Rachmaninoff Hands

The surgeon who fixed Finn’s heart had Pygmalion hands, well scrubbed and seemingly cast of marble. Hands you’d want to see in a surgeon, with long fingers, tapered at each knuckle, nails buffed and professionally rounded.

These are hands you’d allow into your child, because—as the surgeon explained a day prior to procedure—this surgery necessitates a cracked chest-bone and exposed viscera. So far as infants are concerned, the heart rests close to the spine, a fact you realize once the rib cage is open like a grotesque and calcified blossom. The heart beats slow and sedated while awaiting the scalpel.

You’d like ‘nimble’ to be a resident fact on the doctor’s CV.

This isn’t like junior high when you’re slicing into frog alimentaries with a dull X-acto and making off-color jokes with your tablemates.

Finn’s surgeon could have passed for a Bond villain. I say this approvingly. He sported a Vanderbilt haircut; a Slovakian name; hands you could envision, within a different context, cinematically threading a silencer onto the barrel of gun. No apparent emotion, his only obvious proclivities being a surgical precision of language and a double-starch of the lapels.

You want an assassin when it comes to life and death. Assassins have good trigger-control.

“It vill be fine,” he held up palms. I thought of Rachmaninoff, who himself had long and expressive hands, the result, perhaps, of acromegaly: a genetic defect of human growth hormone. Genetic defects had been on my mind for the last three months. Finn was diagnosed with Down Syndrome shortly after birth.

The surgeon was either unerringly decaffeinated, else a Batman-type who maybe woke early everyday, breakfasting on half a grapefruit sprinkled with cinnamon; a neat and measured demitasse of espresso; and a plain hard-boiled egg. He was a man who had control of his faculties, who would maybe finish his evening with ten sets of rowing exercises in a cedar-lined room before retiring cross-armed to a mattress. He wore no ring on any of his impressive digits.

Me, on the other hand—I have dumb and stubby fingers. On the day Findlay was born, I sat in a fluorescent-lit hallway, too early, fumbling a Nikon camera and checking the light registers by taking pictures of the ‘Exit’ sign. I was in the hallway because hospitals sometimes make dads tourists in the birthing process, especially when C-sections are involved. The hospital either aids else emasculates Dad by curtaining him off from his wife before she’s cut open. Both my kids were born this way. I’ve therefore seen my fair share of hallways and surgical drapes, spent much time twiddling my clumsy thumbs.

‘You can’t handle this. Go sit for a spell.’ Take the pictures, cut the cord, be the et cetera, just don’t be here to hold any hands. We’re literally going to remove your wife’s insides for a minute and set them atop her chest.

<Click> ‘Exit.’

I can actually handle these things, just like I could’ve held the surgeon’s hand while he knived tissue from my son’s pericardium to later sew into his heart. I can, I could’ve. These are heart and gut things, and I specialize in heart and gut things. I’m still bad with a camera, though.

<Click>

The obstetrician who delivered my son had massive hands, a celestial exaggeration of his calling: a guy engineered to pull life into the world on the regular. The backs of his hands were neatly haired, fingers smoothed by pumice and iodine, still masculine despite their polish.

When he lifted my son into the world, he held a red-haired, flap-eared raisin up for review, and my initial and guilty thought was that Findlay was not as beautiful as Cayden upon leaving the uterus.

The obstetrician was triumphant, hands clasped around Finn’s waist and the baby was passed to robotic attendants who were eager to wrap Findlay’s frog-belly into swaddles.

“Dad—come here for pictures!” And I cut Findlay’s cord like I hadn’t with my eldest son, Cayden. The nurses had me fake cut it a second time because the first picture came out blurry.

“Why isn’t Dad cutting the cord?” Cayden’s attendants had asked five years prior, and from behind surgical masks. With their mouths covered, you could only see the nurses’ raised eyebrows. There was a table lined with blue huck cloth and neatly autoclaved steel, but goddamn if the only instrument they cared about was the camera. How you complete memories with the only unsterilized gadget in the room.

My hands were busy holding my wife’s hair in a bundle. She was puking into a plastic depository, and my hands were better deployed holding her sweaty ponytail, while the surgeon re-threaded her fascia and peritoneum back together with God-knows-how-large a needle.

“Guess, Dad’s not cutting the cord,” the nurses shrugged, while my wife retched for a second anesthesia-induced time.

Fast-forward five years and Findlay’s obstetrician, triumphant, hadn’t noticed that he’d just delivered a baby informed with excess, noadisjunct chromosomes. Essentially: Trisomy-21, in a womb-soggy, redheaded vehicle. Findlay had these constellated eyes that still and stubbornly remain Sinatra blue. They were open.

The OBGYN passed off Finn to the attendants without remark. It was akin to having just delivered a unicorn while deeming it a horse.

Children with Down Syndrome often have Brushfield spots, these stars that ring the iris. It’s a trick of the tissue, something buried deep in the 21st chromosome, and it’s a tell–an obvious one. Kids don’t usually have galaxies for eyes before getting their first astronomy book.

Obstetricians aren’t palm-readers, either, nor do they always look deep into infants’ eye upon birth. Doctors have flesh to sew, which is a real and corporeal thing, especially when narrowly looking through the fenestrated window of a surgical cloth. There’s the room full of bustle and the next appointment to consider.

Also, the lights in the OR are bright. They don’t always reveal the miracle of birth or its sometimes accidents. I’m sure the lights better highlight the work left to do, the reds and yellows of things left to close, the blue nitrile gloves and the Betadine-swabbed torsos. I figure the obvious is most likely ignored when urgency takes precedence and the attendant nurse hands you a stainless-steel tray of sharp things.

