Cut to the Quick

The doctor’s office called me with the good news.  The spot on my left calf was basal cell carcinoma; it was not life threatening.  Then came the bad news: It would require Mohs surgery; the sooner the better.

One week later I was in the waiting room at the dermatology clinic watching a DVD explaining what Mohs surgery was all about.  I probably could have seen it earlier had I asked, but all that would have done was increase my apprehension about anything necessitating someone to carve on my flesh with a scalpel.

Let me back up for a minute and explain something.  When it comes to a trip to the dentist’s office I have no fear whatsoever.  I give credit for that to seeing Dustin Hoffman in Marathon Man back in 1976.  In the movie Hoffman was tortured by a Nazi war criminal (Laurence Olivier) who strapped him to a chair and took a drill to his teeth—one at a time—until Hoffman told him what he wanted to know.  Hoffman’s character was a long distance runner who acclimated himself to tolerating a great amount of physical pain, a trait that came in handy for just such an emergency.  I ran my first marathon three years later, and can honestly say if my dentist came at me with a jackhammer, ice pick and/or blowtorch I wouldn’t blink.  In fact I had three cavities filled two weeks ago without an anesthetic and fell asleep while the dentist was drilling on my teeth.  Twice.     

That courage all gets thrown out the window when it comes to doctors, however.  If a doctor approached me with a sharp Q-Tip in his hand, my pulse will double; triple if he’s holding a needle.  But a scalpel such as the one I saw a doctor use in the Mohs surgery video?  I damn near stroked out in the waiting room with headphones on and a DVD player on my lap. Miraculously I was able to limit myself to a severe case of butterflies in the stomach, rapid ‘panic’ breathing and a moderately cold sweat.  I was doing my very best to channel my marathon man persona.

It didn’t work.

‘Mr. Ludwig, we’re ready for you.’  By the sound of her voice you would have thought the nurse was auditioning for Julie Andrews’ role in a stage production of The Sound of Music.  From my perspective she was calling me in to audition for a role in an off-Broadway production of Hostel.  A starring role.

‘Lie down on the table, please.’  Her instructions were clear, concise and absolutely bone chilling.  My left calf was entirely at her mercy, which in this case were numerous (50?  100?) injections of lidocaine to deaden the area surrounding my basal cell carcinoma.  Normally  sharp needles terrify me, but in this case I considered them to be necessary evils.  Do with me what you will.   

I forgot to mention something: My nurse was accompanied by another nurse whom recently joined the dermatologist’s staff and was in the process of learning the ropes.  That meant everything the nurse did to me she verbalized so the new nurse could learn the procedure.  I did OK with this until the doctor walked in and followed the exact same protocol.  After all, who wants to hear how they’re about to be butchered?  (See Hostel for reference.)

‘I’ll start with a 1.5 millimeter removal of the epidermal area’ (or something to that effect).   The doctor’s words were so matter of fact and spoken with so little emotion they came across as terrifying. 

Two thoughts immediately came to mind: ‘Great day for a new nurse’ and ‘Thank God I never understood the metric system.’ In hindsight I may have said that first one out loud.

Fifteen minutes later the nurses treated my wound and told me what I needed to do—for up to the next six months—to take care of it.  Meanwhile the doctor was telling me how he left the wound open so that I would still be able to run while demonstrating how the wound would pull open if I were to run on it after being stitched up.  (Not a pretty sight.)  Then I was asked to take a seat in the waiting room while the doctor examined the silver dollar-sized piece of multiple layers of flesh he removed from my poor left calf under a microscope to determine whether or not he had removed all the cancer.   

 

In the waiting room I was surrounded by four other patients whom also had just been subjected to Round One of Mohs surgery.  Wait: Round One?  Apparently the procedure was a little more than (a) remove skin and (b) examine skin.  If cancer were found after the first pass the doctor would make a second pass.  If any cancer remained after the second, a third.  And so on and so on.

