Hand surgery pioneer: ‘If I wanted to shake your hand before, I couldn’t open it. I’ll give you a claw’
John Purcell was sitting in the atrium of the National Orthopedic Hospital when he asked, half jokingly, if advise Noelle Cassidy can help with her hands.
She said she would look into it. Only then did John pull his hand out of his pocket for the consultant to check. She says she doesn’t work with her own hands, but she knows someone who will.
Since birth, John Unable to straighten his arms, a genetic condition that was first known to his family from John’s grandmother, Mary Ellen Purcell.
“For all intents and purposes, they are like claws,” says John.
“If I wanted to shake your hand first, I could give it to you, but I can’t open it. I would maneuver around on my own but I can’t open my arms. I will give you a claw.
“And I would know right away by looking, though people would never say, that they would think, ‘What’s wrong with his arm?’”
Mary Ellen, John’s grandmother, was a seamstress in the PJ Bourke Repertory next to the Olympia Theatre. She was born in 1875 and lived to be 85 years old.
“She has what we call a ‘Purcell hand,’” says John.
“I remember her hands very well. She had six children, two boys and four girls. None of the girls have hands, but two boys have hands.
“They are my father, John Purcell, and his brother, Joe. Joe has pretty bad hands, but he’s still a lifelong bachelor.
“My father has five children. I am the eldest child. Myself, I have hands. My next brother, Martin, has a last name. The next three do not. ”
The Purcells were raised in Whitehall on the north slopes of Dublin. He remembers the days before going to the supermarket, he went shopping for his grandmother. Back then, her hands were unremarkable. Indeed, John doesn’t directly recall many of his troubles, at least initially.
“As a child, it was not a problem. It happened when I was in my teens and when I started working. You will notice people looking at your hand. “
Mrs. Grainne Colgan, Consultant Orthopedic Surgery
John entered the printing business, which brought him in contact with Silicon Valley executives.
“We did a lot of work with Apple in Cupertino. I would go to meetings there twice a year for about 12 or 13 years. We will meet with the best minds in America.
“There would be about 20 people around the table and I had my hands in my pockets because there was no way I could prove it, even though the others would point to screens and boards.
“I have learned to manage it very carefully. It became second nature to me.”
Five years ago, John received a lifetime achievement award for his services to the printing industry. It stands alongside his other award to the referee.
“I have played international FIFA/UEFA matches. I referee for the World Cup. I was referencing the League of Champions. I did the big matches.
“Ironically, I have always been very shy about indirect free kicks because you have to raise your hand to indicate it.
“But the only way I can basically get my hands up in the air is with my fists. I have consulted in the United States and in Israel but not one of my observing colleagues has ever asked me, ‘What is the story with the fist?’
“There is always a joke with my FIFA colleagues that whenever I referee, there are never indirect free kicks. It is a direct free kick or a match. ”
Having enjoyed such an illustrious career, John’s family was amazed at his fortunate intention to have surgery.
“My wife thinks I’m crazy,” John said.
“She said to me, ‘Do you know how old you are? Are you for the birds? Now you’ve passed 70 years and you’ve made it through really well and life has been good to you and it doesn’t affect you really. ‘
“It really happened, but I coped.
“No one without conditions will have an idea of what it is like.
“Even my two sisters and another brother who didn’t have the condition said, ‘I think you’re crazy, John. It was a serious surgery. No one has ever done that before. You don’t even know if it works or not’. “
John had seen his hand therapists before, but no one had any good news.
The first moment of optimism was that day in Cappagh when he casually asked if anyone could help.
John Purcell from Ashbourne, County Meath
His youngest daughter happened to have surgery at the hospital and John was sitting with her surgeon, Ms. Cassidy while her daughter had an MRI.
“We were chatting about anything and everything and I just joked, ‘You can’t hold Noelle’s hand, can you?’
“And she said, ‘What do you mean, John?’
“So I showed her.”
Ms. Cassidy said she knew the person and suggested Ms. Grainne Colgan, a colleague who had just returned from the UK.
A few months later, John received a call from Miss Colgan’s personal secretary to come the next morning.
He was first seen by one of Ms. Colgan’s team, and then by another. They advised he might have to wait another hour.
“I said, ‘I don’t mind waiting. I’ve been waiting for 70 years,’ John recalls.
“About 20 minutes later, Miss Colgan arrived with about five other doctors with her.
“She looked at my hand and she said, ‘Wow. She asked, ‘Can you do this? Can you do that? ‘
“So anyway, we talked about it and then for a while we were sitting in her office.
“I said straight to her, ‘Grainne, is there anything you can do for me? What can you do? ‘
“She doesn’t have monolids. She goes, “John. I can fix that for you.’ It’s like she’s saying she can fix a puncture. There’s no ambiguity.”
