Tuesday, August 11, 2009

Wear sunscreen!

I am home today and hoping to get a few things done around the house. However, I seem to have a throbbing headache to go along with the nose that feels like someone socked me good.

I went in yesterday to have minor out patient surgery on my nose. From 1991 to 1996 I worked in skin cancer surgery. One in four people get skin cancers and so I figured that given my fair skin and eyes, the fact that I grew up at altitude and the many, many sunburns I have had over my life TRYING to get a suntan. I would be there someday also.

Most of the surgeries we did were on retired people. We had the oddball ones in there - the young, gorgeous model redhead who was 38. The black man with a horribly invasive and misdiagnosed cancer (because skin cancer in African Americans is extremely rare). One uber-famous marathon runner in his early 40's. May, the 90-some year old with large cancers who was probably a case of elder-neglect/abuse. And then my favorite people too - like the elderly guy named Bob who had so many cancers that we used to see him every other month. Despite the fact that we could rarely "clear" the margins on his cancer because we would just run into another, he still was in great humor and would sit in my lab and chat and tell jokes.

I knew one day I too would be in having surgery for skin cancer, but didn't quite expect it to be in my late 30's and that my first would be a squamous cell carcinoma (in the world of skin cancer, the step up from the most common one and the step below a melanoma).

I wasn't terribly surprised to get the diagnosis of the spot on my nose and they quickly got me in for Mohs surgery, to track the edges of the cancer.

Worried? Not terribly. I knew exactly what they were going to do. I knew exactly what was on my nose. And in the larger scheme of things there are people I am close to dealing with a whole hell of a lot more than a bitty skin cancer caught early (since I knew what I am looking for).

AB went in with my yesterday as I sat on the other end of the knife than I was used to over a decade ago. (And the job that I still to this day dream about.)

Honestly I was less than impressed with this doctor mostly because I was used to my old doc I worked for who had a great bedside manner, was friendly, shook hands like a man (thanks to my dad and now my husband I have a severe aversion to wimpy handshakes).

I hadn't met him prior to the point of sitting under his knife. I told him that I was well versed in the surgery after having spent five years working in this surgery in the 90's. We compared notes a little, I was shocked to hear that he does 10-12 cases a day (we did 3-4) and the size of his lab. But he is also the only one for miles that does the surgery. Everything now was fitting in as to why I never saw him prior. He doesn't see any other patients, all his nurse practitioners do.

Then he offered me a job.

I laughed and politely declined citing the fact that I have a great job at The Lab and a graduate degree (i.e., nearly as much education as he does).

He proceeded to remove the offending spot off my nose. Then he stopped and talked to AB about doing laser surgery on his port wine stain - to which AB politely declined (a few times). Then he walked it to the lab.

And that was the last I saw of him. I sat for the next 2 hours in the waiting room with retired old men and their wives.

His nurse came out a half hour later to tell me it was clear and then they set me up for a closure, which I was stunned to find out was performed by a nurse practitioner. I asked a lot of questions about this and AB seemed skeptical, but we went ahead.

It needed stitches. And my thought was that I knew in my mind what Dr. S would have done and if her plan deviated much, then I would be raising a stink. She did exactly what my Dr. S would have done with the thousands of spots I had seen similar to mine. Loosened up the tissue underneath (hated that part), pulled it together with 3-4 dissolving sutures underneath and 6-8 fine sutures on top while flattening the edges so that I have a line down the side of my nose.

Yesterday I felt as though I had been socked in the nose. Today it just aches a little. Tomorrow I will work.

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