On a Scale from One to Ten

I fractured my right thumb on September 1 of last year. I was just beginning a sabbatical and had decided that I would try to read and write during the day, and then go to the gym at night when I was too tired mentally to do anything productive. The gym in America has become a booming industry and a consequential cultural institution, with large rooms filled with all manner of sophisticated exercise equipment: treadmills, step machines, elliptical trainers, rowing machines, several varieties of stationary bicycles, as well as other contraptions whose operation remains mysterious. In the newer gyms, these machines are positioned in front of an array of television sets broadcasting different programs (sports, news, soap opera, comedy, educational documentaries), which people can listen to through wireless headsets. A few people read, but those who are not watching television seem to be listening to something on an iPod or (among the more geriatric) a Discman. Very few ears are unplugged. Each exercise machine gives detailed and up-to-the-minute data on time expended, current heart rate (and whether it falls in the ‘weight loss’ or ‘aerobic’ zone), calories burned, repetitions per minute, and miles (or, if one prefers, kilometres) traversed without moving. All of this is motivated, as someone has noted, by the eternal desire of Americans to look good naked, clearly a losing battle.

I had done forty-five minutes on the elliptical trainer, listening to Wilco’s ‘A Ghost is Born’ on a Discman and had moved into the weight room for thirty minutes of ‘strength training’. The weight machines are also high-tech and daunting, designed to isolate each muscle group with precision. At the end of thirty minutes, with my mind lost in a reverie, I moved toward something called the ‘calf lift’, designed to strengthen the legs. Not knowing quite how it worked, I pulled a lever that appeared in need of pulling. A large weight came down from above and smashed my right thumb. I could move my thumb and so did not think it was broken, but it was bleeding rather profusely. A teenager at the next machine said to me, ‘You okay, man?’ (which is the way that young people in America express concern to their elders). I said that I was, although I really had no idea. I walked to the ‘Help Desk’, where two young women in matching shirts were seated, my bleeding right thumb held in my left hand. Since she was an employee of the gym, the women were more polite, ‘May I help you, sir?’ I allowed my thumb to bleed on the Help Desk and requested a towel. By this time, the pain was becoming severe, so I sat down, while one of the women took out her first aid kit and bandaged my hand, telling me that it didn’t look ‘too bad’, certainly not broken, but I might want to have it ‘looked at’. I gave her my cell phone and asked her to call my wife and ask her to come and get me, since I did not feel that I could drive home safely.

My wife arrived quickly and took me to the hospital’s emergency room. The University of Michigan Medical Center is a huge complex. The American medical system and the American legal system are reputed to be the best in the world (at least by Americans), but my limited experience with both has suggested that they are at their best when one has no contact with them whatsoever. It had been my happy experience not to have ever had to set foot in the emergency room at this hospital despite teaching at the University of Michigan for seventeen years, until that night. The emergency room is much more than a room; it is its own world, with valet parking and two entrances, depending upon whether one enters vertically or horizontally. I entered the former door at 10.30 p.m., still in my sweaty gym clothes, and was made to produce various plastic health insurance cards and sign forms (with my left hand). I was then directed to the waiting room, where I became the object of triage; the order in which patients are seen by nurses is based upon the severity of their malady. I was simultaneously relieved and alarmed to be seen almost immediately, after a woman who was suffering severe abdominal pain but before several other people.

I was taken in to see someone who appeared to be a doctor. He removed the bandage I had received at the gym and washed the wound. He then said, ‘On a scale of one to ten, with ten being the most intense pain you have ever experienced, how severe is the pain in your hand right now?’ Although I did not say so, I thought it was an odd question. I tried to recall other moments of severe pain but had trouble remembering anything. I had broken a toe once but that was kind of a dull pain. Another time, I had wrenched my back, and that was very uncomfortable. Everyone has been scalded by hot water or cut themselves with a kitchen knife. But I couldn’t really remember, much less calibrate, the intensity of the pain. I had had a kidney stone in 1987 that was very painful, but I wondered whether my memory of the pain was coloured by how a nurse described it to me at that time. She had wryly called a kidney stone ‘the worst pain a male can experience’. According to this description, the pain of the kidney stone would have to be a ten. But how do you compare a pain in your lower back to a pain in your thumb? And how is pain remembered? The fact of the pain is something one can recall, but the affect, the intensity, seemed absent from the memory. And English seems to be particularly deficient in describing pain; in common parlance one would have only two registers: ‘it hurts’ and ‘it really hurts’. All these thoughts passed through my mind in a split second. I said, ‘Seven.’

My hand was wrapped in ice and I was then transported in a wheelchair (although I could walk perfectly well) to the next level of the emergency room, the x-ray department. I sat for some time in another waiting room where the attendant was watching a college football game, before a young woman wheeled me into a room where the now dripping ice pack was removed from my hand. A lead apron was placed across my lap and I was instructed to place my hand on a table while she positioned an x-ray machine above it, focusing the crosshairs on my thumb. She then left the room while the x-ray was taken, returning to move my hand into increasingly uncomfortable positions while she took two more x-rays. After some time, she wheeled me back into the waiting area and then picked up the phone and said, ‘We have a fractured right thumb in Radiology. Where do you want it?’ Her statements, which were not directed to me, indicated two things: (1) my thumb was broken, and (2) I was my thumb.

