HINT OF MORTALITY
I recently experienced my first “Mohs” surgery, a “minor” procedure to remove basal cell skin cancer from a spot above my right temple. Two weeks earlier, when the dermatologist had found the offending spot at the end of my routine, annual check-up, he exclaimed, “Wow, 99.5% done with the examination and there it is!” His enthusiasm was somehow lost on me. It was as though he’d found a missing wallet or keys, as always, in the last place he’d thought to look.
First, let me acknowledge clearly a patch of basal cell skin cancer is not in any waycomparable to “real” cancer, the type that kills or debilitates. My “suffering,” if I dare use that word, is infinitesimal compared to that of numerous friends, relatives and millions of other cancer patients around the world. Still, the first time one hears “CANCER” in a doctor’s office in connection with oneself, it is a bit of a shock.
*****
The young doctor followed up his diagnosis by explaining my two options: first, since the spot appeared small and largely covered by hair, he could scrape it off at his office, and patch me back together, leaving a small scar. “That will almost certainly take care of it,” he said. “Of course,” he added, with a nod towards my age appropriate receding hairline, “you might not always have hair there.”
Second, he could refer me to a Mohs surgeon who, as I understood it, undertakes the same procedure, but with greater precision to make sure “it’s all gone,” and who repairs the resulting wound in a manner less likely to leave a scar. Though irrelevant in the scheme of things, it is interesting to note the cost of the first procedure, barring complications, is in the realm of $300-$500; the second procedure costs $1,500-$2,500, the variable largely based on whether all the cells are deemed gone after the initial scrape or if several scrapes are necessary.
“Take a week or two to think about it,” he said. “No rush. This cancer grows very, very slowly.”
*****
My wife, Katie, who is wise and efficient in these matters, searched reviews of local Mohs surgeons within ten minutes. “It might take awhile to get scheduled,” she said, “And we can always cancel if you just want to let the dermatologist handle it.” She was right, as usual. The first appointment with “the best one around” was two months away.
What price vanity? The internal debate proceeded as follows: Each morning for a week I looked at myself in the mirror. On one hand, my forehead already has a few scars from a college soccer injury and a childhood fall. And it would be nice to just visit the doctor I already know and have him “take care of it” expeditiously. On the other hand, the idea of a “specialist” handling the situation seems prudent. And, yes, though there surely is a point at which vanity is tooexpensive, $1,000-$1500 isn’t too much to avoid another scar. I’d hate to feel compelled to do a comb-over – Commander Bone Spur in Washington has made that distasteful. What to do?
*****
My telephone soon vibrated with the answer. A cancellation at the surgeon’s made it possible for me to undergo Mohs on half an hour’s notice. No more waiting, no more walking around with cancer cells growing, however slowly, in my scalp, and no scar. I drove to the office with as much enthusiasm as I could muster for the prospect of someone applying a scalpel to my skin. In two or three days, I thought, I’d take off the bandage and be done.
Boy, was I naïve. Again, Mohs surgery is minor in every respect compared to “real” surgery, but to my surprise, it’s a lot more than “a scrape and a band aid.” First, after the customary twenty minute wait in the chilly room, the nurse arrived to review my medical history. Next, my vital signs were taken. Then, after another multiple-minute interval, the surgeon entered and introduced himself along with an assistant (resident doctor) to look at and touch my temple. “Hmmm,” said the surgeon. “Yes,” said the resident. “Should be okay this way,” said the surgeon.
The doctors took photographs. They drew a diagram on my head of the planned incision, a slightly ticklish sensation. They injected me with local anesthetic. They told me they’d be back in “a little while,” and left. After half an hour to assure the anesthetic worked, the team reassembled. My effort at humor in regards to being a “numbskull” fell flat. Perhaps, it was not the first time they’d heard that one.
Finally, excavation began. And continued… and continued. I pictured myself ending up like Jack Nicholson in “Cuckoo’s Nest.” After a few particularly decisive scrapes (I felt no pain, but could feel pressure) the doctor and his assistant pronounced themselves satisfied, took some photographs, and explained that I could go to lunch and return in 60 minutes, by which time they would know if they had “gotten all of it, even the roots.” The surgeon used an instrument to temporarily cauterize the wound and left me in the care of the nurse who placed a massive gauze bandage over it.
*****
I stopped in the restroom to wash my hands and glanced at the mirror. Ugh. I looked like I’d truly had a lobotomy. Could I really be seen in public? Fortunately, my self-consciousness receded when I arrived at the local sandwich shop and noticed three other people with roughly the same appearance. Apparently, the surgeon’s offices are in a hotbed of Mohs activity. The procedure is practically a rite of passage for people “of a certain age,” an age I have now attained.
When I returned to the waiting area at the appointed time I waited for an additional hour. Apparently, said the receptionist, someone’s surgery became “much more involved” and the surgeon was running behind. “Hmmmm,” I cringed to myself, “I hadn’t considered the possibility this procedure could become ‘much more involved.’”
To my relief, the nurse came out shortly thereafter and informed me the examination of my cells indicated all the cancer was removed, and I would not need additional scraping. “We’ll bring you in in a few minutes for stitching,” he concluded.
“Stitching?” I said.
“Just two layers,” he responded.
So much for a couple of days with a Band-aid.
*****
Two layers of stitches helped me realize the procedure was a lot more than just a scrape. The surgeon and his assistant seemed to take turns tying and snipping and pulling. The process probably took ten-fifteen minutes but I perceived it took hours. When they finished, a relatively smaller bandage covered the incision. I received three pages of instructions for “wound care.” Basically, after the first week, one must change the bandages every day after a thorough cleaning with a Q-tip (sort of a contradiction in terms), slathering of Vaseline, and placement of a fresh bandage. The doctor’s final words were: “Don’t be too active for two to three weeks and try to minimize bending over. Also, don’t sleep on that side.”
*****
Three weeks have now passed and all seems well. The outer stitches have fully dissolved and the instructions indicate the inner stitches should be dissolving also. Some sensations are returning to my right temple. I’m back to athletic activities after a period of extreme antsy-ness. And I have resumed sleeping on both sides, which is a relief. I have a new respect for wearing a hat when I go into the sun. Also, though fully aware my procedure was not major and unworthy of excessive self-pity, an appreciation for what should be a proverb: “Minor surgery can only describe surgery that occurs to someone else.”
stuartsandersblog 