The Fourth Hand

by John Winslow Irving

  It was Irma. Dr. Zajac, only hours before he would attach Otto Clausen’s left hand and wrist to the waiting stump of Patrick Wallingford’s left forearm, felt his heart constrict; his lungs seemed to cease expanding and he experienced a stomach cramp that was as crippling to his forward progress as being hit by, let’s say, a beer truck. Zajac was doubled over in the slush when Irma came sprinting back to him.

  He was speechless with pain, gratitude, shame, adoration, lust—you name it. Irma led him back to Brattle Street as if he were a runaway child. “You’re dehydrated—you need to replenish your fluids,” she scolded. She’d read volumes on the subject of dehydration and the various “walls” that serious runners supposedly “hit,” which they must train themselves to “run through.”

  Irma was what they call “maxed out” on the vocabulary of extreme sports; the adjectives of maniacal stamina in the face of grueling tests of endurance had become her primary modifiers. (“Gnarly,” for example.) Irma was no less steeped in eat-to-run theory—from conventional carbo-loading to ginseng enemas, from green tea and bananas before the run to cranberry-juice shakes after.

  “I’m gonna make you an egg-white omelet as soon as we get home,” she told Dr. Zajac, whose shin splints were killing him; he hobbled beside her like a crippled racehorse. This lent nothing newly attractive to his appearance, which had already been likened (by one of his colleagues) to that of a feral dog. On the biggest day of his professional career, Dr. Zajac had breathlessly fallen in love with his housekeeper/assistant-turned-personal trainer. But he couldn’t tell her—he couldn’t talk. As Zajac gasped for breath in hopes of quieting the radiating pain in his solar plexus, he noticed that Irma was holding his hand. Her grip was strong; her fingernails were cut shorter than most men’s, but she was not a nail-biter. A woman’s hands mattered a lot to Dr. Zajac. To put in ascending order of importance how he’d fallen for Irma seems crass, but here it is: her abs, her buttocks, her hands.

  “You got Rudy to eat more raw vegetables,” was all the hand surgeon managed to say, between gasps.

  “It was just the peanut butter,” Irma said. She easily supported half his weight. She felt she could have carried him home—she was that exhilarated. He’d complimented her; she knew he’d noticed her, at last. As if for the first time, he was really seeing who she was.

  “The next weekend Rudy is with me,” Zajac choked, “perhaps you’ll stay here? I’d like you to meet him.”

  This invitation seemed as conclusive to Irma as his hand on her breast, which she’d only imagined. Suddenly she staggered, yet she was still bearing only half his weight; the unpredictable timing of her triumph had made her weak.

  “I like shaved carrots and a little tofu in my egg-white omelets, don’t you?” she asked, as they neared the house on Brattle Street.

  There was Medea, taking a dump in the yard. Seeing them, the craven dog furtively eyed her own shit; then she sprinted away from it, as if to say, “Who can stand to be near that stuff? Not me!”

  “That dog is very dumb,” Irma observed matter-of-factly. “But I love her, somewhat,” she added.

  “I do, too!” Zajac croaked, his heart aching. It was the “somewhat” that sent him over the edge for Irma; he had the exact same feelings for the dog. The doctor was too excited to eat his egg-white omelet with shaved carrots and tofu, although he tried. Nor could he finish the tall shake Irma made him—cranberry juice, mashed banana, frozen yogurt, protein powder, and something grainy (possibly a pear). He poured half of it down the toilet, together with the uneaten omelet, before he took a shower.

  It was in the shower that Zajac noticed his hard-on. His erection had Irma’s name written all over it, although there’d been nothing physical between them—discounting Irma’s assistance in getting him home. Fifteen hours of surgery beckoned. This was no time for sex.

  At the postoperative press conference, even the most envious of his colleagues—the ones who secretly wanted him to fail—were disappointed on Dr. Zajac’s behalf. His remarks were too trenchant; they suggested that handtransplant surgery would one day soon be in the no-big-deal category of a tonsillectomy. The journalists were bored; they couldn’t wait to hear from the medical ethicist, whom all the surgeons at Schatzman, Gingeleskie, Mengerink & Associates despised. And before the medical ethicist could finish, the media’s attention shifted restlessly to Mrs. Clausen. Who could blame them? She was the epitome of human interest.

