Wednesday, November 14, 2012

Final Countdown

So the date for my MOHS procedure to remove the basal cell from the side of my nose is now officially looming. 

Next Wednesday, November 21st.

One more week.

I have managed to keep quite busy and somewhat successfully suppress the memory of the pre-opp appointment I had with my chosen surgeon about a month ago.  In addition to being trained in MOHS, this particular surgeon also does "plastics": boobs, lips, tummies, eyes, noses…noses…

My alarm sounded an hour earlier than usual for my 7:15 a.m. appointment.  The plan was to give myself an hour to drive the 40 miles to the office.  Yes, there are plenty of very well-qualified dermatologists who are trained in MOHS right here in my own backyard but this particular doctor has treated my father and two friends to terrific results.  Nothing but nothing beats a personal referral for anything: restaurant, hair-dresser, gardener, babysitter, surgeon…surgeon…

Jeff was out of town on business so my brother-in-law, who fortunately lives nearby, won the privilege of arriving at my door at 6 a.m. to feed breakfast to my Vince and Nick, get them showered up and deliver them to school by 8:25. 

I raced out to my garage carrying my purse, laptop, jacket, scarf and KIND bar that was meant to serve as my breakfast.  Of course I was already running late.  I had dilly-dallied and allowed myself to get distracted by campaign coverage while I drank my coffee.  This brand of story-telling only comes around every 4 years…I couldn't help myself!

"Bye, Uncle Todd!  Thank you!  I'll call you from the road!"  I yelled to Jeff's brother as the door slammed shut behind me.

When the clock on my dashboard read 7:00 and I was still at least a half-hour from their office, I called them to apologize.  The receptionist was positively lovely.

"Ok, Elizabeth.  We'll be here whenever you get here.  Drive safely."

"Thank you."  

That's how all doctor's offices should respond to tardiness.  I thought to myself as I made the first of three wrong-turns once I exited the freeway.  That was a response grounded in "wellness".

No real surprises as I entered the quiet lobby.  Pretty much just me and a few old, white guys who had apparently made the call to sacrifice their epidermis and go ahead and grow old under the California sun. 

In line behind one of the aforementioned patients, I saw that the receptionist had some pretty heavy-duty bandages on her nose.

Nose job?  I thought to myself.

When she was ready to help me, I stood before her head-on and could tell her big bandage sat to the side on the tip of her nose.  I also saw that she had a separate bandage further up on the side of her nose.

Must be a skin thing.

Once I had given her all my paperwork I couldn't help but ask.

"Was that a basal cell?"

"Yes."  She went on to explain that the bandage was some special bandage with magic healing powers because the location and size of her basal cell had required that they do a skin graft. 

A fucking skin graft?

"I'm sorry.  Did you say skin graft?"

"Yes."  She answered nonchalantly.  "They took the skin from up here."  She pointed to the bandage further up on her nose.

Mother fucker.

"Oh.  I see." 

I think I'm going to throw up.

"So how long ago did you have the procedure?"

"Four days ago.  Today is my first day back."

I guess that's not so bad.

"Well, you seem to be doing great."  I had to say something to compensate for the look of utter horror on my face.

"The doctor is the best."

Because I was late, I was sent to an exam room in no time at all.  I was quizzed by another female staffer in a white coat.  Are they Nurses?  Physician's Assistants?  Are they Administrators of some kind?  What are they?

"So you've had other basal cells in the past?"  She asked.

"Yes, but this is the first one on my face."  Like she cared"And I had a pre-melanoma removed right here."  I lifted my shirt to expose a scar just below my rib cage.

"So you've had melanomas and basal cells?"

"PRE-melanomA.  Singular."

She gave me a closed-mouth smirk and nodded her head knowingly.  A bowl of patronizing with just a dash of kindness.

I want the lady from out front with the bandages.

"The doctor will be with you as soon as he's done with his current patient."  She was off.

There I sat and listened to a fundraiser for a local university radio station while flipping through a stale tabloid.  There was a quiet knock at the door.

Why do they do that?

"Come on in."

So awkward.

A reasonably tall, beyond middle-aged man walked toward me with his right arm extended and introduced himself.

Limp shake.

He turned away toward my chart which was on the counter next to my exam chair.

"So, you have a basal cell?"  He asked.