One after another the other four patients were called back for a second pass.  I noticed all of them had skin removed from above their shoulders; I was the only one with bandages below the waist.  I wondered if it was a good sign or a bad sign.  I realized I was the Last Man Standing (or sitting, in my case).  

Thirty minutes later the nurse came in and asked me to return to the doctor’s office.  I assumed the face down position on the table and the nurses removed the bandages they had so delicately applied less than an hour before.  ‘This can’t be good,’ I thought.  I wanted to ask but I didn’t have the courage.  Sad to say for someone who is virtually impervious to pain and various instruments of torture at the dentist’s office.

Speaking of instruments of torture, I mentioned a blowtorch earlier. I forget to mention one little tidbit about how my wound was treated once the scalpel was given a rest.  Ironically the good doctor took a blowtorch to the area and welded the open skin shut.  Sure, he used some fancy-schmantzy word—‘cauterize,’ I believe—but he didn’t fool me for a second. The open wound on my calf was (I’ll play your silly game, doc) ‘cauterized’ before the Nurse Ratched’s  coated it in Vaseline and bandages.

Allow me to define cauterization as it was described to the new nurse.  It means that my skin was burned (think ‘welded’) so that the bleeding would stop and infection would be prevented.  It also meant if more skin had to be removed the doctor would use the scalpel to cut through the layer of cauterization to remove it.  I’ve seen horror movies tamer than that.  (As I suggested earlier, see Hostel for reference.)

I lied on the table—face down, as you would on a masseuse’s table—and listened for the door to open so Round Two could begin.  After what seemed like a lifetime the door creaked open and the doctor asked if he could come inside.  He may as well have asked me to help him with his jackhammer because I knew whatever he had to say couldn’t possibly be good. I said yes although I was totally lying: I knew it, the doctor knew it and Ratched 1 and 2 both knew it.    

Then the best thing I’ve heard in a long time came out of his mouth: ‘I have good news.  We’ve removed all of the cancer.’ 

On the outside I was cool, calm and collected.  ‘Great to hear, doc.’ 

On the inside I was Julie Andrews on the mountaintop in The Sound of Music.

I have a follow up visit in a few weeks and will probably be changing the dressing and bandage on my left calf until next year, but for now I’m cancer free and very, very thankful. 

Plus, for the next six months I have a really neat hiding place for a silver dollar.  

lower case ‘c’

From what I’ve heard and read, pretty much everything can cause cancer.  Here’s a short list:

Sunshine.  Genetics.  Tobacco.  Diet.  Radiation exposure.  Alcohol.  Cell phones. 

Pollution.  Obesity.  Asbestos.  Household wiring.  Physical inactivity.  Red meat.

It’s only a matter of time before wearing leisure suits in the ‘70’s, listening to 8-track tapes and watching all of the Rocky movies back to back are added to the list.  (Guilty on all three counts, by the way.)  But until that day comes I never thought I’d hear a doctor say these words to me:

I’m pretty certain it’s cancer.

Yes, he said it.  Cancer.  The dreaded ‘C’ word.  Cancer; with a capital ‘C.’   

Let me back up for a minute.  Earlier this year I noticed what I thought was a scab on the back of my left calf.  I scratched at it a time or two and it seemed to be going away.  When the scab eventually resurfaced—bigger and badder than before I thought I might have picked up a tick one day while my grandson and I walked through the woods looking for zombies.  After all it hadn’t been too long since I discovered a tick on Krischan one afternoon after saving humanity from the undead yet again.

I was wrong.  It wasn’t a tick.  And it wasn’t going away.

My friend Al said I should have it looked at.  Eventually everyone did.  Everyone who saw the nasty growth on my calf, that is. 

Finally I listened.  (Translation: I finally realized the growth was only getting bigger and it was becoming evident I couldn’t simply wish it away.)  I made an appointment with a dermatologist, the same one who removed a cyst from my right cheek three years earlier.  I had a lot of faith in him because after the aforementioned procedure I was only called ‘Scarface’ for a few weeks, the amount of time it took the surgical scars to heal.  I figured I could put my trust in a man who took a scalpel to my face and didn’t leave any evidence behind. (Worth mentioning: His last name is Marcet.  The first time we met I thought it was Machete.  Funny now; not so much three years ago.)      

