If the pace is too much to stand,
Just examine the hand
Let your eyes linger
While you check out the fingers
The patient will think it is grand
Next time you can speak safely with a violent person, ask to look at their hands. If you look at several sets of hands that have been asked to solve problems inappropriately, you will see a pattern.
The knuckles of the pointer and middle finger become enlarged, and the skin over them becomes reddened. The skin of the hand itself becomes a network of scars and marks, tracks of ineffective reactions.
Martial artists who are not violent by nature will show the hypertrophy of the knuckles. People who work hard with their hands will show scars. Put those two things together and you generally find someone you do not want on your team.
Others things leave enlarged knuckles of the index and long fingers. Rheumatoid arthritis, psoriatic arthritis, and Lyme disease will enlarge the joint where the finger joins the hand and the joint of the finger closest to the hand, and spare the last knuckle. Any repeated small trauma, or even a one time large trauma, will leave a finger joint permanently swollen.
A patient today had the worst fractured finger I’ve ever seen; the bone had been exposed since last week. Those two telltale knuckles on one hand were enlarged enough to give pride to a Kung Fu master, but were normal on the other hand. The patient had never trained in martial arts, hadn’t been in a fight for decades, couldn’t remember any significant trauma, and didn’t have any morning stiffness. No scars on the back of the hands, no enlargement of the other joints. It was a pattern I’d never seen.
A lecturer in med school said, “If you’re stuck and you need time to think in front of a patient, if you need to stall and you want to seem caring rather than clueless, examine the hands.” If someone takes both your hands and looks closely at them, you immediately sense caring. I generally use that trick every week or two, sometimes more. In the moment of silence it buys me I can put my thoughts together, think things through, and figure out the next step.
In the process, over the last thirty years, I have learned a lot about people from looking at their hands. Outdoors people who have the skin of their index fingers roughened and thickened in the middle bone on the surface that faces the thumb have problems with blisters (they tie their boots too tight). Smokers with rigid personalities have the nicotine stains; the more flexible ones rotate their grip.
Biting nails is a nervous habit but to really get them gnawed down to the quick takes devoted obsessive compulsive disorder; those people will have other OCD characteristics in their lives.
If I suspect Parkinson’s disease, I’ll sit and hold the patient’s hand while I talk to them and feel between the thumb and forefinger for the subtle trembling of the muscle that precedes the frank pill-rolling tremor. I’ll use the degree of quaking to judge progress of Parkinson’s progression or treatment. Don’t look in the textbooks for that one, it’s an observation I found on my own.
I’d like to think that someday it will be in the medical dictionary as Gordon’s sign.