Turn of Mind

that we were going to have to start eating more fish. You know, for the omega-three fatty acids. He wasn’t enthusiastic. It’s hard to get good fresh fish in Chicago.

Right. So you know what I’m talking about. So I’m wondering if you’ll humor me. Talk to me about your work, the memories you do have of Amanda O’Toole. Play some word games. I want to try and trigger a reaction from that very large brain of yours.

I’ll cancel my appointments for the morning.

The woman nods gravely. I appreciate that.

She takes out her phone. Do you mind if I record this? I have a bit of a memory problem myself. So, do this: Think about Amanda. Here’s a picture if it will jog your memory. No? Well then, don’t worry about what she looks like. What do you think of when I say the name Amanda?

I think of someone tall and straight and unyielding. Someone with dignity.

How would a dignified person meet death?

It’s a silly question. The only good death is a swift one. Dignity has nothing to do with it. Whether you suffer a heart attack or die due to a head trauma, it doesn’t matter. As long as there’s little or no suffering it’s a good death.

But you do hear of people who die with honor. Not just soldiers. You know what I mean.

It’s drugs. Drugs get most people through. Without drugs our own families wouldn’t wait for a more natural end. The drugs are as much for them as for us.

You’re a doctor, so you’re closer to death than most people. But then you don’t often deal with fatalities in your line of work, do you?

No, not many deaths due to hand trauma. I permit myself a smile.

But amputations?

Yes, a fair number.

What are the reasons you would amputate, say, a finger?

Infection, gangrene, frostbite, vascular compromise, bone infection. Cancer.

Is there ever any reason you would amputate all the fingers and leave the rest of the hand intact?

Yes. In cases of extreme frostbite or meningococcemia, there’s the possibility of gangrene, and you might well need to remove all digits.

And what, exactly, is gangrene?

A complication of necrosis, or cell death. In effect, a part of your body dies and starts to rot. Amputation is eventually required.

Have you ever had to perform an amputation due to gangrene?

Yes, occasionally. In this climate, you get some frostbite cases. It doesn’t usually get to the point where amputation is necessary—when it does, it’s unfortunately mostly among the poor and homeless.

But you wouldn’t see homeless people, would you? Not at your practice?

I do pro bono work at the Hope Community Health Center over on Chicago Avenue, and most of my work of this kind takes place there. And occasionally you get cases of what is called wet gangrene, which is due to infection. That’s more serious. If you don’t do an amputation in those cases, the gangrene can spread and eventually kill the patient.

So, in other words, you cut off body parts to keep the rot from spreading?

Yes, that’s one way of putting it. For the serious type of gangrene.

But there would be no reason to amputate after death.

No, of course not.

None?

None whatsoever.

Then why would someone do such a thing? In your opinion.

I’m not a psychiatrist. Certainly not privy to the deranged or criminal mind.

No, I realize that.

But it seems to me it might have symbolic value.

How would that work?

Well, if an amputation stops rot from spreading, then someone who was guilty of using their hands to do wrong—if their hands were, say, corrupted by unclean activities—that might be a way of sending a message. You know what Jesus says at the Last Supper: Behold, the hand of him that betrayeth me is with me on the table.

But why the fingers, not the hands?

That could be symbolic, too. A hand without fingers can’t easily grasp, can’t easily hold on to things. It could be a message for someone perceived as greedy, mercenary. Or someone who won’t let go emotionally. After all, without fingers, a hand is just a paddle of bone covered with soft tissue. Good for very little.