Upper Extremity

There’d never before been a woman president of the American Society of Hand Surgeons, and Martha was to be the first. She had not been elected: an aneurysm had ruptured in the president’s brain, and neither the vice president nor the chair wanted the job. As treasurer, Martha was third in line. She would be inducted in Omaha, at the annual meeting, where she’d give a little speech. She paid for her daughter Jules to fly from New England to Nebraska to join her.

The last time Martha traveled with her daughter was when she’d dropped her off at college. That was four years ago, when Jules was planning to study linguistics. The memory was disjointed: she had snarled at Martha in a Bed Bath & Beyond, then they’d eaten bowls of lukewarm mussels in a restaurant with checkered tablecloths. Now Jules was a senior and lived with five other girls in a hundred-year-old house the color of Pepto-Bismol. All the furniture in the pink house came from the girls’ parents. Martha had offered to buy them a modest television, but Jules wanted an apparatus that transformed tap water into seltzer. It confounded Martha, the things her daughter wanted. At some point the girl had transferred to the arts school and selected, as a course of study, Glass. ‘Glass,’ Martha said. ‘Like, the concept of it?’

In Omaha, Martha stood on the balcony of the hotel’s executive suite. Below, the city looked plain, compact, forgotten. A grey sedan parked near the entrance, and a woman stepped out, a green backpack on one shoulder: Jules, Martha discerned, after a moment. No suitcase, no coat. She’d bleached her hair and was wearing the blue coveralls of a mechanic. It was the girl’s posture Martha eventually recognized: that sheepish hunch.


Martha was more than a hand surgeon: she was an expert on the entire upper extremity, from collarbone to fingertip. She knew about the foot, too, and parts of the leg. But it was the hand she loved most.

By the time she became an attending, Martha made so much money that her husband had turned feral. Then she made more and divorced him. He moved to the other side of Chicago, where he now taught children how to play the piano. Once she saw him playing piano on the first floor of Nordstrom, near the women’s shoes, so she went to Neiman Marcus instead.

After the divorce, Martha kept the dogs. They were named after dead monarchs. They slept all day on the living room floor. The little one had epilepsy, and the big one was clinically depressed. Twice a day, Martha shoved pills the size of Tootsie Rolls down their throats, then clamped their jaws shut. The pills made the dogs dopey, but this was better, Martha believed, than sad or dead.

While she was in Omaha, the dogs stayed in a kennel. Normally Martha would have asked her protégé, the chief resident, to watch them, but Evelyn would be at the conference, too. She would present a paper about polydactyly. She was becoming a real hand surgeon’s hand surgeon. She was a rising star.


Help, Jules said, before hello; she needed help: a bottle of shampoo had burst in her backpack. Purple shampoo meant to keep her hair blonde. Everything was glazed violet: her lacy, insubstantial underwear; a hamburger wrapper; an oatmeal-colored sweater; some bright orange garment; a cheap blush compact; a bottle of Gaviscon.

Two hours until dinner. There was time to rinse everything, hold a blow dryer to the clothes. But Jules was distraught, close to sputtering. She upturned the bag in the tub and switched on the shower, drenching everything.

‘Or you can borrow something, if you want,’ Martha said, and fetched one of the dignified jackets she’d slid on a heavy hanger.

‘It’s like a chef’s uniform,’ Jules said, snappish. ‘Like you’re going to flambé bananas.’

Maybe she was trying to be funny, Martha thought, so she issued a little laugh. There were articles about dealing with daughters like hers—difficult ones, full of scorn. The only advice she could remember was: Tell your daughter she’s wonderful.

She left Jules in the bathroom and sat at the desk across her bed. Leaning close to a compact mirror, Martha lined her eyes like the Nieman Marcus lady had taught her: little strokes with a fine brush.


Dinner was at a steakhouse. Martha led her daughter into the private dining room: white tablecloths, dark mahogany floors, and men in somber suits, their bald spots gleaming. The men gathered around a seafood buffet in the middle of the room, lifting bright shellfish from heaps of ice.

She touched the elbow of a man who was collecting shrimp, and he turned, shrimp suspended. His face lit up. ‘Martha!’

She hadn’t seen Hiram since last year’s meeting. He led them to a table in the back. He was extremely tall, his face more sunken than Martha remembered.

She introduced him to her daughter as the father of modern thumb reconstruction, the man who taught her everything she knew. Martha told Hiram that Jules was in her last semester of college.

‘And what are you planning to do after graduation?’ Hiram asked her.

‘Glass work,’ Jules said. Her dress was still a little damp around the collar. An orange second-hand shift in a garish 70s floral. ‘I’ll be an artist.’

