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.