It's about the dermatology, stupid

Biopsied thumb

Not too long ago, I had two dermatologists, but now I seem to have accumulated two more, some of them giving me conflicting information. This has left me farblonjet, not knowing which way to turn.

They are Dr. Lin, my primary dermatologist; Dr. Liu, the one who sees me for graft vs. host disease of the skin; Dr. Cornejo, who I saw when I was worried about a spot and couldn’t get in to see the other two; and Dr. Schmults, the Mohs surgeon.

Dr. Cornejo told me after three biopsy results that I needed Mohs surgery on all three. But when I went for the Mohs on Tuesday, Dr. Schmults said she only needed to do one; she told me to apply a topical chemotherapy combination to the other two spots, one on my cheekbone and the other on the top of my neck, at my hairline.

Meanwhile, when I saw Dr. Lin on Jan. 28^th, she said that she thought my face would benefit from a return to the face fry, or more formally, PDT, photo dynamic therapy, which I thought was a thing of the past. Her scheduler called me up to book it. But before I had a chance to return that call, I saw Dr. Schmults, who said to apply the chemo cream to my face and don’t do the PDT. I think Dr. Schmults, the surgeon, wins out on this one. I hope I am right because I would rather have the cream than the burning light. I think I will have to call Dr. Lin’s office to get this straightened out.

I had back-to-back weeks of dermatology appointments.

For the one on Jan. 28^th, I had neglected to get the PT1 for the address where I was going. That is the form that needs to be filled out for my MassHealth transportation, aka, the crazy driver pool. The address, 221 Longwood, Boston, is very close to Dana-Farber, for which I do have the PT1. I figured I would get the ride to Dana-Farber and walk.

In a book I am reading, the narrator calls her partner The Boyfriend. I am going to try it on but probably only use it once because in the book, Maybe You Should Talk to Someone, things have not gone well with The Boyfriend, and I don’t want to jinx myself. In any case, The Boyfriend would have taken me but he was already taking me the next week for the Mohs. Also I knew it wasn’t a good day for him, and I didn't want him to spend it in a dermatologist's office.

Not knowing how long the visit would take, for a 2:45 appointment, I told the driver to get me at 4:30 for the ride home. Because I don’t trust my sense of direction, when I got to Dana-Farber at 2:15, I put the address in my phone. It was raining. At some point when I was heading down Longwood, I realized I had done it again. “It” being that I was heading for 221 Longwood in Brookline, not Boston. I don't know how I did that with the phone in my hand.

I had already done this once, on a day that I had driven myself, arriving so late, once I figured it out, for my appointment at the right Longwood that I almost wasn’t seen. (The receptionist started to turn me away that first time but I caught Dr. Lin's eye as she was coming out of a room, and she had pity on me when she saw a tear in my eye.)

For the Jan. 28th visit, I reversed course and ran through the rain. I was 15 minutes late. For an office that often makes me wait at least an hour, that didn’t seem bad. A guy at the desk said it would be OK. Apparently it wasn’t. After I waited almost an hour, I asked what gave. A different person said that since I was late, I would have to wait until 5:30. I explained about the ride, bla bla bla, and they fit me in…around 5. The driver kept calling. Then his dispatcher called. I said I couldn’t help it and I hoped he wouldn’t leave without me. It was my first time back with the driver of the car in the car crash. The company kind of owed it to me to get me home safely.

This is the appointment where Dr. Lin said that I should get the face fry again. Not only that, but she wanted to use a stronger red light, not a blue light. Among the activities were a biopsy on a tiny hole on the knuckle of my thumb. The hole has been there so long I lost track.

The resident, or maybe it was fellow, did the biopsy. The biopsy itself didn’t hurt, but the needle in my thumb killed. There were a few extra people in the room. I don’t remember who did what. But one of them zapped some precancerous spots. (Zapped = performed cryosurgery.) She did such a “hard freeze” on my ring finger that the blister looked like the Astrodome. It hasn’t healed, and I am worried that it might be infected. I got another one on my cheek and several on my chest.

While the resident (or fellow) jabbed me with the anesthesia, Dr. Lin rubbed my back. She is a sweetie. We go way back, far enough to have discussed many things. “How’s the guy?” she asked. “Good,” I said.

“The guy” drove me on Tuesday for the Mohs, which, as I said, turned out to be a single and not a triple. It is in a strange place, at the edge of the top of my cheekbone, bordering my ear. I have had a hard time keeping the band aid on for a week. I have to change it every night, and it is not easy to cut a piece of gauze into the right shape and tape it on so it doesn’t fall off. One morning it had dislodged while I was sleeping, so I had to put it on all over again. I had a few choice words.

Inside my room

Luckily I don’t have to go back to Boston to get the stitches out. When I told someone that they sent me home with a suture removal kit, the person asked if it was a DIY project. No it isn’t. A nurse friend does it for me when there aren’t too many stitches. When there are more, I go to my internist. My nurse friend will be taking them out for me on Tuesday.

While I was at Dr. Schmults’s office, they read the biopsy report on the thumb. It is another squamous cell carcinoma, albeit a tiny one, and I have instructions to treat it when I do both hands, starting next month.

My house is coming along, post tree-fall. They have re-shingled the garage roof and begun taking down damaged parts of the kitchen and bedroom. I'm getting used to the little cubby hole in which I'm sleeping. (It was a kids' room that I never got around to fixing up. Procrastination pays.) It took me a while to stop being disoriented when I woke up.

In other news, here's something I wrote about scars being a roadmap of where we've been. Thanks to my cousin Bob for that one.