It sounded so self-serious to Martha; she wanted to laugh.

The man hummed. ‘The only way to make it as an artist,’ he said, ‘is luck.’ He bent a crab leg until it snapped.

Jules considered this. ‘Isn’t that also true of surgery?’

He shook his head. ‘Only way to make it as a surgeon is getting things right,’ he said. He set down a claw. ‘There’s no sweepstakes.’

Before Jules could speak, the man went on. ‘No, surgery’s nothing like art,’ he said. ‘Surgery’s about fixing people.’

He said, ‘What artists want is to impress people. Or please them. Agitate them. Upset them. Make them laugh. Soothe them. Distract them.

‘But not fix them. They can never fix them.’

Martha tore pieces from a Parker House roll and felt a perverse thrill, watching her daughter turn red. With her eyes, she tried to signal to the man that she, too, found her daughter ridiculous. In truth she held all fanciful pursuits – namely, the humanities – in plain contempt. She knew her daughter would make no money after she graduated. Maybe forever. The girl had already asked her to pay for an apartment, studio space, takeout meals, art materials: something called a diamond saw, an ultraviolet curing lamp, heaps and heaps of high-quality sand. Supposedly you could tell when the sand wasn’t pure. How long would the girl glide through the world? When Martha was her age, she knew how to intubate and resuscitate and read an EKG. She worked nights on an ambulance, saved to buy her own mother a new refrigerator.

‘I think it’s great, though,’ the father of modern thumb reconstruction said, ‘to have a hobby.’

Jules gave him the barest smile, then shook her napkin open and smoothed it over her lap. When they were getting dressed, she couldn’t find her watch. ‘The rhinestone one, with the pink crocodile strap. I could have sworn I packed it,’ she said. Martha knew the watch her daughter was looking for. Cheap, gaudy. It depressed her to think Jules wore it regularly.


Martha’s protégé, Evelyn, appeared at the table. She leaned across to shake the man’s hand, then Jules’s. She was only a few years older than her daughter, but it may as well have been decades, Martha thought, when you considered the ways they carried themselves.

Evelyn wore sparkly little earrings and a tailored grey suit. She’d recently taught Martha how to stream music from her phone and play it in the operating room. Any song you wanted. Like magic. It made Martha feel like a god.

Evelyn sat next to Hiram. He touched her shoulder, said something in a low voice that made her tip her head back and laugh.

A waitress came, and Hiram requested whiskey for himself and red wine for the table. They were to choose from three entrées, and Martha picked the filet. The waitress nodded, made a note on her pad.

Jules ordered the filet, too, and Evelyn ordered the prime rib.

‘Never mind,’ Martha said, before the waitress went away. ‘I’ll have the prime rib.’

With the meat, they were served grilled asparagus, neat mounds of mashed potatoes. A dish of buttered cremini mushrooms that no one touched but Jules.

On the other side of the room, the vice president of the American Society of Hand Surgeons stood, and everyone quieted. He paid tribute to the deceased president. At some point while he was speaking, Martha noticed Evelyn wipe a tear from her cheek. Her eyes had also brimmed at Martha’s mother’s wake. Evelyn had brought flowers, and shuttled Martha paper cups from the drinking fountain. It made Martha feel cared for.

‘Worthington never looked at a patient and saw only their hand,’ the vice president said. ‘He saw all the rest of them, too.’

Everyone clapped. Jules took too big a swallow of wine. She was red-faced already.

Across the table, Evelyn whispered something to Hiram. He nodded, and Martha saw on Hiram’s face that he was impressed with Evelyn, which meant he was impressed with Martha, too.


In high school, Martha’s daughter was caught shoplifting a nail polish called Foreplay, then a pair of gold-plated hoop earrings, then, inexplicably, an empty flower pot. At seventeen she drank too much pomegranate vodka and threw up on her friend Kaitlyn’s step-mom’s suede couch. And twice Martha walked past her room at night and heard the girl making breathy, pornographic moans. She sent the girl to a therapist, who dressed like a senator and spoke of coping skills. What could her daughter possibly have to cope with? She’d been handed everything: raw-hemmed denim skirts, gel pens by the dozen, private viola lessons. An SAT tutor – hell, a PSAT tutor. The therapist had Jules keep a gratitude journal, and once, when Jules wasn’t home, Martha flipped through its pages and was briefly full of hope.

For her college art thesis, Jules had fashioned a series of translucent glass vases, made to look like body parts, to which she’d attached real human hair. There was an armpit with stubble, a lower leg, a furry cock-and-balls, a bald head with eyelashes. She displayed them filled with water, Gerbera daisies in each.