"Yes.  On my nose."  I pointed to the area where the biopsy had been done a few weeks prior.

He turned toward me and leaned closer to my face to examine the area. 

He leaned back away from me.  "When did you break your nose?"

Excuse me.

I looked at him knowingly.  This wasn't the first time I had been asked this question.

"You did break your nose."  It was a statement with just a hint of a question.  "When did you break it?"

I guess we've moved on from my basal cell.

"My nose took some accidental hits growing up.  I have an older brother.  There was no big moment where we went to the doctor or anything."

"Do you have trouble breathing?"

"No.  I do have a drip on my left side but no trouble breathing."

And the truth was I actually went to another "plastics" guy that was right in my own backyard to see if straightening out my septum would alleviate or minimize the drip about a year ago.  He couldn't make any promises about the leaky faucet but could make my nose look at least slightly more main stream.

The doctor moved in closer and craned his neck looking first at one side of my profile, then the other.

"So was it playing sports?"

Sweet mother he wasn't going to let this go.

"I'm not sure.  Probably messing around wrestling.  Or swimming.  I remember being kicked in the nose hard while swimming when I was younger."

Now he was shining a light up my nose and staring up each nostril.  Had he NOT come SO highly recommend by my father, and two different friends, I probably would have cut him off sooner. 

He's a perfectionist.  We're in LA.  I told myself.  This is a good thing.  I took a deep breath.

He stood back.  "Straightening your septum is not a minor procedure.  We would have to break your nose and re-set it."

Holy Mary.

"You know what?  Let's just focus on the basal cell for today."

"I understand.  You are a busy person.  You have young children.  If it doesn't bother you…" He trailed off as he went back to my chart on the counter.

If it doesn't bother me?  I own mirrors, asshole.  I realize I have a nose to be reckoned with, even if it wasn't crooked.  Since junior high (because that's when most amazing life experiences begin), I have been party to unkind and uninvited editorial regarding my nose but guess what?  My nose has gotten me this far in life.  Forty years we've been in this thing.  Realistically, I am half-way there and don't think the rest of my life will be appreciably better with some other version of it sitting smack in the middle of my face.  And I see that you're wearing those ridiculous Sketchers shoes under the guise of comfort but really to make you appear about two inches taller so you can suck it!

He finally took me through the nuts and bolts of the actual business at hand: getting these unhealthy cells off of my body.

 1. Hours long MOHS procedure that would take place right there in a regular exam room where small slices of skin would be removed and analyzed until the area was unhealthy cell-free

 2. Move to surgery center down the hall in same building where "graft" procedure would take place

 3. All done with a local anesthetic

"You'll wear the bandage for 8 weeks but that's just the beginning of the healing process."

"I understand."

"And based on your previous surgeries, you tend to scar so it may be even longer."

"I know."

"So you understand everything?"

How many times have you been sued?

"I understand."

I laid there in the exam chair, which was really more of an exam barcalounger, and recalled the 1993 Mel Gibson movie The Man Without a Face.  

I was getting nervous.

My thoughts were quickly interrupted by the low murmur of the doctor's voice.  He wasn't talking to his nurse.  He was talking to himself.  To his Dictaphone.  He was ticking off a list out loud:

"Patient understands procedure involves skin graft procedure." 

"Patient understands that longer term scaring is possible based on patient history."  

And the grand finale:

"At time of consultation, patient is seemingly healthy; 5 foot, 10 inch; 130 pound woman with a crooked nose."

I guffawed out loud in my barcalounger. 

The nurse giggled, too but tried to cover it with a cough. 

He pressed pause and leaned over to look at me.

"Are you ok?"

"Yes.  I'm fine.  I was laughing.  I laugh when I'm nervous."

And then I cry.  Back at the reception desk.  While attempting to make my surgery appointment.  There, a different but equally lovely woman without bandages passed me tissues, then peanut butter cups from the candy file drawer.

"I'm sorry."  I told her.  "I know it's not a big deal.  I know I'll be ok."  I couldn't stop crying.

"It is a big deal and you will be ok," she assured me.

Then she went back to the candy drawer and grabbed me another peanut butter cup.

"Thank you."  I wiped my nose.

One more week.

And why am I using a doctor with seemingly zero bedside manner to perform this procedure?  Because the last time I used a doctor with seemingly zero bedside manner to perform a procedure, I got two babies.

One day old.