Clem's Hands

Parish

Chapter 16: Clem's Hands

The hands are large. This is the first thing people notice when they meet Clem, the size of the hands, the hands that are disproportionate to the body, though the body is not small — Clem is six-one, 220 pounds, a big man by most measures — but the hands are bigger than the body suggests, the fingers thick and long, the palms wide, the hands of a man whose hands were made for the work he does or whose work was chosen because of the hands, the cause and effect being impossible to separate after fifty-five years of the hands being Clem's hands and twenty-eight years of the hands doing what they do.

The left hand has a scar across the palm, a thin white line that runs from the base of the index finger diagonally to the heel, the scar being the record of a cut sustained in 2004 when a horse pulled back while Clem was holding a lead rope and the rope burned through his glove and into his skin, the burning being the friction, the friction being the horse's fear converted into the rope's heat converted into the skin's damage, the conversion being the chain of cause that veterinary work produces, the chain that begins with the animal's emotion and ends with the veterinarian's body bearing the mark of the animal's emotion, the mark being the scar, the scar being the record.

The right hand has a callus on the thumb, a thick pad of hardened skin that developed from the repetitive use of the hoof rasp, the rasp gripped by the right hand and pushed along the hoof wall a thousand thousand times, the pushing producing the friction and the friction producing the callus, the callus being the body's defense against the friction, the body building its own armor in the places where the work wears, the armor being the adaptation, the adaptation being the body's answer to the work's demand.

The knuckles are enlarged. Both hands. The enlargement is the arthritis that has been building for a decade, the arthritis being the inflammation of the joints that is the price of the work, the work requiring the gripping and the twisting and the pulling and the squeezing and the reaching and the holding, the holding being the thing, the constant thing, the hands always holding something — a syringe, a rasp, a rope, a chain, a calf's head, a hoof, a stethoscope, a bottle, a pen, a coffee cup — the holding being the hands' permanent activity, the hands at rest being the hands between holdings, the between-holdings being the brief intervals that do not last long enough for the joints to recover, and the not-recovering is the arthritis, the arthritis being the body's invoice for the holding.

Clem does not talk about the arthritis. He does not mention it to Renee, though Renee knows because Renee sees the way he holds his coffee cup in the morning, the grip slightly different than it was ten years ago, the grip adjusted for the stiffness, the stiffness being the arthritis's morning gift, the first gift of each day, the gift that says: Your hands worked yesterday and the working has a cost and the cost is this, this stiffness, this aching, this difficulty in closing the fingers around the cup, the difficulty that eases as the morning progresses and the joints warm and the warming is the relief, the temporary relief that the day provides before the day's work produces the next day's morning stiffness.

He does not mention it because mentioning it would be acknowledging it and acknowledging it would be giving it weight and giving it weight would be admitting that the weight is a burden and admitting the burden would be the beginning of the conversation about the end, the conversation that says: When will the hands not be able to do the work? When will the arthritis progress from the stiffness to the limitation? When will the limitation become the disability and the disability become the retirement? The conversation is the future and the future is the thing that Clem does not discuss because the discussing would make it present and the present is the practice and the practice is the hands doing the work and the work continuing and the continuing is the identity.

The hands have been inside thousands of animals. This is the fact. This is the number that Clem does not count but that could be counted if counting were the point, the point being not the number but the knowledge that the number represents, the knowledge that lives in the fingers, in the joints, in the tendons and the muscles and the nerves that connect the hands to the brain, the connection being the pathway through which the knowledge travels, the knowledge that is not intellectual but tactile, the knowledge of how a thing feels, the knowledge that the fingers have accumulated through twenty-eight years of touching the insides of living bodies.

The reach. The arm goes in. The hand enters the animal's body through the orifice that the procedure requires — the rectum for the palpation, the vagina for the obstetric work — and the hand enters the dark. The dark inside the animal is not the dark of a room or the dark of the night but the dark of the interior, the dark that is the inside of a living thing, the dark that is warm and wet and pressured and that the hand must navigate without sight, the navigation being entirely tactile, the fingers reading the interior the way a blind person reads braille, through touch, through the interpretation of texture and shape and temperature and resistance, the interpretation being the diagnosis, the diagnosis being the reading of the body's text by the hand's literacy.

