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.
Coming from prison to the institution, the big red-headed Randle Patrick McMurphy enters the ward and sees that he belongs on the side where the Acutes are. With big, scarred hands, he goes down the row, shaking all the men's hands.
When he comes to Chief, he grabs his hand and tells him if he does not shake hands, he will consider it an insult. McMurphy turns and glances at the other men. Chief stares at the new man's hand; it is a hand that has worked and fought. When McMurphy shakes Chief's hand, the Chief remarks that he feels the hand closing over his and
...my hand commenced to feel peculiar and went to swelling up out there on my stick of an arm, like he was transmitting his own blood into it. It rang with blood and power. It blowed up near as big as his....
McMurphy's hand tells of his past. On it is "a road map of his travels up and down the West." There is carbon under his fingernails, indicating that he has worked on cars. Above one of the knuckles is a tattoo of an anchor; on the middle knuckle there is a dirty Band-Aid; all the knuckles are covered with new and old scars and cuts, some filled with dirt. The palm of this hand is smooth but muscular and hard from having hefted the wooden handles of axes and hoes.
Clearly, Randle McMurphy has had an interesting life. His calluses reveal that he has worked hard, manual labor jobs. The scars on the knuckles indicate that the red-headed McMurphy has been in many fights. And the size of his hand suggests that McMurphy may have won more fights than he has lost. The hands of this new inmate suggest that Big Nurse may soon be challenged.