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I remember the real clear way that that hand looked: there was carbon under the fingernails where he'd worked once in a garage; there was a dirty Band-Aid on the middle knuckle, peeling up at the edge. All the rest of the knuckles were covered with scars and cuts, old and new. I remember the palm was smooth and hard as bone from hefting the wooden handles of axes and hoes, not the hand you'd think could deal cards. The palm was callused, and the calluses were cracked, and dirt was worked in the cracks. A road map of his travels up and down the West. That palm made a scuffing sound against my hand.
Early in the novel, Kesey describes McMurphy's hands in order to characterize him. Although he is only describing one physical aspect of McMurphy, his hands encompass every aspect of his personality. He is a tough man whose life experiences have made him calloused and scarred, not only on his hands, but also inside. Kesey is letting us know that he is "thick-skinned"; he will be able to take a lot from Nurse Ratched and remain unphased. Furthermore, the scars, cuts, and dirt suggest McMurphy is a fighter--one who is not afraid to "get his hands dirty", literally and figuratively. McMurphy's strength and resilience, which is going to help the patients find themselves, is symbolically represented in his hands.
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