It started with a cat bite.

Nearly retired, healthy, athletic and active, smart and successful, he’d almost never been sick in his life.  And now the staph infection from the bite had spread from his finger throughout his hand, up his arm, across his bicep and almost to his shoulder.  His whole arm was red and swollen, his hand and finger oozing and cracked by the time he finally agreed to come to the hospital.

After a few days off, I came back to work the day after they amputated his index finger.

He was a lost soul.  It was hard to see a person who was so obviously independent and self-sufficient forced to be so reliant on the nurses, doctors and staff.  The amputation was absolutely life altering.  A month ago, life had been normal.  Now he had nine fingers, and was in danger of losing his entire hand.

I chatted with him in the morning as I checked his vitals and hooked up his IV antibiotics.  Like most people in shock, he fixated on things that weren’t really important at the time.  I tried to gently guide him back to the ‘now,’ to the moment, to simply getting well and caring for himself.  Despite the enormous cast brace that immobilized his entire forearm, all he wanted to do in the world was take a shower, wash his hair and rinse off the betadine that stained his skin orange.  I covered his arm in a trash bag and taped it closed, protecting the brace, and told him to get his ass in the shower.  HIs son was there to help him.

He looked at me.  “How am I going to manage this when I get home?”

I said, offhand (as I do), “You’re going to jump off that bridge when you come to it.”

He replied, oddly, “Yeah, well, I might just do that.”

Those kind of comments, filled with despair even as he tried to be lighthearted about it, filled his day.  When his doctor returned the next day to see him again, I attacked.   He is NOT okay, I said, trapping the doctor in the nurses station.  He is NOT dealing with this.  He has not accepted that his finger is gone and that his life is suddenly out of his control.  He NEEDS help.

I’ll speak to him, said the doctor.  But he didn’t.  To give the doctor credit, I think he wanted to.  He’s a good physician.  But what do you say to a man, older than you, his grown children in the room, hovering over him, as he tries to simply keep it together and not completely fall apart?  How do you broach that subject?  There wasn’t an opportunity, and the doctor didn’t create one.  And so he left, and wrote for a psych consult.  That was all.

The hand surgeon called me.  I’m coming in to see him, he said.  Unwrap the hand and put it in a hibiclens soak so I can take the packing out.  We’ll get him out of the brace today and into normal bandages.

I placed the big pink bucket of antibiotic soak on the bed next to him, and pulled the trash can over.  I unwrapped the layers and layers and layers around his hand, and as I pulled the final layers of gauze off the hand, he turned his head away from his hand and from me.

His daughter, hovering and clearly scared for her father, and for her own helplessness, held his other hand and said, Don’t look.

“You don’t have to look,” I murmured, intent on getting the last of the petroleum gauze off.  His hand was absolutely ravaged.  The stump of the index finger was an open well where bone used to be.  The palm of his hand was split open, gaping, the tissue underneath showing where the surgeon had done his best to drain and debride the infection.  The back of his hand was swollen, the skin peeling away in chunks, his wrist nearly raw from the edema.

And as I looked at his hand, I realized that I had said the wrong thing.

I put his hand in the soak, and busied myself with meaningless tasks in the room for a few minutes while I gathered my courage.  His daughter sat by his bedside, trying to comfort her dad with bad jokes and gradiose promises of hope and happiness and all-will-be-well.  Then I walked over to the bed.

“I need you to do something,” I said.

“All right,” he replied.

“I need you to take your hand out of the water, and look at it.”

The room went absolutely silent.  Three of his children were there, and no one said a word.  I’m not sure anyone breathed.  I didn’t.

His face began to tighten.  “What, she’s a psychiatrist now?” he said, trying to make a joke.

“Look at it,” I said.

He pulled his hand out of the water, and looked directly at it.

“Oh, god,” he said.

And his face shattered, and he began to cry.