Yesterday, I spent a lot of time thinking about hands.  Mostly because I spent a lot of time looking at hands.  Not how you and I normally look at hands though.  I was looking at a hand with no skin... the naked, impersonal, functional, stripped, insides of a man's hands.  It was strange.  And made me think.

I'll give you a little background.  Remember that big burn I talked about in my last post?  The one we spend 8 hours operating on on Monday?  Well, we took him back to the OR for another 8 hours yesterday, to finish excising (removing) his burns to start the healing process.  Like any other damaged, dead, or dying organ, the damaged skin has to be removed or it will continue to wreak havoc on the body and make him very sick.  So, we worked on removing the burns from his chest and arms while the plastic surgeons removed the burns from his hands. 

I spent a good amount of time holding his hand to lift his arm off the table so we could get to all the parts we needed to.  And it was strange.  You can tell a lot about a person from their hands;  how hard they work, if they smoke, if they nervously bite their nails, if they use lotion, if they have had a lot of sun exposure.  But when you take all the skin off, you can't tell any of that.  A hand with no skin is depersonalized.  But you can see what a hand can do, how it works, where the muscles and tendons and veins go. 

Before surgery, his hands were still and leathery, immobile.  Once the skin was removed, they were pliable and mobile, like normal hands.  You could imagine them doing things again, feeding himself, scratching an itch, holding someones hand.  And while they were depersonalized, there were no judgements or stigmas attached.  Just a hand, a person's hand, who was injured, whose life is totally different than it was a week ago, who needs our help to live.  There's no difference between a perfectly manicured hand that spent it's life playing the piano, and the dirty hand of a homeless man, when there is no skin left. 

By the end of surgery, his hands, and every other part of his body where we'd removed skin, were covered with a synthetic dermis that will hopefully allow for him to heal, and eventually we will graft new skin onto them.  And then they will be hands with scars, suture lines, and skin.  Right now, they are just hands, stripped down, exposed, and waiting to be turned into something new.