Updated: Jan 27, 2022
One day during my residency many years ago, an older man arrived in clinic with a large neck mass that had been growing for months. The mass, which by then was the size of half a baseball, wasn’t bothering him much, so he hadn’t rushed in. He finally made an appointment to see if anything should be done. “I only came because my family has been bugging me,” he said.
One of my fellow residents evaluated him. Standing behind the man as he sat in the examination chair, the resident cupped his hand over the mass and moved it side-to-side and up-and-down. It wasn’t painful and did not seem to be extending deeply into the tissues—those were good things. As the resident continued the examination, I am certain he was asking his fingers to tell him more. Maybe he was wondering, What does this mass represent? What scans and biopsies will I need to order? What’s going on here?
Suddenly, the resident and the patient yelped simultaneously. I heard the commotion and rushed to the room. The resident and patient were both wide-eyed. “It came off!” the resident exclaimed. “As I was palpating the mass, it just fell off!” He stood still, holding the mass tightly against the man’s neck in case he had torn any underlying blood vessels. The man looked surprised but, otherwise, seemed fine. There was no blood accumulating. I reached for supplies.
“Quick!” he said. “Grab some gauze!”
I opened a couple of gauze pads and got ready. The resident gently pulled the mass away from the man’s neck. Nothing happened. The circular area where the mass had been attached was red and a bit angry looking. The surface oozed, but only a little. Within a couple of minutes, we had cleaned the neck skin, stopped the small amount of bleeding, and taped on a dressing.
The man looked in a mirror and grinned.
“You’ve got magic hands, Doc!” he said. “Now, my family will leave me alone.”
The neck was, basically, back to normal. I picked up the mass and pressed against its surface with my hand before dropping it into a specimen container. It was firm, and the size and shape of an old-style paperweight. No harm, no foul, I thought.
There was more to the story but, given the decades that have passed since then, I don’t remember either the pathology or what treatment was needed. I do know that I never again saw a large, worrisome neck mass simply come off in the physician’s hand during a physical exam.
Using our hands for work
Our hands are central to what we do. When I have had to offer virtual visits over the past couple of years, I missed the “hands-on” of clinical medicine. With a patient in front of me, I can fill in the gaps in their story while performing the examination. I check for pulses, areas of numbness, muscle strength, and joint function. I palpate tissues and press my fingertips into tender areas. I hope that my patients will trust me to use my hands wisely as I search for masses, perform procedures, and remove cancers. In return, my hands offer a moment of connection with the patient and allow me to feel my own sense of purpose more intently.
Our hands, variously, bring healing, inflict pain, and provide comfort. If all is well, our hands might signal that everything is fine. If all is not well, they might offer solace.
Our hands are integral to our identities
Too often of late, we have been forced to trade our hands-on moments for virtual visits, Zoom conferences, and social distancing. In clinic, we bump fists or wave to patients and family members when, once, we would have shaken hands or, even, hugged. I miss the personal contact. Maybe that will change again soon. Our hands are not idle, of course, since our fingers must still complete the day’s medical record notes.
Philosopher Immanuel Kant noted, “the hand is the visible part of the brain.” This makes sense to me, confirming that our hands extend into the world to fulfill our missions and gather information from everything with which we come in contact. That might be why I remember that day in clinic when a big neck mass simply came off of a patient, and I held it in my wondering hand.
A slightly different version of this essay entitled, "Using our Hands for Medicine and Wellness," appeared in the January 28, 2022 issue of the Transformational Times, a newsletter of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.