I spoke.