The uterus. Clem's hand knows the uterus. His hand knows the uterus of a cow the way a pianist's hand knows the keyboard, through repetition, through the thousands of palpations that have trained the fingers to recognize the structure, the bicornuate uterus that branches into two horns, the horns that carry the calf, the calf that Clem's fingers can detect at thirty days as a slight swelling of the horn, a thickening that is barely perceptible but that the trained fingers perceive because the training is the perception, the training having calibrated the fingers to detect the difference between the horn that contains a calf and the horn that does not, the difference being subtle, a matter of texture and tone and the faint fluid thrill that the amniotic fluid produces when the fingers press gently against the horn's wall.

At forty-five days, the calf is the size of a mouse. Clem's fingers find it. The fingers slide along the horn and find the swelling and within the swelling the amniotic vesicle and within the vesicle the embryo, the embryo that is becoming a calf, that is developing the legs and the head and the organs that will make it a cow, the development happening in the dark, in the warm dark of the uterus, and Clem's fingers touch the outside of the vesicle and feel the presence of the thing inside and the feeling is the diagnosis: Pregnant. Forty-five days. And the diagnosis is the knowledge, and the knowledge is in the fingers.

At ninety days, the calf is the size of a beagle. The fingers can feel the head. The fingers can feel the legs. The fingers can count the legs — one, two, three, four — and the counting is the confirmation that the calf is a single calf and not twins, because twins in cattle are a complication, the complication being the freemartin, the female twin of a male that is born infertile, the infertility being the result of the shared placental blood supply, the male's hormones affecting the female's development, the development altered in the dark, in the womb, the alteration being the price of the twinning, and Clem's fingers can detect the twinning at ninety days, can feel two heads where one should be, two sets of legs where one set should be, and the detection is the diagnosis and the diagnosis is the information and the information is the farmer's decision: keep or cull, the decision depending on the sex of the twins, the sex that Clem's fingers cannot determine at ninety days but that the pregnancy's progression will reveal.

The heartbeat. Clem's stethoscope finds it. The stethoscope placed on the horse's barrel, behind the left elbow, the bell of the stethoscope pressed against the skin, and the heartbeat is there, the lub-dub that is the heart's rhythm, the rhythm that Clem's ears have heard ten thousand times and that his ears know the way a musician knows a note, instantly, the recognition being the training, the training being the ears calibrated to the heart's frequency and the frequency's variations, the variations being the diagnosis.

The normal heartbeat: regular, strong, the lub-dub clear and distinct, the two sounds being the closing of the heart's valves, the mitral and the tricuspid producing the lub, the aortic and the pulmonic producing the dub, the closing being the heart's mechanism, the mechanism that pumps the blood, and the blood carries the oxygen, and the oxygen sustains the life, and the life is what the stethoscope confirms.

The abnormal heartbeat: irregular, or muffled, or accompanied by a murmur, the murmur being the extra sound, the whooshing sound that occurs when the blood flows through a valve that does not close completely, the incomplete closure producing the turbulence, the turbulence producing the sound, the sound being the diagnosis, the murmur telling Clem's ears what the heart is doing wrong, the wrong being the pathology, and the pathology is the information, and the information is the treatment or the prognosis, the prognosis being the future that the heart's condition predicts.

Clem's ears know the difference. The difference between the lub-dub that is health and the lub-whoosh-dub that is disease. The ears know it the way the fingers know the uterus, through repetition, through the thousands of hearings that have trained the ears to discriminate, the discrimination being the skill, the skill being the practice.

The lump. Clem's fingers find lumps. The lump in the dog's abdomen that is the tumor. The lump under the horse's jaw that is the abscess. The lump on the cow's shoulder that is the injection-site reaction. The lump that is the thing that should not be there, the thing that the body has produced or that has invaded the body, and the fingers find it by pressing, by palpating, by the systematic examination of the body's surface that is the physical exam, the exam being the hands' reading of the body's text, the text being the surface and the subsurface and the structures beneath, the structures that the fingers can feel through the skin and the muscle and the fat, the feeling being the detection, the detection being the skill.