In Omaha, at dinner, she showed her mother pictures of the work. Martha was anxious: where had the hair come from? She couldn’t think of a single thing to say.


In the morning Martha rehearsed her presidential address on the balcony. She practiced thanking the audience. She allotted time for applause.

When she was younger, she’d paid for hour-long sessions with a man who taught her to sound more authoritative, less unsure. Fewer question marks. No more hesitation. Best thousand dollars she’d ever spent, she thought now. She was happy with what she’d written. Looking out at the soft Omaha dawn, she felt a swell of pride, and joy. President!

The first conference Martha attended was in Tampa, next to a golf course. Other surgeons made vacations of it. They showed up to lectures with bright sunburns, noses lacquered in aloe. There was a spa in the hotel, and the surgeons’ wives had their toes painted and their backs rubbed. Martha’s husband had gone to the zoo. He insisted their hotel room smelled like smoke, then insisted she was crazy not to smell it, too.

It was possible there had been pleasant moments between them – there must have been – but those were not the moments she remembered. She recalled only nuclear fission. He’d resented her love for work, and he wanted impossible things: to have help with parenting, and to be the only one who parented, for example. Jules adored him. He was the one who encouraged her art classes. Martha was the one who paid.

Once, near the end of the marriage, Martha left the wax paper from a stick of butter on the counter, slick-side-up. Her husband came to her with the paper in his hand. ‘There’ll be no more butter until you learn to throw the wrapper away,’ he said.

‘And how will I learn to throw the wrapper away,’ she said, ‘if there’s no longer any butter?’ She took a bite of toast.


All day there were presentations about the hand: its bones, its nerves, its disorders.

Martha sat in the front with her daughter, who wore lilac trousers and a men’s sweater and drank orange juice from a bottle. Earlier she had tried to get away with not wearing a bra. ‘Your nipples,’ Martha had said. ‘I can see the contours of your nipples!’

This was who her daughter had become. ‘Do you need me to buy you a bra?’ Martha asked, snappish. When Jules tearfully pulled one on, Martha saw that her armpits were thatched with hair.

The only difference Martha was able to perceive, after the girl had started going to therapy, was that she stopped apologizing. For all things, big and small.


If the protégé was nervous, one couldn’t tell. Behind the podium, she clicked through high-res photos of little kids’ hands. With poise, she spoke about how to decide, when a baby was born with an extra thumb, whether to cut off one and reconstruct the other, or to excise parts of both thumbs and, as she said, ‘unite them into one, better thumb.’

Martha knew it all, of course: she’d overseen the protégé’s research and listened to her practice many times. Early on, the protégé had a tendency to speak in a breathy register – irritating – so Martha made her practice until she sounded less spacy. ‘Don’t worry. I used to sound the same way,’ she’d told her, ‘but now people take me seriously.’

The protégé had a girlfriend. An actuary. Martha had once glanced at the protégé’s phone screen and seen the girlfriend had sent two orange heart emojis, to which the protégé had responded with a dolphin. Martha wagered they wouldn’t last. It was for the best. You couldn’t pay Martha enough to go back to being a young doctor in love. All the things she’d thought would abide – they’d all dried up.

After the presentation, the father of modern thumb reconstruction raised his hand. But Martha didn’t hear him; she was no longer listening. She scanned the protégé’s face and replayed the presentation in her head, conscious of the obligation to find something constructive to say. The protégé still needed things from Martha: expertise, feedback, letters of recommendation. Some days, praise or motivation. Martha wanted to always have something to give her. She hoped to never run out.


Before Martha’s speech, there were cocktails on the mezzanine. The set-up had a cheesy, anachronistic feel: high two-tops covered with creased maroon tablecloths that puddled on the ground. Martha and her protégé held wet glasses of white wine.

‘You were very poised,’ Martha told her.

‘I feel good about it,’ the protégé said. Her forehead was shining. ‘Do you think it’s ready to submit? I think I’ll send it to Hand.’ The premier journal in upper extremity studies. Martha had never had anything in Hand.

‘We’ll have to take another look,’ Martha said. ‘We’ll want to review it again. We’ll want to make sure it’s perfect before we submit.’

The protégé nodded dutifully.

Jules appeared, holding an amber bottle of beer. ‘Oh my god, you were so good!’ she told Evelyn. ‘You didn’t seem nervous at all. You were so – articulate. I could never do something like that.’ She turned to her mother. ‘Do you remember when I was in second grade, and I had to give a presentation on deer?’

‘No,’ her mother said.

‘Yes, you do.’

‘I don’t.’

