2005 Hand Blog

If you are viewing this page, you probably heard that I injured my hand quite badly in an accident with glass on March 11, 2005. As a sort of personal journey, I have decided to keep a succinct journal that tracks the process of recovery. I will occasionally post pictures and personal observations about the healing process on this page. Currently I type quite slowly with my left hand, so I won’t go into great verbal detail. I simply don’t have the time to do that right now. I’m keeping this blog in the spirit of education for those who might someday have similar mishaps (and I pray you don’t.)

The blog is basically finished, sealed up and presented here in a final form. When I moved everything to the new site, I rearranged the reverse-order text to a forward order, to make things a bit easier to read. photos will come later.

Thanks to the many people who have written to share their kind wishes for recovery after the hand accident.

March 16, 2005

I’ve had an “Interesting” few days this last weekend. I am typing with left hand, after four hours of surgery Saturday morning (March 12). I slipped with a glass jug that I had been cleaning, which broke and pierced my right wrist, severing an artery, 7 tendons and the ulnar nerve. Quite a mess. I woke up after the anaesthesia with a big fat wrap on my arm, making it rather hard to do anything since then. Things should be OK. I’ll be re-learning how to move three fingers over the next few months, and hoping for sensation to come back to the little finger over that time. Luckily most of my music doesn’t require much hand dexterity (…well, flutes will be tough for a long time, and I guess I won’t be doing another piano album anytime soon!) I have chosen not to cancel my various commitments in the coming months, so I should have plenty of distractions and some extra challenges.

All the best,
Robert Rich

Look, I can move my finger … sorta. 3/16/05

Just back from the hospital, with the cat keeping watch. Thanks to my wonderfully patient wife Dixie for taking pictures and putting up with my clumsiness (and driving me around for the next month or two.) 3/13/05

Spice-cat keeping guard over the patient (photo by Dixie)

March 22, 2005

Fight the power!

Or, if nothing better to do, I’ll try every 5-10 minutes to pull up on some rubber bands attatched to hooks glued to my fingernails. Susan Clark at Daniel’s Therapy in Mountain View made a custom molded thermoplastic shell to frame it all. She’s wonderful, with a warm sense of humor and a good understanding of what I should expect in the coming months. The entire left side of the hand feels crawly and numb, with sensations not unlike worms crawling around inside. I think it’s phantom nerve pain, the blunt ends of cut nerves sending confused signals up to the brain.

Me and my stitches, seeing them for the first time, trying not to feel queezy. I’m either smiling for the camera or just gritting my teeth. Wow, that was a big chunk of glass.

First hand therapy session.

March 25, 2005

Today I visited my hand surgeon, Dr. Anthony Nguyen, who removed the stitches and evaluated my progress. Bad news. The tendons have apparently stuck together during the healing process, despite my efforts to keep moving my fingers. He decided to schedule a second surgery for next week, where he’ll go in and un-stick the tendons, separating them from each other and from the scar tissue that appears to be attatching them to the meat nearby.

Despite my best efforts, I got a bit nauseous when he was moving my fingers around, because the stuck tendons feel like they’re pulling on my whole body from the inside. I try to put on a bold face to the whole process, but I must confess I feel a bit defeated today. Hearing that I need another surgery just took the wind out of me.

On the positive side, I was able to wash my hand for the first time in two weeks. That’s an improvement, at least.

Not wanting to post anything too disgusting… but here’s my hand today, right after the stitches came out.

March 31, 2005

Giant cocoon hand thing.

Returning back to the larval stage, the giant armiloptera caterpillar is known to pupate several times before emerging fully into its mature winged stage. Notice the thumb-shaped proboscis protruding from the dorsal side of the pupa, which in its mature form will evolve into a sophisticated tool capable of manipulating objects in the animal’s environment.

