The Opposable Thumb

 

The day after thumb surgery 2019 © Stephen Bruno

Perhaps you’ve heard about the opposable thumb that we humans share to a degree with all primates. I have known this relationship with primates since I was a child. Of course, as a naturalist, I understood the importance of the opposable thumb. However, it took an unexpected injury to learn just how significant our opposable thumb is to us, humans.

One morning I awoke intent on performing my countless routine tasks and getting out in nature to photograph wildlife. I quickly realized that whenever I moved the thumb of my dominant right hand in a specific direction or touched something too hard, I experienced intense pain.

I can’t recall having a trauma that created this unexpected situation. I had recently moved to a charming small mountain town and for the first time in many years had to shovel snow on my driveway. I thought maybe that was the cause, but I don’t remember the thumb being painful soon after the snow shoveling. I can’t think of anything that had occurred within a few weeks of the pain that I had done to create this condition.

I could not easily turn the key on and off my vehicle, write using a pen or pencil, brush my teeth, open jars, and at least twenty other normal activities. It soon became apparent that how this occurred was not as important as how it had suddenly and dramatically changed my life.

The intensity of the pain was distracting, to say the least not to mention how restrictive my life had suddenly become. I’m certain that if any of you have experienced what I’ve described some of this is not new to you. Each day I am amazed at the new tasks that I could no longer do without pain.

This month I had surgery on my thumb, and I continue to encourage healing. I remain optimistic in my prognosis.

Throughout all of this and in spite of the pain and definite limitations, the majority of my thoughts are a wondrous curiosity about the power and influence of our opposable thumb and how vital it is in our daily life. How could I have missed this obvious awareness?

Perhaps, it’s true that we don’t fully appreciate something until we no longer have it. I will look at other aspects of my life that I’ve taken for granted with equal dismissal.

Cross Between a Saber-Tooth Tiger and a Fire-breathing Dragon

Stephen Bruno

When I was in the first grade in elementary school in East Los Angeles, I had a serious accident outside the classroom. My symptoms included a nosebleed, swelling, bruising, crooked nose, black eyes, trouble breathing and a “cracking” sound when touching my nose.

I was rushed to the hospital by the school nurse who had me hold an ice pack on my nose. In the ER the doctors examined me and diagnosed severe facial fractures that included a broken nose, a septal perforation, and a deviated septum. They decided that I required immediate surgery.

I was prepped for surgery, given a local anesthetic and quickly brought to the operating room. The surgical nurses positioned me on my back, and I remained awake for hours watching several otolaryngologists working on my nose. Whenever the local anesthetic wore off, I let them know, and they provided more help that I appreciated. The operation was all a surreal experience especially since I was only six years old.

After the lengthy and intensive operation, a surgical nurse and several orderlies brought me to a post-surgery recovery room for monitoring. A splint was made to hold the nasal tissues in place until it stabilized and to protect the nose from accidental bumps when I slept and help it heal normally.

The next day, the nurses brought me to a children’s ward for recovery. The ward was a large rectangular open room with many children my age and a little older lying in their beds. Thirteen years later I was reminded of this setting after being drafted and sharing a similar large room with wall-to-wall beds during Basic Training at Fort Ord, California. The doctors told me that I would remain in the ward until I began to heal for several days, weeks or longer.

The kids could tell by the bandages on my nose and the sterile strips of gauze hanging out of each nostril that I recently experienced nose surgery. Of course, after the anesthesia wore off, I was in a lot of pain and continued to receive pain medication and antibiotics during my stay on the ward.

I began to get to know each of the kids in the ward out of curiosity and the means of distraction from the ever-present pain. Eventually, I found out that each of the children in the ward had a terminal illness and most of them had lived on the ward for months and some longer. It didn’t take long for me to feel humbled by their tragic medical circumstances while I only had a broken nose that required healing. I didn’t know what my nose would look like after the surgery and recovery. However, I knew my life was not in imminent or probable danger from the nose fracture.

