The other day I played a certain guitar chord requiring all four fingers of my left hand. It rang with a sharp, sustained joy I hadn’t heard for half a year.
It was six months ago tomorrow that I got that hand into a table saw. The blade mangled the last joint of the little finger and also slashed the ring finger, which by comparison was trivial. The force felt like a hammer blow.
Panting something like “Whuh! Whuh!” I held the hand out of sight behind me and stumbled over to the workbench for paper towels. I wrapped the mess without looking at it, compressed the wad with my good hand, and gathered strength to go back and look for fingers on the table. Or on the floor, where the saw had flung the board I was cutting.
I poked through the sawdust and found much blood but no pieces. So I wrapped more toweling around the soaking wad, threw the roll on the car seat, and drove one-handed to Lakeview Hospital in Stillwater — the start of an unexpected healing journey that has become the most precious gift I’ve had in many a Christmastide.
Injury as allegory
If illness is metaphor, as Susan Sontag said, then injury is allegory or perhaps even parable, with much of the same subtext of blame.
Among people who asked about my splinted paw with any interest in how it happened, I noted two main types. Woodworkers wanted to know exactly how the cut went wrong so they could avoid my mistake; the others were focused on how I’d gone wrong, if I had somehow been careless, whether I’d learned my lesson.
No complaint meant there. Even before reaching the emergency room I, too, was retracing what I could remember of the event for evidence of fault. Problem was, I didn’t really know what had happened and wouldn’t until that evening, when I traced the blade’s path through a cedar board (picture and details at end.) But that’s getting ahead of the story:
I got to the ER in dusty shorts and sweaty T-shirt, fairly calm but strangely thirsty. A receptionist got me a cup of water, which I managed to gulp down before a nurse scolded me for putting something in my stomach when I might well be heading into surgery. Meaning, I assumed, for amputation.
An hour or so later I was in a hospital bed with the mess unwrapped and cleaned up enough to go to X-ray. A physician’s assistant was telling me as she probed around that she didn’t think I’d have to lose much more of the finger, if any. But the reassurances didn’t align with her grimaces and head-shaking.
Alone for a moment, I took my own first long look from various angles and also made a couple of fumbling cellphone pictures, just to rule out any chance I’d ever forget this moment and its lessons, whatever they turned out to be.
It looked like the blade had entered the back of the finger and gone almost through to the other side, or else entered at the tip and ripped back to the first joint. The nail was split both lengthways and crossways in a few places and shards of it were gone, along with much tissue formerly beneath and behind it.
I learned that this wound was not a laceration but an evulsion — new word! — meaning less of a sharp slice than a sloppy, torn-out furrow. Also, that X-rays showed the bone to be shattered, with fragments missing. On the plus side I could flex the finger, so the tendon was still there, and I could feel her stroke it on either side, so the main nerves were good.
Still, there wasn’t much the PA could do. She put in three sutures but finding good anchor points was difficult; the threads drew the banks of the ditch together but now the end of the finger came to a point.
She added a splint to correct an inward tilt beyond the last knuckle, then added yards of gauze and tape around both fingers, then anchored the dressing back to the wrist with turns of flexible bandage. Then she sent me on my way with instructions to see a hand surgeon ASAP and, in the meantime, to quit obsessing about amputation.
Fair enough. I shifted to thinking in a matter-of-fact way about the limitations of living with nine and a half fingers, a list that grew longer as I learned about the importance of the pinkie.
Importance of the pinkie
Did you know that half your grip strength is dependent on your smallest finger?
I didn’t until I read a blog post helpfully entitled, “If Kidnappers Chop Off One Of Your Fingers, Here’s Which Finger You Should Sacrifice.” Its somewhat medically informed wisdom was that the pinkie is the last finger to offer up, if the terrorists give you a choice; the index finger is first because the other three can fill in for it. (The ring and signaling fingers are also less essential than the pinkie but create a difficult gap for the others to bridge.)
This was not reassuring, as it extended the zone of potential impairment to the handling of kayak paddles, mainsail sheets, garden spades, lumber ….
The hand surgeon confirmed all this as he added an additional, figure-eight suture to pull the pointy end back into round. The fingertip now looked like a tiny, boneless leg of lamb trussed for roasting, and it was floppy; bone regrowth was going to be the critical issue.
X-rays showed the bone as a stream of pebbles, but he said it was possible that new bone would grow among the fragments. If not, scar tissue might fill in and do the job; if neither, we could look at options a few months down the road.
But considering the violence of the injury, he said, your situation looks pretty good. Keep the dressing dry, wash the wound only by running clear water over it, take antibiotics for seven days, come back in two weeks to have the stitches out.
Healing progresses, unevenly
There was never much pain during the healing period and only a little bleeding, at the very first. By the time the stitches came out an eschar — another new word! — had formed at the fingertip, blocking the wound like a boulder in a ditch. It looked and felt like a cooked, shriveled, rock-hard black bean and would become a major annoyance in typing.