Yup, second surgery time. Dr. Nguyen went in to cut away the scar tisssue that was binding the tendons together. The tendons to all four fingers got bound together, including the forefinger, which had not originally been injured in the accident. I learned before the surgery that it’s rare for this binding to occur so early in the healing process. Apparently tendons can bind to scar tissue more often in the 2-4 month time-frame. It seems I might be prone to healing almost too fast for my own good. For that reason, Sue Clark (hand therapist) has me on a very intense movement/exercise schedule to keep things from sticking after this new surgery. Every 15 minutes I need to cycle through 10 finger extensions for each of the individual joints on the four fingers, a soft grip with help from the other hand (passive flexion), thumb flexion, and stretching each finger joint up against a toungue depressor. Those exercises take at least 5 minutes, which leaves very little time to do anything else.

April 8, 2005

It’s hard to believe that four weeks have passed since the accident. The time has rushed by in a blur. We took Ian Boddy to the airport today after a successful week of recording. Ian did most of the computer driving while I added opinions and a few simple additions.

Today also marks a major milestone in the recovery process: no more brace, and a lot more stretching. I had a meeting with the hand surgeon and physical therapist together. I thought the stitches would come out today from the second surgery, but no. Dr. Nguyen was rather concerned about my tendency to develop scar tissue so quickly that the tendons are starting to bind up again. (I have a hunch he’s writing a paper on this.) He instructed me to remain without the protective brace, to encourage a wider range of motion; and he decided to leave the stitches in for another week as a protective measure to allow more vigorous stretching.

The therapist told me, “Party time is over. We’ll have some hard work to do.” Meaning that my visits wth her will become quite a bit more painful in the coming weeks. As we attempt to break the tendons free from the binding scar tissue, I will work towards being able to spread my hand flat onto a table surface. It’s like tearing off a scab from the inside. Currently the fingers curl inwards and pull on my wrist tissue as I try this, feeling like someone is yanking on my guts with a fish hook. I think my intake of pain killers might increase for a while. Numb is good. I’m fighting to regain full motion of this hand, and it’s going to hurt.

The fine art of one-handed rock scraping, while Ian Boddy steers the computer and takes a snap.

April 15, 2005

Stitches out from the second surgery today. I’m becoming familiar with the surgical term tenolysis, cutting away the scar tissue that forms around tendons. That’s what we did two weeks ago. We’re discussing another one, in a few months maybe, after the swelling and irritation subsides around my wrist and joints. Next time, we’ll do it without a brace or cast following the surgery, hoping to maintain full motion from the very start.

In the meantime, I’m supposed to keep moving my hand so I don’t lose what little motion I have. The therapist has me on a schedule of stretching, vibration, electrical stimulation, hot/cold baths and tissue massage in an attempt to break up or soften the scar tissue that has once again caused the tendons to bind up in the wrist.

My friend Nick Zirpolo suggested I look into acupuncture. He recommended Chris Macie at Integrated Healing Arts in Palo Alto. I asked the surgeon what he thought, and he shrugged, saying it would probably neither help nor hurt. So, maybe I need a good placebo right now. I will meet with Chris on Monday for an evaluation, and we’ll see if he can help direct my body into reducing its tendency to build thick scar tissue.

In the meantime, I have figured out how to hold a pen again, so I signed the artist statements for the upcoming “Echo of Small Things” box. These aren’t my most legible signatures, but they’ll do for now. Dixie caught me scribbling at our dining room table, preparing for the release:

Signing “Echo of Small Things” art box inserts.

April 28, 2005

I’m in a philosophical mood today, so stop reading if you get bored by meandering thoughts. Sometimes it just helps a bit to ponder the meaning of life, and I think the hardships that we all face occasionally serve as essential reminders about the importance of enjoying each moment, without which we would slide ahead oblivious into darkness. The Sufis say, “If you have no troubles, buy a goat.”

First, though, a progress report from medical perspectives. I saw the surgeon yesterday, who noted that the scar tissue that has stuck to my tendons is leather hard right now, too tough for him to operate on easily. He wants to wait a couple months to see if it softens, with help from physical therapy and any other means. Hopefully by then the inflammation will have decreased and we will have a more likely chance of success. In the meantime I will learn to function with fingers that barely move – luckily with a thumb that can still grip lightly.

