Skin Surgery

On Tuesday, December 4^th, I went under the knife. On the last couple of annual visits to my physician, he has taken measurements of a reddish hued spot on my back shoulder. The spot hadn’t changed significantly between visits. My doctor also didn’t know what the spot was. That would require a biopsy of the tissue.

Some time ago my brother, Bill, suggested I call his dermatologist to appoint having her take a look at some of the spots on my arm. An appointment was made and the date came around. The dermatologist took scrapings of the red spot on my shoulder for a classification by the pathology lab. She also took a sample of a mole on my lower back, as well as a scraping from a spot on my scalp.

The doctor’s lab report came back. The spot on my head was no worry. The red shoulder spot was a form of cancer, as was the mole. None of the spots on my arm were a problem and the doctor had used nitrogen to burn the few blemishes into disappearing. A new appointment was made for me to return to have the two bad places surgically removed.

 So, here I am in one of the many patient visiting rooms in the doctor’s office wing. The nurse

had already asked me to sign a release form for the work to be done. The form’s wordage was very canned and it left no door open for patient comeback.

   It is 3:15pm and the doctor came into the room at the appointed time.  She began by sketching football shaped drawings around each of the two spots on my back. She explained that the shapes would guide her with the cutting, and that the shapes would also show her were to retrieve skin to stretch over the wound when she was stitching over the gap.

The doctor explained to her nurse where and how she wanted the skin numbing agent, Lidocaine, to be administered. Lidocaine is a nasty chemical. I could not feel the prick of the needle with each insertion, but the small amounts of injected Lidocaine created a sharp sting. This sting reoccurred with each of the couple of dozen pokes I received to cover the affected areas of the two surgery spots.

I was arranged face down on an adjustable chair/bed. The nurse gave me a couple of pillows to lay my head on. It was just a few short minutes between the Lidocaine injections and the large area numbness result.

The doctor returned and the surgery began. There was continuous conversation between the doctor, her nurse, and me. During the surgery all I felt was occasional firm pressure on my back. I was asked if I was comfortable on the bed. That led to a discussion of the cost to replace the chair/bed

with a more modern unit for the cost of $16,000. It was at this time that I shared with the good doctor that one could construct a more comfortable bed using a padded solid core door and adjust its height with a couple of attached floor jacks.

She agreed with the functional simplicity of the reality of the adjustable surgery bed. However, she also wanted to do some redecorating of the room and the surgery bed would become a center feature. Looks were everything.

A bit of time was spent discussing the relative lack of attractions on the room’s walls. There was a typical framed print of what the cross section of the skin looks like. Certain features were blown up in scale to highlight a visual point. One section of the print displayed color depictions of different skin anomalies. These ranged from acne to cancer. The room had one other print which hung on the rear wall. This was a watercolor of a picket fenced driveway, through a grove of trees, which led to a farm house. It was momentarily interesting to study the artist’s use of perspective in the painting of the fence as it approached the house at the far end.

Two padded chairs were in one corner of the room. None of us liked the pattern or the colors of the fabric used for the back of the chairs. We also mused about the benefit of having a few magazines to help pass time for the waiting patient.

During the nearly one and half hours I was in the room, there was regular questioning regarding my level of comfort. We had already discussed most of my discomforts about being there, so I responded that I was “happy as Larry”. Neither one asked me who he was.

After the cutting was all done then came the cauterizing. This prompted a short discussion

about whether the bottom opening section of the garden window had ever been used. I learned that its summer use was quite regular. This window looks out onto a six foot wide space between sections of the building. The strip is about 30 feet long, it is open to the sky and it is floored at the parking garage below. Planted in this narrow space is a variety of bamboo. We talked a bit about how marijuana may grow in this publicly hidden recess. The window didn’t open today, and there was no exhaust fan in the room.

For several minutes the surgeon created loose flaps of skin which extended to the perimeter of her pre-drawn football. We had earlier discussed whether to use dissolving suture, or to use thread that needed to be removed. I was given the choice, but the doctor told me it would be sewn up with non-dissolving thread. Shucks. That means another visit. I guess that is ok, though, because it requires an examination of the result.

The stitching took some time. There was some dissolving suture used after all. The crater created with the removal of the mole required a bit of intermediate level sewing. I could feel the skin being tugged as the darning was completed. As the doctor stitched, the nurse occasionally patted the wound with gauze.

When the job was pronounce done, I asked the doctor to take a couple of photos of the damage done.  This she did. As I sat in the readjusted chair/bed the doctor began to worry about my post-surgery state. I noticed that I was quivering a bit. I put that to myself as being caused by a stress

relief. The doctor insisted that she fetch me a glass of water and a granola bar. I was asked what flavor of bar I would prefer. I chose the chocolate variety.

The nurse constructed patches for the two wounded areas. She then put together a bag which had materials and instructions regarding when and how to replace the patches. While the nurse was bandaging me, the doctor was preparing a prescription for antibiotics and for pain pills, should I feel I need them.

I was scheduled to return in two weeks to have the stitches removed. A second appointment was made for six months out for follow-up on my skin condition. It has been two days now and the only discomfort has been from a feeling of tightness when I flex my shoulder. I have taken a couple of doses of Tylenol in anticipation of pain, but it hasn’t happened. I had been cautioned to avoid upper body exercising for at least two weeks. Well, I am not going to the gym just to ride the bike – so, not at all.

My skin condition, although not too bad, is the result of not wearing protective clothing when I was younger. I remember bailing hay on the farm while wearing neither a shirt nor a hat. I rarely apply sunscreen, but I also avoid over exposure to the sun’s rays today. The sunburns of the past happened. Which one may have caused the skin mutation which led decades later to the two growths on my back, I will never know. I suspect, however, that they could have been prevented.