The old man hands over a recently discarded medical bracelet made of paper to the doctor. When a paper bracelet is looped around a person's wrist, the fibers loosely re-align into that shape. When removed, it will maintain a portion of that curvature. The bracelet he hands her, however, is unequivocally flat, as one would be if never looped on a wrist.
It would be physically impossible for the long-haired boatman to shove a u-shaped spear (hook) into the game warden's head from the position he was standing (to the warden's direct left).