The therapist and I have come to feel that acupuncture might be helping a bit in at least two ways. It seems to be reducing the pain during physical therapy, and it seems to reduce the inflammation for a day or two. It also affords me an opportunity to relax and get slightly better attuned to my body, something which I made a habit of ignoring for the last few years. The acupuncturist gave me a pair of small Bo Ding balls to try to manipulate with my injured hand. Our cat Spice finds them slightly amusing, especially when they jingle (see photo.) My fingers don’t move enough to rotate the balls, so I mostly tilt them against my thumb and use gravity to help them orbit each other.

Now I have a rare opportunity to feel what it’s like to be handicapped – hopefully only for a few months, maybe a year, and luckily in a relatively minor and non-life-threatening way. I’m reminded of the instinctual feelings of pity (usually blended with fear and disgust) that we naturally have for injured or helpless animals. I picture the determination of a three legged dog crossing the street in front of traffic; and rather than feel pity I feel the naturalness of that determination. I know that some people carry their handicaps as stigmata, punishments, reminders of past disaster; but we all only carry the weight of life, nothing more. This weight is a gift. Each of us will return this gift to its giver when we die.

The spirit of life is intense, indomitable, essential and pure. As I think back to the moment when I noticed that my wrist was cut, that I might bleed to death, the will to survive seemed anything but heroic, almost an afterthought. I remember laughing uncontrollably in a state of mild shock, thinking of the humor in this cosmic joke. In such instances the mind shifts seamlessly into pragmatic survival, with the energy of life leaving no opportunity for self-pity or heroism to enter the scene. Now that the emergency is long past I jokingly refer to myself as a gimp. Pity is still meaningless. (Ironically, such self-deprecation can bite back when it comes from outside. Words like “gimp” only seem funny when applied to oneself.)

I am reminded of a distinction that Nietzsche made in The Genealogy of Morals between pity and mercy, stating essentially that pity was a useless emotion deriving from weakness, while mercy was a positive action deriving from strength. I can now sense at a visceral level that pity fails to acknowledge the Life Force, for which all struggle grows naturally from essential being. As sentient animals, we can accomplish such immense acts of kindness and beauty (while hopefully avoiding their opposites) that I see no purpose for such wasted effort.

My largest struggle now comes in the form of laziness. Now that I have survived a small calamity, what mediocrity will I tolerate in order to make life easier? If instead I can manage to stay awake, then how much energy can I muster in order, first, to make myself whole again; and furthermore, to improve myself beyond merely repairing what’s broken.

Such minor hardships can sharpen our focus upon the reservoir of energy that comes to each of us as the gift of life. To whatever extent that we can or cannot reach our greatest potential, such reminders can also teach us humility and kindness, generosity toward the fallen and respect for those who carry the weight of life lightly. We can place into better perspective the essential nature of love and hope.

May 31, 2005

Sorry for the month-long silence. A few people wrote me expressing concern about the fact that I hadn’t updated my journal here, but all is OK. I have been a bit preoccupied with the release of “Echo of Small Things.” Furthermore, there hasn’t been a lot of drastic change in the hand process.

I’m in the midst of an important but boring time in the healing process. With the help of frequent physical therapy and seemingly constant exercise, stretching, and other forms of time-wasting attention, I have been slowly regaining strength in the thumb and index finger while trying to maintain joint motion in the four fingers that are stuck by tendon adhesions. I can lift things with my right hand by using the curl of my fingers and actually letting the scar tissue in the wrist take some of the weight. It sounds disgusting, but I keep hoping the glop in my wrist will tear free someday when I try to use it.

Spice investigating the Bo-Ding balls

So, basically, I’m in a holding pattern. I’m waiting to meet with the surgeon again in a couple weeks. We’ll discuss the progress and consider a time to do the third surgery. While I wait I’m trying to let things heal and keep the hand moving as freely as possible.

In the meantime I have had an opportunity to ponder the universe of medicine and those victims of physicality who inhabit its vortex. I try to remain optimistic and as “normal” as possible in my flirtations with malfunctioning meat. Black holes exist in this universe. They are psychic black holes, slightly different from Stephen Hawkings’ variety. The medical black hole is surrounded by the event horizon of injury and mortality. I have met victims of these strange attractors. I have met some who have fallen into the vortex of medicine to find themselves inexorably pulled into the looping magnetic fields of depression and chronic pain.

