Melanoma: Know More

A couple of weeks ago, I got a diagnosis of melanoma, and posted Melanoma is Sneaky over at Dangerous Intersection. Go there to see a nice video exhorting regular skin check-ups.

I considered several “objects” on which to hang this post. My first thought was of surgical tools or the fancy high-tech, waterproof, breathable membrane bandage that covered the wound for a few days. But I chose to showcase the memento I will forever carry around with me, the scar where the tumor was removed.

But before I show you the image of this silly badge, here’s how my day of surgery went:

Karen talked me out of walking to surgery as we had walked to the preoperative visit. So we drove the few blocks to the hospital and parked there in about half the time walking took. We finally found the right elevator and went up to the third floor to the ambulatory surgery unit. There was no one at the reception desk, but as we proceeded past toward the nurses station, we hear a “Be right there!” A very swishy man bustled over and cheerfully took my detailed information. He was fun and flirtatious. He passed me to another nurse, who weighed me, and brought me to curtained cubicle #12 on the end of the hall.

I changed into the paper gown, keeping on my shorts and socks as instructed. The gown had many fasteners and ports. I figured out that one wall mounted gadget was a hair dryer-ish gizmo with a hose that could be plugged into one of the several ports built into this disposable gown for warming. Karen went for coffee as I settled into the comfy recliner between layers of pre-warmed blankets. I handled my anxiety at impending surgical assault by falling into a zen-like trance. I happily observed the various light fixtures and gadgets in my cubicle, and the curtain fabrics and hardware. I listened to the layered conversations invisible around me, mapping the people in my visual cortex. I had an hour and a half to wait, and was in no hurry. Karen came back with coffee and occasionally got impatient and fetched nurses to move along the stages of my prep. She has always been a good patient advocate, and has even considered doing that for a living.

Several nurses came in to ask pages of questions that had already been answered. Each department seems to need its own set of answers to the same suite of questions. It’s a pity that medical histories cannot travel with patients from practitioner to practitioner. I find filling out these forms not only tedious, but an insult to the computing technology that could have replaced such iteration a generation ago. I also blame the HIPAA act that seems to do all it can to inhibit the portability of medical information that it was supposed to enhance.

One nurse gave me a set of packaged, heated, antiseptic sponges with a page of detailed instructions on how to use them. Three minutes scrubbing with each and in a particular order on specific areas from neck to toes. I thought this was a silly step. But I had been forewarned by phone the previous night that it was to be done. Afterwards, my hands felt quite sticky and softened.

The surgeon was ready for me while the third iteration of questions was still being administered. They had brought a gurney, but then decided to just wheel me in the throne. I commented that I should have had a crown and scepter to be so royally escorted to the operating room. I did wave to the peons as I was wheeled past. I was having a good time, and as far as I knew  had yet to receive any drugs aside from the antibiotic in my neutral saline IV.

Once in the operating room, I stepped from my throne over to the narrow operating table starkly lit under the triple set of suspended and jointed reflector lights, one with a camera built in. The nurses and resident seemed to be a cheerful team. I tried not to distract them, but wanted to join in. When the first set up an arm table to the side, I pointed out that this would not work. They seemed surprised at my effrontery. But then they saw I was right and rearranged me to have my arm on my belly. I seemed to puzzle them a bit, as I was completely cooperative, alert, cheerful, and knowledgeable. Yes, I was aware of compensating for anxiety; I began studying psychology in 8th grade, got a degree in it, and have been studying related fields ever since.

They gave me a nasal cannula and draped me with green crinkly paper sheets. When they first smoothed it across my face, I suggested that my nose was actually supposed to be convex. After that a hand appeared in my green world occasionally to lift the paper from my nose. But it wasn’t bothering me. I’m not claustrophobic, and was getting cool oxygen in my nose. They started the Lidocaine drip without my noticing. But I quickly got more relaxed.

When the surgeon, Eddy Hsueh, came in, he told me that they were now going to give me the sedative, a truth serum. (Precedex, I believe.) He said that now I would have no secrets.

