When multiple sclerosis made it impossible for Dr. Arnold Arem to perform surgery, he rediscovered an old love -- writing.

Arem worked in Tucson as a hand surgeon for 20 years. After tremors in his hands stopped his practice, his wife suggested trying to write, a pursuit he enjoyed in college.

The longtime member of Congregation Chaverim enrolled in a writing course at Pima Community College. His assignment was to come up with a publishable piece of work by the end of the semester. Arem wrote an essay about a patient of his who had lost both legs and one hand from a nearly lethal case of strep, and how he fought to save the remaining hand. Approval from his classmates and professor encouraged him to continue.

"My teacher said, 'Do this nine more times and you have book,'" he remembers. Two years later he landed an agent at the college's annual Pima Writer's Conference. A book contract with Times Books followed shortly thereafter.

The book is called In Our Hands: A Hand Surgeon's Tales of the Body's Most Exquisite Instrument. Equal parts medical memoir and cultural study, the book delves into one of the body's most overlooked parts. 

People rarely notice their hands until something goes wrong with them, Arem explains.

"Suddenly the world stops. Suddenly life stops," he says. "We all have hands and we take hands for granted. Hands are highly tied to our humanity."

A patient's perception of a hand disability often is well out of proportion to how noticeable it is to other people, he says.

One chapter in Arem's book tells the story of a biker who was bitten by his pet rattlesnake and lost a forefinger. The patient despaired of ever being able to live a normal life until his fellow sheet metal workers showed up. Two of them showed him their own damaged fingers. They were able to do their jobs so well that the patient had never noticed their injuries.

One of the most difficult procedures Arem had to perform was a pollicization, which replaces a missing thumb with another digit. The patient was a two-year-old boy who had been born without thumbs as the result of his mother's cocaine use. 

Arem's first obstacle was the mother herself. The boy was in the care of other relatives, and they had to convince her to sign the paperwork approving the surgery. Before he could get her signature, Arem had to weather a raging family feud in his office, and control his own feelings about the woman. She even tried to wheedle some free painkillers from him.

The next task was the surgery itself. Arem had never performed the operation before, and learned the method through a training video produced by a doctor in Germany. He started by shortening the index finger to the length of a thumb, then turned it 90 degrees into the proper position. Arem had to reposition muscles and tendons, and alter the webbing between the digits so that it would look normal. 

The hard work paid off. Just two months later, the boy was playing in Arem's office, doodling with a pencil and tweaking his big brother's nose. Instead of suffering a severe handicap, the boy now had a functioning hand.

The second half of Arem's book covers the lore and mysteries surrounding the hand. He covers such diverse topics as palm reading, phantom limb, and the left hand-right brain connection.

His next project is a book about empathy in medicine.

Arem complains that the insurance companies encourage doctors to get patients in and out the door as quickly as possible. In that situation, it is difficult for a doctor to get a real feeling for what the patient is going through. 

"Time is a precious commodity and physicians don't have it. That's why many people are unhappy," he says. "Nobody's going to reimburse you for taking the time."

For Arem, talking with patients is the most rewarding part of the practice.

"That's where the fun of medicine is," he says. "They have to know what's wrong so they can be partners in their own care."

Arem now conducts independent medical exams for lawyers and insurance companies, examining patients who are having problems after their treatment. Because his workload is lighter than a regular doctor's, he is able to develop a more empathetic relationship with his patients. 

"I can spend two hours with a patient if I want," he says.