In a blue and white room,
Light fingers unwind
A white castunveiling
Dark, deadskin.
Above the cast, the split tomb,
Light fingersdance around
Dark fingers, revealing
Red fingerswithin.
A tanned, stocky, middle-aged Hispanic man lay flat on the operating table in front of me. Last week he had 3 fingers cut off by a machine at his construction job, but the surgeon was able to sew them back onto his hand. This week he worried about a dead ring finger and sent in pictures. The surgeon agreed that the finger should be amputated before necrosis spread, so he was back in the operating room. As a second-year medical student, I was there to shadow.
As the surgeon peeled back the charred and crusty layers of dead skin, he was surprised to see red within. The finger was alive! There would be no need to amputate; they would only clean and cast it.
Little by little,
Layer by layer,
They peeled off death
From flesh and finger.
Afterward, the patient—feeling woozy—lay awake but with his eyes closed. As the minutes passed, he opened his eyes and strained his neck against the weight of anesthesia to look toward his hand.
“Anyone speak Spanish in here?” the surgeon asked.
Usually humble about my Spanish but confident about my next words, I said, “Su dedo anular tiene circulación. Está vivo.” (Your ring finger has circulation. It is alive.)
The patient became animated and spoke quickly. “No cortar,” he said, meaning, “not cut.” I reassured him, “Sí, no necesitamos cortar. Lo estamos limpiando.” (Yes, we did not need to cut. We are cleaning it.) The surgeon finished and the patient was moved to a recovery room.
I was there to shadow—to see—and indeed, I saw. The physical contrast of the light fingers dancing around the dark, as well as the fault lines where the machine had met his hand, made me think harder and feel more than before about a topic we are taught in medical school—socioeconomic factors. Innocent, light fingers were healing innocent, dark fingers, but socioeconomic factors helped place these fingers in these giving and receiving positions.
Did he choose to be a construction worker? Was it his dream to become one? Perhaps this man, shackled by a language barrier, a lack of higher education, and the hardships of immigration, found that construction work was the most reasonable line of work for him. But in this work, he was constantly exposed to hazards. And unluckily, an occupational mistake almost cost him 3 fingers.
The patient did not have insurance. What went through his head when he bled? Was it, “I don’t have insurance, where do I go? I have no money, so how do I pay? How will I work? How will I feed my family?” What were his questions? What order? What priority?
Imagining myself in his shoes made me feel compassion. But that was not enough. I was wondering when I should have been directly asking him questions to uncover the truth. We have lived different lives; how would I know what questions, in what order and importance, went through his head?
The yearning I felt to interpret meaning in Spanish also highlighted to me how inequalities in care are widened by language barriers. A language barrier translates to a greater risk of misunderstanding and inferior care explanations.
Meditating on the hands, I realized how important it is to ask personal questions regarding patients’ experiences to understand their illnesses, as well as the significance of fluency in their languages. The construction worker might never know how much he taught the medical student who observed his case. As I move forward with my education, patients will surely continue to teach and inspire me.