I was very impressed with each of the kids and how they handled the challenges of immense pain, isolation from their family, countless medical tests, and insufferable boredom. I learned a lot about myself and other people that have lasted a lifetime from this experience that transcended the surgical trauma and recovery.

When finally, I was released from the hospital and sent home for more weeks of recovery, everyone in the children’s ward including the nurses shared a heartfelt sendoff. It was a bittersweet time given that some child abuse issues were waiting for me when I returned home.

During my recovery at home, there was still considerable bruising as well as swelling, and I had to make sure that my head was elevated, especially when sleeping or lying down to prevent further or prolonged swelling of the nose. I had to continue with the long strips of gauze hanging down out of my nostrils to soak up the blood. I imagined looking like a cross between a Saber-Tooth Tiger and a fire-breathing dragon. Nonetheless, I couldn’t stop thinking about the kids and especially some of the boys I talked with the most.

I still have a deviated septum, and my nose never quite looked the same. I have received comments like, “Your nose is an interesting conversation piece.” Although I am uncertain of exactly what that means, I have gracefully adopted my new nose.

After more of my recovery, I gathered up all my classic plastic green army men soldiers with a few military vehicles and accessories. I asked my mom to take me back to the children’s ward and wait in the lobby. Talking with the nurses who kindly remembered me, I was sad to hear that some of my newfound friends had died from their illness since I last saw them. It was too heartbreaking to give the toys in person, so I arranged with the nurses to anonymously share the gifts with my remaining friends and to see that everyone received something to sustain their playfulness during the countless boredom.

Frequently over the years, I’ve thought a lot about my time on that ward and each of the kids. We shared life and death conversations only young children with a terminal illness can have. It certainly puts into perspective the traumas that we must face when we think of what others must endure, and I began to embrace unconditional compassion as a lifestyle to the best of my capacity.

Heart & Soul

When I was in my late 20s, I had an unexpected experience with a noted cardiologist that touched my heart and soul. Consider playing this video as you read the post, before or after.

I was the Executive Director of a mental health agency in California. One afternoon the President of the Board of Directors asked to meet with me in my office. Although not uncommon to meet with me, she sounded excited rather her usual calm. After a warm greeting, she said that a close friend of hers was the Director of Cardiology at a major Adult Cardiology and Heart Surgery Hospital. I had recently written and received a large grant for the mental health agency, and she wanted me to meet with the Director of Cardiology and discuss my writing a grant to expand their Adult Cardiology and Heart Surgery departments as soon as possible. That same day I called the Director of Cardiology and scheduled an appointment to meet with him the next day as he was very eager to discuss the possibility of a grant.

I expected an administration staff member to initially offer a tour of the hospital and especially the Department of Cardiology. And then I’d sit down with the Director of Cardiology to casually discuss what the medical needs were, and the time frame for the grant. When I arrived at the 900+ bed hospital, the Director of Cardiology was nervously waiting for me in the lobby. He was exuberant in his appreciation of my willing to write a grant.

He ushered me into a large wood-paneled conference room with many men and women physicians and staff sitting around a large rectangle oak table. The Director motioned for me to sit at the head of the table, as he leaned against a large laminated Anatomy of the Heart Anatomical wall chart.

He introduced me as the Executive Director of a mental health agency who was going to use my grant writing expertise to obtain enough money for expanding the Adult Cardiology & Heart Surgery departments.

“Stephen, please give your presentation to the department heads and staff about how you are going to bring us an abundance of money for the hospital to better serve our patients.”

I must admit I was a bit stunned and not quite prepared to provide a formal presentation. I had also dressed rather casually. I didn’t have any appropriate background information on the hospital’s needs to intelligently address acquiring money through a grant. Not to mention, all the pairs of eyes looking at me with glances and stares representing everything from curiosity, hopefulness, and suspicion.

I took a long pause and a deep breath trying to figure what I could share. I briefly described the process of writing a grant and the large grants that I had written and received for the mental health agency. I explained that I would need more specific information about the needs of the hospital and especially the Adult Cardiology and Heart Surgery departments before I could provide them about what would be involved in the grant and the timeframe.

“Does anyone have a question for Mr. Bruno?”