  Someone had got her clean, more feminine clothes, free of Green Bay logos. She’d washed her hair and put on a little lipstick. She looked especially small and demure in the TV lights, and she’d not let the makeup girl touch the circles under her eyes; it was as if she knew that what was fleeting about her beauty was also the only permanent thing about it. She was pretty in a kind of damaged way.

  “If Otto’s hand survives,” Mrs. Clausen began, in her soft but strangely arresting voice—as if her late husband’s hand, not Patrick Wallingford, were the principal patient—“I guess I will feel a little better, one day. You know, just being assured that a part of him is where I can see him… touch him…” Her voice trailed away. She’d already stolen the press conference from Dr. Zajac and the medical ethicist, and she was not done—she was just getting started. The journalists crowded around her. Doris Clausen’s sadness was spilling into homes and hotel rooms and airport bars around the world. She seemed not to hear all the questions the reporters were asking her. Later Dr. Zajac and Patrick Wallingford would realize that Mrs. Clausen had been following her own script—with no TelePrompTer, either.

  “If I only knew…” She trailed away again; undoubtedly the pause was deliberate.

  “If you only knew what ?” one of the journalists cried.

  “If I’m pregnant,” Mrs. Clausen answered. Even Dr. Zajac held his breath, waiting for her next words. “Otto and I were trying to have a baby. So maybe I’m pregnant, or maybe I’m not. I just don’t know.”

  Every man at the press conference must have had a hard-on, even the medical ethicist. (Only Zajac was confused as to his erection’s source—he thought it was Irma’s lingering influence.) Every man in the aforementioned homes and hotel rooms and airport bars around the world was feeling the effects of Doris Clausen’s arousing tone of voice. As surely as water loves to lap a dock, as surely as pine trees sprout new needles at the tips of their branches, Mrs. Clausen’s voice was at that moment giving a hard-on to every heterosexual male transfixed by the news. The next day, as Patrick Wallingford lay in his hospital bed beside the enormous, foreign-looking bandage, which was almost all he could see of his new left hand, he watched Mrs. Clausen on the all-news network (his own channel of employment) while the actual Mrs. Clausen sat possessively at his bedside. Doris was riveted by what she could see of Otto’s index, middle, and ring fingers—only their tips—and the tip of her late husband’s thumb. The pinky of Patrick’s new left hand was lost in all the gauze. Under the bandage was a brace that immobilized Wallingford’s new wrist. The bandage was so extensive that you couldn’t tell where Otto’s hand and wrist, and part of his forearm, had been attached.

  The coverage of the hand transplant on the all-news network, which was repeated hourly, began with an edited version of the lion episode in Junagadh. The snatching and eating took only about fifteen seconds in this version, which should have forewarned Wallingford that he would also be assigned a lesser role in the footage to come.

  He’d foolishly hoped that the surgery itself would be so fascinating that the television audience would soon think of him as “the transplant guy,” or even

  “transplant man,” and that these revised or repaired versions of himself would replace “the lion guy” and “disaster man” as the new but enduring labels of his life. In the footage, there were some grisly goings-on of an unclear but surgical nature at the Boston hospital, and a shot of Patrick’s gurney disappearing down a corridor; yet the gurney and Wallingford were soon lost from view because they were surrounded by seventee
n frantic-looking doctors and nurses and anesthesiologists—the Boston team.

  Then there was a clip of Dr. Zajac speaking tersely to the press. Naturally Zajac’s

  “at risk” comment was taken out of context, which made it appear that the patient was already in the gravest trouble, and the part about the combination of immunosuppressant drugs sounded blatantly evasive, which it was. While those drugs have improved the success rate of organ transplants, an arm is composed of several different tissues—meaning different degrees of rejection reactions are possible. Hence the steroids, which (together with the immunosuppressant drugs) Wallingford would be required to take every day for the rest of his life, or for as long as he had Otto’s hand.

  There was a shot of Otto’s abandoned beer truck in the snowy parking lot in Green Bay, but Mrs. Clausen never flinched at Patrick’s bedside; she kept herself focused on Otto’s three fingertips and the tip of his thumb. Moreover, Doris was as close to her husband’s former hand as she could get; if Wallingford had had any feeling in those fingertips and the tip of that thumb, he would have felt the widow breathing on them.