From the very beginning of her surgical training, Miss Colgan was fascinated by the hand.
“I actually trained with plastic surgeons after my orthopedic training because hands have always been my real favorite, but I also do trauma and emergency cases,” she said.
“Hand surgery is bone and also soft tissue, so tendons and ligaments. I put my own fellowship here [in Ireland] – with the assistance of an orthopedic and plastic surgeon.
“It was the first scholarship of its kind and that’s where I really found my passion, which is more complex hand surgery – including pediatrics and cerebral palsy.
John Purcell and his brother Martin
“It’s both bone and soft tissue, and very relevant. That’s what I really love.”
Ms Colgan explains that when it comes to surgery, “the hands tend to be a bit alienated” at the cost of “big bones”.
But the hand, she says, is “very complicated”.
“The results are very skill-based. It is very intuitive. It is very clinical. There are a lot of terrible tests. What really matters is that you do the right thing.
“There’s a little bit of everything, so that’s a challenge. Hands are very important. The hand for the surgeon is very important. And I love the idea of the hand operating on the hand.”
The Purcells’ case is complicated by how well they have adapted to their situation. Although both brothers were unable to straighten their arms, there was no pain sensation and hand function was not unduly affected.
The strength of their hands did not diminish.
“John’s first question to me was, ‘Can you squeeze my hand? ,” said Mrs. Colgan.
“I say yes, because straightening is so easy. It is doing that and keeping that functionality is a challenge.
“There are a lot of possibilities to make it worse. And there is nothing about it in the documentation. I asked a lot of hand surgeons and none of them saw it.
“I want to know if they’re going to lose power, because I’m going to have to stretch all their tendons.”
In a normal hand, the muscle inserts into the tendons that are attached to the fingers. The tendons control the opening and closing of the fingers. Tendons are made up of collagen protein. When the tendons are shortened, the fingers cannot fully open.
Ms Colgan continued: “I knew from examining them that the tendons in the forearm were short.
“Every tendon is like a rope, like an elastic band. To lengthen it, I split it in the middle and sewed the tendon to the tendon. The complex bits are evaluating it right. If I don’t stretch them enough, they’ll still be tight. If I stretch too much, they will be weak, because the tendons will sag.
“I had to cut every tendon in my hand, stitch it up, repair it and then rehabilitate them.”
While the surgery itself is complex enough, repair and recovery carries its own risks.
The surgeon added: “One of the risks is the water breaking.
“The tendons are stitched together but they can break, it’s a cut. Or they may have been stuck together. What was really important was that we got them moving early before the risk of then breaking. It’s a good balance. “
John’s hand and forearm were cast while the team waited. There is uncertainty as to how the surgery will go.
“I am not sure how it will turn out. Nothing is written about this. We will do that surgery for injuries where individuals may have accidentally cut their tendons, but not in cases like this.
“Then when I saw John was recovering and everything was moving strong, I was quite surprised.”
Both John Purcell and Ms Colgan acknowledged that the care received at Cappagh made the surgery a success.
Ms Colgan said: ‘Hand surgery is nothing without a hand therapist.
“I honestly appreciate Orla Brady and Carina Wiid-Kenny for a fantastic job. They did all the monitoring, all the strength checks and all the objective measures and then linked back to me.
“That’s a huge part of it. You cannot have that type of surgery without specialist therapy.
“The skill and support of the nursing staff is invaluable. All the nurses were very caring, one of the theater nurses even changed her shift to come see me, which I really appreciated. I have senior interns with me and junior doctors, and their input is also important.
“A surgery like this is not for anyone. It’s the entire team, the anesthesiologists, the admissions people trying to get them in. It’s a small team in Cappagh and we think of ourselves as a small country but we have loads of expertise and talent.
“And that’s reflected in how well they’ve done.”
Back at Co Meath, John and I are chatting over Zoom. He’s wiggling his fingers. He says he is back in golf and the strength in his hands is almost completely back.
He currently serves as a patient representative on the board of directors of Cappagh Hospital. Sure, he seems to have won the hearts and minds of the wards.
“When we went to see John with the team after his first surgery to see if he was awake,” said Ms. Colgan, his reaction was so strong that we literally choked.
“It was then that I really understood how important it was to him, and how important surgery and medication can be.
“It was a moment that will probably be unmatched in my career.”
Cappagh National Orthopedic Hospital is at the forefront of orthopedic medicine, education and innovation. Check nohc.ie
https://www.independent.ie/life/health-wellbeing/health-features/pioneering-hand-surgery-if-i-wanted-to-shake-hands-with-you-before-i-couldnt-open-them-id-be-offering-you-a-claw-41440142.html Hand surgery pioneer: ‘If I wanted to shake your hand before, I couldn’t open it. I’ll give you a claw’