A scalp in room 11

The familiar ring tone of my cellphone interrupted a visit with friends on our cottage deck on a sun-drenched mid-September afternoon. They were cat-sitting for our neighbours while they were away on a three-week camping trip. We rented their Casa in Modica, Sicily, in June 2017 and had some reminiscing to do. I glanced at the phone, intending to ignore the call but the caller was identified as “Dermatology.” I had to take this call. Two weeks earlier, I had seen my personal dermatologist for a number of seemingly benign skin lesions. I had previously been scraped, curetted and liquid nitrogen’d for a spectrum of skin curiosities and given my rather open schedule these days, I elected to indulge myself. I have known “Dr. Dermis” for 45 years and for the past 23, our offices have been across the hall from each other, the proximity allowing for a cooperative and mutually convenient consultative relationship. The scalp lesion, recurrently scaly and very persistent, took precedence this time. “This will sting a bit,” he warned, as the local was infiltrated into my follicle-challenged pate. “I think I’ll curette this one, just in case,” and then the excavation began, followed closely by the sizzling of the hyfrecator. I don’t love the smell of burning flesh in the morning. Instructions were provided for aftercare. The “no news is good news” concept went unspoken. But there was news. The cellphone reception in our neck of the cottage country woods is “sub-bar” at best. I excused myself, walked away from our guests and answered. And then the all too frequently heard “can you hear me, can you hear me” conversation ensued, followed predictably by the call failure. I called back, same result. I tried again, got through to the office, spoke with the secretary who put me on hold for the doctor. He picked up and I suggested he talk quickly as the combination of tower insufficiency and arboreal canopy was bound to disrupt our cellular communication in mid . . . . Dr. D. is a soft-spoken, kind and gentle human being. There is a reassuring raspiness to his soothing voice. He confirmed the clinical suspicion that the scalp lesion was an actinic keratosis, but! There was a pause before the punch line. A “very small focus of squamous cells” was identified. I was in the 2% cohort of AK’s in which focally invasive squamous cells are found. Interestingly, as I listened to the voicemail backup to the call, the word “carcinoma” was never uttered. Was he sparing me the dread, protecting me from the reality of the pathology? The findings warranted a wide excision, the exclusive realm of the plastic surgeon. A referral would be arranged for an out-patient clinic procedure. “There’s no urgency,” he reassured. Easy for him to say. Read Dr. Goldstein: Gone in 60 seconds Two weeks later, I drove up to “Portal D” at the hospital, the access driveway reminiscent of a busy day at Pearson Airport. I handed the key fob to my wife, kissed her goodbye, and masked up prior to entering the building. Once having cleared security, I entered the first door on the right, picked up #37 and stood in the expansive waiting area shared by both orthopedics and plastics. My number was called minutes later and I was directed to kiosk #4 for registration. In the process of completing the requisite specifics, one of the receptionists greeted me by name. She had worked in Dr. D’s office for years and was a casualty of COVID downsizing in the private sector. After populating the computer entry data for my electronic chart, I was asked to sit in the adjacent waiting area. My 10:30 appointment was looking more like 11:00, realistically. Immersed in CP24 news banners running across the wall-mounted flat-screen, I heard someone call me by name, “Howard.” I stood and followed the nurse into one of a dozen or more procedure rooms. She reviewed my health history as might be relevant to today’s visit. My responses betrayed my as yet identified professional status. She confirmed that I was a physician, her demeanour changing, encouraging a more fulsome conversation, more professional. “It’s so different talking to a medical person than the usual patients from off the street.” I elected not to pursue this dialogue. I was again asked to wait. Soon thereafter I was repositioned, literally, in the room and on the table where my procedure would be performed. Watching the clock I sat watching the digital clock on the wall above. Time moves at a slow pace when you would wish it otherwise. I heard the nurse talking in the corridor on her cellphone, a private conversation in a foreign tongue. I heard the doctor ask about his remaining schedule for the morning. There was a “postop followup” arriving late because of traffic and “a scalp in room eleven.” I apparently was the “scalp.” Dr. P. entered the room, introduced himself and immediately related his conversation with Dr. Dermis about my case specifics. He was familiar with my practice history, retirement and had several observational comments and opinions about the unfortunate impending extinction of the GP and hands-on, bedside medicine. His dad is a retired GP. We had an engaging and respectful conversation and then, I left him to his work. Everything was explained in detail as he went about his meticulous excision, S-plasty, and fine suturing. I felt nothing, no pain, only the mechanical sounds of the restoration of my scalp’s integrity. I have great respect for the utility and efficacy of local anesthetics. Postop care was reviewed, take-home instructions provided in writing. I may have been otherwise distracted during Dr. P.’s closing remarks. Contact #’s were given, just in case. I would do my best to avoid the vividly described “in case” scenarios. Sutures out in two weeks, appointment to be booked prior to leaving. And with that, Dr. P. was gone. I took off my gown, a decision I had made in order to avoid soiling my shirt with whatever prep was used or anxiety-provoked hyperhidrosis. All was quiet and serene as I exited the plastics unit. I went back to registration and booked my appointment for two weeks hence and walked out into the main hall. I called my wife, briefly reporting my morning’s uneventful surgical adventure and indicated my likely whereabouts for pick up. I bought a cup of Lavazza for sustenance and walked out into the welcome warmth of a brilliantly sunlit day. A bulky, gauzy dressing had been applied over the surgical wound to sop up any immediate oozing which might otherwise interfere with the surgical aesthetics. I neglected to bring my new Tilley hat which would have provided ample cranial coverage, channelling my suppressed Indiana Jones persona. I stood on the sidewalk awaiting my highly personalized Uber. I elected to be passenger not driver for the journey home. The rest of the day was totally uneventful, painless and surprisingly relaxing. The night that followed, restless, uncomfortable and sleepless. There is no ideal position or pillow on which to place one’s head when the crown has been subjected to such a surgical insult. The nights ahead will be easier and sleep will soon follow. What I must remember, however, is quite clear. I must be (the) patient. Read Dr. Goldstein: Closure: Looking back, one year later

A scalp in room 11

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HOWARD GOLDSTEIN

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