  Those fingers were numb. That they would remain numb for months would become a matter of some concern to Wallingford, although Dr. Zajac was dismissive of his fears. It would be almost eight months before the hand could distinguish between hot and cold—a sign that the nerves were regenerating—and close to a year before Patrick felt confident enough in his grip on a steering wheel to drive a car. (It would also be close to a year, and only after hours of physical therapy, before he would be able to tie his own shoes.)

  But from a journalistic point of view, it was there, in his hospital bed, that Patrick Wallingford saw the writing on the wall—his full recovery, or lack thereof, would never be the main story.

  The medical ethicist spoke for longer, on-camera, than the twenty-four-hour international channel had given Dr. Zajac. “In cases like these,” the ethicist intoned, “candor like Mrs. Clausen’s is rare, and her ongoing connection to the donor hand is invaluable.”

  In what “cases like these”? Zajac must have been thinking, while he fumed offcamera. This was only the second hand transplant ever, and the first one had been a failure!

  While the ethicist was still speaking, Wallingford saw the cameras move in on Mrs. Clausen. Patrick felt a flood of desire and longing for her. He feared he would never attain her again; he foresaw that she wouldn’t encourage it. He watched her shift the entire press conference from his hand transplant to her late husband’s hand itself, and then to the baby she hoped she carried inside her. There was even a close-up of Mrs. Clausen’s hands holding her flat stomach. She had spread the palm of her right hand on her belly; her left hand, already without a wedding ring, overlapped her right.

  As a journalist, Patrick Wallingford knew in an instant what had happened: Doris Clausen, and the child she and Otto had wanted, had usurped Patrick’s story. Wallingford was aware that such a substitution happened sometimes in his irresponsible profession—not that television journalism is the only irresponsible profession.

  But Wallingford didn’t really care, and this surprised him. Let her usurp me, Patrick thought, simultaneously realizing that he was in love with Doris Clausen. (There’s no telling what the all-news network, or a medical ethicist, might have made of that.)

  But a part of the improbability of Wallingford falling in love with Mrs. Clausen was his recognition of the unlikelihood of her ever loving him. It had previously been Patrick’s experience that women were easily smitten with him, at least initially; it had also been his experience that women got over him easily, too. His ex-wife had likened him to the flu. “When you were with me, Patrick, every hour I thought I was going to die,” Marilyn told him. “But when you were gone, it was as if you’d never existed.”

  “Thanks,” said Wallingford, whose feelings, until now, had never been as easily hurt as most women assumed.

  What affected him about Doris Clausen was that her unusual determination had a sexual component; what she wanted was brightly marked, at every phase, with unconcealed sexual overtones. What began in the slight alterations in her tone of voice was continued in the intensity of her small, compact body, which was wound as tightly as a spring, coiled for sex.

  Her mouth was soft-looking, her lips perfectly parted; and in the general tiredness around her eyes, there was a seductive acceptance of the world as it was. Mrs. Clausen would never ask you to change who you were—maybe only your habits. She expected no miracles. What you saw in her was what you got, a loyalty that knew no bounds. And it appeared that she would never get over Otto—she’d been smitten for life.

  Doris had used Patrick Wallingford for the one job Otto couldn’t finish; that she’d somehow chosen him for the job gave Patrick the slimmest hope that she would one day fall in love with him.

  The first time Wallingford even slightly wiggled Otto Clausen’s fingers, Doris cried. The nurses had been told to speak sternly to Mrs. Clausen if she tried to kiss the fingertips. It made Patrick happy, in a bitter kind of way, when some of her kisses managed to get through.

  And long after the bandages came off, he remembered the first time he felt her tears on the back of that hand; it was about five months after the surgery. Wallingford had successfully passed the most vulnerable period, which was said to be from the end of the first week to the end of the first three months. The feeling of her tears made him weep. (By then he’d regained an astonishing twenty-two centimeters of nerve regeneration, from the place of attachment to the beginnings of the palm.)