I gained official permission to give up the splint and abbreviate the dressing, which at full size was maybe an inch in diameter by four inches long; I kept bumping and catching it on things.
Life went on. Within the first week I was using the table saw, minimally and a bit apprehensively, to finish my interrupted project, which I like to think of as The God-damned Fence I had to build around my garden in unconditional surrender to deer and rabbits. (But I relied on hand tools for the particular cut that had gone wrong.)
We were set to go on vacation for July Fourth and again right after suture removal, and we did, and except for swimming I was able to do it all: biking, sailing, even visiting one of these aerial obstacle-course parks where you ride ziplines, climb rope ladders and cross rope bridges (with steel rope in place of hemp, which required leather safety gloves, which in my case required a medium on the right and XXL on the left).
Cleaning and caring for the injury became simpler and sometimes interesting, sometimes revolting, as new tissue grew and old parts fell away. The Bean shrank very slowly and finally fell off — OK, with just a little help — at the end of July, leaving a raw-looking crater beneath.
The nail had grown out ragged, but was now long enough to shape with a clipper, and though the last joint had grown less floppy the tip still wobbled like the rubber joystick knob in a laptop keyboard.
No dressing seemed to be needed, unless I was working in the dirt, but accurate measurement was now possible and it seemed clear the pinkie was going to end up as much as a quarter-inch short, with a possibly permanent groove in the tip. The limits to regrowth seemed to have arrived.
More regrowth to come?
I had my last visit with the surgeon in early September; new X-rays showed a bone that was a little short and irregularly shaped but essentially covered the distance. We talked about the fingertip’s strange variation from warm to cold, numb to hypersensitive, and he explained that while the main structures were now essentially complete, it might be a full year before all vessels, and the tiny nerves that open and close their valves, would be fully re-established.
I told him that my typing accuracy was pretty good, except for a tendency to hit the Caps Lock key instead of the A, which mDE IT LOOK LIKE I WAS SHOUTING bout something, and I confessed my dejection at not being able to fret a guitar string with a fingertip that was too short, too clumsy and too sensitive to pressure. Was there anything I could do?
His answer was amazing, and I paraphrase it here from notes I made afterward:
You have to tell your finger how you want it to heal, how you want it to grow back, by using it now in the way you want to use it forever. So press the strings as much as you can stand. Type a lot — or tap a tabletop with just the pinkie, over and over, to train it.
This was a horrible injury. The healing you’ve had so far is toward the upper end of what we could have expected. But in a way it’s not so unusual. People think of hands as intricate and complicated, which they are, but also as fragile and slow to heal, which they are not.
We are part of an evolutionary line that goes back to cave dwellers, and if you were a caveman who had split your fingertip shaping a spear point or something, you might have lost your ability to handle the spear or an axe, therefore to hunt, therefore you might well have died.
Our hands heal quickly and I believe this is why — because they have always been so critical to our survival. Usually you’d be better off blind than without functioning hands.
You may have more regrowth by the end of next summer, or you may not, but either way you’ll have essentially full function.
I followed his advice and went into pinkie-tip training, but the guitar part was so painful and disheartening I did it only rarely. Still, the overall program has now paid off and part of the reason I’m writing this today is to pass the surgeon’s encouragement on to you:
Know that if you should happen to suffer a serious hand injury next week or next year or whenever, there’s good reason for faith the healing will surprise you.
* * *
A note to woodworkers and others interested in the deets of how this happened:
I was making lap joints, which required sliding the board over a blade raised only about a eighth-inch above the table surface, to cut a pattern of shallow, parallel grooves; later, with a chisel, I’d remove the wood between the grooves and have a flat recess in the board, to match a recess in the other board that formed the joint.
I had done this hundreds of times but never (so far as I can recall) at a miter, meaning that the grooves were not cut straight across the board but at an angle, in this case 45 degrees. At the fateful moment my left hand, holding the board against the sliding miter gauge, was at least 6 inches from the blade.
It seems clear from the saw tracks in the wood that the blade hit a knot and spun the workpiece violently to the right, chewing out a wide arc as it lifted the board and threw it across the room, and there was no way to let go of it in that split second. A fluke of bad luck but also of good luck; if I’d been cutting deeper grooves, with the blade higher out of the table, the odds of fingers on the floor would also have been higher.
What did I learn? Instead of cutting these boards to length, then shaping the joints, it would have been better to cut/clean the laps in a full length of cedar and then divide it. Also, that before ever again doing table-saw work on pieces this small, I’ll build one of those sliding sleds with multiple hold-downs so the sled holds the workpiece and I hold the sled, hands gripping loosely and a long ways from spinning steel.
Oddly enough, as I finished the joinery for this project with hand saw and chisel, it brought back memory of the evening 30-some years ago that I went to an emergency room with the only other woodworking injury I’ve ever had that needed suturing. I was making big dovetails in a bunkbed for my little boy, and as I cleared out the waste I hit a soft spot in the board, and ran the chisel all the way through the wood and into … the ring finger of my left hand.