In this parallel universe to the world of the healthy, some unfortunate travellers disintigrate immediately into the passive flotsam of the industrial healthcare system, crushed by the gravity of insurance companies and bureaucracy. Others resist the psychic crush for a time, and retain the outward appearance of their doppelganger in the universe of the healthy. They walk among us with their vital energy constantly sucked from within, distracted by the siren’s call of illness, injury, mortality.

We need powerful thrusters to pull free from this vortex. As we try to escape the gravity of injury we dig inside for hidden reserves of fuel. We sometimes need to drop ballast. We return to the simple activities that take less energy. We postpone projects that can wait for later. We get less done. It’s a part of the healing process.

June 24, 2005

Another long gap has passed without writing, while I still play the waiting game. Today I met with the surgeon , Dr. Nguyen, to decide when to go in for another tenelysis. I’m home now from the meeting feeling somewhat frustrated with the long time this is taking. He wants to wait another two months before the next surgery. He seemed somewhat pleased with the slight softening that the scar tissue in my wrist has shown, and seems hopeful that the muscles in my hand are not starting to atrophy very much due to reduced range of motion. He wants to wait until the scar tissue is softer still, as that will make the surgery easier with more likelihood of success. We’ll meet again in three weeks, and probably decide to cut again in mid-August.

In the meantime, hand therapy continues twice a week, as we work to maintain muscle tone and joint motion. I am working only a little bit on music, so I have fallen behind schedule on the new CD with Ian Boddy. My productivity seems to have taken a big hit, and I find myself rather distracted and barely able to concentrate on music. Part of me seems to have gone off-line for a while. I do expect to get this album edited and mixed soon, so it can come out in Autumn this year. I also feel a need to return to the half-done “Electric Ladder” solo CD, which has been sitting on ice since February. Hopefully my self-inflicted work guilt will force me out of this gimpy state of suspended animation.

July 24, 2005

I met with Dr. Nguyen on Friday, and we are planning the date to do the third surgery around the third week in August. He seemed pleased with the progress of healing, as he has been waiting for the scar tissue to get soft enough to diminish the chance of re-building adhesions after the tenelysis. Now I have about a month to strategize the exercise (and painkiller) regimen that I’ll maintain to prevent re-adhesion. I expect this will mean full-time attention for at least a month and probably longer. Not much more to report, except that I’m trying to work out the finance realities of all this medical stuff. It won’t be cheap.

August 4, 2005

I maintain the standard practice, physical therapy, exercise, waiting for the next surgery with hopes that I get it all working eventually. I woke up from a wonderful dream last week. I dreamt that I was showing my tendon adhesions to someone, curling my fingers and watching the skin on my wrist wrinkle, when I surprised myself with a squelching sensation and – miracle occurred in front of other eyes – the tendons broke free of the scar tissue and I could move freely again. I could feel every grain of tissue slide past the tendons in my dream arm, meaty and visceral, like rubber bands pulled through hamburger. Not a drop of pain, just amusing discomfort in a strangely meaty context. I woke up so hopeful from this dream that I wriggled my fingers trying to recreate the sensation. Damn. Still stuck. I hope that’s what it feels like in a month, when I’m trying to maintain motion through the next tenelysis.

I’ll take a few days off next week. I’m going up to the Sierra Nevada high country to camp with some friends. These folks retrieve me from Silicon Valley every year or so to remind me about the things that really give me joy. Pat Fleming used to work at Sequential Circuits around 25 years ago when I was playing in a band with Rick Davies, who also worked at Sequential and introduced us. Pat now designs elevator control systems in Sacramento, and lives in Fiddletown (gold country) in a cabin with a vineyard, growing grapes and making wine when he’s not thinning the chaparral scrub and poison oak. Pat and I felt like long lost brothers from the moment we met. He grew up in the Sierras and knows them like his own body, and I rely on him for wilderness guidance. We’ll hike with our friend George Bergantz, a geology professor at University of Washington. What joy to have such friends!

