Hektoen International

A Journal of Medical Humanities

The middle finger: identity crisis in the emergency room

Lara Bazelon
San Francisco, California, United States

I am a lawyer who writes. I write about the criminal justice system, single parenting, divorce, and I am also an aspiring novelist. I had always written, scribbling in diaries as a little kid, writing early in the morning before I went to work or on the weekends, eking out a novel over a ten-year period. But my writing took place in small, carefully carved out spaces, early in the morning before I went to work or on the weekends. It was part of me, yes, but a secret identity. I never talked about it openly before.

Some time ago I decided to try my hand at fulltime writing. As I no longer had a regular paycheck and benefits, I decided to cut back on expenses, and as I worked from home I no longer needed regular manicures and pedicures. I could do it myself. Except, as it turned out, I could not.

One afternoon, exasperated by the sound of my fingernails clicking on the keyboard, I decided to take control of the situation. I figured the more ruthlessly I cut, the longer the interval before I would have to do it again. So gripping the clippers with my left hand, I gouged the skin that cushioned the nail bed of my right middle finger. The nail splintered, leaving a short stub. It hurt. I used tweezers to pull it out. That hurt even more. I doused the bloodied area with rubbing alcohol and went back to writing.

The wound did not heal. The skin stretched tight around the cut and the fingertip became slightly swollen. Seven days later it began to throb. It became difficult to type. Every time my middle finger hit a key, I felt a shot of pain. Then the finger became grotesquely swollen. There was an algae-colored circle where the gouge had been, and a black underline had formed around the rim of the nail—like a phrase that needed emphasis. I am infected.

The next day my finger felt like it was on fire. The pain was now intense; the algae spot was larger; and the fingertip looked like a maraschino cherry. I pulled on a pair of jeans and a tee shirt, laced up my running shoes, and ran three blocks to the emergency room.

The guy at the intake desk had braces and a nervous smile. He looked all of sixteen. I described the problem.  He described the wait: Four hours. “You’re kidding, right?” He shook his head, still smiling. “Please sign the intake form.” I concentrated on not wrapping my good hand around his throat. “I can’t,” I told him.

I took my seat in the waiting area.  I pulled out my book, an erotic thriller I had taken out of the library that day, but it was awkward turning the pages with my left hand and the book kept sliding off my lap. My throbbing finger made it difficult to concentrate, even on the graphic sex scenes. I found myself reading the same naughty words over and over as I tried to follow the characters’ complicated physical entanglements.

The triage nurse, a young woman with long dark hair and a sweet-looking but hard-to-read face, called out my name. Seated in a small cubicle, she asked me to rate my pain level on a scale of 1-10.

Compared to what, I wondered. Childbirth? Low-grade sciatica? Getting shot in the face?

“A six?” I ventured. She told me to have a seat.

“Is it going to take four hours?” I asked.

She smiled politely. “I can’t say one way or another.”

“Do you think I should just go home?”

Her smile remained in place. “That’s up to you.”

Ever the trial lawyer, I pressed on in my quest for an admission. “Well, we can agree, can’t we, that if I go home and do nothing for a few hours, I’ll be fine.”

The triage nurse neither agreed nor disagreed. Instead, she inclined her head slightly, as if waiting for me to continue.

I took a breath. “I mean, it’s not like I am going to get gangrene, and have to have my finger amputated, right?”

“I can’t really say one way or another.”

I went back to the waiting room. After some begging, a security guard brought me a plastic cup of ice chips.

An hour later I had made it inside, lying on a bed in a hallway next to a moaning man with a distended abdomen trying to pass a kidney stone. The ice chips were long melted but my finger remained in the cup, absorbing the slight chill. As my head lolled, a young woman approached and introduced herself as the doctor. I tried not to weep with relief. She looked at my finger for less than two seconds. “Oh,” she said, it’s a paronychia.” That sounded important, so I sat up. “Is it serious?  Will I need surgery?” I could see her trying very hard not to smile. “I’m going to give you a shot of lidocaine to numb you up and then make a small cut to drain the infection.”

I got the shot and the drainage. Unable to feel anything, I watched with sick fascination as primary-colored green and red fluid seeped out of my finger. When I was all bandaged up, the doctor returned for aftercare instructions. I listened, but not really. At this point, it was almost 3:00 a.m.

“Do you have any questions?”

“Yes,” I remembered suddenly, jolted awake. “When will I be able to type again?” The thought of not being able to get up the next morning and write was making my heart pound. I felt wretched with anxiety at the idea that something so vital might be taken away. “It’s important,” I told the doctor, “I need to be able to go back to work as soon as possible.”

“Why?” she asked. “What do you do?”

I blinked, bleary-eyed, and suddenly the answer was simple and obvious.

“I’m a writer,” I said.

LARA BAZELON is a writer, attorney, and law professor living in San Francisco.

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