Pics of my nails: Out with the old...

What happened this time around? I was putting up some stage backdrops for Arts 5th Ave.  We needed concrete nails put into the mortar pretty high up on the wall.  This is a bad combination since, first or all, concrete isn't very forgiving of mistakes.  Unlike wood where you can make course corrections as you go, you have to do it right the first time or you just bust up the mortar leaving nothing to grip the nail.  The second problem is that I was up on the ladder and hammering over my head rather than the eye-line level that's ideal.  Having a couple fingers nearby to guide the nail while hammering from an odd angle worked for a bit, but halfway through the second nail things went horribly, terribly wrong and the hammer hit the kind of nail I wasn't aiming for.  Fortunately there weren't a lot of kids around at that moment or they would have picked up some colorful additions to their vocabulary.

I iced it down for a bit, and it didn't look too bad, just a bluish half-moon across the middle of my nail.  It didn't seem to want to spread.  I decided to take it easy and went home with the plan that I'd return in a few hours to help break things down with my good hand after the show.  By the time I was home though, I was really starting to feel it.  Dani and Erin went to show, but I called it a night.

The next day the nail was starting to look worse.  Whereas less than a third of it was black and blue by bedtime, by the next afternoon less than a third was still the original color.  It was clear I had to do something, so I took a drill to it that night.  No, I didn't get all Terminator (first movie) and mutilate myself; this was a precision exercise.  I used the finest bit and only drilled until I was just a fraction of a millimeter from going through to the flesh, then I switched over to a needle to puncture through the remaining bit.  Unfortunately, this didn't relieve a lot of the pressure.  Even a second (and larger) hole didn't do much good (These are the two holes shown in the picture).  Very little blood came out.

Leslie is less squeemish than Dani so she wasn't phased at all when I asked her to slice open the quick and get some blood out of there.  She did, but again, not much came through and not much relief followed from it.  She offered to make the incision still wider, but I declined; I didn't want it to be positively gaping and still not yield benefits.

In spite of my efforts (and certainly not because of them), things only got worse.  By the next night I could barely sleep because of the constant throbbing, and bumping into things every time I moved didn't help.  When I saw in the morning light how much larger it had grown, it was clear I needed to get to a doctor.

Dani got me in with her medical director who put a cauterizing needle through it.  If you've never seen one, they're a battery-powered pen-shaped instrument with a fine filament at the tip much like that on a soldering gun (and with a similar purpose).  The wire is actually finer than even the smallest paperclips are made from.  Small as it is, you wouldn't think it could handle the pressure of pushing through a nail.  Actually, it's the heat that does most of the work.  No, they didn't deaden the finger before doing it; a nerve block is more painful supposed (confirmed by several independent sources with the first-hand experience) and besides, the area immediately under the nail was effectively dead anyway.

The hole seeped out quite a bit of blood, but it was draining from the more distal end of the finger.  The puffy area around the cuticle stayed engorged in spite of highly unpleasant attempts by the doc to "milk" it toward the opening.

The doc, being a family friend and somewhat ADD, gave me a call the next day to say that he should have given me a tetanus shot when he left an open hole in my finger, could I come back?  I did, but also because the finger was swelling back up again.  The hole had sealed up again with clotted blood.  Soaking it only got some slight seepage to continue, but not nearly enough to drain it effectively.  So he burned through and reopened the original.  Nothing came out except more profanity from me (Seriously, that shit hurt worse than the first five minutes after the hammer hit me).

The nurse said the tetanus shot would make me sore.  I thought she meant the injection itself.  Some anesthetics in particular burn momentarily upon injection.  No, nothing here.  It wasn't until the next day that it really started hurting.  That morning I felt like there was a tennis ball-sized knot of soreness in my shoulder.  Naturally, it was right there in the spot I'm most likely to use to lean against a wall or bump against an elevator door.

Worse yet, I couldn't raise my arm more than a few degrees.  I had the foresight to tell her to put the shot in the arm of the injured hand.  As a result, I walked with it held against my side while my forearm held my injured hand at chest level to keep the blood out of it (any increase in pressure still hurt quite a bit).  I looked like I was doing an impression of a T. Rex with its tiny, useless forelimbs jutting from its chest.

For the first three days when the pain was at its worst, it wasn't just the index finger that hurt, but also the distal portions of the middle and ring finger on that hand.  For that matter, the index finger hurt right on down a full knuckle beyond it.  None of these areas had been hit by the hammer, however.  This was what is known in the medical and neuroscientific community as referred pain.

Probably the best-known example of this phenomenon is that an impending heart attack is registered as pain in the arm,  In reality, it's the heart that hurts and the arm is physically unaffected, but the nervous system doesn't read it as suchSame here.  The pain response extended across my somatotopic map beyond the borders of its relevancy.  I spent much of the time rubbing the erroneously-sensitized fingertips and sides of finger.  The relief lasted only as long as my massaging did, even after the first time I drained the injured finger.  Even more than a week after the fact, it was still really sore.  However, the puffiness had finally gone down when I took a needle to it and drained the pooled blood that wasn't going anywhere.