Back to the hand recovery stuff…. I have been wanting to write a bit about the fascinating layers of nerve regrowth. I haven’t gone into detail simply because I feared that readers would misinterpret my descriptions as evidence of pain and misery. I should let everyone know that I have been very lucky in terms of pain. I haven’t been bothered much by pain. I’m not saying that I haven’t had some periods of intense sensation, and certainly some painful moments, but for the most part, the intense sensations have been more abstract and interesting than “painful” in the pure sense of the word. Maybe I’m just skilled at dissociation. So please read the next paragraphs with that in mind. This is observation, not complaint.

Nerves on Parade

Immediately after cutting myself, I felt no pain. I think I sensed a slight stinging, but the shock of injury sent an injection of adrenaline and endorphines into my brain, making the whole experience seem distant and surreal. Very coherent, I could observe what had happened visually and mentally, but I couldn’t really feel it. In self-defense my brain shut off those sensations.

The day after surgery, the general anaesthetics worn off, the ulnar nerve started to send a few signals to my brain as it attempted to guess at what was going on downstream. Of course, the nerve had no way of knowing that the signals were false, chemical phantoms from a recent blunted termination.

Confused by the signals, my brain tried to interpret their meaning in the best way that it could. Consciously, I knew these were false interpretations, so I was able to observe them somewhat dispassionately (which I still can, I think.) Yet I was fascinated at how convincing the interpretations could be. At night I would awaken with distinct sensations. Often, these would fall into a few categories: 1) the feeling that someone was pounding a nail into the joint of my little finger; 2) the feeling of putting my fingers into an electric socket at full voltage, or sometimes a slower shocking at steady mid-current; 3) alternating cold and hot burning sensations; 4) a feeling like someone was abrading my hand with sandpaper.

During the next month, I started getting a bit of sensatation in the little finger, which may have come from cross-enervation with the median nerve. These sensations had little relation to reality, though. I could brush a part of my little finger against a surface, and I felt like someone was trying to rip the fingernail off. Or, in a related way, I felt like I had squeezed the fingernail in a vise, then released it, with that intense resonating echo of deep proprioceptive pain. That’s not a good thing, trust me.

Those intense sensations dissipated over the next month, and left behind a lingering electric current. I could tap on my wrist and find the growing tip of the nerve when I sensed a shock ringing up into my hand. I could tell that the new nerve growth came in waves, because certain active times felt different, like worms crawling under my skin. During calmer times, the phantom sensations often felt like a bad burn, as if I had splashed boiling water on my hand the previous day, leaving me with a tingling stinging sharpness.

During this period of healing and regrowth, I had a few moments of outright laughter. Once, I wanted to carry a chilled plastic bottle of drinking water into the studio with me to start some work, and since my right hand couldn’t grip, I clutched it in my right armpit so I could free up my left hand to operate the door key. As soon as I placed the clammy wet bottle against my inner arm, I felt an echo of the cold damp sensation along the numb section of my hand, as if I had dipped it in water, as my ulnar nerve was grasping for any strong sensation that it could find to replace the absence of a signal past where it had been cut. Since then I have sometimes noticed other tactile echoes. If I brush something hot, cold, or textural up against my inner forarm, it often rings in the area where the nerve is re-growing. I think that’s fascinating.

Overall, the nerve regrowth is coming along quite well. Now, in the ulnar area (pinky, ring finger and that edge of the hand) I have rather constant mild tingling- cold- hot- wet- electric- tickling random sensation, as the dendrites of the nerve spread their tentacles through the tissue of my hand. My brain hasn’t quite figured out how to map these new nerve endings. Sometimes it misplaces their location, other times it confuses cold for hot, rough for smooth. I still don’t feel much at the skin level, but I am beginning to feel things inside, if I squeeze my finger firmly. It doesn’t feel like squeezing, but at least it feels like something.

Here’s something else I never thought about: cutting my own fingernails. I do it frequently, as an afterthought since I’m accustomed to keeping them short in order to play piano without interference. With no sensation in some of the fingers I want to trim, it becomes a different process. I actually find myself worried that I’ll cut into my skin, since I can’t feel the clippers. I don’t know how far I’m cutting except from visual inspection. How do manicurists do this for other people? Same thing while cooking: I have to keep my eyes on a flame or a knife edge, to make sure I don’t burn or cut myself without knowing it.

