The hands that prepared it.

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"Bless this meal that we are about to receive. . .

. . .and the hands that prepared it. . . ."

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"I know exactly why this happened, doctor."

"You do?"

This was the start of an exchange I had with one of my patients on rounds last week. A man in his ninth decade with a weathered face like dark tan leather but eyes with the innocent twinkle of an infant. He had just been hospitalized for worsening of his long-standing heart failure.  His complaints included the standard drill of a weak left ventricle--shortness of breath upon exertion, a "drowning sensation" when trying to lie flat, and ankles that looked exactly like they'd been padded with Play-dough.

"Too much salt.  That's what happened, I know. Too much salt."

"Wow. I appreciate your honesty," I replied while still holding the hand he'd used to greet me.  "Were you taking all of your medicines?"

"Yes, ma'am. I tekks my medicines like clockwork. But see I been moving a little more slow and with my arth-er-itis  my hands get to aching when I try to prepare a meal, see."

"Okay."

"Yeah, so I ain't been mekk-ing my own meals like usual, see.  See, normally? I cuts up and cleans my own greens, snaps my own peas, all that. All fresh. But I can't do all that so I been going over to the senior center. They got meals for the seniors over there, see. Jest three dollars."

"Hmmm."

"But, see, since they gots to mekk all that food for so many folk they gets it all from cans and such. They collards come out a can. They give you some soup, too. You know, 'cawse some of the seniors they can't chew so well."

"So you've been eating there a lot?"

"Every day. Tha's all I can do.  'Cawse my chil'ren don't live nearby. I mean, they see about me when they can, but not ev'ry day.  So thank God for that senior center or else I'd be goin' hungry."

"Hmmm, I hear you, sir. Sounds like they've been a big help." I pressed my lips together for a moment and looked down at his hands. "Your hands.  Tell me about your hands hurting you."

"Oh, well I was tekkin' some Aleves. But then my doctor say don't tekk no Aleves if you got heart failure 'cawse it can mekk your heart flare up. And look like she was right 'cawse my heart was backing up fluid when I was tekkin' them Aleves."

"Uh huh."

"But, see, them Aleves? They sho' knock that ol' Arthur back and put him in his place." He cackled and shook his head. "She, you know--my doctor--she said go on and tekk some Tylenol. But you know Tylenol don't do nothin'."

"So your hands started hurting you more?"

"Yes, ma'am. I tried some salve, too. That salve work on my knees but for the hands it ain't no count."

"I hear you."

"Yep. So my hands can't prepare my food. And the food I can get don't agree with my heart 'cawse is all salty. Not salt-shekker salty. Jest that salt that hide in it from the can, see.  That's why this happened."

"I think you are right, sir. I really think you have it exactly right."

And after that I just stood there for a few beats holding his hand in some kind of trance. Wondering what the hell I could do to help with this vicious cycle.  I rubbed my thumb over the lumpy and swollen joints of his fingers.  His knuckles rose and fell like the Rocky mountains and each finger sunk inward like a swaybacked horse.  I thought about his insight about what had happened and why he was hospitalized and marveled at how spot on he was.

"Is it okay if I examine you now?"

"Go right ahead, baby."

I smiled at him calling me "baby." It was the kind of "baby" that floats perfectly out of the mouths of elders and immediately wraps you in a cocoon of safety and love. Not that "baby" that's often preceded by "hey" that spews from the mouths of slimy dudes holding toothpicks between their teeth.

And so I carefully palpated his heart. I felt it leaping beneath my palm, pushing it back like some kind of bully in the lunch line. I lay my stethoscope down and heard the rhythmic galloping of the blood passing through his stiffened and dilated heart muscle. I inspected his neck veins and wasn't the least bit surprised to find them swollen like stuffed sausages--visible clear up to his earlobe. All of this done with him sitting almost fully upright, which wasn't exactly ideal but was the most comfortable position for him.

He took deep breaths for me as my scope traveled across his octogenarian back.  I tried not to notice a large blackhead that beckoned me to squeeze it; I quickly shook my head, closed my eyes and focused on listening to his lungs.  With each inspiration it sounded like bubbles being blown through a straw; this was why he couldn't lie flat and this was exactly what happens when a body that is sensitive to fluid gets too much salt.

"What is it about salt anyways?"  he finally asked as I mashed my finger into his doughy ankles.

"Salt is a bossy little leader and water is a total follower," I told him. "Wherever salt goes, water follows behind it. So if you get a bunch of salt in your body, the water wants to follow right behind it."

"Into your lungs and into your legs, right?" he added.

"Yep."

"And you might not know this, but into your scrotum-sack, too."

I chuckled out loud at that and nodded.  "The water follows gravity. If you are walking around and it's only a little extra fluid, it's just in your ankles. If you lie in bed then it could be on your backside or yes, even your scrotum-sack."

"Wheeeewwww-weeee. Whatchoo talkin' bout!" he exclaimed with a playful wince.

I found myself pausing again. Just standing there puffing one of my cheeks out like a child and not knowing what to do. I knew what to do in the short term, just not the long term.  Like, I could give him more diuretic to get some more fluid off of him, I could restrict his diet of salt in the hospital, and control his blood pressure--I knew that part. But as far as a longterm solution? That wasn't so easy.

The simple fact was that he had it right on. Food for masses almost always involves more sodium than somebody on a two-gram-per-day diet should have. And when that's the food that's keeping you from "goin' hungry" then honestly? What choice do you have?

Those knots and lumps on his eighty-something year-old hands had been earned. And he was right. No salve or over-the-counter pill was going to make them less stiff or less eighty-something years-old.

Damn.

"Sir?"

"Yes, baby?"

"Have you ever thought about. . .  not living by yourself?"

"No, ma'am. Not really. I likes to do for myself. Always have."

"Oh, okay."

Of course, he did. Who doesn't like (mostly) doing for themself that's full-grown? I wasn't sure what to say next, so I didn't say anything.

"Doctor?"  I looked up and noticed that sweet twinkle in his eyes again.

"Sir?"

"Don't worry. I'm 'on be okay, baby. Alright?"

I nodded while looking at him. Marveling still at his initial insight, but even more at this insight especially.

"I been through way harder than this, baby. Way harder."

I ran my hands over those pecan-colored Rocky mountains again wondering where they had toiled.  Next I caught a glimpse of his date of birth stamped on the wrist identification band--the early 1920's.  I thought about what all his hands have had had to fight since that decade and gave that hand a squeeze.  When I looked up again he was closing his eyes to catch a few winks.

"Alright then, sir," I said softly.  "I'll be back to see about you, okay?"

He didn't speak. He just squeezed my hand back and drifted to sleep.

***
Now playing on my mental iPod. . . . . by the great Bill Withers--"Grandma's Hands."