  Albeit very gradually, his need for the various painkillers went away, but he remembered the dream he’d often had, shortly after the painkillers had kicked in. Someone was taking his photograph. Occasionally, even when Wallingford had stopped using any painkillers, the sound of a camera’s shutter (in his sleep) was very real. The flash seemed far away and incomplete, like heat lightning—not the real thing—but the sound of the shutter was so clear that he almost woke up. While it was the nature of the painkillers that Wallingford wouldn’t remember for how long he’d taken them—maybe four or five months?—it was also the nature of the dream that he had no recollection of ever seeing the photographs that were being taken or the photographer. And there were times he didn’t think it was a dream, or he wasn’t sure.

  In six months, more concretely, he could actually feel Doris Clausen’s face when she pressed it into his left palm. Mrs. Clausen never touched his other hand, nor did he once try to touch her with it. She’d made her feelings for him plain. When he so much as said her name a certain way, she blushed and shook her head. She would not discuss the one time they’d had sex. She’d had to do it—that was all she would say. (“It was the only way.”)

  Yet for Patrick there endured the hope, however scant, that she might one day consider doing it again—notwithstanding that she was pregnant, and she revered her pregnancy the way women who’ve waited a long time to get pregnant do. Nor was there any doubt in Mrs. Clausen’s mind that this would be an only child. Her most inviting tone of voice, which Doris Clausen could call upon when she wanted to, and which had the effect of sunlight after rain—the power to open flowers—was only a memory now; yet Wallingford believed he could wait. He hugged that memory like a pillow in his sleep, not unlike the way he was doomed to remember that blue-capsule dream.

  Patrick Wallingford had never loved a woman so unselfishly. It was enough for him that Mrs. Clausen loved his left hand. She loved to put it on her swollen abdomen, to let the hand feel the fetus move.

  Wallingford hadn’t noticed when Mrs. Clausen stopped wearing the ornament in her navel; he’d not seen it since their moment of mutual abandonment in Dr. Zajac’s office. Perhaps the body-piercing had been Otto’s idea, or the doohickey itself had been a gift from him (hence she was loath to wear it now). Or else the unidentified metal object had become uncomfortable in the course of Mrs. Clausen’s pregnancy.

  Then, at seven months, when Patrick felt an
unfamiliar twinge in his new wrist—one especially strong kick from the unborn child—he tried to conceal his pain. Naturally Doris saw him wince; he couldn’t hide anything from her.

  “What is it?” she asked. She instinctively moved the hand to her heart—to her breast, was what registered with Wallingford. He recalled, as if it were yesterday, how she had held his stump there while she’d mounted him.

  “It was just a twinge,” Patrick replied.

  “Call Zajac,” Mrs. Clausen demanded. “Don’t fool around.”

  But there was nothing wrong. Dr. Zajac seemed miffed at the apparently easy success of the hand transplant. There’d been an early problem with the thumb and index finger, which Wallingford could not get his muscles to move on command. But that was because he’d been without a hand and wrist for five years—his muscles had to relearn a few things.

  There’d been no crises for Zajac to avert; the hand’s progress had been as relentless as Mrs. Clausen’s plans for the hand. Perhaps the true cause of Dr. Zajac’s disappointment was that the hand seemed more like her triumph than his. The principal news was that the donor’s widow was pregnant, and that she still maintained a relationship with her late husband’s hand. And the labels for Wallingford were never “the transplant guy” or “transplant man”—he was still and would remain “the lion guy” and “disaster man.”

  And then, in September 1998, there was a successful hand-and-forearm transplant in Lyon, France. Clint Hallam, a New Zealander living in Australia, was the recipient. Zajac seemed miffed about that, too. He had reason to be. Hallam had lied. He’d told his doctors that he lost his hand in an industrial accident on a building site, but it turned out that his hand had been severed by a circular saw in a New Zealand prison, where he’d been serving a two-and-a-half-year sentence for fraud. (Dr. Zajac, of course, thought that giving a new hand to an ex-convict was a decision only a medical ethicist could have made.)

  For now, Clint Hallam was taking more than thirty pills a day and showing no signs of rejection. In Wallingford’s case, eight months after his attachment surgery, he was still popping more than thirty pills a day, and if he dropped his pocket change, he couldn’t pick it up with Otto’s hand. More encouraging to the Boston team was the fact that his left hand, despite the absence of sensation at the extremities, was almost as strong as his right; at least Patrick could turn a doorknob enough to open the door. Doris had told him that Otto had been fairly strong. (From lifting all those cases of beer, no doubt.)