The fingers have detected tumors that saved lives. The fingers have found the splenic mass in the dog that would have ruptured and bled and killed the dog if the fingers had not found it, the finding producing the surgery and the surgery producing the survival and the survival being the fingers' gift, the gift that the fingers gave without knowing they were giving it, the fingers simply doing what they do, which is: feel, assess, detect, the doing being the practice.

The temperature. The fingers know temperature. The fingers placed on a cow's ear know the difference between the normal warmth and the fever's heat, the difference being a few degrees that the fingers can detect because the fingers have been calibrated by the years, the years of touching animals and registering the temperature and comparing the registered temperature to the thermometer's number and the comparing being the calibration, the calibration being the training of the fingers to do what the thermometer does, to measure the temperature by touch, the touch being the instrument, the fingers being the thermometer.

The texture of healthy hoof. The fingers know this. The healthy hoof wall is smooth and hard, the hardness being the keratin's density, the keratin that the hoof produces the way the body produces all its protective structures, the nails and the hair and the horn and the hoof, the production being continuous, the hoof growing at approximately a quarter-inch per month, the growth being the hoof's nature, the nature that requires the trimming, the trimming that Clem's hands perform with the nippers and the rasp.

The texture of unhealthy hoof. The fingers know this too. The hoof wall that is crumbling is the hoof with white line disease, the fungal infection that eats the keratin from the inside, the eating producing the hollowness that the fingers detect by tapping, the tapping producing the sound, the hollow sound that is the diagnosis, the fingers and the ears working together, the two instruments collaborating on the detection.

The hoof wall that is soft is the hoof with too much moisture, the moisture from the mud that Louisiana produces in abundance, the mud that the hooves stand in and that the standing-in produces the softening, the softening being the environmental damage, the environment attacking the hoof the way the environment attacks everything in the parish, relentlessly, with the water and the heat and the humidity, the attack being the condition, the condition that the maintenance addresses, the maintenance being the trimming and the drying and the treating that Clem's hands perform.

The hands at night. The hands in the dark barn at 2 AM, the hands inside the cow, the hands finding the calf's head and turning it, the hands that operate without sight in the dark interior of the animal's body, the hands that know what they are doing because the knowing is in the hands, not in the eyes, the eyes being useless in the dark of the body, the dark where the hands must work alone, guided by the touch, by the training, by the twenty-eight years of reaching into the dark and finding what is wrong and fixing it or not fixing it, the fixing or the not-fixing being the outcome, and the outcome is determined by the hands and the knowledge and the animal's body and the intersection of the three, the intersection being the moment, the critical moment, the moment when the hand finds the thing and the thing is the problem and the hand must decide: Can I fix this? And the decision is made by the fingers, by the assessment that the fingers perform in the dark, by the calculation that is not a calculation but a feeling, the feeling that says: Yes, the head can be turned, or: No, the head cannot be turned, and the yes or the no is the diagnosis, and the diagnosis determines the next step, the turning or the surgery or the euthanasia, the steps that follow the hands' assessment like consequences follow decisions.

Clem sits on the porch in the evening and looks at his hands. He does this sometimes. Not often. Not as a ritual or a meditation but as a noticing, the way a person notices a part of their body that has been working all day and that the evening's rest brings to attention, the attention that comes when the working stops and the resting begins and the transition from working to resting is felt in the body, felt in the specific parts that did the work, and Clem's hands did the work and the hands are where the transition is felt.

He opens his hands. He closes them. The closing is slower than it was ten years ago. The arthritis. The stiffness. The cost. He opens them again. The palms are mapped with the lines that palmists claim to read, the lines that supposedly predict the future, and Clem does not believe in palmistry but he believes in the lines, believes that the lines are the record, the creases formed by the folding and the gripping and the holding, the lines deepened by the years of use, the lines being the hands' autobiography, the story of what the hands have done written in the skin of the hands that did it.

The life line. The heart line. The head line. The lines that the palmist names and that Clem would name differently: The palpation line. The hoof line. The syringe line. The lines that the work created, the work being the author, the hands being the book.