Before I directed the good doctor to priority number one, I pointed out several other ‘items of interest’—bumps, blemishes and the like.  He didn’t bat an eye.  If they’re not bothering me, he said, don’t worry about them. They weren’t bothering me so I got ready to show him the main event: The growth on the back of my left calf. 

Let me be the first to say: Under the bright lights of a doctor’s office the growth looked absolutely horrific.  (Why didn’t I listen to Al sooner?)  With absolutely no uncertainty in his voice the doctor said he was pretty certain it was the ‘C’ word (not his exact words, but how it sounded to me).  He added that he was fairly sure it was benign and wouldn’t affect my internal organs.  Worst case he would remove it surgically and all would be well in a matter of weeks.

He asked if he could take a biopsy (this was apparently my day to hear ominous and foreboding words from a doctor that were directed at me), send it to a lab and get back to me in a week with the results (see what I mean?).   He explained the he would perform a ‘paper cut biopsy,’ which to medically inept ears like mine sounded as if it were nothing more than his nurse taking a tiny scalpel and nicking off a piece of the growth about the width of a paper cut.  That’s why I was surprised when the nurse took out a rather large needle to inject me and ‘deaden the area.’  Seriously, for a paper cut?

As I lied on my stomach and let the nurse have her way with me I tried not to focus on the several hundred injections she made around the perimeter of the growth, deadening my entire left leg from the knee down in the process.  Then the doctor leaned in with his scalpel and commenced carving on my calf like it was a Thanksgiving turkey.  I asked him to save me the wishbone; not surprisingly he had no idea what I was talking about.  (I say things like that when I’m drenched in fear-sweat.) 

After the procedure I was given my ‘wound care’ instructions.  Wound care?  I wondered to myself why something described in the vernacular of ‘paper cut’ would be considered a wound.  I would have asked the doctor that question but something told me I didn’t really want to know. 

What I didn’t want to know I found out for myself the next morning when I had to remove the Band-Aid and dress the wound.  A simple application of water-then-petroleum jelly with a cotton swab followed by a Band-Aid was all that was necessary.  At least that was what the written instructions said.  Here’s what was left out: ‘Prepare yourself to look at the horrific gaping wound in your body that in no way, shape or form would you have had any inclination we were going to make when we had you face-down on our examining table.’         

So I treated the wound for the first time, a gaping pink hole in my left calf about the size of a silver dollar.  I tore off the Band-Aid with one quick clean yank, the way my mom did when I was a little boy.  It felt almost the same, except that five decades later the searing pain of having hundreds of leg hairs pulled out by their roots in a split second was excruciating.  The application of the water came next; it felt like I was pouring salt on an open wound.  The petroleum jelly didn’t feel much better.  By comparison I came to the realization that pain-sweat was infinitely worse than fear-sweat.

I also decided that from now on I would refer to my dermatologist as Doctor Machete.           

After any necessary follow up procedures he may need to perform on me down the road, of course.  I wouldn’t ever want to be on his bad side.     

The royalties from the sales of all of my books are either donated to charity or set aside for my grandson's college education.  The charities dedicated to finding a cure for cancer are the ones nearest and dearest to my heart.  I, like almost everyone else throughout the world have had my fair share of family and friends afflicted with cancer.  It is a horrible disease, but I have faith that one day a cure will be found.

I have a large plastic crayon bank at home.  Every penny I get from change at the store or find on the ground goes in it.  Eventually they will all be counted, rolled and deposited in my grandson's college education fund because one day I dream of Krischan becoming an astronaut, curing cancer or being elected the 55th President of the United States.

Then one day when a cure for cancer is finally found I will know in my heart it was that last royalty dollar I earned or that partially buried penny I found in the dirt that made the difference.