I was next wheeled into yet another domain of the emergency room world, this one appearing more like a hospital ward, with rooms and beds. I was taken into one such room where the nurse instructed me to lie on the bed. My wife sat in a chair and began reading a dissertation on Slovak identity that one of her students would defend the next day. The nurse asked me whether I was cold and placed a blanket over me when I said that I was, saying that ‘the PA’ would be in to examine me. I did not know what ‘PA’ meant, but eventually determined that it meant ‘physician’s assistant’, a medical professional who occupied a place in the health hierarchy above nurse and below doctor. The PA soon came in and said that she would read the x-ray and then consult with a physician. She examined the wound and said that they wanted to run an IV in order to give me some antibiotics as well as ‘something to make me more comfortable’. By this time, it was midnight. The nurse tried to find a vein to insert the IV but after several attempts was unable to do so. She told me she would find someone who was ‘really good at finding veins’, and a young man soon arrived who tied rubber tubes around my arm at various points but was also unsuccessful. Finally, a pregnant nurse was summoned, presumably the Queen of Veins, who after several more attempts was able to insert a needle into the back of my left hand. Soon the antibiotics and the ‘something to make me more comfortable’ (which turned out to be morphine) were flowing. In order to determine the efficacy of the latter, the first nurse returned and said, ‘On a scale of one to ten, with ten being the most intense pain you have ever experienced, how severe is the pain in your hand right now?’ This time, I didn’t have to think about it. ‘Three,’ I said.

The PA now entered the room and informed me that I had ‘a very interesting fracture’. The longer bone of the thumb had been split vertically between the two joints. She had sent the x-ray as an e-mail attachment to the hand specialist who was on duty at the hospital that night. He never appeared but informed the PA by telephone that the ‘hand surgery team’ would discuss my fracture in their seminar the next day and determine a course of treatment. In the meantime, she would clean the wound and ‘immobilize’ the thumb. She had me stretch my arm out onto a table, where she set up a sterile field, injected my hand with Novocain at several points, washed off the blood that was caked on my hand and arm, and then cleaned the wounds. There were puncture wounds at the base of the thumb, on both sides of my hand. She told me that these would need to be sutured, and she began to sew.

Thus far, my communication with the various members of the medical staff had been quite minimal: the transmission of facts, mostly from me to them. It was now well after midnight. I was still in my sweaty T-shirt, gym shorts, white socks and sneakers, all splattered with blood, with an IV in my left hand and a surgical needle passing in and out of my right. And now, the PA wanted to chat. ‘So, what do you do?’ she asked cheerily. ‘I teach here at the university.’ ‘What do you teach?’ Here, I paused. My title at the University of Michigan is Distinguished University Professor of Buddhist and Tibetan Studies. In my current state, none of those words seemed at all relevant, or anything that I wished to chat about. I could have used my default answer to such questions when proffered by the person in the next seat on the airplane: ‘Asian Studies’, which usually had the desired effect of stopping further inquiry. But my defences were down and I said, ‘I teach courses on Buddhism.’ I quickly regretted my candour. The PA stopped her needlework, looked away from my hand and at my face and said, ‘What did you say your name was?’ I actually had not said, but I answered, ‘Lopez.’ She stared up at the ceiling and muttered to herself, ‘Lopez, Lopez.’ Then she turned to me and said, ‘Are you the one who wrote all those books?’

I wasn’t sure exactly how to answer. I suppose that every author likes to be recognised, but this was one situation in which I would have preferred to remain anonymous, especially because I feared the direction in which the conversation would turn. The PA seemed only aware of my name as something that appeared on ‘all those books’ about Buddhism. It did not seem that she had read any of them or, if she had, that they had made a particular impression on her. And what did she mean by ‘all’? Still, I answered, ‘Yes.’ But I feared the next question. The city in which I live, Ann Arbor, Michigan, is a famous leftist (by American standards) city of 120,000 residents, known for its liberal marijuana laws and its sixties legacy. It has a high concentration of ‘dharma groups’, many led by local (rather than Asian immigrant) teachers, some of whom are self-styled gurus who teach their own eclectic and idiosyncratic Buddhism. I have learned over the years to maintain a polite professional distance. But here I was, pinned down by a person who I assumed, correctly, was a member of such a group. And so I feared the inevitable question, which the PA duly uttered, ‘So, do you have a personal practice?’ This question did not give me the slightest pause, and I answered immediately, not with an answer but with a question, ‘May I have some more morphine please?’

And so my adventures in the health care system began. My entire right hand and forearm were first ‘immobilized’ in a plaster cast. A week later I moved to a ‘splint’ of plastic and Velcro for seven weeks while the bone healed. When the splint was removed, the bone had healed but my thumb had become completely rigid. I then began three months of ‘occupational therapy’ where I was often asked to rate the pain from one to ten and to perform infantilizing exercises, by therapists who became close friends.

In the course of my adventures, I learned that the opposable thumb is indeed the source of all human culture. I learned that the loss of the opposable thumb precipitates a loss of that culture. Over the course of my treatment, I devolved both physically and mentally; my wife, who always used to sit across from me at the dinner table, moved to my side so that she would not have to watch me eat like a left-handed Neanderthal. I could not write and did not want to read. And I learned that the Victorian anthropologists were right after all in their postulation of the stages of cultural evolution. Having been stuck for the last month in the stage of hunter and gatherer, I have recently moved to the stage of slash and burn agriculturist, worshipping the goddess of the earth on full moon nights. I am moving slowly toward monotheism and then beyond it and back to my former self, contemplating the nature of pain, while asking for morphine to assuage it.