I’m a bit surprised to be feeling some new tingles of nerve growth in the web between my thumb and forefinger, sometimes a line of shooting discomfort when I exercise my fingers into flexion. The ulnar nerve should not be growing there, should it? My physical therapist thinks it’s the median nerve, which may have gotten injured a bit with all the other mess, and now might be re-growing its lost tendrils. It’s a strange feeling, but I figure the sensations are mostly artificial, artifacts of chopped nerves that don’t know what signals to send. They show signs of new growth, and teach a good lesson on the relativity of sensation. That’s a good thing, right?

For me, this remains a science experiment with personal ramifications. I have not been haunted by the pain, but rather fascinated by sensations that show me the inner working of the body’s healing mechanisms. It’s cool stuff.

August 16, 2005

In two days I go in for my next surgery. After that, I’ll keep moving my hand so the tendons don’t get a chance to stick again. I’ll sleep with a CPM (Continuus Passive Motion) device attatched to my wrist, slowly moving my fingers up and down with a stepper motor. I won’t have a brace, only a pressure bandage around the incision, so I should have full motion of my fingers. Maybe I’ll even be able to play piano? Wish me luck!

September 3, 2005

It’s been a rough two weeks. I’m tired. The third surgery was only partly successful in freeing up all the fingers. My tendency to form scar tissue deterred the surgeon from freeing up the little finger and ring finger, because their tendons were stuck to each other up in the palm of my hand, beyond the carpal tunnel. That’s a very sensitive area for scarring, and messing with it risks triggering new adhesions later. (Even people who don’t create excess scarring have troubles in that area.) Furthermore, the tendon connected to the tip joint of the middle finger ruptured during surgery, and it won’t be fixable.

I went back into the hospital last Wednesday with a post-op infection, had a fourth surgery to clean out the wound and spent 5 days on intravenous drip of antibiotics and morphine. It took another few days to recover from the intestinal aftermath of the morphine, and I’m still setting the alarm every 90 minutes at night to wake up and exercise my fingers to keep the gains we achieved in the surgery. On the good side, I can now move my index finger and middle finger independently, so there has been some improvement. Suffice to say I haven’t gotten much work done lately.

I am starting to resign myself to the possibility that I won’t be able to play flute again, at least not my homemade flutes with their wide fingerings. Those flutes require me to lift my little finger independently from my ring finger. Right handed keyboard parts will also be rather clunky, so Open Window may remain my only solo piano CD. I’m trying not to let this get me down, and I feel lucky that I’m mostly known as an electronic composer, where the tools allow me to work in the realm of pure sound, and manual virtuosity doesn’t matter so much. Still, the dark moments do intrude, and I look forward to the near future when I have more energy, the scars have healed over, and I can move onward with all this in the past.

October 12, 2005

Some good things have been happening lately. I’ll see Dr. Nguyen on Friday and I can’t wait to ask him about one of the improvements I discovered. In the last week I have learned to bend the tip joint of my middle finger, which I shouldn’t be able to do since the tendon ruptured. It doesn’t bend very much, and it takes a big effort to isolate it from the other fingers, but if it bends at all I think that means there must be some connection to a tendon. Maybe my weird scarring patterns actually did something useful for a change? Perhaps the loose tendon-end is getting stuck to other tissue that can pull it along? It’s hard to imagine.

Furthermore, as I continue to get a bit more ulnar nerve sensation in the little finger, I am working to get that and the ring finger to move separately again. I doubt that they’ll ever really move freely (they are still stuck to tissue in the wrist), but I have been getting some progress. I even played a bit of flute last week while working on some sound design elements for Paul Haslinger. The flute parts consisted mostly of dissonant overtone screeches, but it felt good to play again regardless.

I have been extremely busy with studio work, and staying very physical these last two weeks during winemaking season. I have been climbing up and down the same staircase that I slipped on 8 month ago, carrying heavy objects with wet shoes. Perhaps I’m a bit extra cautious, but the activity does some good during the process of psychic healing, which must always accompany the physical healing and probably helps pull the physical side along.