‘Well,’ Jules said. ‘Everyone had to give a presentation about their favorite animal. And my mother said she’d help me make a poster. She printed out pictures of fictional deer: Bambi, Bambi’s dad, all Santa’s reindeer. And she didn’t even cut them out. She just paid for them at Kinko’s, and I taped them to a poster. And when I stood in the front of the class, all I had was those pictures. I didn’t have anything to say about deer. I didn’t know the first thing.’ She swigged from her bottle.

Evelyn smiled. ‘Oh no. What happened?’

‘Nothing,’ Jules said.

Martha shifted her weight. ‘I don’t remember this,’ she said, and strained to smile.

‘This one girl’s mom wrote out notecards about the life cycle of the kangaroo,’ the daughter said, ‘and made her a kangaroo costume. By hand.’

‘Wow,’ Evelyn said. ‘With a pocket?’

Jules nodded. ‘And a stuffed baby kangaroo inside. Another mom rented a live snake from the zoo. A python. We watched it eat a mouse.’

‘You can rent a snake?’ Evelyn asked. ‘Like a car?’

Jules nodded again.

Martha tried to summon kindness. ‘You did like deer, didn’t you?’ she said. ‘You thought Nixon was one of Santa’s reindeer.’

‘That’s so cute,’ Evelyn said.


It wasn’t too late, she thought – her daughter could do one of those post-bacc programs. Pre-med, or pre-law, even. Martha would gladly pay. In time the girl would see how much Martha cared, how invested she was – had always been – in her daughter’s success. They’d have long phone calls about professional development, Martha dispensing advice: how to negotiate salaries, how to manage the egos of men. Maybe someday the girl would become a president of something, and she’d thank Martha in her acceptance speech. It was never too late.

Ten minutes to go. In the bathroom mirror Martha moved her hair around. Adrenaline shot through her. She buzzed her lips, trilled her tongue, massaged her jaw. ‘How can a clam cram in a clean cream can?’ she asked the mirror, again and again.


When Martha finished, the applause seemed to go on and on.

After, there was dinner. A game bird in the middle of a wide plate. Everything was exquisite.

Her daughter was across from her, and the protégé sat at the other end, next to the father of modern thumb reconstruction. Before dessert, he raised his wine glass and toasted to the new president, and the work ahead. And everyone clinked glasses. For me, Martha thought. For me!

Her head was swimmy with delight. Years ago, when she was a new mother and first felt herself slip behind her peers, it seemed less and less possible she would ever catch up. This, though, was the start of a fresh epoch, an epoch of prosperity. She’d never been so hopeful.

She saw it all so clearly: she would become like the father of modern thumb reconstruction. Patients would be desperate for appointments with her; she would be booked months out. Residents would revere her. Her face would in magazines, local TV commercials. Eventually she’d be asked to operate on the elbow of a B-list celebrity. From society president to editor of a landmark textbook to dean of the medical school, then chairwoman of the whole hospital. Momentum would beget momentum. No end to the success she would accrue.

It all seemed not just possible, but inevitable. Martha would soon be known as the mother of something. Finger replantation, or nerve repair.

It did not occur to her that she would have to wait for opportunities to present themselves, and that waiting was no guarantee they’d arrive, or that at future meetings, when she is still waiting, she will watch each new president of the American Society of Hand Surgeons approach the podium. She will be mortified to recall the excitement she felt in Omaha.

It will also come as a surprise that Evelyn will not be in attendance at future meetings, not for many years. She will be on maternity leave, and then she will refuse to travel until her child turns ten.


Back in the executive suite, Martha ate a Kit Kat from the mini-bar. While Jules was in the bathroom, she added her new title to her email signature, then admired how it looked.

A note from the kennel: one of the dogs had diarrhea. Probably just anxiety, they said, but they’d keep an eye on it. ‘OK,’ she wrote back. ‘Administer probiotics.’

She refreshed her inbox, willing someone to write her. When there was nothing, she slipped off her shoes and sat back against the pillows. Martha’s mother had had a thing about hotel coverlets – they were never washed, she insisted. Reused guest after guest. Disgusting. Not to be touched. When Martha was young, she was made to fling the coverlet to the floor. Of course, back then, she and her mother had only ever stayed in cheap motels, in places like Sandusky, Ohio. Nothing like the executive suite. They washed the coverlets here.

She hadn’t thanked her mother in her speech. It would have been infantilizing. And her mother had loved her, sure, but she’d never understood Martha’s ambition. Martha knew, from expensive therapy, that all her life she’d only wanted to impress her mother. But her mother had never cared about Martha’s accolades. They meant nothing to her. She’d once asked, ‘What the hell is the Mayo Clinic?’

