Mohs - the procedure...

The thing I was most dreading about the mohs procedure were the numbing shots. After three cutting sessions with my dermatologist in the past two years, my experience was that shots in the nose are an awful, if short-lived, little torture. At least the first shot is. And each shot gets less and less painful until you can't feel them anymore. At that point, if your eyes are closed, the only indication you're still getting shots is liquid lidocaine dripping down your numb check.  

I've tried to explain the experience to my husband, and this is the best I can come up with... It's like getting a punch in the nose without the punch. It's just all pain delivered in a concentrated spot at the end of a needle. It's short-lived, but it's the longest 15 - 20 seconds of your life. At least, that's how I've experienced shots in the nose.

Anticipating that, I mentioned as the surgeon pulled out the needle, "This is the worst part, I know."  To which he replied, "It shouldn't hurt too much."   Yeah, yeah yeah...  I've been gaslit about pain enough in the last few years, I should be glowing like a neon sign.

Not believing him, I braced myself and held my breath until the tiniest little sting landed on the side of my nose.  And then it went away. 

"Was that it?" I asked cautiously, sure that the worst was yet to come.

"That was the first shot"

"Wow. I barely felt it!"

"We pride ourselves on being as pain-free as possible."

"Wow," was all I could say in stunned disbelief.

There were more shots. Lots of shots. One of them, I did feel deep in my nose, but by that time I was so numbed up, it was mostly just annoying. Not pleasant, but not exactly painful.  

Done with the shots, I relaxed a bit as I thought, "Okay, this is going to be easy, because I know I shouldn't feel anything once I'm numb. "

After a drape (with an opening for surgery) was put over my face, I started to settle more into the chair.  I didn't even flinch when I felt a tiny sting move down the side of my nostril.  It was so tiny and so slow, it didn't register to me, at first, what it was.  But I must have made a noise, because the doctor asked if I was okay.  I casually said, "Yeah, I just think I feel a little burn." and he immediately got the needle back out.  "We don't want you to feel any of this."  Another shot or two later, he was at work slicing.  It was only then I realized I had felt his first slice.  It didn't hurt, exactly, but it makes me squirm a tiny bit to think about that.

I couldn't see or feel anything that was happening, but his surgical assistant was responsible for keeping my nose out of his way. She started by just gently bending it to the side, but eventually, it felt like she was using both hands and putting all her weight into flattening my nose to the opposite side of my face from where the surgeon was working. The pressure got so intense I asked with all sincerity, "Is it possible that you could break my nose?!?" She assured me she wouldn't break my nose, but there was no more relaxing for me!

I don't doubt that another tiny groan must have come out when the doctor told me to breath with my mouth, and to breathe deeply.  I tried, but with a drape covering my face (and mouth), breathing (at all) wasn't very satisfying.  Trying to breathe deeply didn't do anything to help - except for maybe it gave me something to think about while my nose was literally being bent out of shape. I guess that was really the goal.  Him cutting on me was nothing. Her pressing my nose to the side for the duration was...  well, I already said it - intense!

I'm sure mohs is a different experience depending on where the skin cancer is being removed from.  Not to mention differing skills and techniques of surgeons and assistants will likely create different experiences.  

I have no idea how long it took, but finally he had done all he was going to do, then he left to go on to the next patient while a nurse put a temporary dressing on my nose.  When I felt ready, I headed back out to the waiting room.  As I walked out, heads turned and I suddenly felt eyes on me.  I wasn't wearing my glasses with the dressing on, so I couldn't see anyone's faces, but I felt their eyeballs following me to my chair where I would sit and wait for who knows how long until I was called back again.

By this time, the waiting room was packed.  Assuming about half the people there were drivers for someone getting mohs, I estimate that there were at least 10 patients in the waiting room, and I have no idea how many were back in rooms.  And at some point, I heard the check-in person telling people they could wait outside - meaning out in the hallway.  Finally, putting my glasses on-ish to look around, I noticed everyone else had cute little bandages on their foreheads, noses, and ears.  A couple of people looked like they had little paper ketchup cups on their foreheads.  Thankful I wasn't sporting one of those, a glance around the room told me I was probably the funnier-looking one with my whole nose enclosed in gauze and tape.

Now that I look at the picture, I betcha there's a little ketchup cup under that bandage.

An hour or so later, and after watching many others go back to surgery and come out again into the waiting room, I was finally called back. As I got back into the surgical chair, I told the assistant, "I'm pretty sure I had the biggest bandage of anyone out there."  

She laughed.  

But she didn't deny it!  

She got me ready for the doctor, and I sat there nervously waiting for the verdict - prepared for the doctor to have to do more carving. But when he walked in, he announced, "We got it all!" 

"Really?!?"

"Yep.  I'm just going to stitch you up and you'll be able to go home". 

"How big was it?"

"About the size of a nickle, and about 3/4 inch deep."

"That deep?"

"Yep. I almost had to go all the way through."  I understood he meant making a hole right through side of the nostril.

Taking a deep breath, I sighed my relief as he explained the repair he was going to make.

Another drape, and I have no idea how much time passed as he stitched.  And stitched. First he made inside stitches to repair the damage under the skin, and on the outside, wound repair was done with a skin flap.  He sliced down the entire length of my nose and about a half inch below my nose (about four inches in total, he said) and pulled cheek skin over to form a flap for the wound and he stitched me up. I was told he put 6 stitches inside the wound, and after the surgeon left, his assistant counted twenty stitches on the outside.  I happened to have my phone on my lap at this point, so I pulled it out to look at the situation with my phone camera.  I wish I had taken a picture of it before a bigger bandage was put on, because it was a beautiful stitching job. Before swelling commenced, all I could see was a nose that didn't look like anything had happened to it.  

But I'm getting ahead of myself.  Back to before the surgeon left the room... I asked about pain management. I started to tell him my normal M/O is to suffer, and I paused trying to think of the next words to say - with clearer head, those words might have been something like, "only to find out later I didn't actually need to suffer".  But I didn't get anything else out.  He took the opportunity the pause gave him to say, "Most people do fine with just tylenol - and ibuprofen once the bleeding stops."  By that time, I was exhausted and a bit dazed by the whole experience, and I accepted what he said - hoping it would be true.   

He left the room, on to the next patient or biopsy, and his assistant bandaged me up good and tight.  Giving me at-home instructions, she did tell me if I had pain into Friday to be sure to call them before they closed for the weekend.  Again, I was in a daze at this point, just wanting to go home and maybe take a nap.  I didn't question that those instructions could have been clearer. I was just relieved to be done with this thing I'd waited 10 weeks for. 

As I walked out into the waiting room, once again heads turned, and I imagined the looks I was getting now that I was sporting an even larger bandage.  Greg told me after we exited the building a little girl (who was at the entrance with her mother, he presumed) just stared at me with an open mouth as I passed.  Poor thing. I didn't even see her.

Next in the series:  the recovery