Archives for posts with tag: recovery




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.”













I’m the envy of several toddlers in the airport waiting area. My canary yellow blow-up floatie features pictures of animals and birds and draws their attention like cotton candy. “Look,” says a little girl, tugging at her mother’s arm. “That man has a ducky.” Indeed, I’m a spectacle as I ease down on the donut-shaped toy and try to relax. I smile at the girl, and wish I could explain the reason for my use of an object so much more appropriate for her.



Merely sitting seems a major accomplishment to me, nearly three weeks after a lovely but routine vacation in Costa Rica became a trip I’ll remember for life. Emergency hemorrhoid surgery has that effect.

Is there a worse location on the human body to undergo surgery than the rectum? It’s possible, but I think this is certainly up there in the top two or three.
“How did this happen?” people ask. “Did you know you had a problem?”
Well, yes, a doctor warned a few years ago, during a colonoscopy (now WAY down the list of unpleasant medical procedures, in my opinion) that I had internal hemorrhoids that “someday” might become “inflamed.” He suggested I raise my fiber intake and prescribed a fiber-rich breakfast cereal that looked like worms used to attract birds. I don’t know what real bird food tastes like, but it couldn’t be worse.
I ate the cereal for a few months and tried to be more attentive to water intake.



But, like the fight against crime, inertia set in. The longer I went without an incident, the harder it became to remain vigilant. For occasional bouts of irritation, such products as Preparation-H provided relief. I figured I was simply experiencing a condition that millions of people deal with regularly. In volcanic terms, I considered myself at risk of a minor lava flow. When I awoke in agony the day after Thanksgiving in Playa de Coco, however, my situation resembled the eruption of Mt. St. Helen’s.


San Rafael Hospital in Liberia Costa Rica

I arrived at the emergency room at the private San Rafael Clinic in Liberia, Costa Rica, after riding for fifty bumpy minutes flat on my chest on the passenger side of a Honda Civic. In Costa Rica, health care is available to every citizen in public hospitals. However, for an emergency situation involving a foreigner, the best chance for prompt treatment is at a private clinic. The doctor on staff looked at my “situation” and immediately concluded what my wife, Katie, and I already knew from a quick Internet search; “stage four” external hemorrhoids require surgery. He checked the schedule and told us, in Spanglish, that the surgeon would arrive at 4:00 p.m.
“That’s five hours from now,” said Katie. “This is an emergency.”
The doctor shrugged, at first, but agreed to call the surgeon on his cellphone and explain the situation. Apparently, he must have conveyed he had a “Gringo with a credit card in distress,” because the surgeon agreed to arrive in fifteen minutes. Fifteen became fifty, but the doctor, in jeans and a tee shirt, bustled in. He spoke no English and bore a striking resemblance to El Chapo.
“So this is where he’s hiding,” I whispered to Katie.
I naively thought the doctor would commence treatment immediately, but he pointed out I needed to “prep” for the surgery and that I should go home to do so. He prescribed the same preparation as for a colonoscopy and Katie went to three different pharmacies outside the clinic to obtain the necessary meds, along with eight bottles of Gatorade to mask their terrible taste.



She also satisfied the front desk that our debit card would cover the $5,000 cost of the surgery. Apparently, if you cannot pay up-front, you will not be treated. Never having used the card for more than expenditures measured in the hundreds, we had no idea what our limit was. To our relief, it was sufficient. I rode back to the condo on my tummy and tried NOT to contemplate the meaning of life and death.



I was deflated by the time we arrived back at the Clinic the next day. I hadn’t eaten food in nearly 36 hours. Sleep had been fitful, the “prep” had literally drained me, and the pain was unrelenting. In kindness, everyone in the waiting room offered me seats, but the one thing I absolutely could not do was sit. After twenty minutes that seemed like five hours, I heard my name and stumbled into the elevator, faint and sweating. An orderly, who I thought might help me, looked more scared than I.        Eventually, he and Katie helped me balance on one knee for the ride up to the surgical ward.
Upon arriving in the operating room, a diffident nurse tried and failed to attach an IV three times, each attempt more painful than the previous one. Flustered, she apparently called a picador from the local bullfighting arena because a large male strode into the room and jabbed a needle into my arm with no difficulty whatsoever, then strode out with a look of “nothing to it.” I lost consciousness immediately.
I awoke hours later, after the surgery, in my hospital room. Katie sat on a sofa across from my bed. I knew I was alive and, of course, that’s supposed to be good. However, the sensations I felt from head-to-toe were less than life affirming.
“How did this happen?” I asked, generally, specifically and miserably.

Nature has provided duplicates for many functions. For instance, we have two arms, two legs, two eyes, etc. If one doesn’t work, we get by, to some extent, with the other. But nature has not provided any back up for the functions performed by the rectum. What goes in eventually comes out and, after hemorrhoid surgery and its attendant stitches and staples and scarring, there is a tremendous disincentive to go to the bathroom. When something does come out, for the first seven-ten days after surgery, the sensation is positively medieval. Think broken glass. If you’re a woman, think childbirth. Of course, each individual event does not approach the magnitude of childbirth, but childbirth is not a several-times-a-day activity.
We assembled a selection of painkillers and creams and wipes, along with applicators and measuring devices. For the first time in many decades I experienced diaper rash; I’d forgotten how unpleasant it could be. I’ll skip the rest of the blood and gore that dominated the first ten days after surgery. Let’s say it’s enough to make a person change his entire diet to avoid ever doing this again. In addition, Katie and I achieved levels of intimacy neither desired nor desirable. To put the best possible spin on it, I learned everything there is to know about certain anatomy I’d always taken for granted.


On the tenth day, we returned to the clinic for a follow-up. The surgeon grasped the situation, literally, and declared me to be progressing properly. Through the hospital administrator who’d volunteered to translate, he reiterated that full recovery would take three more weeks. He continued the ban on swimming and added specific bans on dairy, meat and, generally, “anything else that might cause constipation.” He prescribed several more creams to salve the pain and good, old Desitin for the diaper rash.
Back at the condo, a virtual convention of Canadian healthcare workers in the pool helpfully offered advice. A pharmacist from Quebec translated the painkillers and regulated my dosages; a nurse from Prince Edward Island formulated a dietary plan; and, a pair of paramedics from Alberta encouraged me to walk, stretch and make initial efforts to sit. Our neighbor from Calgary helped us score the bright yellow blow-up donut from a souvenir shop.


I resumed walking at a normal pace and even sleeping almost normally. Other functions were still painful but not torturous anymore. By Day 19, we planned to travel home to North Carolina via American Airlines. At the airport, when we tried to check in, the attendant demanded a doctor’s note. Apparently, to fly internationally after surgery one is supposed to present such a note twenty-four hours ahead, and no one had told us. But Katie persisted and, through the magic of cellphones and email, the necessary documents were provided. It only took fifty agonizing minutes. And that takes me up to where this story began, in the lounge, making the three-year-olds jealous.


Another week has passed. I sat without my donut for nearly half an hour today. My fiber intake is off the charts. My water intake rivals the Titanic’s. Sleep is pretty good, except for disposing of the water. The rash is nearly gone. I see the end of the tunnel. May this never happen again.