January 3, 2006

The hand is slowly repairing parts of itself, but I doubt it will overcome the scar tissue adhesions. This over-active scarring is like a clumsy cousin who intends all the best, but somehow stumbles into everything and sticks to it. The ulnar nerve seems to be growing back still, slowing down a bit but still trying. I watch to make sure I don’t burn or scorch my little finger, since I don’t tend to feel such things for several hours, and then only with a curious discomfort that filters through the tingling. The pinky and ring fingers will probably remain coupled together and stuck at the wrist. The tip of the middle finger will probably always try to flip off my friends, but hopefully they won’t notice.

Work related: I have been making new end-blown flutes that I can play better with limited right-hand motion. The embouchers are different and I haven’t quite mastered them, but I am hopeful that I will get better by the Spring tour. I’m trying hard to finish the new CD by tour time, and feeling lucky that people don’t mostly know me for fast playing.

Things are pretty good, really. When I’m out in public, people usually don’t notice that I’m a but clumsy with my right hand (unless I’m doing a transaction at a cash register and fumbling with my wallet, when I sometimes take long enough that I have to apologize to the person behind me.)

Overall, I feel I have gained back about what I’m going to get, although I still expect strength and sensation to improve over time. I stopped physical therapy in mid-December, because the advantages seemed more related to time than attention at this point, and therapy sessions were getting rather expensive. (74 sessions total.) I send my extreme thanks to Sue Clark and the folks at Daniel’s Therapy for their excellent care (Carlo for the deep tissue massage with steamshovel thumbs, Steve and Quinn for extra assistance, Ron Daniels for runing a skilled and friendly office, Candice and all the others I didn’t name…) Anyone who gets a major injury should work through physical therapy. Really. Healing doesn’t all happen automatically. It’s an active process, and a good therapist can guide the process towards the best results possible.


Here is an example of a typical response that I have given to one of the many people who have written me about their similar injuries:

Dear () – wow, that sounds like a serious mess. I am ashamed to say I still get a bit queazy when I see these sorts of scars, so you can spare me the pleasure of seeing your slice… but my goodness, I do sympathize.

I can council this: be patient, and work hard with physical therapy. Don’t despair, and try not to get depressed if things seem to be healing slowly, or if scar tissue starts to fill in. It is natural to feel a sense of sadness, loss, frustration, anger. Just try not to wallow in it. Deep tissue massage from a good physical therapist may not cure everything, but it can help soften the scars and allow better healing. The physical therapist also will understand your feelings, he/she has seen this many times before, and can offer social support as well as good advice. You might not feel the same in your hand ever again… or you may get lucky and start growing connections quickly. In either case, you will learn to deal with your new body as it heals.

For me, it was a mixed bag. My hand can’t do what it once could. It probably is as good as it will get (where I left off on the blog.) I am very lucky that I can pinch with my thumb and forefinger, as the radial nerve was not cut. That is a huge help for me. I was a pretty good piano player before the accident, not so good now, but I still play music (it’s my career) I just adapt to my shortcomings. Most people don’t notice that my two small fingers always move together, that I don’t feel much on the ulnar side, that I can’t spread my fingers, or bend the tips. It doesn’t matter –  I work with what I have, and I am happy I didn’t bleed to death or similar. People have worse problems.

The key is to find your strengths and weaknesses, and focus on your strengths after your hand starts to heal, while working on improving your weaknesses. Scar tissue is your worst enemy in these healing times. If you have a good surgeon and if you don’t scar up too badly, you might even get full control out of your hand over the next few years, as the nerves grow back to fill the gaps. It will take time, so be patient. When the nerves do grow in, they might not map to the same places in your brain. Cold might feel wet, hot might feel sharp, tickles might feel scratchy… your mileage may vary. You can use this process as a laboratory to learn about nerve connections, it is an amazing experiment happening inside your own body. It also hurts, creates sadness, regret, frustration, all of those things. You will have to try to forgive yourself over the years for a trivial accident, a momentary slip that created months of hurt. You probably know this already.

Keep me updated about your progress. I wish you a safe journey.
All the best – Robert

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