He thinks about what his hands have felt. The inventory of touch. The catalog of textures and temperatures and pressures and resistances that his hands have registered over twenty-eight years, the catalog that is not written anywhere but that exists in the nervous system, in the pathways between the fingertips and the brain, the pathways that carry the information, the information being: This is what a healthy uterus feels like. This is what a pregnant uterus feels like at forty-five days. This is what a tumor feels like under the skin. This is what a fracture feels like through the swelling. This is what a dead calf feels like inside a living cow, the deadness being the absence of the warmth, the calf that should be warm and is not, the not-warm being the coldness, the coldness being the death, and the death is what the fingers find in the dark and the finding is the worst finding, the finding that the hands carry home, the finding that the hands remember.

The hands remember everything. This is the burden. The hands remember the calf they could not turn and the cow they could not save and the horse they put down, the putting-down being the euthanasia, the injection that ends the life, the injection that the hands administer, the hands that healed and that also end, the hands that give the drug that stops the heart, the drug entering the vein and traveling to the heart and stopping the heart and the stopping is the death and the death is the hands' doing, the hands that held the syringe and pushed the plunger and delivered the drug that delivered the death.

The hands carry this. The hands carry the deaths they delivered because the delivering was necessary, because the suffering was more than the living, because the veterinarian's judgment — a judgment made by the hands' assessment of the body's condition — was: This animal's suffering exceeds this animal's ability to live with the suffering, and the exceeding is the threshold, and the crossing of the threshold is the euthanasia, and the euthanasia is the hands' hardest work.

Clem has euthanized hundreds of animals. Hundreds. The number is large and the number is the work and the work is necessary because the work is the mercy, the mercy being the ending of the suffering that cannot be ended by other means, the suffering that the medications cannot address and the surgery cannot fix and the time will not heal, the suffering that is terminal, and the terminal suffering requires the terminal intervention, and the terminal intervention is the injection, and the injection is the hands.

The hands that give the injection are the same hands that deliver the calves. The same hands. The same fingers. The same palms. The hands that bring the calf from the dark into the light are the hands that send the horse from the light into the dark, and the bringing and the sending are the two poles of the practice, the two ends of the work, the beginning and the ending that the hands perform with the same skill and the same care and the same weight.

The weight is in the hands. Clem can feel it. The weight of twenty-eight years of beginnings and endings, of births and deaths, of calves pulled and horses euthanized and cattle treated and goats held and hooves trimmed and lumps found and heartbeats heard. The weight of the knowledge that is in the fingers, the knowledge that will not leave the fingers because the knowledge is the fingers, the knowledge and the fingers being the same thing now, after twenty-eight years, the fingers knowing what they know because they have done what they have done, and the doing is permanent, the doing is written in the callus and the scar and the arthritis, the doing is the hands' identity.

He closes his hands. The closing is the evening's gesture, the gesture that says: The day's work is done. The hands are at rest. The rest is temporary. Tomorrow the hands will work again, will reach into the dark and feel for what is wrong and find it and fix it or not fix it, and the finding and the fixing and the not-fixing will be the day, and the day will be the practice, and the practice will be the hands.

Renee reaches over. She takes his hand. She holds it. Her hand is smaller than his, the fingers thinner, the palm narrower, but the holding is the thing, the holding of the hand that has held a thousand other things today, the holding that says: I am holding the hand that held the parish today, and the holding of the hand is the caring for the carrier, the care for the man who cares for the animals that the parish cares about.

Their hands together on the armrest of the rocking chair. His hand large and scarred and calloused and arthritic. Her hand smaller and unmarked by the work that his hands do but marked by her own work, the work of shelving and sorting and typing and holding the books that hold the words. Two hands. Two kinds of work. Two kinds of knowledge. Two kinds of carrying. The hands together on the armrest being the marriage's evening image, the image that is the practice's counterpart, the counterpart to the work being the rest, the counterpart to the holding of the hoof being the holding of the hand.

Clem's hands rest in Renee's hand. The hands that have been inside thousands of animals rest in the hand of the woman who has been beside him for thirty years. The hands that know the dark interior of a cow's body rest in the hand that knows the bright interior of a book. The hands that carry the knowledge of touch rest in the hand that carries the knowledge of words. The two kinds of knowledge, the two kinds of carrying, the two hands held together in the evening, on the porch, in the parish.

The hands rest. Tomorrow they will work. The work will continue. The hands will continue. The continuing is the practice, and the practice is the hands, and the hands are Clem, and Clem is the parish's, and the parish is held by the hands that rest now, in the evening, in the chair, in the quiet.