Martha texted the protégé: did she want to meet for a nightcap in the lobby?

She did! Martha stood and went to the bathroom door. Jules hadn’t spoken to her since the thing about the deer. What had that been about, Martha thought, but still forced herself to gather some compassion. She understood it was difficult for her daughter, seeing her mother achieve so much. It must be a lot of pressure.

She knocked. ‘I’m going down to the lobby.’

Jules did not respond right away. Maybe she was still in a foul mood, Martha thought, seeking attention. But then she opened the door. Her face was shining, all the makeup wiped away. ‘Sure. I just need a minute,’ she said. ‘I’ll just put my dress back on.’ She’d heard an invitation.

Martha made herself smile. ‘Great.’


‘Oh,’ Jules said, when she saw Evelyn sitting at the bar.

They sat three across, Martha in the middle. There were peanuts in a wood bowl, and Evelyn ate a handful, then raised her empty wineglass and shimmied it at the bartender. Martha understood she was drunk. She ordered a glass, too, and one for her daughter.

The lights were low, and in the corner was a lounge singer in a cheap black satin vest, a fishbowl of dollar bills perched on a stool. The place was mostly empty, but at one table Martha recognized a group of doctors from the conference: five young guys with broad shoulders and gelled hair, their ties loose, glasses of golden beer in front of them.

Evelyn was excited. She leaned close to announce that the father of modern thumb reconstruction had offered to put her in touch with the editor of Hand.

‘Wow,’ Jules said. It almost passed for friendly.

Martha said, ‘He did?’

Evelyn nodded. ‘Yeah. I gave him my email address. He said he’d send an intro email tonight.’

He’s a weasel, Martha wanted to say. He’s just trying to sleep with you.

‘Who knows!’ Evelyn said. ‘Maybe nothing will come of it.’ But Martha could see she expected something would.

The guys at the table were calling requests of the lounge singer, but he ignored them. He was scatting, or trying to, and had stepped down from the stage to stride toward the women at the bar. Snapping along with whatever music he’d cued up – Martha didn’t recognize the melody. The microphone cord kept unspooling as he came closer. Martha hoped it’d jerk taut, keep him leashed to his corner, but it seemed an endless cord, and then he was right there, and the three of them turned to face him. He was still scatting. He had a tidy goatee. ‘Doo bop, squee bop de bop,’ the man sang, ‘doo bop dee doo.’

Someone must have told him it was important to engage with the audience. And there he was, extending a hopeful hand to Jules.

She shook her head.

‘Why not!’ Evelyn said. ‘Go on! Go dance! You’ll have fun!’

Jules looked at her with unalloyed contempt. She shook her head again. ‘I don’t want to.’

The man pretended to plead.

‘You don’t have to, Jules,’ Martha said.

‘Oh, fine, I’ll do it,’ Evelyn said. She slid from the stool, and the goateed man put an arm around her. He gave up scatting and started to sing a song about how lovely she looked. He twirled her, and she grinned, and then they did the fox trot.

Jules eyed Evelyn a moment, then touched her mother’s arm. ‘Mom,’ she said, hesitant. ‘What’s Hand?’

Martha felt a surge of gratitude: oh, her sweet daughter, her magnificent Jules. ‘Just some magazine.’ She leaned toward her. ‘You know I think you’re wonderful, don’t you?’

Jules nodded. She smiled and finished her wine. In a couple months the girl would graduate, and Martha would be there, wearing loose linen separates and heels that sunk into the grass. Her ex-husband would childishly refuse to come. ‘What a bright future Jules has,’ a professor would tell Martha, and she would nod, agree, and for the first time consider it. All the furniture in the pink house would be thrown in a dumpster or carried to the curb. The girls’ fathers maneuvered the sofa down the stairs. They did all the heavy lifting. Martha wanted to help – she wasn’t just being polite – but the men told her, ‘That’s okay.’

For now, Martha watched Evelyn sway with the man in the vest. He sang a song about a faraway city, and Evelyn didn’t seem to realize she’d been up there too long: her skirt was riding up, and her face was flushed, her underarms dark.

Had Martha ever had fun at a conference? She couldn’t think of a single time she’d allowed herself. She cradled her chin in her hands. Jules rotated her wrist to check her watch, then remembered it wasn’t there. It was so quick, less than a second, but Martha saw her daughter’s tiny let-down. Maybe someday Martha would tell her she’d hidden the watch, stashed it in her toiletry kit to take it home to Chicago, for her daughter’s own good. Maybe they would laugh and laugh.

‘Christ,’ Jules said, arms crossed, staring at Evelyn. She cringed. ‘Could never be me.’

— Claire Luchette (from Granta)