Joel Fish is the medical director of the Burn Program at Toronto’s Hospital for Sick Children.
My hands are not pretty. They could easily belong to someone who makes sausages for a living, or possibly a construction worker. They are thick and short – a bit like sausages, now that I think about it – and have, for the most part, survived relatively unscathed despite years of martial arts and boxing. I’ve heard many comments about the fact that they don’t look like the hands of a plastic surgeon. I’ve never apologized for this, and I don’t really care. It’s how I use my hands that matters. They are my tools.
I am a plastic surgeon, and I specialize in treating burn patients. I am grateful this profession chose me. I am proud of what I do.
My job requires an innate sense of touch. Examining the scars or burn wounds of patients is a necessary part of my work. When I touch a patient, it’s more than just a physical evaluation. It tells me about who they are. It helps me understand what it is I’m supposed to do. The laying on of hands is very personal for the patient, and a privilege for the surgeon. It’s something I do many times each week. If I ever lost my ability to “feel,” I would lose my ability to be a burn surgeon. If I could not use my hands to feel the stiff sheets of skin, and understand the power in a tightly-healed scar, I could no longer help the children in my care. It’s that simple.
I am just one member of the burn team; together, we treat more than 300 new families a year. A moment in time changes everything for the children in our care (scalding liquids is the most common injury). We treat the burn wounds and help them heal with special dressings, pain control and – sometimes – surgery with skin grafts. We follow these children and their families as they return to school and play.
My love of plastic surgery developed in the 1980s, when I learned the skill of microsurgery – replanting amputated parts. Later, I moved into burn surgery. If you ever wonder what you are going to be when you grow up, a burn surgeon is likely not on the list. The job was offered to me when I finished my training as a plastic surgeon. I applied for the position, but it was offered to someone else; when they didn’t sign the contract, it was offered to me instead. I learned to park my ego and took a job doing what few plastic surgeons want to pursue. I travelled to three of the world’s top burn centres and, under the mentorship of a few great burn surgeons, developed my passion for treating burn patients and their families. I did not find this job; it found me.
Until recently, I had never contemplated what I would do without a sense of touch. But then I underwent shoulder surgery – a result of falling off my bicycle. When I awoke from the surgery I had no sensation in my dominant arm, the result of a blocked nerve for pain control. Even though the nerve block was temporary, I was scared that my arm was permanently damaged. For a brief period, I thought my career might be over. How could I operate without a sense of touch? I am fortunate it was only temporary.
The opposite is true for burn patients; their scars feel “different.” Patients with deep electrical injuries often describe permanent, and painful, altered sensations. Many burn patients are left with skin that is not as sensitive to touch. We know very little, for instance, about how altered sensation in scarred skin might affect a person’s sexuality. We can never fully comprehend the loss that burn patients might experience. There are no doubt some who are just happy to have survived – decreased sense of touch or not – but they are a minority.
I recently attended a conference in Halifax for Canadian burn survivors. It underscored the importance of what we do. I listened to a patient, 50 years after having suffered injuries, who described being examined by a physician who put his hand on their leg even after being asked not to as it was so painful when touched; they recalled it as if it had just happened last week. Another patient described how the softness and warmth of the surgeon’s hands, after enduring years of reconstructive surgeries, helped with her recovery. I wish I’d known the importance of touch when I first started working as a burn surgeon – I don’t recall being taught about touch’s therapeutic properties when I was in medical school. This is something nurses, who approach patient care more holistically than doctors, know well. Unfortunately, I learned this important lesson late in my career.
We recently examined a small boy’s leg while he was asleep for a laser treatment to soften his burn scars. The injury and its aftermath are permanent and will be there forever. The tight scar around his knee is symptomatic and pulls when the leg is straight. He feels this with every step. His parents feel every step, as well. The scar and the joint were examined and the team was able to determine the next steps and future surgery needs for this young boy. It is the sense of touch that guided this decision and binds the patients and families to us. Like all senses we are born with, we take them for granted but mourn their loss.