“He’s healthy! It’s a boy!” There’s the declaration, but then the obstetrician has to duck back down, thread a needle, and remember the stitch-loops he’s practiced on apple-skins back in med-school (form a bight in the end of the line, and tie an overhand knot, form a bight in the end of the line and tie an overhand knot…)

These things we do with our hands.

We generally always see the backs of our hands, never our palms, when working. Unless, of course, we’re juggling. But juggling is a trick, and work is not. Palm-reading is also a trick, but as mentioned, doctors aren’t palm readers.

When a doctor delivers a baby by C-section, the doctor’s thumb is perhaps the first thing the baby grips. The baby wraps his hand around any of the doctor’s available fingers, and hides his palm by enfolding it around the digits that delivered him.

The OBGYN didn’t see Finn’s eyes, or Finn’s single palmar crease when delivering my son. Finn, like a good blackjack player, hid his ‘21’ when holding the doctor’s thumb.

‘Always hide your hand,’ is the advice.

Finn, apparently, knew as much in the womb. The single palmar crease, like the constellated and almond eyes, is an obvious tell that a newborn has Down Syndrome. It wasn’t until the Recovery Room that these things were noticed. The attendants there were better palm-readers.

As far as fortune-telling goes, Finn’s diagnosis came with its predictions, less psychic than scientific.

“He’ll most likely have a heart defect.”

“He’ll most likely need surgery.”

“His heart will most likely be ok.”

At the hospital, days before scrubbing in, they show you a plastic doll with a multitude of wires trailing from its pretend heart-space. It’s a mock-up so that you’re prepared to see your baby hooked up to as many, if not more, cords and filaments and sensors immediately following surgery.

The sight is enough to make your own heart feel suspended by wire, cruelly commandeered by some unseen marionettist.

Finn’s cardiac surgeon, our man with the Rachmaninoff fingers and heavy accent, explained the procedure one day before surgery. He was clinical, matter-of-fact without somehow sounding clip or cold. His voice had right angles; his hands, however, posed as they were in various ways to demonstrate Finn’s heart and how it was to be fixed, had softness to them. I imagined the surgeon cupping Finn’s heart as if it were a newly feathered thing, a fallen sparrow, a creature to be gently returned to its proper nest.

The plastic doll had my wife and I in tears; the surgeon’s pantomime of Finn’s heart, to what nest it would be returned, had us dry our tears just as quickly. There is comfort to be taken when gestures alone conjure confidence, when panic is disappeared through a particular and subtle kinesic. The surgeon, for lack of a better term, presented as suddenly and consolingly able.

When Finn’s gurney was hurried down the hallway following surgery, there was a coterie of nurses running alongside the rig like a team of gowned Secret Service agents. Four sets of hands on the transportable bed, more steadying the rack of wires, the swinging bladders of dextrose and lactated Ringers. All ran in soft shoes, their orthopedics still covered in surgical slip-covers. It was a near silent 100-meter dash from OR to ICU. I leapt up from the waiting room couch in order to join the controlled footrace. The surgeon followed the gurney at a moderate distance, his surgical mask removed and dangling loosely like an awry runner’s bib. I searched the nurses’ faces for sign of an outcome, for assurance that our quickstep down the corridor was one of expedience and not urgency. They, however, were a hive of back and forth buzzing, a language of numbers and stats fluently exchanged. Any edgewise word would’ve seemed an interruption, though I am the father.

“How is he? How is he?”

The surgical rig disappears through a series of automatic swinging doors, my son and his zipped up chest, closed eyes, and fortune-foretelling palms swallowed up by a secondary corridor.

“How is he?” I turn lastly toward the surgeon, and he barely looks my direction. He says simply, “It vent vell.” Despite having emerged from surgery where the lights were undoubtedly intense and the minutiae of needles and scalpels as stressful, say, as choosing whether or not to cut the red wire—maybe the blue—the surgeon was nonplussed and devoid of sweat.

“He is fine,” and the surgeon, too, disappeared into the corridor leaving me for the second time in three months, the father at bay, staring blankly at a hospital exit sign.

<click>

I looked down at my hands and spread wide my fingers. Rachmaninoff could play C E♭ G C G with his left hand alone. I could maybe duplicate that feat with both hands together, but—as they were—my hands were slightly trembling, and unfit for piano keys let alone otherwise surgical poetries. I curled my fingers into my palms, exhaled mightily, then turned back toward the waiting room.

 

_____________

 

The Recovery Room has natural light by means of a large plate-glass window. Though it overlooks the parking structure, the windowed room is welcome respite from the fluorescent halls, the dimly-lit waiting areas, and labyrinthian stairwells.

Findlay lies in his bed, less the marionette than his post-op and ersatz Pinocchio. There are only a few wires still attached, sensors which inform the technician how Finn’s heart is performing beneath all the stitches and an already-knitting breastbone.

Finn smiles—smiles!—atop his sheets, and wraps his hand around my extended finger. He’s effectively hiding that palmar crease again, the one line that divides his hand neatly. My hand has the usual two. The irony, though, of him having an extra chromosome means his body is sometimes made simpler: fewer lines, smoother eyes, an inexact heart. All these things used to scare me. I adore complication, after all. It’s maybe why Finn hid the fact of himself for nine months in the womb, why he escaped detection in the delivery room. Why he held his hand tight close to his chest.

I smile down at him. The surgeon appears in the doorway. Two days out of surgery, and the doctor doesn’t even enter the room anymore. He simply stands in the doorframe, waves and nods, before walking quietly away. His work is done.

Findlay continues to hold my fingers, my clumsy but suddenly capable fingers, and my work is just beginning.

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