One physician understandably asked if I had any medical experience. I told him that I was in the medical field with the Army in Vietnam for fourteen months and that I had an experience as a combat medic. An administrator asked about the size of grants and how much governmental red tape was involved. Another physician inquired about the time it took to receive the money once a grant was submitted. A staff member asked if the money had to be returned at the end of the fiscal year if grant money remained.  I responded to these and other important questions.

The question and answer process seemed to appease the group who believed I might have the necessary knowledge and skills to successfully write a grant. The Q & A seemed to be a turning point and I began to feel more comfortable. At the end of the meeting, the physicians and staff approached me at the coffee machine sharing that they were appreciative of anything that could be done to make a difference for the Adult Cardiology & Heart Surgery departments. I could feel the compassion and genuine caring that these people had in their excitement for the possibilities of obtaining high tech medical additions and more physicians and staff.

The Director then took me to lunch in the cafeteria and shared a bit about his personal life, his family, how he got involved in cardiology and all that he looked forward to in the future. I grew fond of him and respected and valued his commitment to compassionate service for more than four decades.  His heartfelt caring for all the patients was refreshing. In some ways, he reminded me of Dr. Schweitzer and his commitment to patients.

After lunch, he gave me a thorough tour of the entire hospital while introducing me as a cardiology Savior to each medical staff much to my embarrassment and probably theirs. The Director’s energy, enthusiasm, and excitement for the medical possibilities was contagious. I too began to feel the same way and couldn’t wait to learn more and get started on the grants.

When we came to the Cardiology and Heart Surgery departments, the Director became more reflective and serious. He described some of the situations of cardiac issues he handled with patients.  It was clear that he still felt deep emotions about the people who did not survive their surgery and his elation for those who went on to lead a lengthy fulfilled life after surgery. I’m not sure if it was more my commitment to him or the hospital in general that inspired me to want to write the best grant that I had ever prepared.

Before I left the Cardiology and Heart Surgery department, I hesitantly mentioned to him that I had experienced some symptoms he described with his previous patients, that had me concerned about my own heart and that I never had a thorough cardiology exam.

“Since you are going to write a grant for us the least we can do is to provide you with a thorough cardiac examination without any fee. I will personally perform the tests and examination along with our best technicians.”

He asked me to return in the afternoon the next day to begin the exam and tests. I expressed my gratitude, and I felt reassured by this generous offer.

I returned to my office thinking about the meeting and trying to figure how in my busy schedule as Executive Director I could have the time to write one or more sophisticated medical grants. I sorted out my options for continued mental health services, and time for the grant and the deadlines. I decided that there were ways to do this with mutual benefits.

The next morning, I received a call from the President of my Board of Directors. She sounded rather solemn.

She asked to meet with me at the office, and I told her to come right over before I left to meet the Director of Cardiology at the hospital. When she arrived, her demeanor was congruent with how she sounded.

“The Director of Cardiology that you met with yesterday suffered a cardiac arrest during the night and died.”

While we both stared at each other, I had to take a few minutes to process what she had said and considered the irony of this doctor so committed to helping people with cardiac issues had suddenly died of one. I thought of his family that he had discussed and their loss and the loss to the hospital. I felt the loss of a new valued friend.

I learned a lot from that experience. I remember him as the epitome of what we would like our doctor to be especially with something as serious as cardiology issues. I have thought about him over the years, and I’ve looked for other doctors who exemplified the same attitude for my personal care and care of my loved ones.

I continued my service on behalf of people needing mental health with a renewed vigor and commitment. I remained at the mental health agency for about another three years before leaving the state and moving on to other mental health services. One thing that never left my mind is how tenuous and precious the moments of our lives are, and how you can’t always prepare for sudden dramatic traumas. I previously learned this in my gang days in East Los Angeles and certainly in Vietnam in the medical field.

I sometimes play one of my favorite Oldies,  Heart, and Soul, which reminds me of how much a difference we can make by lightening the load for others, being enthusiastic and hopeful, and sharing joy, like this compassionate doctor who cared so much from his heart and soul.