Arriving for mohs...

Wednesday of last week I was the first patient to arrive at the mohs cancer center at 6:45 am. Probably four or five people arrived within minutes of me, but I was the first one called back.

In case you're unfamiliar with mohs surgery, patients are typically scheduled on top of each other because the surgeon goes from patient to patient, and from biopsy to biopsy throughout the whole day - though I have no idea in what order all of that happens.  

The surgeon uses great skill in cutting off only as much tissue as necessary to remove all cancer cells and to obtain clear margins.  If all the cancer isn't removed on the first round, a patient gets more cut off, and that process is repeated until there is no more cancer and the wound is then dealt with (in my case, by the same surgeon).  The whole process really is pretty fascinating.  It's not just slicing some skin off and hoping for the best.  The surgeon studies the removed tissue under a microscope, mapping the exact location of remaining tumor and any "tendrils" or other cancerous tissue.  There is lots of information online if one wants to understand it better.

The surgeon came in and introduced himself and started getting the information on my situation.  He was kind, but seemed like a serious fella when he first walked in.  Kind and serious - two qualities I'm partial to in a doctor.  Though, if I had to pick only one, I'd pick kind.

I don't remember exactly how the conversation flowed, but it took a bit of back and forth between him, his surgical assistant, and me before he fully understood that my dermatologist had cut on this same spot three different times in the last two years before referring me for mohs. I was trying to be as clear as I could be, but I think he had only gotten the most recent pathology report from my derm's office - not the two prior ones on the very same spot.  Nevermind, that when I sent a picture of the cancer site (as requested the week before) I mentioned the previous two biopsies in 2022.  That information must not have been added to my file.  I wish I'd remembered in that moment that I had explained all of this in the email they requested - this really shouldn't have come as a surprise to him. 

He grew more serious as he got the story straight in his mind that this was the fourth time my nose would be carved on in the same spot.   He expressed his disappointment, and told me the more times a site is worked on, the harder it is to complete an effective mohs surgery.  

I told him I had just read that very thing online last week, and, shaking my head I offered, "Believe me, I'm not happy about it either."  He said something else - it seemed he was kind of repeating himself, and that didn't feel good.  I didn't want to be rude, but I think subconsciously I probably did want to interrupt what felt a bit like a rant starting, when I said, "Patients can't know this if they're not told, or like me, find out for themselves online."  He softened and replied, "Of course, you're right."  That exchange turned what was starting to feel like I walked in with his biggest headache for the day into us being on the same team.  

I was very glad right then that I had gone online and came across this information.  I think I might have taken his frustration personally, if I didn't fully understand for myself that I was not responsible for what my dermatologist had done.  I had no reason to not trust she was doing exactly what she was supposed to do.

In reflecting on it later, I've wondered if his expressing his frustration like he did was his way of preparing me that removing all of my skin cancer may not be easily accomplished on the first pass.  He didn't know I came in understanding that already.  He didn't know I had mentally prepared myself for every possibility (except for any worst-case scenarios - I drew the line at preparing myself for that).

He asked what my dermatologist's name was, and I told him.  It was a weird moment. I felt like a child tattling on another child, and the other child was going to get a whuppin'.  While he didn't strike me as violent, I wish now I had asked him what he was going to do with that information.  I wondered if he knew her personally?  Was he going to say something to her?  Give her the what for?  Or if nothing would happen.  My guess is likely the last thing.  That said, he asked me if I'd like a referral to a different dermatologist - a colleague of his.  With a vigorous nod, I replied, "Definitely.  I was going to ask before I left."

Next in the series:  the procedure