A company secretary, victim to the vagaries of technology overuse, finds light at the end of the tunnel with medical advancement and ma ka pyaar
“My right hand hurts like hell,” Josephine told me as she settled into her chair, supinating her palm in front of me. She showed me with the finger of the other hand where and how her pain radiated: around the wrist and into the first few fingers. “I have to shake the pain off my hand sometimes, mainly at night,” she demonstrated, replicating the gesture of drying droplets off a wet hand in the air. “It’s a combination of burning and tingling and numbness and heaviness,” she tried to explain, wincing her face. She was a company secretary in her sixties, and wore a red dress that reflected a rose tint in her thick glasses. Her 97-year-old mother sat next to her, upright and vigilant to every word of the discussion. “I can’t do any work around the house and Mummy needs to chip in, as it’s only the two of us living together,” she described her situation. “That’s what keeps me young and fit,” Mummy said. “I’m 97, and the only times I’ve been to the hospital is to accompany people younger than me,” she joked, poking her daughter with her walking stick.
“What’s your secret to a long life?” I asked Mummy. She strained her neck to hear me. “Getting a little deaf,” she replied. I wondered if that was her answer or she wanted me to repeat the question, but she followed it up with, “People talk all sorts of nonsense today, so the less you hear, the longer you’ll live!” Mummy shed a few pearls of wisdom.
“Do you have any pain in the neck or the arm?” I asked Josephine, as sometimes, pain in the hand can arise from a pinched nerve in the neck. But her symptoms were typical of a condition called carpal tunnel syndrome, where the nerve in the wrist gets strained by the overgrowth of the soft tissue around it. “Are you diabetic?” I questioned, as it is more common in people with elevated sugars, thyroid problems, arthritis, and those who are slightly plump. “I find it hard to open bottle caps, turn door knobs, and even cook,” she interjected, remembering how she was incapacitated by her problem.
“The carpal tunnel is a space in your wrist bones. It’s like a shaft cut through the mountainside, but instead of making room in the rock for cars, it’s a passageway in your bones that lets tendons, ligaments, and nerves pass through it to reach your hand. The nerve is getting pinched here,” I said, tapping on her wrist with my fingers, making the pain shoot through the first four fingers of her hand. “This is called Tinel’s sign, which confirms my diagnosis,” I demonstrated, and gave her the full low down of the condition.
She told me her job involved sitting at the computer all day, although she did take breaks and rest her hands as often as she could, following some good advice that she had been given. “Repetitive movements of the wrist is a reason why some people get it,” I affirmed. “Also, women get it three times more than men,” I gave her some trivia. “Chefs, waiters, bartenders, dishwashers, and people who use machine guns often are also prone to it,” I added. Her face registered mild scepticism. “I have operated on a few army men with the problem,” I explained, in case she thought I was joking about the machine gun.
Josephine told me that another doctor, who had suggested a nerve conduction test to confirm the diagnosis, had recommended a splint to ease the repetitive movements on the wrist, but that hadn’t helped. Someone else had asked for an ultrasound of the wrist and tried a steroid injection around the nerve, but after temporary relief, the pain had returned to bite her. “I am your only hope now,” I grandiosely pacified her, as Mummy lent her outstretched hand for me to hold. I had operated on another family member of theirs a year ago for a colossal brain tumour, so they were familiar with my jest. They had come mentally prepared for surgery, which a few others had recommended.
“This is not as big an operation as we had for Francis, correct?” they tried to gain some perspective. “Not as big, but just as important,” I mentioned. “I don’t consider any surgery as simple or small,” I reiterated my stance, “but you’ll be able to do everything from the next day,” I reassured her. “We can ideally discharge you the evening of the operation itself, but as you have insurance, you’ll need to stay the night,” I explained. “Mummy will stay with me,” she told me, to which I said there was no need. “Do mummies ever listen?” she said, smiling at her fondly.
A couple of days later, when they entered the hospital and the nurse intuitively went to Mummy to put the patient wrist band on her, Mummy redirected her to the correct patient. It’s funny how our mind is programmed to believe the cultural stereotype that the older person must be the sicker one. These stereotypes permeate through life – women don’t drive well, thin people are fitter, older people cannot manage technology, or that the French are arrogant – and are especially true in the medical field, where people believe that the younger doctor must be less skilled or that all hospitals are here to fleece patients. And my favourite: All neurosurgeons are dashing.
We took Josephine to the operating room the next day as the anaesthetist skilfully knocked her out. We infiltrated some local anaesthesia around the wrist and made a 2 cm incision to extend the lifeline on her hand and take it all the way up to the crease of the wrist. “This is the only surgical procedure that can astrologically extend your life,” I joked with my assistant. “Now she’s sure to live as happily as Mummy,” he quipped. We separated the fat until we saw the thick band of tissue we were supposed to cut. We nicked it to slide the instrument under it, and cut along its entire length so that the nerve below could be fully freed from the tension it created. “Such severe compression,” my colleague and me enunciated simultaneously, imagining the plight of the patient.
We closed the skin meticulously and wrapped a comfortable bandage around the wrist. Mummy was delighted to see Josephine when she returned to the room. “My pain is gone,” were the first words she said. “My hand that was asleep and pricking is alive and kicking!” she rhymed. “Amen,” I said to her, as Mummy beamed.