I had to get the hang of typing without my index finger.  The weird math of it was that there was only one bad finger and nine good ones, but somehow a 10% reduction in labor resulted in an immediate >50% reduction in efficiency.  The pain was certainly a distraction that kept me from doing anything very fast including playing guitar.  I gradually figured out how to use a guitar pick EVH style (i.e., thumb and middle finger.  That's how Eddie plays; it isn't just the beginnings of the hand gesture version of the VH logo).  However, in the beginning I did everything soooooo sloooooowly, maybe in part because of the pain and/or the fear of a misstep that would lead to bumping the finger, but I felt like I was creeping along.

This wasn't the first time I had to relearn to play guitar.  Remember how I pulled out one at the wedding?  Well, that almost didn't happen.  Even putting aside the blame for the fact that Dani slammed my index finger in the bathroom door (which sounds more like a honeymoon story than something that would happen a couple months before the wedding), I honestly couldn't play even open chords properly for more than a month.  I actually spent several weeks practicing the song with the next three fingers, going through the awkward process of relearning all the basic shapes.  Fortunately, even though the nail was still black and blue at the reception (to match the guitar, really), I was at least able to play conventionally.  As of this writing almost a year after the fact), there is still numbness in the tip of that finger that I wonder will it ever go away?

The only time prior to this that I lost a nail was when my ex and I first came out to Texas for job interviews.  We were at Arby's late one night as they were getting ready to close.  I was in the bathroom, and one of the employees mopped the area outside of it while I was inside, unaware.  When I came out, I started to slide on the wet floor and so I grabbed onto the door frame to keep from slipping.  Unfortunately, this was the hinged-side of the door frame (not the latch-side), and the door was pulling itself closed behind me at that exact moment... right onto my ring finger and, to a lesser extent, the tip of my middle.

I was miserable with pain for the rest of the night, but I don't remember it bothering me for much beyond that.  It took months before the skin at the quick fell away and I could take a pin and scrape away the dried blood under my nail.  One night I was at a party and went to put my hand in my pocket as I was talking to a friend when the edge of the dead nail caught the seam and pulled back.  It didn't completely come off, but it was the world's largest hangnail at that point, so I had to cut it away and file down the relatively healthy part it was formerly attached to that seemed to want to catch on everything it came near.

This time around, it was nearly two weeks before the pain subsided enough to begin using my hand normally for everything I normally take for granted: getting my keys out of my pocket and staring my engine without resorting to contortions (i.e., left arm reaching over the steering wheel to crank it), tucking in my shirt, reaching for anything without screaming when I bumped it, and typing (although I've gotten in the habit of avoiding that finger still).  The nail is mostly back now though.  Although I can type with it, the missing portion is close to the tip, which means it is still easy to bump or scrape the exposed area.

Want pics?  Read on (unless you're Katie in which case, assuming you've made it this far, you probably don't want to).


2008-05-27

The two holes are the attempts to drill through to the pooled blood and relieve the pressure.  Didn't really work all that well.  This was the thrid day after the "hammering," so the leakage into the sub-nail space had continued for quite some time.

I didn't take any photos, but the first day was little more than a half-moon.  By the second it was almost completely black and blue, but with much less swelling (e.g., the cuticle was not yet filled with blood).


The swelling as viewed from the side.  Note the speed-bump of a cuticle.

The doc's new hole, still seeping.  (Apologies for messing up the focus here.)

The blood-soaked bandage by that evening.

2008-06-03

Picture taken following the draining of the cuticle (which was a completely independent pool from the rest of it under the nail).  The cuticle looks deflated.  The paper towel cropped from the image was filled with several dozen blots like that at the right of the frame.

2008-06-07

All dried up.  The cuticle begins flaking away.  The holes are scabbed over which was fine since there was no longer anything to drain.

2008-06-08

Next day.  The cuticle continues peeling further away now.  The stretched skin gave out.

2008-06-11

No more cuticle.  Also, I began trimming the nail back starting from the distal end.

Side by side comparison with index finger on left hand.  Even a couple weeks later it's still fairly swollen.

2008-06-13

Very busy day for the nail.  We're about to have a breakthrough, no pun intended.

The white region at the center is where it started to separate after my repeatedly pushing on a raised ridge at the promixal side of the white.


Eventually it yielded to the continuous prodding and peeled away.

Alternate view.

After cutting it away.  Excised bit placed on knuckle.  Some additional trimming followed in order to remove sharp edges.

Wet after attempting to wash away the apparently congealed blood.  It wasn't just scabbing through, more like blood-profused tissue.  The spot in the center is where the cauterizing iron burned through.

2008-06-16

New nail!  A ridge had formed at the cuticle end, and pushing back on the flesh near there revealed new nail emerging.  Considerable pressure on it eventually broke away the center swath of the nail.

Further efforts cleared away the remainder.

2008-06-19

It took several more days for the scabby flesh to fall away after that, though some small bits remained for still longer.

2008-07-08

The nail growing out.  Halfway point, almost.  There's still some old flesh in the pit of the nail bed that eventually peeled away.

2008-07-30
Still more growth.  Note that it was originally somewhat warped across its surface, but subsequent growth is smooth and along the expected contours of the original nail.

Copyright 2008 Alexplorer.
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