His deformity was so vivid that it was impossible not to stare at the appearance of his hands; they looked like claws.
To stare was not only impolite, but it violated a cardinal rule of your first contact with a patient, which is to gather an image of the whole person before you focus in on the area of the body in question.
The appearance was so dramatic that I lost my mantle as a physician and reverted to being an onlooker. Trying to regain my equipoise, I asked how I could help. His response was the obvious: Was there anything that I could do for his hands?
He had the most severe form of Duputyren's contractures that I had seen in my 30 years of experience, both civilian as well as military.
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The contractures cause the last three fingers of both hands to be curled up upon the palms. When it is mild one can overcome this by simply extending the fingers, by impulse. But when it is severe, the fingers must be manually released by the opposite hand to be partially effective.
There was nothing I could do for him at the Kandahar airfield base in Afghanistan. He needed and should have already had hand surgery to release the scar tissue along the tendons in his palms that were the root cause.
At this point, the only way this could be done was to ship him back stateside and that meant sending him out of the combat zone, which was a no-no unless imperative.
It was within my power to order such but it was a power rarely invoked for my non-combat injured and ill that I as an internal medicine specialist was called upon to see.
The critical question that we were called upon to ask and answer as physicians was whether the illness or injury made that individual incapable of performing his or her MOS, military occupation specialty.
Like most things military, it is given a number; I couldn't identify his when he gave it to me so I asked for a literal translation: He was a mortuary affairs specialist.
Ours was a big base and the mortuary was responsible for preparing the bodies of those killed in action in our area of operations to be sent back home.
Too often those KIA were the victims of roadside explosions and the carnage could be horrific. These explosives could carry thousands of pounds of force.
One can only imagine the visual and mental images that this man would carry for the rest of his days. In a pinch, he could do his job but it was a struggle.
He should have never been sent there but he wanted to serve and honor the dead, needless to say his specialty was in short supply.
We agreed to see him back in a month and to reassess his case. At that time I saw a change in his appearance; for the first time he brightened up and became far more animated. As he was leaving, I looked at his eyes and saw someone who was deeply haunted.
His case stuck in my mind over the next few weeks; I was extraordinarily busy with both my medical and command responsibilities, but I had not lost the ability to be human and empathize.
When I saw him back the next time it was apparent he was struggling to do his job, both physically as well as mentally. He did not ask to go home; he was "the good soldier" and the personification of duty.
His visage was even more haunted. He had seen too much and was laden with far too much in his soul. I made the decision to send him home. I knew it would be fought by the chain of command, but to a large extent my word was law and he was on the transport out within a few days.
Had I overstepped my bounds? Doctors are accused of "playing God." Was I acting like my own personal deity? I felt comfortable with my decision. I felt I had helped to repair his body but. far more important, I was perhaps saving his soul.
I never heard further about him or his outcome, but I think of him periodically and feel at peace with my decision.
In a lousy war, as all are, I felt that if I could salvage at least one soul then I could rest content for the remaining days of my military career as well as for the remainder of my personal life.
I would do it again.