I said, “I’m on FaceBook; I have no secrets!”

Best laugh of the session. They chuckled and repeated it to each other. One of the nurses later repeated it to Karen when she wheeled me back.

I distinctly felt the first couple of shots of local anesthetic in my arm. I don’t think that I actually passed out at any point, but things were fuzzy while he cut out the initial disk of skin. I tried to “see” from under my green sheet by listening carefully. At one point the tone of the heart monitor seemed to change. I asked about it, and they assured me that it hadn’t. In retrospect, I think I’d gone under briefly and come back without noticing at that point.

I was quite alert as they (surgeon and resident) started stitching. I could feel the pulling, even the vibration of the gentle texture of the stronger sutures pulling through. Dr. Hsueh is a teacher, and was guiding the resident to close. In this case, closing involved pulling the open circle into a line, and then trimming the puckered “dog ears” on each end to allow a smooth closure. I had assumed that the necessary eye-shaped cut would be the initial profile. But apparently they cut out a circle, and then trim the pointy ends after pulling the circle mostly closed. Hsueh was a harsh critic, a perfectionist, who scolded the resident for cutting the end too round, for pulling with the wrong suture (including a pedantic lecture on the physics of force), and for not having good technique in pushing the needle through the skin. I’d never before heard a grown man chewed out for not doing his homework. I was embarrassed for the doctor. But from their point of view, I wasn’t there. All they saw was an arm and green sheets. Often even when people can see me, I manage to be invisible: I see more, this way.

So they finished suturing and started undraping me before they got the bandage on. I started to get up, and they told me to wait as they put some gauze and a clear adhesive patch covering the whole thing. This oxygen-permeable membrane is certainly new since my last surgery, in the early 1980’s. No cumbersome wrap of bandages was necessary

I stepped easily off the operating table and back to the padded throne, and was wheeled back to the cubicle. Karen was retrieved from the waiting room, and we sat for a while, waiting for discharge. I felt like I was sobering up quickly. But I was certainly hazy, and glad that Karen was there to hear the post surgical directives. My arm didn’t hurt at all; the local was very effective.

When they came in with the discharge papers, I was ready to go. I asked to use the restroom, and they let me. We discussed the necessity of the ceremonial wheelchair as I walked, and pirouetted to walk backwards, and then ducked into the restroom. It is good to have dancer reflexes. But they were adamant about wheeling me out. One nurse rolled me down the hall and elevator, and out to the door while Karen got the car. I grew tired of sitting, and the nurse reluctantly let me stand up. She guarded me like a wary physical therapist as I rose, then stayed close to me as I walked out the door, and waited. When Karen arrived, the nurse escorted my to the car door. She was taking no chances. It was about 2:00 as we drove the mile or so to South Grand.

First we picked up my meds at our local pharmacy: A prophylactic antibiotic and Percoset. I rarely use pain pills, and was feeling fine at the time. But I figured that I might use the latter as a sleep aid, at least the first night. We stopped in next door to the pharmacy to chat with our investment banker, and then walked a block to use a coupon for lunch at Qudoba. I was feeling a little dissociated, but not dizzy, nor in pain. It seemed about as traumatic at that point as getting a large filling in a tooth.

Once home, I settled in front of Roku for the remains of the day. Not a movie, just old TV shows like Ally McBeal and Cheers. We don’t have cable or satellite, so Netflix feeds my video addiction. After a few hours, the local anesthetic wore off, and I began to see the wisdom of pain meds. Each time I’d shift, my arm kersploded with a bright flash of unpleasantness. I did resist the oxycodone till bedtime by holding the arm very still as much as possible. Owy. Only woke a few times in the night.

So now, a few days later, I unveil my new dermal embellishment:

Melanoma: 14 stitches for an odd mole

2 Responses to “Melanoma: Know More”

  1. 1 JoeTheJuggler May 23, 2011 at 10:50 am

    A few blocks from your house? Was your surgery at SLU Hospital? That’s where Rados works. Though she was enjoying a rare 5 day stretch of days off right then, I think.

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