Post 41. My Left Hand, Part 1

Pins, Patience, and a Little Bit of Rebellion

Of the two major hand surgeries I underwent, it's strange to me that I remember the hand operation on my right hand - the bigger and riskier of the two - in the summer of 1993 with such vivid clarity, yet the one on my left, which I believe happened in the latter half of 1992, is less etched into my memory. Maybe it’s because it came within a brutal stretch—20 operations in under six months. Despite the gravity and risk of each one, I seemed to cope better as time went on, almost like I’d been training for it. This was to be the last “big” operation Mr Clarke did on my hands before the baton was (reluctantly) passed to a specialist hand surgeon who we’ll introduce in time.

I love the flap of skin on my left hand. It’s soft—almost like a mini comfort blanket—and it serves as a daily reminder to be grateful. Yes, I lost two-thirds of the use in my hands, but that flap of skin gave me one really good hand and that opened the door to finishing my education, living independently, travelling the world, picking up poker chips, and taking on people at the pool table (I needed to find a sport I could still compete at).

My left hand, my survival tool

We’ve mentioned before that scar tissue, when fresh, relentlessly contracts, which is bad news anywhere you have joints that want to move. And the hand has a fair few of them. Before a donor flap of skin could be inserted to give my left hand the elasticity in the skin it needed, the existing skin had to be prepared with another surgery. The process was brutal but necessary: the tension of the scar tissue on the back of my hand had to be released. To do this, Mr. Clarke cut through the skin and grafted fresh, live skin—shaved from the backs of my thighs and buttocks—over the wounds. But before this was laid and dressed with gauze and bandages, my fingers were bent forward as far as they would go at the knuckle joints, shaping my hand into a kind of fist. Then pins were hammered through my knuckle joints to hold everything in place.

This occurred not long after my eye surgery, so I still had those delicate bandages stitched under my eyes. When I woke up from the surgery, my hands rested on pillows on either side of me, ten shining pins glinting in the sunlight. It was a shock to see, especially as I was still coming out of the general anaesthesia, where I could confused, worried, argumentative, still a bit high from the pre-med drugs—or a mixture of all of the above.

Mr. Clarke often did rounds in the evening before going home; I think this was especially true for younger patients like myself. He stopped by that night and we set the scene for what led to the biggest argument we ever had as doctor and patient.

We’d had plenty of smaller spats before. I suppose it happens when an immovable object meets an unstoppable force- we were a stubborn pair. But it was healthy for our relationship. His stick balanced out all the carrots on offer, and it was refreshing to have that honesty, even if it felt brutal at times.

When he came to see me that evening, he obviously didn’t have much time—or patience. The pins stuck out of my knuckles like weapons, or at least, that’s how I saw it. The bandaged area around my eyes still itched, especially when I lay down at night. I was discussing with a nurse how we could put some sort of foam protection around the pins, just so I wouldn’t accidentally scratch my face in my sleep. Mr. Clarke overheard, gave a firm 'no,' and walked off. No discussion. We did it anyway. Love a bit of rebellion, me...

And what’s the risk? We’d just take it off first thing in the morning before his rounds. My memory is a little hazy—it was over 30 years ago, after all—but the feelings, the connections, and the reactions are clearer than the details. I don’t remember if he started his rounds early or popped in to see me first thing, but we hadn’t removed the foam protectors in time. Shit. He saw them and lost it. With the nurses, with me, with anyone in his sight.

Facing me, he said something like, 'You need to face up to the state your hands are in. You’ll need plenty of pins as time goes on!' His words hung heavy, almost like a warning. He turned his frustration towards the nurses, dressing them down in that classic Mr Clarke style—sharp, unfiltered, unapologetic.

I hope John Clarke’s fuse was longer on this particular day

I tried to interject, 'I have accepted what’s happened to my hands. It’s my face and the work you did on it last week that I’m trying to protect!'

He shot back, 'A bit of foam to hide the pins isn’t going to…'

'You’re not listening to me,' I interrupted. 'I’m fine with looking at the pins, but those things are weapons!' My voice was firm, unyielding. I wasn’t backing down.

I’m not sure how long that scene played out, but Mum had already done the sensible thing and walked out, leaving me to face him alone. She headed down to the small kitchen to make a cuppa, where she bumped into the (normally) lovely little cleaner lady. Mum was caught off-guard when the woman, clearly aware of the commotion, asked bluntly, 'Do you not care about your son?'

Mum looked her dead in the eye and responded, 'I care more than you could ever imagine.' And that line was so on point. To the outside world, from the cleaner’s perspective, it looked as if Mum had walked away and left her 14-year-old son to battle it out with a man in his fifties. But she acted perfectly. I’d been through a lot by that stage, and I’d already had battles with Mr. Clarke. I didn’t need anyone speaking for me—I still dislike that to this day. Without Mum there, I was probably less conscious of holding back. She couldn’t fight every battle for me and she empowered me to take care of my own business when I was able to.

Don’t mess with my mum when she’s making a cup of tea!

The foam came off, and we agreed to disagree. I was an outpatient by this point, only staying over for operations unless it was a biggie—like what was coming up, so I knew I could put the foam back on that night back home. Despite all the pins and the very painful donor site, this procedure was comparatively minor. But it would have been something I’d need repeatedly for years if the cutting-edge flap insert technique hadn’t been developed yet. But I was in one of the best burn units in the world, so it was. Blessings.

And despite the shouting matches and stubbornness, I respected Mr. Clarke so much. His methods were brutal at times, sure. His bedside manner was more military sergeant than nurturing doctor. But he got results. More than that, he forced me to find my own voice—to fight my own battles. That argument wasn’t just a row; it was training. I was learning to stand my ground and to push back when I needed to.

The next operation would be the first really big one. The flap. That soft patch of skin still sits on my left hand like a comfort blanket. It’s strange to think of surgery as a gift, but that’s exactly what it was. And it was only possible because of all the hard lessons that came before it.

And maybe that’s the point. Maybe you have to endure the sharpness of the pins before you get the softness of the flap. Maybe you have to argue with one of the most important people in your life to understand that you’re capable of standing on your own two feet.

Next week, I’ll take you through that operation and three very different, but equally vital, kinds of compassionate care that got me through it- some of which we’ve touched on here.

I’ll see you back here then.