Dupuytren and I

Adam Thomas -


The anaesthetist tried to distract me.

What do you want to think about?

Mountains, I said.

Lying on my back, my left arm stinging from the intravenous line, my right arm aching from the tourniquet, I squinted at the blinding lights. In the background, the thrum of machines and people, the clatter of steel instruments on aluminium trolleys.

The lights went out within seconds.

After the operation, I woke abruptly from a blank dream, as though the anaesthetist had poured life into the cannula in my left arm. The bandage on my right hand was very large.

Two years earlier, on a walking trip in the Cairngorms, I had noticed a small pit beneath the bend of my little finger, an inversion. Over time, that became a barely noticeable lump. And then a painful pea-sized growth.

My wife Julia urged me to get it checked. I refused. No time for recovery, I said. Too busy.

You need to get comfortable doing nothing, she said.

A year later, I could not hold things in my right hand; a rucksack strap, a pan handle, the edge of a box. My fingers would not straighten. I was unable to write without pain. A hand that cannot hold a pen is a problem for a writer.

Am I a writer? In 1987, my parents bought six-year-old me a typewriter for my birthday. I produced a weekly newspaper called the Daily Adam. None of the 500 inhabitants of the village of Rippingale, Lincolnshire bought it. It was a commercial and literary failure. Since then, I have written thousands of unread words. I have filled notebooks with dead articles, and drawers with unseen novels. Ever since I could write I have been a writer. A writer without readers.

On January 3rd 2021, two years after I noticed the lump, I scrawled my new year's resolutions - slowly - into a notebook.

1. Get comfortable doing nothing.
2. Fix your hand
3. Write to be read.

One month later - after two ultrasounds, a missed appointment and an x-ray - the surgeon diagnosed me with Dupuytren's Contracture.

You have two options, he said: operate, or don't.

An operation would be simple and risk-free, needing around 10 weeks of recovery time. If I chose not to have the operation, I would lose even more use of my hand.

Patients are usually cured with an operation, he said (with not quite enough conviction for my liking). But the disease comes back in the same place for 40% of people.

Operate or don't

Dupuytren's Contracture is a strange affliction. It is also known as the Viking Disease or Celtic Hand, because it predominantly affects people of Scandinavian ancestry. Sufferers experience uncomfortable nodules under the skin of the palm or fingers. Over time, the fingers become permanently flexed.

My condition is named after a man who is stranger still. As I researched the disease, I grew worryingly interested in his life. He was an unbearable perfectionist, desperate for wealth and fame, and widely despised. Despite his polemic nature, his talent however was unquestioned. Did I see parallels with my own life? When I learned he was born on my birthday, October 5th, over 200 years ago, I became obsessed.

So it was that I came to learn everything there was to know about Guillaume Dupuytren, a French anatomist and military surgeon. One of nine children, Dupuytren was kidnapped at the age of three by a lady who thought him cute. Having been rescued, he ran away from home at the age of seven. Aged twelve, he mesmerised a troop of hussars who took him to Paris, where he began to study. Later his father forced him to follow the family tradition and enrolled him in a medical school in Limoges (tu serais chirurgien!). Dupuytren, disillusioned by the quality of the teaching, returned to Paris.

In Paris, he studied in abject poverty, using the fat of cadavers to make oil for his night lamp. In 1801, aged just 23, he became the Head of Anatomy at l'Ecole de Santé. In his first year, he dissected 1,000 bodies. Later in his career, Dupuytren allegedly saw 10,000 patients a year at his clinic. His industry was legendary.

So too, now, is Dupuytren's place in surgical history. His name is carried by at least twelve diseases, operations, or instruments, including the contracture that was closing my hand. Of him, The Lancet said, "we hesitate not to place the late Baron Dupuytren at the head of European surgery." Even Balzac immortalised him as the surgeon Desplein in his short story The Atheist's Mass.

Dupuytren's temperament has not been forgotten. Pierre-François Percy, a medical contemporary, referred to him as "first among surgeons, last among men." Dupuytren died at 58, embittered and disliked, having diagnosed his own symptoms as pleural effusion. Water on the lungs. He refused surgery, saying, "I would rather die by the hand of God than of man. Nothing is to be dreaded more for a man than mediocrity. I have made mistakes, but I have made fewer than others." He died soon after.

I decided to book the operation.

Le repos - c'est la mort!

During the first two weeks of my recovery, Dupuytren's determination was fresh in my mind. I read On Writing Well and felt inadequate. I struggled through Dare To Lead, and felt irrelevant. I tried to dictate short stories to my Macbook.

Watching countless YouTube videos about the creator economy, I grew listless and agitated. Endless email newsletters about knowledge management and and cohort-based communities passed me by. Eventually, I relented and achieved the first of my three resolutions. I became comfortable doing nothing.

Post-op physiotherapy was excruciating. After one week, the hand therapist removed my bandages to reveal an ugly zig-zag wound, decorated with blue stitches, that ran down the length of my little finger and onto my palm. Five times a day, I had to work through a painful routine of flexing and stretching. Sleep wasn't easy. Most days, I could not bear to look at my own hand. Every day the movement came back a little more.

Then, during one physiotherapy session, while scrolling through my emails with my good hand, I found a link to a writing community. I immediately envisaged a regular writing practice. The confidence to show my work to others. Readers! I painstakingly typed out my application with one hand. A day later; a positive response. Then an interview. Finally, a week later, they accepted me and I joined. My first piece, edited by the Compound Writing community and published to the world, was well received. This is my second.

Hand therapy is going well. My daily exercises continue, but they are less painful each day. As I do them, I often think of Dupuytren, daring to believe that I share some of his determination, but little of his unlikeable nature. To a new assistant, Dupuytren once said: "You are to replace me when I am absent or ill. I warn you: I am never absent or ill." Unlike Dupuytren, I no longer fear inactivity; it brings reward.

Who knows what would have happened to Dupuytren if he had worked a little less. Or been a little nicer. Or opted for surgery to cure the disease that killed him. And who should change history? A complex and contradictory life is one worth obsessing about. Thanks to this conflicted French surgeon from the 18th century - a pompous, confrontational, determined and brilliantly talented man - I have achieved my resolutions.

Rest does not feel like death. My hand straightens and bends. My notebooks and drawers are full with words again.

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Thanks

To my Compound Writing editors (Giselle Sproule, Ergest Xheblati, Gayatri Taley, Steven Ovadia), and Julia Hildebrand, for making this better.

Sources