Richard Ratzan
Cell 2 Soul. 2007 Spring; 3(1):a15
Elementary, My Dear
Watson.
Elementary.
You see
all the pieces
once assembled
must
fit.
Must fit together seamlessly
A perfect whole
of logical and aesthetic integrity.
The failure to solve
a puzzle be it medical or
economic or geologic
is a failure of one of two sorts.
Either one does not have all the pieces
or one hasn't the necessary skill
(I am of course subsuming
patience under skill
since skill includes the realization
of the necessity —
which makes it a necessary skill —
for patience.)
When I walked into the room
I saw a red — headed man
of diminutive but
pugnacious appearance
(I may seem to be
contradicting myself but
I am as usual
selecting my words carefully —
Correct diction is the mark
of a man who chooses
to solve the puzzle
of communication.)
He was in his thirties
with a swollen left hand.
Both were calloused
leading me to deduce
considering his dress as well
that he was a manual laborer.
He had no marks about the face
suggesting either
it was a brief scuffle or
he was the faster and
superior pugilist — or luckier.
One must not confuse luck with skill
(It is true that skill leads
more frequently to success
evincing the appearance of luck but
even the supremely skillful can suffer
misfortune in the face of —
let us simply agree with
those who call them —
Acts of God.)
His hand
as I said
was swollen but
Beg your pardon? How did I know it was
fisticuffs? A man under thirty — five
with calloused hands and swelling near
the left pinky is a left handed boxer sans
gloves until proven otherwise, Watson.
To continue: there was no ecchymosis
visible suggesting either no fracture
or a fresh altercation or
a palmar distribution of bleeding which
I'd discover on examination.
Thus much before speech.
What happened I asked
to gather more pieces
for what was a picture already
too clear in mental outline.
Someone threw a drink on my girl
when I went to the men's room —
this was two days ago —
and when I came out she was all wet
I asked her what happened and
she said the guy next to her
at the bar had asked her to dance.
She said No so he threw his drink all
over her I asked him about it
and he said Get lost pipsqueak
and when I asked him
to repeat what he said he said it
again so I socked him one.
Now clearly we have
a nearly completed tapestry.
The Scene: a bar on a Saturday night.
The Setting: alcoholic beverages
Saturday night, a bar, a ménage à trois
(what the Americans, I think,
in their typically more
geometrically obsessed fashion,
call a triangle.)
I examined his left hand.
It was tender over the fifth metacarpal
with an inward turning of the little finger
on his forming a fist which
of course as we already knew
he knew how to do well
he knew how to do well
albeit
painfully
now.
In his attempted fist
the alignment of his
cascade of fingernails —
the hand surgeons'
colorful description of what I
prefer to liken to a palisade —
was ruined by a bashful
little finger trying to hide
its head in the crowd.
Diagnosis, the only one possible now:
a boxer's fracture of the last
metacarpal of an oblique —
or "spiral" — nature.
The roentgenograph confirmed
the already rationally reached
deduction.
The puzzle? What makes this a puzzle
you ask? Astute as always My Dear Watson.
Astute as always. You've noticed I'm confident
I did not ask him my two customary
questions. Questions I ask every patient with
a hand injury: handedness and occupation.
To be candid — you know I am ever
candid with you Watson even if I do
not divulge as much to our
striving poseurs of fellow detectives —
I mean readers —
to be perfectly honest Watson I
must admit that genius enters here —
genius suffering a
momentary lapse of reason
as Pink Floyd will one day see fit
to entitle their album. After leaving
the patient's room with the final
diagnosis and plan for therapy
(the ulnar gutter plaster splint you
yourself were all too kind to apply)
a nagging doubt — nagging doubts are
but the persistent internal alarm clocks
of genius Watson —
a niggling doubt restored
the habit of inquiry.
I returned to the room and asked
Are you left handed? No
he replied cheerily. Right.
Aha, my brain announced to itself —
I have never seen a boxer's fracture
in a non — dominant hand. Why now?
Now all but one piece has been assembled.
We have an Etruscan mosaic of a
pugilist with the last tile missing
but at hand ...
Waiting to be gathered
and then inserted into its
patiently waiting vacancy. This moment,
Watson, it is for this moment I detect —
the anticipatory moment of
cognitive release if I may be excused
an uncharacteristic double entendre:
fitting the last piece into place. Its place.
But if you are right handed
why did you lead with
your left? He looked
stunned for a second or two
as though the question posed
a puzzle for him as well
and then realized —
anagnorisis our literary colleagues call it —
he realized the answer
even as he said it aloud:
I'm a bricklayer he said jovially flexing
his left arm
even as he rotated and up
his palm back
into hod — carrying position.
My left hand has always
been stronger than my right.
Thank you Watson
but it was
as you can see
Elementary.
Postscript:
This poem is dedicated to Lord Peter and Lady Peter Wimsey as a wedding gift since I wrote it while reading about their adventures during their busman's honeymoon:
"I hate violence! I loathe wars and slaughter, and men quarreling and fighting like beasts! Don't say it isn't my business. It's everybody's business."
— Lord Peter Wimsey to his new bride, Harriet.
Busman's Honeymoon (1937), Avon 1968: page 107
It is also dedicated to Larry Rand, who loves Arthur and Sherlock, and to Rex Stout, for all the wonderful hours I have spent in their orchidarium, study and dining room with irrepressible Archie and erudite Nero.
Lastly, it is dedicated to Irwin M. Braverman, MD, who has taught so many young physicians to see what was already in front of their eyes.